Highlights:
- new chapter related to stress
- PTSD modified criteria with new subtypes
- Acute Stress Disorder criteria modified
Stress
- biological and psychological responses to adjustive demands
Categories:
1) Frustration - absence of an appropriate goal
2) Conflict - incompatible needs
a. Approah-Avoidant Conflict - to approach and t avoid the same goal
b. Double Approach Conlfict - two or more desirable goals
c. Double Avoidance Conlfict - undesirable alternatives
3) Pressure - speed up, change direction
Predisposing Factors of Stress
1) Nature of the stressor
- importance
- duration
- cumulative effect
- multiplicity
- immenence
- involvement
- degree of control
- crisis
- life changes
2) Perception of Threat and Stress Tolerance
- stress tolerance (withstand stress without becoming seriously impaired)
3) External Resources and Social Support
a. Coping Strategies
a1. Biological
a2. Psychological
a3. Sociocultural
b. Basic Coping Skills
b1. Task Oriented Coping
b2. Defense Oriented Coping
c. Decompensation
General Adaptation Syndrome (GAS)
1) Alarm Reaction - resources for coping tress are alerted and mobilized
2) Resistance - maximumum adaptation in biological and psychological resources
3) Exhaustion - coping patterns begin to fail
Trauma- and Stressor - Related Disorder
- exposure to traumatic and stressful event
Reactive Attachment Disorder
- disturbed and developmentally inappropriate attachment behavior
- emotionally withdrawn behavior toward adult care givers
- persistent social and emotional disturbance
- experienced extremes of insufficient care (evident before age 5, starting 9 months old)
Disinhibited Social Engagement Disorder
- culturally inappropriate, overly familiar with strangers
- interacts with unfamiliar adults
- same as RAD
Posttraumatic Stress Disorder
- symptoms develop after exposure to a traumatic event
(experienced directly, witnessing, happened to close family, repeated exposure)
- avoidance of stimuli
- intrusion symptoms
- negative alterations in cognition and mood associated with the event
- marked alterations in arousal and reactivity associated with the event
(Disturbance is more than one month, causes significant distress and impairment
Posttraumatic Stress Disorder for Children 6 years and younger
- fear of being separated by parents
- losing acquired skills
- nightmares
- compulsive play, trauma are repeated
- phobias and anxieties unrelated to trauma
- pains without cause
- irritability and aggression
PSTD Risk Factors
1) Pretraumatic Factors - environment
2) Peritraumatic Factors - violence
3) Posttraumatic Factors
PSTD Etiology
1) Biological - dampening activity on amygdala, hippocampus, prefontal cortex, cortisol
2) Psyhological
PSTD Interventions
1) Pharmacotherapy - antidepressant, benzodiapines, antipsychotics
2) Psychotherapy - exposure, cognitive reconstructing, stress mngt training
Acute Stress Disorder
- last 3 days to 1 month after exosure to traumatic event
- symptoms similar to PSTD but short duration.
Adjustment Disorder
- emotional and behavioral symptoms within 3 months of onset stressor
- distress
- impairment in areas of functioning
- without stressor, symptoms do not persist for more than 6 additional months.
- specify with depressed mood, anxiety, disturbance of conduct
