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Summary PYC4802 Psychopathology - essays from past exams
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Essays done from past exams for the subject PYC4802 Psychopathology. Past essay exam questions were written as practice for the exam.
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Trauma related disordersDSM criteria for Post Traumatic Stress Disorder
The DSM-5 Criterion A stipulates that in order to be diagnosed with Posttraumatic Stress Disorder
(PTSD), the person must have been exposed to actual threatened death, serious injury, or sexual
violence. Exposure can include directly experiencing the traumatic event; Witnessing the event as it
occurred to others; learning of a traumatic event that occurred to a close family member or friend;
or being repeatedly exposed to the details of traumatic events (for example, as in the case of
policemen and paramedics). Criterion B stipulates that the person must further display one or more
of the following intrusion symptoms that is associated with the traumatic event: Recurrent,
involuntary, and intrusive distressing memories of the traumatic events or repetitive play with
themes representing the traumatic event with children; recurrent, distressing dreams where the
content or emotions experienced are related to the traumatic event (children may have dreams with
frightening and unrecognizable content); Dissociative reactions (for example, flashbacks) in which
the individual feels or acts as if the traumatic event(s) were recurring; experiencing intense
psychological distress when exposed to internal or external cues that resemble the traumatic event;
and noticeable physiological reactions to internal or external cues that resemble the traumatic
event. Criterion C requires that the person should exhibit a persistent avoidance of stimuli
associated with the traumatic event by attempting to avoid distressing memories, thoughts or
feelings associated with the trauma; and/or attempting to avoid external reminders (for example,
people and places) that cause distressing memories or feelings associated with the trauma. Criterion
D stipulates that the person should present with two or more of the following negative alterations in
cognitions and moods: an inability to remember an important aspect of the traumatic event (due to
dissociative amnesia); negative beliefs or expectations about oneself, others or the world; distorted
cognitions about the cause or consequences of the traumatic event (the individual blames
him/herself); a persistent negative emotional state; loss of interest or participation in significant
activities; feelings of detachment or estrangement from others; and a persistent inability to
experience positive emotions. The following arousal and reactivity criteria are listed in Criterion E:
Irritable behaviour and angry outbursts expressed as verbal and physical aggression; reckless or self-
,destructive behaviour; hypervigilence; an exaggerated startle response; problems with
concentration; and sleep disturbance. The person must have experienced all symptoms listed above
for a period of more than 1 month and causes clinically significant distress or impairment in all areas
of functioning. The symptoms must not be better explained by the use of a substance or another
medical condition. The DSM further lists several specifiers. The first is to specify dissociative
symptoms, which can be either depersonalisation (the feeling of detachment from one’s own body
or mind) or derealisation (experiences of unreality of surroundings). Secondly, the professional
needs to specify whether the symptoms have presented with a delayed expression.
Challenges involved with the diagnosis of Post Traumatic Stress Disorder (PTSD)
The difficulty that arises in diagnosing PTSD is related to the anxiety that these patients can
experience. The issue is that anxiety is a normal human reaction and can be viewed as a normal
adaptive and functional response to a threatening situation, it prepares the body for a fight or flight
response. This makes it difficult to determine if the presenting symptoms are a normal reaction to an
adverse event or if they require a diagnosis of PTSD. However, the DSM has stipulated that the
symptoms need to have developed a month after the traumatic event, therefore, it appears to not
be a normal reaction to the event as it has a delayed response. The DSM further stipulates that the
symptoms need to cause significant distress or impairment in social, occupational, or other
important areas of functioning. The way in which the symptoms are interfering with the person’s
level of functioning can help the professional in determining whether or not these are a normal
reaction.
Another challenge that may arise in the diagnosis of PTSD is that anxiety is a symptom that is found
in many other psychological disorders. For example, PTSD and Major Depressive Disorder have many
symptoms in common, including anxiety, depression, and thoughts of suicide. Anxiety can also be
present in Substance related disorders, especially when the abused substance is alcohol. A person
may also abuse substances in order to help ease the symptoms and distress associated with PTSD.
The fact that the disorders are so similar and that the one disorder may cause the person to develop
another disorder (for example, PTSD may lead to either Substance related disorders or to Depressive
episodes), it may be difficult to determine which of the abnormal behaviours are the cause and
which are the result. In other words, the symptoms of various disorders overlap with one another.
Therefore, this can lead to misdiagnosis. However, the major diagnostic criterion for PTSD is that the
person has to have been exposed to a traumatic event prior to symptoms developing. Therefore, this
may aide in ensuring that a proper diagnosis is given.
, Another issue in the identification and diagnosis of PTSD is related to the aetiology of the disorder.
Anxiety disorder, obsessive-compulsive disorders and dissociative disorders may in fact be one of
the causes of PTSD developing. In other words, another disorder may have been present before the
traumatic event occurred which would predispose the person to developing PTSD. Previous anxiety,
in particular, plays a major role in the development of PTSD. Once again, the fact that a traumatic
event needs to have occurred in order to receive a diagnosis of PTSD, this can aide in determining if
there was any sign of another disorder present before anxiety symptoms manifested. The
professional may have to determine if there were any signs or symptoms of other disorders prior to
the traumatic event or if the symptoms worsened after said event.
A factor that can influence the identification and diagnosis of PTSD is that most people who
experience a traumatic event do not develop PTSD. This is due to resilience, which is influenced by
personality factors, developmental factors, social support and gender. To further complicate this
issue, some people that present with PTSD symptoms find that their symptoms are manageable (it
does not interfere with their daily functioning) or that their symptoms resolve spontaneously. This
suggests that there may be other underlying factors that lead to the development of PTSD, for
example, the person may have a previous disorder such as General Anxiety Disorder, which in turn
could lead to misdiagnosis.
A factor that always needs to be considered in diagnosing all disorders, including that of PTSD, is the
cultural and ethnic background of the person. This is because a person’s culture has an effect on
how symptoms manifest and how the person will interpret these symptoms. There are also culture-
bound syndromes which need to be taken into consideration. A culture-bound syndrome is when a
pattern of abnormal behaviour presents itself within a particular culture only. It is possible that the
practitioner may misdiagnose symptoms if they are unaware of any cultural differences or culture-
bound disorders. Therefore, it is of utmost importance that practitioners need to keep a person’s
culture in mind when assessing for Disorders, as symptoms may present themselves differently than
in the expected, Westernised view.
It is clear that the diagnosis of PTSD is not as simple as it may appear, and that there are some
difficulties which may lead to over or under diagnosis of this disorder. In a country such as South
Africa, where there are high crime rates and levels of violence (including sexual trauma and domestic
violence), it is extremely important to ensure that the diagnosis of PTSD is done correctly. The fact
that there are high rates of crime and violence means that many people in the country will be
exposed to traumatic events and therefore could be potentially diagnosed with PTSD. Care needs to
be exercised when diagnosing PTSD, for two reasons. Firstly, South Africa is a multicultural nation
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