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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Generalized Anxiety Disorder

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. Generalized anxiety disorder is not considered to a dangerous disorder, however, it can cause some severe dysfunction in patients’ lives. In this paper, I will discuss generalized anxiety disorder from a neurobehavioral perspective.

Generalized Anxiety Disorder

According to the Diagnostic and Statistical Manual, Fifth Edition, (DSM-V), generalized anxiety disorder is characterized by excessive worry and apprehension that last longer than six months and pervades every aspect of the person’s life, or nearly every aspect, and the individual finds it difficult to control these thoughts (DSM-V, 2013). This anxiety causes a variety of symptoms of which three or more must be present for more days than not over the six-month period; restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and/or sleep disturbances. These disturbances in a person’s life cannot be explained by either an addiction, such as a drug or alcohol addiction, or by another psychological disorder (DSM-V, 2013).

Biopsychosocial Theory

Generalized anxiety disorder is a disease that is caused by a variety of factors. Anxiety is generally considered to be a disorder that people are genetically predisposed too. Research has shown that generalized anxiety disorder has a heredibility factor, however, one’s environment will contribute a great deal to rather or not one develops generalized anxiety disorder (Brown, O’Leary, & Barlow, 2001). Although one may be predisposed to develop generalized anxiety disorder, evidence shows that stressful life events in childhood may play a contributing factor, events such as child abuse, the loss of a parent, or insecure attachments to caregivers (Brown, O’Leary, & Barlow, 2001). It is a comorbid disorder often occurring along with other disorders such as; autism, depression, sleep disorders, or substance abuse.

Evidence shows that the amygdala and areas of the forebrain are involved in generalized anxiety disorder. The basolateral amygdala complex (BLA), and centromedial amygdala complex, receive information about potentially negative emotions, activating the GABA neurotransmitters, leading to somatic manifestations of anxiety (Nuss, 2015).

Epidemiology

Generalized anxiety disorder is not a rare disease. In fact, it’s prevalence in the US may range as high as five percent of the population. It is found to be more prevalent in low income families, white, adult, women, and within those social groups of people who are widowed, separated, or divorced (Weisberg, 2009).

Complications

Generalized anxiety disorder is more than just excessive worrying. It can impair one’s ability to think clearly, and concentrate on a task. It can sap a person’s energy, and make it hard for them to sleep. It can lead to a worsening of, or be the cause of other psychological disorders such as; depression, substance abuse, insomnia, digestive problems, headaches, and may even cause heart problems. Generalized anxiety disorder has also been linked to suicidal tendency, and some people who suffer from the disorder to manage to carry out their suicide (Mayo Clinic Staff, 2016).

Treatment Options

The two main treatment options for generalized anxiety disorder are psychotherapy, or medication; usually a combination of both. Cognitive behavioral therapy is the most effective therapy for generalized anxiety disorder, as it involves teaching the patient how to respond better to stress and negative emotions. Several different medications are used to treat generalized anxiety disorder including antidepressants, antianxiety, and benzodiazepines (Mayo Clinic Staff, 2016).

Antidepressants such as selective serotonin reuptake inhibitors (SSRI’s), and serotonin norepinephrine reuptake inhibitor (SNRI), are usually the first choice of physicians when treating anxiety disorders. Antidepressants and antianxiety medications take up to several weeks to work, and the side effects can be drastic, to include suicidal thoughts; physicians are advised to carefully monitor patients, changing medications if severe side effects do occur. Benzodiazepines are only used on short term basis for patients who are suffering from acute anxiety attacks, and should not be used for patients with a history of substance abuse because they can be addicting (Mayo Clinic Staff, 2016).

Conclusion

Generalized anxiety is a psychological disorder that is quite prevalent in the population of the United States. People who suffer from this disorder are likely to stress and worry over the smallest thing in an uncontrollable manner, and this stress is likely to affect their personal life increasing the likely hood of them developing another psychological disorder. But, anxiety can be controlled with the assistance of a physician, through the use of psychotherapy, and medications. I believe Juliana Hatfield described anxiety, and its symptoms, best when she said, “Sometimes I feel like a human pincushion. Every painful emotion hits me with ridiculously exaggerated force. And, the anxiety feels like hands inside of me, squeezing my guts really hard.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Nuss, P. (2015). Anxiety disorders and GABA neurotransmission: a disturbance of

modulation. Neuropsychiatric Disease and Treatment11, 165–175.

http://doi.org/10.2147/NDT.S58841

Brown, Timothy A., O’Leary, Tracy A., & Barlow, David H.(2001). Clinical Handbook of

            Psychological Disorders, Third Edition: A Step-by-Step Treatment Manual, Chapter

Four. Retrieved from:

http://commonweb.unifr.ch/artsdean/pub/gestens/f/as/files/4660/21992_121827.pdf

Weisberg, Risa B. (2009). Overview of Generalized Anxiety Disorder: Epidemiology,

Presentation, and Course. Journal of  Clinical Psychiatry 2009;70(suppl 2):4-9. Retrieved

from: http://www.psychiatrist.com/jcp/article/Pages/2009/v70s02/v70s0201.aspx

Mayo Clinic Staff. (2016). Generalized Anxiety Disorder, Complications. Retrieved from:

http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-

disorder/basics/complications/con-20024562

Juliana Hatfield. Retrieved from: https://www.brainyquote.com/quotes/keywords/anxiety.html

Autism Spectrum Disorder (ASD)

This week in class, I read something I had never heard before; that Autism is a consciousness disorder. I have a nine-year-old with Autism, and had never heard or read that before; strange huh? I’ve heard autism be called a spectrum disorder, a neurophysiological disorder, and a sensory disorder. I’ve always explained it as, “his senses do not work the same way ours do.” That description is right, and wrong. Let’s take a closer look at autism.

Autism does not have one known cause, and the disorder can range from severe to high functioning, leading scientists to believe that there are probably many causes. (Autism is NOT caused by vaccines, and that is all I will say about that in this paper.) Because of the complexity of the disorder, researchers believe that the cause of Autism may be both environmental and genetic (Mayo Clinic, 2016). Post mortem examinations have brought about many discoveries in how autism effects the genes, and the brain.

Several different genes appear to be involved in Autism Spectrum Disorder. Some children have mutations in their genes, that may be the involved in Autism. Some children who have Autism also have a genetic disorder, such as fragile X syndrome or Rhett’s Disease. Some mutations may be on the genes that affect communication, or determine the severity of symptoms. Some mutations may occur spontaneously, while others may be inherited (Mayo Clinic, 2016). One’s chances of having autism increase if one has a sibling or other blood relative with autism, however, scientists believe that many environmental factors may be involved in autism as well.

Environmental factors are currently being explored, and some causes that have been considered are; viral infections, medications or complications during pregnancy, air pollutants, and GMO’s (Mayo Clinic, 2016). All of these factors are considered to effect the baby in utero, evidence shows that around thirty-two weeks in utero, the baby’s brain stops developing normally.

The cerebellum, limbic system, and cortex appears to be affected by Autism. The cerebellum controls fine motor skills, balance, and coordination of the body, as well as, receiving sensory information from muscles, joints, and visual and audio input. Post mortem examinations of the brains of people with Autism has shown an under developed prefrontal cortex and a decrease of purkinje cells in the cerebellum, and that this mutation occurs around thirty-two weeks in vitro. This cell deficient in the cerebellum appears to increase the risk of seizures, and the risk of Autism (Blatt,2012). Many autistic patients also suffer from severe epilepsy.

Many neurotransmitters are affected in the autistic patient including dopamine, serotonin, GABA, and Acetylcholine. Dopamine plays a large role in regulating sensitivity and processing of information, perception of change, relying information, cognition, motivation, emotional responses, attention and focus, movement, and posture (Autism Couch, 2017). A decrease in dopamine levels can impair attention and focus, while an increase can cause the mind to race, and increase sensory processing causing an overload on the brain’s ability to process information. Studies have shown that individuals with autism have increased dopamine receptors on the mRNA expression (Autism Couch, 2017).

GABA is a neurotransmitter that contributes to calming a person down; prohibiting neurons from firing. Research has shown that individuals with autism have an imbalance of glutamate to the GABA receptors, causing over excitement, explaining why so many individuals with autism also have a co-morbid diagnosis of ADHD.

Acetylcholine is an excitatory neurotransmitter that contributes to the contraction of muscles, and stimulates the release of certain hormones. It is involved in wakefulness, attentiveness, anger, aggression, sexuality, and thirst, among other things. A decrease in acetylcholine may explain why so many on the spectrum suffer from issues with aggression.

Autism spectrum Disorder is an extremely complicated disorder, and individuals can range from low functioning to high functioning. What may affect one autistic person may not affect another. However, there are common characteristics that all patients with autism will share to one degree or another.

Social interaction and communication are issues for almost all individuals on the spectrum. They may fail to respond to their own name, after someone has called it many times. They may resist hugging and may not want to play with other kids, often times they will appear to be “in their own world.” They may lack eye contact when having conversations, and they may lack facial expression as well. Delayed speaking, or never speaking at all are common, as well as the inability to use words correctly, and some may lose the ability to speak. Conversations are hard for people on the spectrum, and often they may appear to be uninterested in what the other person is saying. They may speak in an abnormal tone, either sing songy, or robotic is common. Social interactions are complicated for autistic people, and they may approach a situation inappropriately by being passive, or aggressive.

As well as communication and social problems, people on the spectrum may have behavioral problems as well. Common behaviors found in ASD individuals include rocking of the body or flapping of the hands. They may self-harm, but not because they are emotionally damaged. They may bite themselves or hit their head against things. Autistic patients are very fixed in their routines and do not like change or surprises. They may be clumsy or have exaggerated body movements, as often they have a hard time with body coordination. (We know that this is due to the damage in the cerebellum.) Most autistic patients are unusually sensitive to light, and sound, but are indifferent to pain and temperature. Children on the spectrum tend to fixate on certain things, have very real food preferences (and that “let them get hungry” philosophy, does not work with autistic kids – they WILL starve before eating something they do not like). They participate in what is called “parallel play.” This means that, yes, they play with other kids, but only alongside them, not interacting or exchanging ideas with them – Jacob still does this.

Treatment for autism is nonexistent. I hate that some people do not care about a cure. I would love a cure for my son. Autism makes his life so hard, and he gets bullied every year because he has a hard time in social situations. Right now, he is in elementary school, and has a student aid that helps him; I’m scared for when he goes to middle school.  I hope they keep doing the research and find something, someday to cure autism. Many on the spectrum suffer from co-morbid diagnosis of epilepsy, ADHD, anxiety disorders, and sometimes OCD. Since the core symptoms of autism cannot be treated; treatment is focused on the symptoms, or what symptoms can be treated.

Jacob suffers from generalized anxiety disorder, and he takes an adult dose of Prozac to combat that. He’s been in behavioral therapy since he was diagnosed at age three. Behavioral therapy teaches him how to interact with his peers, and how to react in social situations. Jacob is high functioning, but when he was younger, and first diagnosed, the doctors told me that he would never communicate, and never have a life outside of my home. Well, he sure showed them! Jacob has many friends, and talks up a storm – he never stops, he even talks in his sleep! While I know that there is no cure for autism, some patients can be brought out of their shell, and can go from low functioning to high functioning. Jacob use to be non-verbal, and non-communicative (meaning no outward signs of communication, not even grunting and pointing), his IQ use to be a 70, now it’s a 92, and Jacob has come so far in his abilities to interact socially.  Jacob use to be in physical therapy, occupational therapy, and speech therapy (all common therapies for autism), and now he is only in speech and behavioral therapy. I have no complaints.

Autism spectrum disorder is complicated and can take many different paths. This is not a complete list of all signs and symptoms. If you feel like your child may be autistic, please see your primary care provider.

 

 

 

References

Gene J. Blatt, “The Neuropathology of Autism,” Scientific, vol. 2012, Article ID 703675, 16

pages, 2012. doi:10.6064/2012/703675

Autism Couch, Neurotransmitters and Autism. Retrieved from:

http://autismcoach.com/neurotransmitters-and-autism/

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

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/