Chapter 5 Stress and Adjustment Disorders by M66oYhW


									                            Chapter 5 Stress and Adjustment Disorders
Stressors - environmental obstacles that place demands on us and lead to stress.
Stress – the organism’s response to a stressor, the result of inadequate coping.
Coping strategies – ways of dealing with stressors
Eustress – stress caused by positive experiences [e.g., a wedding, or a promotion].
Distress – stress caused by “negative” events [e.g., losing one’s job].
Both eustress and distress tax resources and coping abilities but DISTRESS is
   potentially more harmful.
Three types of stressors:
   [1] Frustrations, occur when progress towards a goal is impeded
       or blocked by some obstacle.
   [2] Conflicts, we are drawn to or repelled from two or more incompatible
       needs, goals, or motives.
   [3] Pressures, force us to speed up, intensify effort, or change
       direction of our behavior.
Types of conflicts – John Dollard and Neal Miller described three primary types of conflicts.
  [1] Approach-avoidance - one goal both attracts and repels us. (e.g., asking for a date
       could lead to a date OR rejection)
  [2] Double-approach - we are equally attracted to two pleasant goals (e.g., having to
       choose between a hot dog OR a hamburger)
   [3] Double avoidance - we are equally repelled by two unpleasant goals (e.g., toothache
       getting worse OR going to the dentist).
Stress tolerance – ability to withstand stress without becoming seriously impaired.
Task Oriented Response - involves changing self or situation to eliminate the stress.
Defense Oriented Response - behavior is directed at protecting the self and avoiding
    pain as opposed to solving the problem and eliminating the stress.
Decompensation (psychological) – a serious breakdown in adaptive functioning.
Hans Selye’s General Adaptation Syndrome (GAS) – consists of three phases. The pattern
  forms an “inverted U function.” Resistance is greatest during "PHASE 2."
  [1] Alarm reaction - the body's defenses are activated and mobilized.
  [2] Resistance - stress resistance is greatest during this phase
  [3] exhaustion - bodily resources are exhausted
"Wear and Tear Theory" - Selye found that each successive stressor leaves a permanent
  scar. We recover from stress but never to the pre-stress level of functioning.
Psychoneuroimmunology – new field that focuses on how long term stress suppresses
  functioning of the immune system, making us more vulnerable to serious disease.
   For example, stress activates the "HPA axis" (involving the hypothalamus, pituitary
   gland, and adrenal gland) resulting in harmful hormonal imbalances.
Adjustment disorder – least stigmatizing of the DSM categories. Often assigned by
   therapists for insurance purposes. If symptoms last more than 6 months, diagnosis
   should be changed to another disorder. It is assumed that the symptoms will disappear
   or lessen once [1] the stressor is no longer present or [2] the person learns to adapt to
   the stressor.
“Anxiety Disorders Section” – both PTSD and Acute Stress Disorder are classified within
   the “Anxiety Disorders” section of DSM.
Post-Traumatic Stress Disorder – requires an event generally “outside” the normal range of
   human experience. More specifically, it would involve having witnessed or experienced
  actual or threatened death or serious injury and having experienced intense fear,
  helplessness, or horror. Symptoms must be present for 4 weeks. Many researchers
  think in terms of three types of PTSD:
  [1] Combat-related - e.g., military and police
  [2] Crime victim - e.g., victims of rape, mugging, childhood abuse, etc.
  [3] Disaster victim - e.g., accidents and natural disasters
Acute Stress Disorder – like PTSD but symptoms need be present only for 2 days and no
  longer than 4 weeks. If symptoms last longer than four weeks, diagnosis is changed to
  PTSD. The symptoms are similar to those of PTSD.
PTSD symptoms: (1 and 2 are the "hallmark" symptoms of PTSD)
  [1] Re-experiencing - intrusive thoughts, nightmares, or flashbacks (dissociation).
  [2] Reactivity to, and avoidance of, trauma-related stimuli.
  [3] Social withdrawal and restriction of affect
  [4] Hypervigilence, easily startled, irritability.
  [5] Various symptoms of “increased physiological arousal” and anxiety.
  [6] Impaired concentration and inability to focus attention
  [7] Depression, though not a criterion for PTSD, is an often associated feature.
 Stranger rape - the victim is likely to experience intense fear of physical harm and/or
 Acquaintance rape - victims are especially likely to
  [1] be reluctant to seek help or talk to anyone
  [2] feel betrayed by the rapist
  [3] feel “guilty” in that they may have contributed in some way
 Social relationships - suffer greatly. The victim may withdraw, especially from intimate
Combat-related PTSD - in earlier wars this was called operational fatigue, combat fatigue
   combat exhaustion, battle fatigue, etc.
Vietnam War – The term Combat-related PTSD most often refers to Vietnam veterans.
   This pattern differs in that symptoms seemed to develop later, after the soldiers had
   returned home.
Causal factors in combat related PTSD:
   [1] Personality traits (e.g., immaturity) may make one more vulnerable to stress.
   [2] Soldiers with histories of personality instability prior to combat were more likely to
       were more likely to break down under the stress of combat (Merbaum &
      Hefez, 1976)
   [3] Acceptance of war goals and identification with the unit ("esprit de corps"), and
       quality of leadership can improve adjustment to combat and reduce PTSD risk.
   [4] Returning to an unaccepting environment (as with the Vietnam war) can lead to
       increased symptoms (esp. anger).
 Short Term Crisis Therapy - focuses on helping the client see the situation clearly,
   form a plan, identify resources, obtain support, and move foward.
Direct Therapeutic Exposure (DTE) – is a often used behavioral treatment which involves
   repeated exposure to trauma-related stimuli in hopes that the conditioned fear
   responses will “extinguish.”
Medications – a wide variety are used (antidepressant, anti-anxiety, and others).
 Long term supporting therapy – is often used (e.g., through the V. A. system).
Delayed onset PTSD – Has been increasingly accepted in recent years, due largely to the
   public being more familiar with, and more accepting of, the diagnosis (e.g., related to
   childhood abuse) (not in book).
Legal issues in PTSD – some have concern over the abuse of PTSD as a legal defense,
   (esp. in the case of sex offenders and other violent criminals) but these concerns are
   largely unfounded. Few cases are won on these grounds (not in book).

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