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Summary case 2 PTSD & OCD
- Instelling
- Maastricht University (UM)
case 2 from the course anxiety disorders. The course is part of the second year of the bachelor health sciences. I got an 8 for the exam myself
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Case 2 PTSD & OCD1. What is a trauma?
- Memory artikel McNally
o When we call an episode from our past, we reconstruct it from elements
distributed throughout the brain. Recollection is always reconstruction. It is not
a matter of reloading a videotape for replay in the mind’s eye.
o Dr van de Kolk believes that memory of a trauma can be “entirely organized
on an implicit or perceptual level, without an accompanying narrative about
what happened”. In other words, victims can be entirely oblivious to the fact
that they suffered extreme trauma, yet their bodies will “keep the score.” The
body remembers even if the mind cannot. This theory is not true
o Although implicit memory is a genuine phenomenon, it cannot be translate into
narrative memory, and it does not show traces of its origins. Accordingly, one
cannot assume that spontaneous panic attacks, for example, are implicit
expressions of a dissociated memory of a sexual assault. Thus, even when the
body does “keep the score,” so does the mind.
o Belief that one has been traumatized can result in subjective and
psychophysiologic responses indistinguishable from responses of those
suffering from PTSD. Accordingly, one cannot infer the veracity of a memory
from the emotional responses accompanying it.
o The previously cited quotation from Spiegel expresses the view that victims
are most likely to dissociate memories that are emotionally intense and most
likely to block out repeated, rather than single, traumatic events. Both notions
contradict what we know about how arousal and repetition affect memory.
Release of stress hormones during aversive or traumatic events strengthens
memory for the traumatizing experience. Intense arousal enhances memory for
the core features of the arousing event; it does not attenuate it. the more a
person is traumatized, the more likely he or she is to remember having been
traumatized, even though details of any particular event may become blurred
with others.
o Traumatic amnesia theorists acknowledge that most victims remember their
trauma all too well. However, they also claim that a significant minority of
victims are incapable of remembering their most horrific experiences, precisely
because these experiences are too traumatic for the mind to contemplate. Of
course, the mind does not operate like a videotape recorder, and so there is no
reason to expect that every aspect of a traumatic experience will be encoded
into memory in the first place. Under conditions of high arousal, most people
attend to the central features of the event at the expense of the peripheral ones.
o everyday forgetfulness that develops following a traumatic event is not the
same thing as traumatic amnesia—an inability to remember the trauma itself.
Unfortunately, traumatic amnesia theorists proffer studies documenting this
general memory problem as if they confirmed amnesia for trauma.
o Although the term psychogenic amnesia is sometimes used as a synonym for
traumatic amnesia, they are different. Canonical cases of psychogenic amnesia
are characterized by sudden, massive, retrograde memory loss, including loss
of personal identity. Traumatic amnesia does not involve complete loss of
one’s identity and a failure to remember anything from one’s past.
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, o Traumatologists occasionally confuse organic amnesia resulting from direct
damage to the brain with amnesia resulting from psychic causes.
o a failure to disclose abuse upon questioning does not count as unambiguous
evidence of amnesia. Although nondisclosure may signify amnesia, it cannot
be equated with a genuine inability to recall unless further evidence supports
that hypothesis.
o Childhood Amnesia Is Not Traumatic Amnesia. Most people remember very
little of their lives before age 4 or 5 years.
o Not Thinking About Something for a Long Time Is Not Traumatic Amnesia.
not thinking about something for a long time is not the same thing as being
unable to remember it, and it is inability to remember encoded information that
constitutes amnesia.
o many adults reporting recovered memories of sexual abuse failed to experience
their abuse as traumatic, partly because they failed to understand what was
happening
o PTSD patients think they know exactly what happened but this is not true your
mind fills in the gaps and this could not be true.
2. DSM PTSD
- No longer under anxiety disorder because anxiety disorder does not have a specific
cause while PTSD does have a specific cause. There is a real etiological component.
PTSD is more of an internalizing disorder. There is a big difference between a
stressful event and a traumatic event.
- PTSD is no longer listed with the anxiety disorders. As a result of a number of factor
analysis studies of Axis I and Axis II disorders, it was concluded that PTSD does not
load on the fear disorders, but instead loads best on an internalizing disorder that the
authors called“anxious misery,”along with the mood disorders. Further, this research
found that a substantial minority of those with PTSD who did not have simple PTSD
tended toward externalizing psychopathology, demonstrating high rates of substance
use disorders and Cluster B personality disorders. Consistent with this research, the
International Classification of Diseases had already moved PTSD to a classification
called “Reaction to Severe Stress and Adjustment Disorders,” which includes acute
stress disorder, PTSD, and adjustment disorder. Classifying PTSD as an anxiety
disorder served well for those who wanted to use animal research to study fear
circuitry, but did not attend properly to people whose PTSD is primarily an anger
disorder accompanied by substance abuse and/or aggression, or those who are haunted
with guilt or shame because of what they experienced, acts of omission or
commission, or erroneous beliefs in the “just world myth” that leave them pondering
what they must have done wrong to deserve such a fate or why someone else was
injured or killed.
- Criterion A (one required): The person was exposed to: death, threatened death, actual
or threatened serious injury, or actual or threatened sexual violence, in the following
way(s):
o Direct exposure
o Witnessing the trauma
o Learning that a relative or close friend was exposed to a trauma
o Indirect exposure to aversive details of the trauma, usually in the course of
professional duties (e.g., first responders, medics)
- Criterion B (one required): The traumatic event is persistently re-experienced, in the
following way(s):
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