Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a neuropsychological disorder that gained attention over the years due to soldiers returning from war with what use to be called “shell shock.” Post-traumatic stress disorder, however, is not solely associated with soldiers returning from war. In fact, the vast majority of people who suffer from PTSD is found in another population; adult women who suffered from childhood sexual abuse. The research for how childhood trauma, especially abuse by one’s caregiver, affects the brain is still a relatively new field, but evidence has revealed that it can change one’s brain, and thereby, change how a person responses to trauma in the future. Researchers also know that early victims are more likely to be re-victimized in the future; increasing one’s chances of developing PTSD. In this paper, I will discuss the effects of PTSD on the adult brain of a childhood sexual abuse survivor.

Post-Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is a neuropsychological disorder that is caused by exposure to extreme trauma and stress. These incidences; sexual assault; unexpected death of a loved one; threatened death to one’s self or a loved one; obtaining or being threatened with serious bodily harm; or witnessing traumatic events such as a serious car accident (such as in the case of first responders); living through a natural disaster; and experiencing war; can cause a person to have vivid, intrusive, reoccurring flashbacks, nightmares, thoughts, or emotional or physical reactions to either internal or external cues that remind one of the incident  (DSM 5, 2013). In response to these intrusive memories, individuals will often employ some type of avoidance behavior; they will avoid talking about or being reminded of the event(s) in any way.

In addition, patients will experience a wide range of emotions that are negative in nature, and they must experience at least two of the following symptoms, in addition to the above symptoms, to be diagnosed with PTSD (DSM 5, 2013). Shortly following the event the patient may be unable to recall details of the incident; they may have overtly negative thoughts about themselves and/or the world; they may have an exaggerated sense of blame for either themselves or someone else for causing the incident; they may experience negative affect (an overwhelmingly negative view of the world); they may experience a decreased interest in participating in life or activities that once interested them;  they may have extreme feelings of isolation; and they may have difficulty experiencing positive affect (DSM 5, 2013).

After a traumatic event, individuals with PTSD will experience at least two of the following reactivity symptoms; they may become extremely irritable or aggressive; they may partake in risky or dangerous behavior; they may become hypervigilant (meaning that they may be always “on their guard” or “ready to run” at any time); they may have a heightened startle response; and they may experience difficulty with sleeping and/or concentrating (DSM 5, 2013). The symptoms must also have a duration of at least one month, they must cause significant distress or functional impairment in the patient’s life, and they must not be due to substance use or another psychological disorder (DSM 5, 2013).

Epidemiology

The National Comorbidity Survey Replication, conducted between February 2001, and April 2003, found that a diagnoses of PTSD, within the adult American population, was a remarkable 6.7 percent. Among men that percentage was 3.6 percent, and among women that percentage was at an astounding 9.7 percent of the population (Gradus, 2017). Women are almost twice as likely as men to experience PTSD in their lifetime, and this is mostly due to either childhood sexual abuse and/or, sexual assault as an adult.

Long term trauma, trauma in which the victim is under complete control of the perpetrator and cannot escape, such as childhood physical or sexual abuse, causes additional symptoms in the victims that may not manifest until later in life, and/or, they can or have, become chronic; causing severe dysfunction in the victim’s life and in their interpersonal relationships. Although it is not listed in the DSM 5, Complex PTSD, is a subtype of PTSD that only effects victims of long term trauma.  Survivors of long term trauma will often display issues with emotional regulation, consciousness, and self-perception; they may have a distorted perception of the perpetrator, often attributing total power to the perpetrator, or becoming preoccupied with revenge; survivors may experience a plethora of problems in their interpersonal relationships, including being unable to trust anyone, repeatedly looking for a “rescuer,” promiscuity may be a problem, or they may take the opposite route and never date anyone; and often survivors are plagued with a feeling of unworthiness, hopelessness, and despair (National Center for PTSD, 2016). Often survivors of childhood sexual abuse have relationships with people who continue to abuse them, or their children. Breaking the cycle of abuse, becomes a major aspect in treatment for these patients.

I started this paper with the belief that not too much research had been done regarding PTSD on victims of childhood sexual abuse, but I found plenty of research. I chose this topic because I am one of the many survivors of childhood sexual abuse, and I plan on targeting trauma, stress, and anxiety related disorders after I complete my doctorate in psychology; I want to know how to help survivors cope with the abuse they suffered through, how to heal from the past, and how to have a quality relationship with a partner in the present.

Natural History of PTSD

Almost everyone experiences some sort of traumatic event at least once in their life, but not everyone develops PTSD. Not everyone with PTSD has been through a dangerous situation either. Symptoms usually start occurring within three months of the incident, but they may not develop until years later. The course of PTSD varies, some patients recover within six months of treatment, but for some patients the condition may last much longer, or it may become chronic. It is important that people who do suffer from PTSD seek professional assistance as soon as possible. Treatment usually consist of psychotherapy and medication, and with treatment, a patient has an increased likelihood of recovering from PTSD. Without treatment a patient may go on to experience additional life problems to include; drug or alcohol abuse, depression or anxiety, physical symptoms of chronic pain, employment problems, and/or, relationships problems (National Center for PTSD, 2016).

Methods used to Diagnose PTSD

Psychologists have a variety of assessments available to them to diagnose PTSD. Some, such as the Beck Anxiety Inventory – Primary Care (BAI-PC), are self-reports, that the patients fill out on their own and then gives to a physician. The BAI-PC is a seven item self-report assessment that screens for anxiety, depression and PTSD, as well as other disorders that are highly co-morbid with PTSD, such as drug or alcohol abuse (Mori, 2003).  A positive score of five indicates the patient may suffer from PTSD, but will need to be screened again by a professional.

Other assessments are designed for use in a primary care setting. The Primary Care PTSD Screen for DSM – 5 (PC-PTSD-5) is a five item screen that was designed for use in a primary care setting and is used to determine those patients with probable PTSD (National Center for PTSD, 2017). However, a positive indicator on this assessment means that the patient should undergo a structured interview by a psychologist who specializes in trauma and stress related disorders. If a psychologist determines that a patient has PTSD, the use of medication may be required, but cognitive behavioral therapy and exposure therapy are two recommended treatments for PTSD (National Institute of Mental Health, 2016).

Risk Factors

While anyone can experience a traumatic event that results in a diagnosis of PTSD at any time, and at any age, there are certain risk factors involved in developing PTSD. People who have experienced long term trauma, or have a genetic predisposition to the disorder are more prone than others to developing PTSD after a traumatic experience. However, most people will not develop PTSD due to high resilience factors.

Some things that may increase one’s chances of developing PTSD include, living through dangerous events and traumas to include natural disasters; getting hurt; seeing another person hurt, or seeing a dead body; childhood trauma; feeling extreme fear; having little or no social support after the event; dealing with additional stress, such as the loss of a loved one, loss of a job or home, and being injured due to, or after the event (National Institute of Mental Health, 2016).

Some things that may make a person more resilient against PTSD include, seeking out assistance and social support, friends, family, and a local support group are all good ideas; learning to feel good about one’s own actions during and following the traumatic experience; and having a positive coping strategy after the event (National Institute of Mental Health, 2016). Research is ongoing about the effects of PTSD on the central and peripheral nervous systems, however, some remarkable discoveries have already been discovered, and may assist in the diagnosis and treatment of PTSD in the future.

Neurological and Biological Systems Involved in PTSD

Women who have suffered and lived through prolonged childhood sexual abuse make up anywhere from eight to thirty-three percent of the American population, depending on how pervasive the abuse was (Steine et al., 2017). They are more likely to develop intimate relationships with abusers, and the abuse continues into adulthood. The patients who develop PTSD report multiple types of abuse, physical, mental, emotional, sexual, and neglect (Steine et al., 2017).  PTSD effects these patients differently than it does patients who have PTSD but did not suffer childhood sexual abuse (Binder, 2013). Post-traumatic stress disorder effects many parts of the brain, and those are some of the very parts of the brain affected by childhood sexual abuse (Blanco et al., 2015).

PTSD is an extremely complicated disorder, and its effect on the brain and hormones in the body are many and varied. The locus coeruleus, a nucleus located at the base of the brain stem, which is responsible for the bodies response to stress, among other things such as cognition and memory, releases increased amounts of norepinephrine (a hormone) into the body in response to stress. This makes the person more aware of their surroundings, and activates the sympathetic nervous system (flight, fight or freeze system). In patients with PTSD, norepinephrine is released in increased amounts; a patient may have a minor event that reminds them of a past traumatic experience, such as a combination of words, or the way a person touches them, that makes them over-react to the stimulus (Wilson, 2013).

Repeat exposure to trauma, such as in the case of childhood sexual abuse survivors, changes the hypothalamic-pituitary-adrenal (HPA) and endocrine response to stress, as well as its function in metabolic and immune systems of the body (McGowan, 2013). The HPA plays an important role in maintaining allostasis, or the body’s ability to maintain stability amongst challenging environmental circumstances.

The decreased size of the hippocampus shown in most patients with PTSD is related to an increase in the activity of the hormone called cortisol. Cortisol is released in relation to stress and the prolonged exposure to the hippocampus of this hormone has been shown to cause atrophy in the hippocampus, the area of the brain responsible for episodic memory creation. Decreased amounts of cortisol release during the initial event may lead to a chronic over-reaction to stress in patients who later develop PTSD (Sherin, & Nemeroff, 2011).  In addition, functional imaging studies have shown a decrease in response of the prefrontal cortex, and an increase in response from the amygdala in patients with PTSD, leading some scientists to believe that stimulators of the limbic stress system prevail over inhibitors (Malejko, et al., 2017). Since, in PTSD, individuals associate neutral cues with the traumatic event(s), it has been suggested that the interaction between the hippocampus and amygdala, as two regions of the brain that play a role in consolidating memories, may contribute to the intense recollection of trauma experienced by patients with PTSD (Malejko, et al., 2017).

The biological and neurological systems that are involved in, and affected by, PTSD are numerous and varied. Interactions between the stress response system and the threat response systems of patients with PTSD may explain the avoidance and emotional reactivity aspects of PTSD. Reduced connections between the amygdala and cingulate cortex imply a decreased ability to cope with fear vigilance and reactions to threats (Wilson, 2013). Research is underway in regards to genetic factors that may make a person more predisposed to develop PTSD. Recent research has revealed a relationship between the SLC6A4 serotonin transporter genotype and elevated PTSD symptoms (Wilson, 2013). Future studies hope to reveal the interconnectedness between all the neural pathways involved in PTSD.

Treatment Options

Diverse pharmacological and psychological treatments have been used for the treatment of PTSD. Pharmacological treatment doesn’t erase the traumatic memory of the incident(s), instead it aims to control such symptoms as anxiety, depression, and/or alcohol and drug related disorders, all common co-morbid diagnosis with PTSD. Medication to help with sleep disorders and/or nightmares may be prescribed as well (National Institute of Mental Health, 2016). Antidepressants, anti-anxiety, and sleep medications are common symptoms control treatments for PTSD. However, the best therapy for PTSD is psychotherapy.

Psychotherapy, also known as “talk therapy,” is the best know treatment for PTSD, and there are various forms of psychotherapy. The two best known treatments for PTSD are cognitive behavioral therapy, and exposure therapy. Both types of therapy should only be attempted with a psychologist who specialized in trauma and stress related disorders.

Cognitive behavioral therapy helps patients to question and then alter their dysfunctional perceptions and reactions to trauma by confronting traumatic memories, and retraining the patient in responding to those memories (Malejko, et al., 2017). Sometimes patients remember the event differently than it happened and in that case psychologists will help the patient remember it the correct way, or help them to make sense of the bad memory. Sometimes the patient may feel blame or guilt for something that is not their fault, and the psychologist will assist the patient in placing blame where it belongs (National Institute of Mental Health, 2016).

Exposure therapy involves slowly introducing aspects, such as tactile, visual, auditory, and olfactory cues that remind the patient of the traumatic event(s) (Malejko, et al., 2017). Occasionally, if possible, the psychologist may take the patient to the place the traumatic incident(s) occurred. This helps patients with PTSD learn to face and control their fear. By slowing introducing the patient to the traumatic event in a safe environment, psychiatrists help the patient cope with his or her feelings (National Institute of Mental Health, 2016). The main theme of treatment appears to be the confronting and restructuring of memories related to the traumatic experience(s).

Psychotherapy helps patients by teaching them about trauma and its effects on the body and brain. It teaches patients how to manage and control their anger, as well as techniques to relax, and calm down. Patients should learn about how to sleep, exercise, and eat better; learning the effects of how these things can effect responses in the nervous system. In addition, psychotherapy is designed to teach patients how to identify and cope with feelings of shame, guilt, disgust, revenge, and how to have a healthy relationship with oneself and with others (National Institute of Mental Health, 2016). In regard to patients with PTSD who also experienced childhood sexual abuse, it is important the doctor imparts to the patient, over and over again, that the abuse is not his or her fault.

Patients are highly encouraged to help themselves as well. Some ways that patients can help themselves recover from PTSD include; taking the first step by talking to their doctor; engage in physical activity every day; break up large tasks into smaller steps, and set realistic goals for oneself. Patients are especially encouraged to engage socially, either with trusted family and friends, or with a support group (National Institute of Mental Health, 2016).  Talking about the event gives it less and less power, and patients are encouraged to talk about the event(s), and triggers to people they trust. Patients should be aware that symptoms will improve gradually over time, not immediately. Patients are highly encouraged to seek professional help in an outpatient facility, such as their local mental health center (National Institute of Mental Health, 2016).

Future Research

Research is still underway on PTSD, but recent research has encouraged scientists and helped them to narrow their focus on different areas and functions of the brain, as well as possible genetic predispositions to the disorder (Sherin, & Nemeroff, 2011).  Some research is looking at trauma victims in acute care settings to try to better understand how the symptoms improve in those patients who heal naturally. Some research currently underway include looking at how fear memories are effected by learning, changes in the body, and sleep. Preventative treatment measures are also underway; scientists are currently looking into how to prevent PTSD following a traumatic experience. Research into trying to predict how a patient will respond to one intervention or another better is also currently underway. With technology improving every year, one-day scientist may be able to pinpoint the exact gene and part of the brain in which PTSD starts to develop (National Institute of Mental Health, 2016).

Conclusion

PTSD is a debilitating disorder that activates the bodies sympathetic nervous system causing the patients to experience a heightened response to stress and trauma, and minor cues of both internal and external stimuli that results in an over exaggerated startle reflex, and intrusive memories of the incident(s). Neurological studies have shown an extensive connection between the stress and fear response in the body’s central and peripheral nervous systems. Long term exposure to trauma, such as in the case of survivors of childhood sexual abuse, shows an increased probability of developing PTSD if one is exposed to trauma as an adult. Unfortunately, survivors of childhood sexual abuse are more likely to engage in unsafe activities and relationships that often result in exposure to more trauma. Psychologists should focus treatment on confronting and reshaping behaviors toward bad memories and traumatic experiences. PTSD is a curable disorder under the direction of a specialists who exposes the patient to the traumatic experience in a safe environment over a long term period. Patient can sometimes expect to see improvement in as little as six months, but, depending on the type of trauma one is exposed to, and its duration, symptoms may become chronic, but manageable. Patients must be willing to take the first step in talking to their primary care provider. “Trauma creates change you don’t choose. Healing creates change you do choose” (Michelle Rosenthal). One must choose to heal by taking away the power of the traumatic experience by talking about it, and remembering that you are not alone.

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The Differences Between DID and Schizophrenia

Psychological disorders are malfunctions in the mind that involve one’s thoughts, behaviors, or emotions that cause an individual significant distress and dysfunction over a period of time. Psychological disorders may interfere with a person’s ability to function in everyday life; they may be unable to meet their own personal needs, and/or be a danger to themselves or others. Psychological disorders are hard for people to understand, even more so when one is unaware that they are suffering from a disease. Considered to be the worst of psychological disorders, Multiple Personality Disorder (MPD) and Schizophrenia are two such disorders; patients are often diagnosed with less severe disorders before the true diagnosis reveals itself. The reason for the misdiagnosis is that MPD and Schizophrenia are often confused with each other, and patients who suffer from these disorders very often suffer from a variety of comorbid disorders. However, DID and Schizophrenia are two completely separate psychological disorders with their own symptoms and treatments. In this paper, I will discuss the diagnostic criteria for both DID and Schizophrenia, and I will discuss rather or not people with Schizophrenia suffer from DID.

What is a Psychological Disorder?

All Psychologists, in the United States, use the Diagnostic and Statistical Manual, Fifth Edition, (DSM_IV) to diagnose psychological disorders. The DSM-IV is a nationally recognized central resource, written by a variety of experts in their field. The DSM-IV lists five criteria that patients must meet to be diagnosed with a psychological disorder; these are known as the five d’s, and they are: deviance, dysfunction, distress, danger, and duration (Davis, 2009). Deviance is a behavior that causes a person to deviate from societies norms, or rules. Dysfunction is a behavior, or, more likely, multiple behaviors that interfere with one’s daily life, normally across the many faucets of their life. Distress is the related stress and issues the dysfunction causes the individual; distress is relative, as a person may have a great deal of dysfunction, but it may cause them very little distress, or vice versa. Danger relates to the individual’s ability or inclination to harm other people or his or herself. Everyone may experience some or all of these symptoms for a period of time in their lives, what makes it a psychological disorder is how long has the symptoms persisted. If the symptoms have persisted for a prolonged period of time, Psychiatrists will give a diagnosis of a psychological disorder (Davis, 2009). There are many psychological disorders, however, two of the worst disorders are Dissociative Identity Disorder and Schizophrenia.

What is Dissociative Identity Disorder?

Dissociative Disorders are listed in the DSM-IV as: Dissociative Amnesia Disorder, Dissociative Identity Disorder, and Depersonalization/Derealization Disorder (LeFrancois, 2016).  Dissociation is when a part of a person’s mind splits away from the rest of his or her mind, leaving part of the mind to function independently. Dissociative Identity Disorder (DID), or Multiple Personality Disorder (MPD), is a severe form of dissociation disorder characterized by the appearance of two distinct identities present within one individual; the patients psyche has broken and fractured into different people, and these different identities have distinct, complex personalities (LeFrancois, 2016). Usually, the dominance of one identity is complete, and amnesia occurs regarding the other identities, but, sometimes, identities may be aware of one another. Shifts from one identity to another may be sudden and dramatic (LeFrancois, 2016). Psychologists usually refer to the identity that pursued therapy as the host identity, and the dissociative identities, which can number in the hundreds for some patients, as the alter identities (Ringrose, 2012).

Prevalence of Dissociative Identity Disorder

Dissociative Identity Disorder is a rare disorder, only one to ten percent of the psychiatric community present with symptoms of DID. “More recently, studies of randomly selected females, age sixteen to fifty-four, of psychiatric inpatients, were found to suffer from DID, using the Structured Clinical Interview for Dissociative Disorders” (Ringrose, 2012. Pg. 4). The vast majority of patients with DID are female (eighty-eight percent), and the average age of diagnosis is between twenty-nine and thirty-five (Ringrose, 2012). Patients with DID always have stories of extreme child abuse, with seventy-six percent reporting childhood sexual abuse, usually by a parent or other close relative. DID is one disorder that appears to be caused entirely by human action, as no connection to genetic disposition, or hereditary histories in patients can be found.

Background of Patients with Dissociative Identity Disorder

A typical background of a patient with Dissociative Identity Disorder reveals that these patients have suffered from extreme trauma and abuse, usually starting at a very early age. Patients will have a poor, insecure, or unpredictable attachment to a parent(s), an emotionally abusive or physically absent mother, torture, physical, sexual, and emotional abuse, repeat admissions to emergency care for suicide attempts – usually in short time frames, such as two in one weekend, continuous contact with mental health services – usually since teenage years, and diagnoses of anxiety, depression, borderline personality disorder, schizophrenia, etc. and a history of alcohol and drug addiction (Ringrose, 2012. Pg.13).

Symptoms of Dissociative Identity Disorder

Patients with DID do share some common symptoms: they report losing time, having amnesia – especially when asked to recall incidences of trauma, anxiety – which may appear out of nowhere and be debilitating, auditory hallucinations – crying, muttering, and self-depreciative remarks are common, except the patient knows they are inside their head, depression, fugue episodes – where clients find themselves in unknown locations with no idea how, or when they arrived, insomnia – where an altar has taken over keeping their physical body awake, if sleep does come – nightmares are reported, mood swings that are too often to be bi-polar -often more than once in a day, numbness – the feeling of being distant, detached, or unreal, and somatoform symptoms – pain that manifests physically, but is often the bodies or altars remembrance of past trauma  (Ringrose, 2012).

Co-Morbid Diagnosis

Dissociative Identity Disorder is a complicated disorder, that is usually masked by the patient’s ability to “function” in society. Often the patient is misdiagnosed because of the comorbidity of DID; patients present with symptoms of more obvious psychological disorders, such as eating disorders, obsessive compulsive disorders, and anxiety disorders (Ringrose, 2012). Often patients receive a diagnosis of “…Schizophrenia, schizoid-affective disorder, schizoid tendency, or bi-polar disorder; occasionally, patients will have another dissociative disorder, such as borderline personality disorder” (Ringrose, 2012. Pg. 12). Resulting in the diagnosis taking, on average, seven years; which is a long time when one considers that there are multiple “people” needing therapy, and that therapy is imperative to their recovery (Ringrose, 2012).

Treatment for Dissociative Identity Disorder

Treatment for Dissociative Identity Disorder can take many years, with patients being seen by a psychiatrist’s multiple times a week – usually two or three times a week, with a support team in place for weekends, and those times that the psychiatrist isn’t in available (Ringrose, 2012). Treatment for DID mainly consists of talk therapy, but drug treatment may be necessary as well, especially if the patient presents with other psychological disorders, such as OCD, or anxiety. Roger’s Client Centered Therapy (LeFrancois, 2016) has proven to be the most effective with patients who suffer from DID.  However, Cognitive Behavioral Therapy, Psychoanalysis, and Family Therapy are also techniques Psychiatrists may need to use when treating a patient with DID, as often more than one type of therapy is necessary, and therapists must remain flexible when choosing to treat patients with DID (Ringrose, 2012). The goal of treatment is to bring all identities to the surface, and have them all start communicating amongst each other, making life less chaotic for the host identity, and giving a voice to the alter identities.

Treatment can take anywhere from two to eleven years, and psychiatrists must be careful of vicarious trauma, and pushing the boundaries of professionalism. Patients with DID tell the most horrific trauma and abuse stories, that may result in the doctor taking on a “mothering” position in the patient’s life, or the doctor experiencing emotional trauma due to the patients past (Ringrose, 2012). Although Dissociative Identity Disorder is an extremely complicated disorder, that causes many problems in the lives of its adult victims, one has to wonder at the abilities of the mind to survive such extreme torture and abuse, especially at such a young age. Dissociation was a life saver to these survivors, without it, they probably wouldn’t have survived the abuse they suffered through.

What is Schizophrenia?

Schizophrenia Spectrum and Other Psychotic Disorders are listed in the DSM-IV as disorders that are characterized by psychotic symptoms such as hallucinations, and delusions, that cause severe dysfunction and distress in the patient’s life (LeFrancois, 2016). Schizophrenia is a severe, sometimes chronic, psychological disorder characterized by a severe emotional, cognitive, and perceptual confusion that results in a breakdown of the patients grasp on reality, and contact with family and friends (LeFrancois, 2016). Patients may suffer from delusions of grandeur, where they think they are of someone of importance, sometimes a historical figure, such as Jesus. Patients also may have hallucinations, often where they fear they are being persecuted by the government or that somebody is “out to get” them. These hallucinations and delusions often go hand in hand (LeFrancois, 2016). Patients may spend years running from their imaginary persecutors, gathering evidence; in some cases, patients may seek to defend themselves or seek revenge, in which case they can become dangerous to themselves or others.

Symptoms of Schizophrenia

In addition, some patients with Schizophrenia may experience “…a decrease in normal functions, include withdrawal from society, the inability to show emotion or to feel pleasure or pain, total apathy, and lack of facial expression or differentiated voice tones (called flat effect)” (Piotrowski, & Tischauser, 2017. Para. 4). Patients may also suffer from periods of extreme anger – often for no reason, disconnected speech patterns, excessive body movement, and purposeless activity (Piotrowski, & Tischauser, 2017). These symptoms are not necessarily life long, as patients can go into remission, or have one psychotic break and never have another.

Prevalence of Schizophrenia

The prevalence of Schizophrenia in the general population is about one percent, and symptoms usually present in adolescent or early adult hood (Nemade, & Dombeck, 2009). The disorder appears to be spread evenly throughout the sexes, although males will only be susceptible to Schizophrenia once in their life – between eighteen and twenty-five years old, and women will be susceptible twice in their life – between the ages of twenty-five and thirty, and again at age forty (Nemade, & Dombeck, 2009). The causes of Schizophrenia are unknown, although there appears to be a genetic connection, as individuals with Schizophrenia almost always have a close relative – mother, father, brother, sister, grandparent, or cousin – with the disorder. However, not all individuals who develop Schizophrenia have a relative with the disorder, leaving doctors to believe that it is a complex mixture of genetics and environmental factors that contribute to Schizophrenia (Piotrowski, & Tischauser, 2017).

Background of Patients with Schizophrenia

The background of a patient with Schizophrenia is usually unremarkable, in that no severe trauma or abuse took place. However, parents of patients with Schizophrenia may describe them as clumsy and emotionally aloof children. As children, they may have preferred to play by themselves, been late to walk, and may have wetted the bed. During adolescences, patients will typically have a noticeable change in personality, resulting in a decrease of academic, social and interpersonal functioning. Usually, a couple of years passes before the individual sees a psychiatrist, and the first “break” from reality doesn’t usually occur until late teenage years and age thirty (Frankenberg, 2017).

Treatment for Schizophrenia

Treatment for Schizophrenia usually consists of therapy, and the use of Antipsychotic drugs (Piotrowski, & Tischauser, 2017). These drugs have been found to be effective in treating Schizophrenia by blocking the creation of excess dopamine, and stimulating the production of the neurotransmitter. The main problem with the treatment is the extreme side effects they can have. Side effects include such symptoms as tardive dyskinesia (TD) (involuntary muscle movements), dystonia (the abrupt stiffening of the muscles), akathisia (the feeling of not being able to sit still) – all of which can be treated by the use of more drugs (Piotrowski, & Tischauser, 2017). As with DID, patients with Schizophrenia attend therapy sessions that usually involve their families; the aim is to help the family understand and support the individual suffering from the disorder, not cure the disorder. Rehabilitation and social skills training may be necessary to re-teach clients how to cope in society, so that they may become independent, functioning members of society again (Piotrowski, & Tischauser, 2017).

Treatment for both Dissociative Identity Disorder and Schizophrenia may not be successful, as the leading cause of premature death amongst both populations is suicide; that’s why early diagnosis and treatment is essential for both DID and Schizophrenia.

Compare and Contrast of DID and Schizophrenia

Dissociative Identity Disorder and Schizophrenia may, on the surface, appear to be the same disorder; after all, Schizophrenia literally means, “split brain,” however, the two disorders are completely different, with different causes and treatments. In regard to Schizophrenia, the “split brain” aspect does not refer to the dissociation or development of complete and separate identities, instead it refers to the way the patient experiences the world – it can appear one way to them, and be completely different in reality. Patients with DID, however, have two or more distinct identities with their own personalities, characteristics, sexual preferences, clothing preferences, and ways of dealing with life.  Patients with DID have remarkably chaotic childhoods, always involving extreme, prolonged child abuse and trauma, whereas, patients with Schizophrenia have unremarkable childhoods, with (typically) no history of child abuse or trauma. Schizophrenia has been proven to have a genetic connection, where as DID is brought about by the care takers of the child. Diagnosis and treatment of both disorders are similar, except the symptoms of DID cannot be abated by the use of Antipsychotic drugs.

Conclusion

The similarities between DID and Schizophrenia do not account for the differences, and one can see that the disorders are caused by completely different factors. Patients with both disorders are often very dysfunctional, and may need family or friends to assist them with the activities of daily living. Social support is imperative to recovery, for both psychological groups. However, where patients with schizophrenia may go into remission and never experience a psychotic break again, individuals with DID will never go into remission, the only cure is long term therapy, and, hopefully, one day, having complete communication between all identities.

This is only a condensed summation of both DID, and Schizophrenia. Both disorders are extremely complicated and can take many different paths. If you feel like you, or someone you know, may suffer from either of these disorders, please contact a mental health facility in your area.

 

 

 

 

 

References

Frankenburg, Frances R. (2017). Schizophrenia Clinical Presentation. Retrieved from:

http://emedicine.medscape.com/article/288259-clinical

LeFrancois, G. (2016). Psychology: The human puzzle (2nd ed.). [Electronic version]. Retrieved

from https://content.ashford.edu/Links to an external site.

Nemade, Rashmi, & Dombeck, Mark. (2009). Schizophrenia Symptoms, Patterns and Statistics

            And Patterns. Retrieved from: https://www.mentalhelp.net/articles/schizophrenia-

symptoms-patterns-and-statistics-and-patterns/

Piotrowski N, Tischauser L. Schizophrenia. Magill’S Medical Guide (Online Edition) [serial

online]. January 2017; Available from: Research Starters, Ipswich, MA. Accessed July

17, 2017.

Ringrose, J. L. (2012). Understanding and Treating Dissociative Identity Disorder (or Multiple

 Personality Disorder). London, GB: Karnac Books. Retrieved from

http://www.ebrary.com

The Last Two Weeks

The last two weeks has been spent devoted almost exclusively to homework as I have a huge research paper due – tomorrow. UGH! Now that I have all the research done, and I am well versed in the subject – I have no idea what to write. My mind is a muddle of thoughts.

I have spent the last two weeks studying and reading about Multiple Personality Disorder (MPD), or, as it is now known as in Diagnostic Statistical Manual: Five (DSM-IV), Dissociative Identity Disorder (DID). As far as I can tell, it is one of the only Psychological Disorders that is caused entirely by human action – more specifically, childhood sexual abuse and extreme trauma.

The stories I have read over the last two weeks would make anyone’s mind or psyche, run, and I have had a hard time wrapping my head around it. People who suffer from DID recount stories of extreme trauma and abuse – some stories that tell of satanic ritual abuse. In a society that denies the existence of such an atrocious act, it’s hard to believe these stories, but at the same time, it’s hard not to. These poor people suffer their whole lives, not understanding what is wrong with them, why they lose time and behave in ways that no rational adult would behave.

Childhood abuse is a subject that is taboo in our society, sexual abuse is something no one wants to talk about. But the truth is one in four women will experience some form of sexual assault or harassment in their life. The department of Social Services, nationwide, receives over three million phones calls a year from people who are concerned about a child they know.  Three million. Some are calls about the same child, and some are calls about multiple children in the same home. But the truth is; child abuse is a subject that needs to be brought out into the light; it’s been hiding in the dark alley long enough.

Many children suffer from neglect, so many the number is unknown. Even more children suffer from emotional abuse. Children are the most vulnerable to abuse as they are completely dependent upon the people in charge of their care. Children are also the most forgiving. If a parent abuses a child, that child will continuously love the parent, and they will place the blame for the abuse on their selves. How sad that they think they are bad and deserve the abuse? No one, especially a child, deserve abuse, of any kind.

Being a parent can be hard, and frustrating, and sometimes it can be hard to remain calm. Especially when you are listening to your child scream for the fourth hour in a row, and no matter what you do, they will not quit crying, but there are ways to remain calm when dealing with a difficult child. The best thing to do when you feel yourself getting overwhelm is take a break. Walk away. Call a friend and have some adult time. Go in your backyard and scream. Punch a pillow if you need a physical release. Please do not take it out on your child.

If you feel like you may suffer from an anger issue, please seek assistance. There are many Mental Health offices in the United States. As well as crisis hotlines that are available twenty-four hours a day. If all you are feeling is overwhelmed, and just need someone to talk too, you can still call these hotlines. That’s what they are there for.

If you are a child in an abusive home, there are people available to help you. The fear of telling is a conditioned response. You have been told that more bad things will happen if you tell. Here’s the truth: the only way the abuse will stop is if you tell. Please tell. Tell a teacher. Tell a friend. Tell a friend’s parent. Tell. Tell. Tell. And remember: The abuse is NEVER your fault.

Hotline Numbers for in the United States:

National Domestic Violence Hotline
(800) 799-7233

National US Child Abuse Hotline
(800) 422-4453

Teen Help Adolescent Resources
(800) 840-5704

Rape, Abuse, and Incest National Network (RAINN)
(800) 656-HOPE

National Domestic Violence/Child Abuse/ Sexual Abuse
(800) 799-7233

Judge Baker Children’s Center – Child Abuse Hotline
(800) 792-5200

Child Help USA National Child Abuse Hotline
(800) 422-4453

Covenant House
(800) 999-9999

Three Techniques to Cope with Anxiety

I am an introvert. In our extroverted society, just making that statement can be anxiety provoking. People assume the worst about introverts; that we’re cold, reserved, don’t like people, like to be alone, etc. But, the truth is, most introverts just like meaningful conversation with people who make them feel good about themselves. Introverts have a hard time with small talk, and may talk too much when nervous or stressed; causing awkward situations for both the introvert and the people around them. As a result of this, introverts often suffer from social anxiety, or, occasionally, generalized anxiety disorder. For this post, I will discuss social anxiety, as that is the type of anxiety I suffer from, and therefore, have the most experience with.

Social anxiety involves fear of social situations, or situations where an individual may be exposed to the judgement of others. These unreasonable fears are usually accompanied by thoughts such as, “everybody is thinking how much better this place would be without you,” “you always make a fool of yourself,” “you can’t do anything right,” or “nobody is ever going to like you, you might as well give up.” These can be debilitating thoughts, and the fear they cause can have physical manifestations. For instance, when I am experiencing an anxiety attack, my hands get sweaty, my heart starts to race, and my stomach starts to twist and turn. This is the body’s sympathetic nervous system; your flight, fight, freeze, or submit system, and it is automatic. While you cannot control this system, you can control your responses.

Three responses, or coping mechanisms, one can employ when having an anxiety attack, rather social or otherwise, include changing one’s thoughts, breathing and relaxation exercises, and distraction exercises.

Changing one’s thoughts is probably the hardest thing to do, however, the benefits of realized that not everyone hates you, are extremely beneficial. Some coping sentences one can use when facing an anxiety provoking situation include: “It is better for me to think about my positive qualities than my negative qualities, or think about what I can do, rather than what I cannot do.”  Focusing on your positive qualities can have an uplifting feeling, and give you the confidence you need to forge ahead, or enter that party, or family get together.

“If I plan what I will do or say, I will feel more confident.” Planning the situation, and an initial conversation you have be beneficial, as long as you do not let your negative thoughts overcome your rational thoughts. Conversations rarely go as bad in real life as they do in your head, or even close to what you rehearse, but planning how to say, “hello, how are you?” may benefit your nervous system and help you to realize that your fears of being hated by everyone are unreasonable.

“I can do this.” Simple, yet, effective. You can do it. Just keep repeating that to yourself while doing some deep breathing. Everything will be fine. People like you. You are a likeable person. Try it.

Breathing and relaxation exercises are extremely beneficial in calming the sympathetic nervous system. The progressive relaxation exercises, developed by Edmund Jacobson, involves tensing each part of your body, starting with your toes and working your way up, for five seconds, without straining, followed by ten seconds of relaxing each part of your body, consecutively. One could also practice mediation, which I have found to be extremely helpful in calming my nerves. While practicing these relaxation exercises, try to employ some distraction exercise.

Distraction exercises are great when you are placed in an unexpected social situation (the fear of all introverts). Some thought distraction exercises I personally employ, are naming items in the room that start with a given letter of the alphabet – just pick a letter. Conjure up images in your mind’s eye of your favorite place, and then walk down all the paths located there. Remember the words to your favorite song, and sing it to yourself, until the fear has passed. Some physical distraction exercises, especially for when you are at a large gathering, include offering to do the dishes, play with or babysit the children, or offer to hand out beverages or food.

Remember that having social anxiety is manageable, and that often your fears are worse than reality. Question your fears. Is it reasonable to assume that everyone hates you? Is it reasonable to assume that you always mess things up? Of course, the answer to both those questions is: no!  Be careful of black and white thinking that places everything and everyone into either or categorizes. Everybody is human and has good and bad days, experiences high and low emotions, and have good and bad moods, just because you are around for a low, doesn’t mean that low has anything to do with you. In fact, it probably doesn’t.

If you suffer from past trauma, or abuse, these techniques will work for you in the short run, but I recommend consulting a psychologist for further techniques in handling anxiety, especially if it interferes with your daily living. Anxiety is a psychological disorder that is manageable by a variety of therapy techniques, and it does not have to rule your life!

Operate Conditioning

B.F. Skinner was a psychologist who was best known for his theories on behaviorism, and his Utopian novel entitled “Walden Two” (Biography.com, 2016). Skinner spent his career studying behavior, especially in regard to rather new behaviors are learned through conditioning, or encouragement, or if animals will learn new behaviors without conditioning. In his pursuit of studying animals in their natural environment, Skinner developed what became known as the Skinner box, in which he could study animals without interacting with them (Biography.com, 2016). Through this study on operate conditioning, Skinner published a book entitled, “The Behavior of Organism” in 1938, in which he determined that some form of reinforcement was necessary to learn new behaviors (Biography.com, 2016).

There is no doubt that Skinner contributed a significant finding to the field of psychology in his operate conditioning theory. One can see this theory play out in toddlers all across the world every day, as parents use reinforcements to coax their children into doing the things they want them to do, and use negative consequences to deter their children from engaging in behaviors they do not want them to do. But, not all species have the ability to learn, and that is what B.F. Skinner set out to prove; can species who are conditioned to learn new information learn it (Artiga, 2010)? For instance, can a rat learn to solve a maze if rewarded with a piece of food at the end of the maze? Of course, the answer is yes, they can.

In the article, “Learning and Selection Process” the author writes about operate conditioning and how it relates to natural selection. Does it help with natural selection and the evolution of species? The answer would appear to be yes, it does. With operate conditioning, an organism flits about performing random operations until one is rewarded in some way. Then that organism repeats the behavior until it is rewarded again, and so on, and so forth, until that new behavior, say a new way of eating, is the way the organism does it now. This usually helps species to adapt because it helps them develop and hone skills that make things like eating or dodging predators easier, allowing them to survive longer (Artiga, 2010).

Operate conditioning is something we all use. We teach our children new skills by rewarding them when they get it right, and with holding the reward if they do not. Work is an example of operate conditioning for adults. IF one didn’t get paid, a reward, or reinforcement for going to work, would one go to work? My guess would be that one wouldn’t; I know I wouldn’t.

 

References

Artiga, M. (2010). Learning and Selection Processes. Theoria25(2), 197.

Biography.com (2016). B.F. Skinner Biography. https://www.biography.com/people/bf-skinner-

9485671

Dissociative Identity Disorder

Part of this paper discusses James McAvoy’s character from the recent blockbuster Split. 

 James McAvoy plays a character names Kevin who has twenty-three distinct personalities “trapped” inside his mind. Everyone goes into the movie knowing it is about a man with a “split” personality, but “Kevin” displays these different personalities in very different manners. As the movie develops Kevin’s personalities manifest physically by changing his clothes, changing his personality (for instance, one personality is an agoraphobia, can cannot even stand a smudge on the mirror, one is a small child, who is excited to have a new person to talk to, one is a nurturing woman, one is a tough guy, who protects and guards, one is a gay man and fashion designer, and one has Type I Diabetes and needs medication), changing his medical needs, and changing his emotional state, as well as his physical appearance. Kevin also attends therapy. (I will not discuss the validity of DID in this paper, as I believe that DID is a real disorder.)

A psychologist uses, what is called, the four “D’s” to determine if a person has a psychological disorder. The four D’s include: deviance, dysfunction, distress, and danger (some consider a fifth D to be relevant in diagnosing psychological disorders; duration) (Davis, 2009). “Kevin” would certainly be diagnosed with DID if he was a real patient.

Deviance can best be described as a disruptive behavior that deviates from society’s norms, or standards of conduct (Davis, 2009). A person’s behavior can be described as deviant when it goes against societies norms, such as when Kevin kidnaps a person, and holds her prisoner, or when Kevin commits murder, multiple times.

Dysfunction can best be described as a behavior or multiple behaviors that interfere with a person’s life in a significant way (Davis, 2009). Kevin’s diagnosis of DID interferes with multiple faucets of his life. It is hard for him to interact with people socially, he has an Obsessive Compulsive disorder, and it affects his ability to maintain employment, friendships, and even his relationship with his therapist suffers over the course of the movie. Keven can be described as very dysfunctional.

Distress can best be described as the related stress the behaviors and dysfunctions have on the individual. A person can be very dysfunctional and not very distressed over those dysfunctions, or a person can have very little dysfunctions in life, and be very distressed over them anyway (Davis, 2009). It depends on the person, and the diagnosis one is looking at. Kevin experiences a high deal of distress, or at least some of his personalities do. The more dominant personalities have taken over Kevin’s physical body, the person who is normally in charge, a separate personality named Barry, has little control. Barry is very distressed by the actions of the other personalities, and he begins to call and email the therapist when he is in charge, trying to get assistance. Barry believes the other personalities will cause trouble or be dangerous, and he is right.

Danger is the fourth D, and it can best be described as the person’s ability or inclination, to harm either oneself or another person (Davis, 2009). The, normally, non-dominate personalities that have taken over Kevin’s physical body present a great deal of danger to others and to Kevin. They even run the risk of getting Kevin killed because of their actions; kidnapping, and murder.

Kevin has suffered from DID for many years, and has been, up until his non-dominate personalities decided to get revenge, a quiet, unobtrusive person who lives and works in the basement of some factory. The fifth D that psychologists look at is duration; how long has the person been suffering from these symptoms (Davis, 2009)?  For Kevin, the answer is probably since child hood, as DID is a disorder usually brought about by severe childhood abuse and trauma.

Dissociative identity Disorder (DID) is a “…complex type of dissociation in which individuals are from time to time dominated by distinctly different, complex, highly integrated personalities (LeFrancois, 2016. Sec. 10.6, para. 23).  The causes of DID are prolonged, severe, childhood abuse, with seventy-six percent of patients reporting a combination of mental, physical and sexual abuse; usually by a parent, or other close relative. Occasionally, the stressor of war can bring on a dissociative identity, as the identity of a person is still developing during childhood. Kevin has twenty-three distinct and separate personalities with their own psychological disorders to include OCD, and Generalized anxiety disorder. They have their own medical needs, and their own interests, and sexual preferences. Kevin has gone to many years of therapy to counter-react the effects of DID.

Treatment for DID mainly consists of talk therapy, but drug treatment may be necessary as well, especially if the patient presents with other psychological disorders, such as OCD, or anxiety.

Another form of treatment therapist may choose to employ for patients with DID is Cognitive Behavioral Therapy. Cognitive Behavioral Therapy is an approach to therapy that attempts to change behaviors and attitudes by changing the reward for these attitudes and behaviors (LeFrancois, 2016).  Cognitive Behavioral Therapists believe that negative behavior can be unlearned and that acceptable behaviors can then replace those negative behaviors.

A more humanistic approach to therapy, one that has proven to be affective with treating DID, is Roger’s Client Centered Therapy (LeFrancois, 2016).  Roger’s client centered therapy is perhaps the most well-known approach to therapy aside from Fraud’s psychoanalyst approach. Client centered therapy is built upon the premises that all people have a desire to self-actualize; to improve oneself. Client centered therapy focuses on providing the client with a safe environment in which to explore past trauma, and their feelings without a sense of judgment (LeFrancois, 2016).  These are the therapists that asks such questions as, “how do you feel about that?” In this sense, the therapist helps the client to self-actualize, or improve upon oneself, by providing an environment where the client can grow and become of aware of their own coping mechanisms.

Because of the severe childhood trauma that accompanies a diagnosis of DID, often family therapy is recommended, if the patient is still in touch with their family. Family therapy aims to help families communicate better, as well as teach family members how to better understand the diagnosis (American Psychological Association:  Society of Clinical Psychology, 2013).

DID, like all mental health diagnosis, can be complicated and hard to understand. However, treatment has been proven to be successful in that it has allowed most patients to carry on with their lives without too much dysfunction. Patients with DID often suffer from a variety of comorbid disorders, as well as severe mental trauma from the abuse that they suffered. Because of the comorbidity of DID, a diagnosis is often not made until later in life, often after many years of suffering by the patient at the hands of psychologists who are doubtful the disorder exists. Some attribute the symptoms to Schizophrenia, however, schizophrenia and dissociative identity disorder are completely different, in that in DID, patients have two or more distinct personalities, whereas, in schizophrenia, patients have paranoid episodes where they may behave like a different person.

 

References

T Davis. Conceptualizing Psychiatric Disorders Using “Four D’s” of Diagnoses. The Internet

Journal of Psychiatry. 2009 Volume 1 Number 1.

LeFrancois, G. (2016). Psychology: The human puzzle (2nd ed.). [Electronic version]. Retrieved

from https://content.ashford.edu/

American Psychological Association:  Society of Clinical Psychology. (2013). Research-

            Supported Psychological Treatments. [Website]. Retrieved from

https://www.psychologicaltreatments.org/

Stress

Stress can have a profound effect on the human body, and human emotional system. Stress can physically cause a person to gain weight, kill brain cells, cause a person’s brain to shrink, and even unravel chromosomes. Chronic stress can lead to psychological disorders, such as depression, anxiety, cognitive problems, personality changes, and behavioral problems. Stress effects all people, even children, in varying degrees depending on one’s personality, and coping mechanisms.

People identify different emotional and environmental situations as a stressor; what may be stressful for one person, may not be for another.  People also develop different coping mechanism for stress, as well. Some of the different coping mechanism people use to handle stress include “…optimism, learned optimism, hope, locus of control (intrinsic or external), self-efficacy, neuroticism, extraversion, openness to experiences, agreeableness, conscientiousness, emotional intelligence, problem solving skills, self-esteem, depression, social support, forgiveness, hostility, humor, and perceived control (Snyder, 2001. Pg. 6). Some of these are more positive coping mechanisms than others, and the positive mechanism will have more of a beneficial influence while the negative mechanism will have a more detrimental influence by employing avoidance behavior (Snyder, 2001). All of these differences are inclusive in human nature, as well as one’s “situation” in life; where one lives, social and economic status, and one’s health will also play a role in how a person handles stress, all at varying degrees.

But, what is stress? What constitutes as a stressor? According to the Holmes-Rahe Stress Inventory, a stressor can be anything from the death of a loved one to a vacation, and although the death of a loved one certainly ranks higher than a vacation on the inventory, either can be stressful, depending on the person (Snyder, 2001). People are different and handle different situations with different attitudes, and personality attributes; while one person may be high in optimism, another person may be high in depression or hostility, these two people will handle stress in very different manners. While the person high in optimism will likely try to shed light on even the death of a loved one, and not be stressed by vacation at all, the person high in depression may have an emotional break down over the death of a loved one, and worry about everything from packing to hotel reservations on a vacation. One’s personality and coping mechanisms will determine how one handles stress.

According to my score on the Holmes-Rahe Stress Inventory (436), I am due to have a health break down within the next two years. However, I handle stress very well, so I’m not worried.

Within the past year, as the test asks, I have experienced many things that I would not consider a stressor, but that the test calls a stressor. For instance, I went on vacation, but I would not consider that a stressor, as I had a blast and relieved my stress while I was there. I have also experienced many things that were, and still are, very stressful; the biggest would be the recent passing of my brother in law. My husband and I struggle with that every day.

The passing of my brother in law has brought about some changes in my personal life. For one, it has made me realize how precious and short life is; I do not want to waste one more minute of it. My husband and I have set a timeline for our goal of moving to a more hospitable place, mainly California, as one year, and we have every intention of meeting that goal. We have also drastically reduced the amount of drinking we do; not that we were very heavy drinkers, but now I almost drink nothing at all, and Tim has cut back to only a few drinks on Friday night. We have chosen to handle this stress by being better people; people our brother would be proud of.

I generally handle stress very well. I cry to relieve stress when I need to; that can be a big stress reliever. However, what I do the most is meditate. I would like to say that I do yoga on a regular basis, but, sadly, I only do yoga occasionally. I could do more yoga to help cope with stress, as it does help very much. My husband and I hike, sometimes seven miles a day, on the weekends. We also communicate our needs to each other; so if he is feeling stressed out, I can empathize and help, and vice versa. One’s social support can be a huge coping mechanism, that’s why it’s so important to surround yourself with good people, who make you laugh. Laughter can also be huge stress reliever.

The way one handles stress can change over time. A person can learn mediation techniques, or pick up a hobby that helps relieve stress, or deliberately change their behaviors. One can learn to handle stress better. Some things, however, will just take time.

 

Click the link below to take the Stress Inventory Test, and see where you fall on the scale. How do you handle stress?

 

 

 

References

Snyder, C. R. (Ed.). (2001). Coping with Stress: Effective People and Processes. Cary, US:

Oxford University Press. Retrieved from http://www.ebrary.com

The American Institute of Stress. (n.d.). Holmes-Rahe Stress Inventory (Links to an external site.)Links to an external site.. Retrieved from http://www.stress.org/holmes-rahe-stress-inventory/