Adjustment Disorder

• Exposure to a stressor of any type or severity
• Symptoms begin within 3 months of exposure to the stressor
• Lasts no longer than 6 months after termination of the stressor or consequences from the stressor
  • Can diagnose after, rule out other problems
• Does not stay with a person long term, shouldn't be as impairing as other disorders
• This individual has difficulty coping with this stressor
  • It exceeds the normal level of difficulty coping

Specifiers

• With Depressed Mood
  • This specifier is used when the primary symptom of the adjustment disorder is depressed mood, such as feelings of sadness, tearfulness, or hopelessness, often in response to a stressor.
• With Anxiety
  • This specifier is used when the primary symptom is anxiety, which could include nervousness, worry, jitteriness, or fear that is triggered by the stressful event.
• With Mixed Anxiety and Depressed Mood
  • This specifier applies when the person experiences both anxiety and depression in response to the stressor. The individual may feel both worried and sad or hopeless at the same time.
• With Disturbance of Conduct
  • This specifier is used when the individual shows behavioral problems such as aggression, violation of social norms, or other disruptive behaviors that are a reaction to the stressor. For example, an individual may act out by fighting, being destructive, or engaging in risky behaviors.
• With Mixed Disturbance of Emotions and Conduct
  • This specifier applies when both emotional symptoms (like anxiety or depression) and behavioral disturbances (like conduct problems) are present. For example, a person may show both emotional dysregulation and disruptive behaviors, such as acting out aggressively while also feeling sad or anxious.

Acute Stress Disorder

• Direct or indirect exposure to a traumatic stressor involving actual or threatened death, serious injury, or sexual violence
• Disturbance persists from 3 days to 1 month after exposure to trauma
• Diagnosis before ptsd: after 1 month it's ptsd
• Many people do not develop PTSD, most recover

Posttraumatic Stress Disorder (PTSD)

• Direct or indirect exposure to a traumatic stressor involving actual or threatened death, serious injury, or sexual violence.
• Symptoms are present for at least 1 month
• Twice as prevalent in women
• Low prevalence in Asian Americans
• Higher prevalence in Latinx and African Americans
• Symptoms may vary cross-culturally

Trauma-Related Disorders

Typical outcomes after exposure to traumatic incidents

• Resilience
  • Can maintain life, not thrown out of balance
• Recovery
  • Initial distress with symptom reduction over time
• Delayed symptoms
  • Few initial symptoms
  • Increasing symptoms over time
• Chronic symptoms

Diagnosis of Acute and Posttraumatic Stress Disorders

Requirements for diagnosis (Symptoms longer than 1 month for PSTD)

• Direct or indirect exposure to traumatic event
• Intrusion symptoms (1+)
  • Nightmares or distressing dreams related to the trauma.
  • Flashbacks, where the individual feels as though the traumatic event is happening again.
  • Intense or prolonged psychological distress at exposure to reminders of the trauma (e.g., anniversaries, similar situations).
  • Marked physiological responses to reminders of the trauma (e.g., rapid heartbeat, sweating).
  • Intrusive memories of the traumatic event that are distressing and involuntary.
• Avoidance (1+)
  • Avoidance of trauma-related thoughts, feelings, or memories.
  • Avoidance of trauma-related external reminders (e.g., places, people, conversations, or objects that trigger memories of the event).
• Negative alterations in mood or cognition (2+)
  • Persistent negative beliefs about oneself, others, or the world (e.g., "I am bad," "The world is dangerous").
  • Persistent, distorted thoughts about the cause or consequences of the traumatic event, leading to self-blame or blaming others.
  • Persistent negative emotional state (e.g., fear, anger, shame, guilt).
  • Markedly diminished interest or participation in significant activities.
  • Feeling detached or estranged from others (emotional numbness).
  • Inability to experience positive emotions (e.g., happiness, satisfaction, or love).
• Arousal and changes in reactivity (2+)
  • Irritability or anger outbursts, often disproportionate to the situation.
  • Hypervigilance, or being excessively alert for potential danger.
  • Exaggerated startle response, reacting strongly to sudden noises or movements.
  • Problems with concentration or difficulty focusing.
  • Sleep disturbances, including trouble falling or staying asleep.
    Clinicians also specify if there are recurrent symptoms of depersonalization, derealization, or dissociation
    ASD involves symptoms that persist for at least 3 days but no longer than 1 month (between 12 percent and 26 percent of adults who experience a traumatic event)

Etiology of ASD and PTSD

Factors associated with increased risk

• More severe physical injuries
• Injury to the head or extremities
• Major burn injuries
• Rape or sexual assault
• PTSD more likely when there is intentional trauma and when there is a close relationship with the perpetrator of sexual assault

Biological Dimension of ASD and PTSD

Body sytsems designated for homeostasis

Some people are more prone to physiological reactivity

• The amygdala sends out a signal to the prefrontal cortex and the sympathetic nervous system
• HPA axis then releases hormones to prepare the body for “fight or flight”

Fear extinction

• Many people with PTSD exhibit minimal fear extinction
• Trauma-related fear responses do not decline with the passage of time
• Stress hormone changes to the brain, orbitofrontal cortex alterations, and genetic differences are possibly implicated

Psychological dimension

• Preexisting conditions such as anxiety and depression, hostility, and anger
• A tendency to generalize trauma-related stimuli to other situations
• Specific cognitive styles or dysfunctional thoughts
• Reframing traumatic events in a more positive light, and optimistic thinking can increase resilience

Social Dimension

• Social support can diminish PTSD symptoms
• Less-than-optimal social support during childhood can increase risk

Sociocultural Dimension of ASD and PTSD

Ethnic Differences

• Race-based discrimination can produce psychological trauma
• Different exposure to previous trauma
• Cultural differences in responding to stress
• Women are twice as likely as men to suffer a trauma-related disorder
• Female police officers less likely than civilian women to have PTSD symptoms

Medication Treatment for Trauma-Related Disorders

Certain antidepressants (SSRI) show some effect

• Effective in fewer than 60 percent of individuals
• Only 20–30 percent show full recovery
  D-cycloserine and Prazosin (hypertension medication)
• Mixed results
  Propranolol (beta-blocker)
• Appears to produce significant improvement in sleep quality and reductions in symptoms of hyperarousal
  MDMA
• Has shown some promise when combined with exposure-based therapy
• Supresses emotional memory circuits involved with intrusive memories
• Allows exposure therapy without overwhelming patient with fear

Psychotherapy for Trauma-Related Disorders

• Cognitive-behavioral therapies are the most effective form of treatment for PTSD (CBT)
• Prolonged exposure therapy (PE)
  • Involves exposure to trauma-related cues
• Cognitive-behavioral therapy (CBT and TF-CBT)
  • Involves identifying and challenging dysfunctional cognitions
  • TF-CBT applies trauma-sensitive principles
• Eye movement desensitization and reprocessing (EMDR)
• A nontraditional therapy combined with CBT used to treat PTSD

Psychological Factors Affecting Medical Conditions

Stress

• Causes a multitude of physiological, psychological, and social changes that influence health
• Study on stress and the COVID-19 pandemic revealed high levels of stress, particularly among parents
• People of color reported the highest levels of stress

Psychophysiological disorder

• Physical disorder with a strong psychological basis or component

Medical Conditions Influenced by Psychological Factors

• Actual tissue damage
• Disease process
• Physiological dysfunction
• Relative contributions of physical and psychological factors vary greatly
• Both medical treatment and psychotherapy may be required

Coronary Heart Disease

Cardiac Arteries Narrow

• Results in complete or partial blockage of flow of blood and oxygen to heart

Some Risk Factors for CHD

• Poor eating habits
• Obesity and lack of physical activity
• Hypertension
• Stress
• Depression

Hypertension

• Normal blood pressure —Systolic lower than 120 and Diastolic lower than 80
• Hypertension — Systolic at or above 140 or Diastolic at or above 90
• About 116 million (45 percent) of U.S. adults have high blood pressure requiring treatment

Migraine, Tension, and Cluster Headaches

Headaches are among the most common stress-relate psychophysiological complaints
Headaches preceded by aura in about 20 percent of cases
Migraine headaches — 20 percent of the U.S. population

• Neurologically based head pain accompanied by symptoms such as nausea, and vomiting
• Prevalence of severe migraines is highest in American Indians
• Three to four times more common in women compared to men
• Brain scans of people with migraine show hypersensitivity in the visual cortex

Tension Headaches

• Stress creates a prolonged contraction of scalp and neck muscles
  • Results in vascular constriction and steady pain
• Most common form of headache
• Approximately 70 percent of adolescents and adults experience tension headaches each year
• Account for more days missed at work than migraine headaches

Cluster Headaches

• Excruciating stabbing or burning sensations located in the eye or cheek
  • Pain so severe that 55 percent report suicidal thoughts
  • Affecting about 1 in 1,000 adults
  • Six times more prevalent in men
• Attacks have a rapid onset
  • 15 minutes to 3 hours in duration
  • End abruptly

Asthma

• Chronic inflammation disease of lungs
• mild - severe symptoms
• Stress or other triggers cause excessive mucus secretion
• Affects 8.2% of US pop.

Etiological Influences on Physical Disorders

Biological dimension

• Stressors can dysregulate physiological processes in the brain and body
  • Release of norepinephrine, epinephrine, and cortisol
• Early environmental influences may produce changes in stress-response systems
• Brief exposure to stressors enhances immune functioning
• Genetic influences contribute to psychophysiological disorders
  • Purer African ancestry increases the risk of developing severe asthma among men
  • Twin studies have estimated the heritability of asthma to be around 35 percent

Psychological Dimension

Psychological and personality characteristics can influence health
status

• Positive emotions help regulate stress reactions
• Negative emotions accentuate the stress response
• Hostility is associated with several psychophysiological disorders
• Control and the perception of control over the environment and its stressors can mitigate the negative effects of stress

Social Dimension

• Social stressors can influence immunological functioning and produce undesired health outcomes
• Good relationships moderate the link between hostility and poor health
  • Social isolation is more likely to negatively affect the health of women
• Risk factors for adverse health outcomes
  • Lack of social support
  • Maltreatment in social relationships

Sociocultural Dimension

Sociocultural factors associated with gender, race, or ethnicity can have a major impact on health
Women are more likely to be impacted by stress

• Due to care-giving role for children, partners, and parents
• More likely to live in poverty
• Chronic disparities associated with having limited economic resources
  Stressful experiences associated with race and ethnicity
• Stressors of living in poverty and having limited access to medical care mitigate vascular reactivity to discrimination
• Achieving upward mobility is associated with an increased likelihood of social isolation and experiences of racism and discrimination

Treatment of Stress-Related Disorders

Relaxation training

• Learn to relax muscles of the body under almost any circumstances
  Biofeedback training
• Learn to voluntarily control physiological processes in order to improve physical or mental health
  • Examples: heart rate, blood pressure
• Visual and auditory feedback reinforces relaxation responses

CBT

Designed to improve coping skills and manage stress

• CBT has proven effective in controlling asthma symptoms and reducing anxiety levels
• Mindfulness-based stress reduction programs, designed to help foster nonjudgmental awareness of sensations and feelings
• Produces significant decreases in stress, anxiety, depression, and physiological markers associated with stress
• Acceptance and commitment therapy (ACT)