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Trauma, Dissociative & Somatic Disorders - EPPP - Coggle Diagram

- - - - Localized: all events during a circumscribed period - most common
      - Selective: some events during a circumscribed period
      - Generalized: entire life history
      - Systematized: one category of information
      - Continuous: new events as they occur
    - - Purposeful travel or purposeless wandering with memory loss
      - Specifier - not a separate DSM-5 diagnosis
- - - - Minimal social and emotional responsiveness
      - Limited positive affect
      - Unexplained irritability, sadness, or fear with caregivers
  - - - Reduced or absent reticence with strangers
      - Overly familiar verbal or physical behavior
      - Reduced or absent checking with caregiver after separation
      - Willingness to accompany a stranger with little hesitation
  - - - Actual or threatened death
      - Serious injury
      - Sexual violence
    - - Intrusion
      - Persistent avoidance
      - Negative changes in cognition and mood
      - Alterations in arousal and reactivity
    - - Hyperactive amygdala and anterior cingulate cortex
      - Hypoactive ventromedial prefrontal cortex (vmPFC)
      - Reduced hippocampal volume
      - Reduced vmPFC inhibition of amygdala - exaggerated fear response
    - - Increased: dopamine, norepinephrine, glutamate
      - Decreased: serotonin, GABA
    - - Cognitive-behavior therapy (CBT)
      - Cognitive processing therapy (CPT)
      - Cognitive therapy
      - Prolonged exposure
    - - Brief eclectic psychotherapy
      - EMDR
      - Narrative exposure therapy
    - - Trauma-focused CBT for ages 3-18
      - Includes family therapy, parenting skills, and conjoint parent-child therapy
    - - SSRIs: fluoxetine, paroxetine, sertraline
      - SNRI: venlafaxine
    - - Similar symptom reduction, attendance, dropout, satisfaction, and fidelity
      - Possible challenge: nonverbal cues and therapeutic alliance
  - - - Intrusion
      - Negative mood
      - Dissociation
      - Avoidance
      - Arousal
- - - - Disproportionate or persistent thoughts about seriousness
      - Persistently high health anxiety
      - Excessive time and energy devoted to symptoms or health
  - - - Seizure-like behavior without matching epileptic brain activity
      - Video EEG records behavior and brain activity simultaneously
  - - - Symptoms are induced or falsified in another person
      - Perpetrator receives the diagnosis
  - - - Evaluation occurs in a legal context
      - Marked discrepancy between symptoms and objective findings
      - Person is uncooperative with evaluation or treatment
      - Antisocial personality disorder is present
    - - Forced-choice testing: significantly below chance suggests intentional wrong answers
      - TOMM: two-image recognition test for feigned memory loss
      - Below 50% correct on two-choice items is suspicious
      - Excessive or atypical neuropsychological impairment may suggest malingering