Analyzing and building upon peers’ threads

In addition, he/she must respond to the threads of at least two classmates (1.1. Grazioso2.2.Cox

with 250–300-word replies in which the student must extend the discussion by analyzing and building upon peers’ threads, asking relevant questions as needed.

Each reply must incorporate at least one scholarly reference.

The student is also required to briefly respond to all classmates who replied to his/her thread as well as to any questions .

All assertions must be supported by in-text references in current APA format.

Use of first person is appropriate. Threads and replies must be well written, well organized, and focused.

1. Grazioso

DB1- Intrusion symptoms

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Trauma exposure has lasting effects on the individuals’ neurobiological and physiological responses due to being unable to emotionally process the traumatic experience which leads to other symptoms of Post-traumatic Stress Disorder (PTSD). PTSD has four symptom categories which include intrusion symptoms, avoidance, altered thoughts and behaviors, and altered arousal and reactivities. This author believes that the most challenging categories for individuals with PTSD to cope with would be intrusion symptoms.

Intrusion symptoms are involuntary sudden images, thoughts or emotions that are difficult to control, and are a source of distress (Bryant, O’Donnell, Creamer, McFarlane, &Silove, 2011). Intrusion symptoms occur spontaneously or may be evoked by associations. Intrusive symptoms can prevent emotional processing of the distressing traumatic event and cause individuals to utilized maladaptive strategies to help them control the intrusions. Maladaptive strategies can include suppression the intrusions, ruminations and dissociation (Clohessy& Ehlers, 1999). Intrusive symptoms can lead to the other categories of PTSD symptoms.

Sanderson explains that memories, both good and bad, play an important role in survival. Memories processed and stored to link them with experiences for future behaviors. Good memories are stored for them to be repeated and bad memories are stored to be avoided. She discussions how trauma exposure creates a cycle. It starts with the trauma event which turns into avoidance in the form distraction or suppression of the memory. This prevents the emotional processing of the trauma which keep the memory vivid and frightening. Resulting in the trauma demanding attention through intrusive symptoms memories, flashbacks, and nightmares (Sanderson, 2013, p. 36-37).

Conway and Pleydell-Pearce (2000) discuss the autobiographical memory fundamentals of how individuals store memories in what they refer to as self-memory system (SMS). The SMS is sensitive to cues and patterns of activation, to include emotional connections with the memories. Traumatic memories are disorganized, fragmented collections of vivid experiences with sensory-perceptual details which need to be organized through therapy (Conway &Pleydell-Pearce, 2000). Memories from traumatic experience will continue to be intrusive until they emotional processed and stabilized.

The brain stores all kinds of memories for survival. When an individual has PTSD symptoms, they usually start with intrusion symptoms from memories of the traumatic experience which triggers other symptoms. These memories are distressing, intrusive, and recurrent memories of the traumatic event which causes an individual to react as if they are reliving the experience again. The individual will try to avoid these memories or cues that reminder them of the traumatic experience. The intrusions will alter they cognitions and moods, and create alteration in their arousal and reactions (Sanderson, 2013).

Overall, this author believes that most difficult symptom of PTSD for an individual to cope with intrusion symptoms since there are linked to their cognitions, emotions, behaviors and reactions to sensory cues in their life. Traumatic experiences demand attention through intrusive memories, flashbacks and nightmare until they have been processed. Once the intrusion symptoms have been processed and worked through, the other symptoms of PTSD will be greatly reduced.

References

Bryant, R. A., O’Donnell, M. L., Creamer, M., McFarlane, A. C. &Silove, D. (2011). Posttraumatic intrusive symptoms across psychiatric disorders. Journal of Psychiatric Research, 45(6), 842-847. DIO: 10.1016/j.jpsychires.2010.11.012

Clohessy, S. and Ehlers, A. (1999). PTSD symptoms, response to intrusive memories and coping in ambulance service workers. British Journal of Clinical Psychology, 38: 251-265. Doi:10.1348/014466599162836

Conway, M. A. &Pleydell-Pearce, C. W. (2000). The construction of autobiographical memories in the self-memory system. Psychological Review, 107(2), 261–288. Doi: 10.1037/0033-295X.107.2.261

Sanderson, C. (2013). Counseling skills for working with trauma: Healing from child sexual abuse, sexual violence and domestic abuse. Jessica Kingsley Publishers: London, UK.

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2.Cox

DB1 Thread – PTSD Symptoms

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Intrusion symptoms of post-traumatic stress disorder (PTSD) can lead to a fragmented emotional personality and to features of dissociative identity disorder (Sanderson, 2013).  It would appear that, of the four categories listed in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013), intrusion symptoms would be some of the most difficult for a person to deal with.  If these intrusion symptoms are severe enough to lead to dissociative identity disorder (DID), treatment course and outcome will likely be affected (Haagen, van Rijn, Knipscheer, van der Aa, & Kleber, 2018).

The intrusion symptom of dissociation has been identified as a subtype of PTSD (PTSD+DS) and is characterized by marked depersonalization and derealization (Boyd et al., 2018).  Derealization involves the experience of the external world to be strange, unreal, and a sense of time that is either accelarated or slowed down (Friedman, 2015, p. 20).  Depersonalization involves a detached experience from one’s own body, as if one is an outside observer of one’s mental processes or body (Friedman, 2015, p. 20).  Complex PTSD includes these dissociative aspects as well (Friedman, 2015, p. 31).

Certain populations diagnosed with PTSD, including military members, veterans, and first responders (police, fire, and paramedics) have been found to experience dissociative symptoms (Boyd et al., 2018).  Military members and veterans with PTSD exhibit heightened functional impairment levels and higher levels of derealization, alexithymia, depression, and anxiety when compared with first responders (Boyd et al., 2018).  These populations have likely experienced prolonged trauma at a higher level than the rest of society, leading to more psychological damage.  Dissociative disorders are often linked to a wide range of self-destructive behaviors, which can lead to time in a psychiatric hospital (Ferentz, 2015).

There is much yet to be understood about treatment principles for both complex PTSD and PTSD+DS.  New studies involving the hypothesis that a hyperinhibition of limbic regions by prefrontal areas occur in situations of excessive emotional stimulation are providing promising results (Chu, 2011, p. 267).  While the DSM-5 does not consider the empirical evidence adequate enough to support the validity of a complex PTSD diagnosis, the World Health Organization in its 11^th edition of the International Classification of Diseases (ICD-11) will include “complex PTSD” (Friedman, 2015, p. 31).  Friedman (2015) identifies this as a very exciting area of research to follow, given the dissociative subtype overlap between the two classification systems (p. 31).

Whatever the label, the trauma therapist needs to remember always that “it makes sense given where they’ve come from” (Ferentz, 2015, p. 21).  When therapists work to depathologize and normalize struggles and symptoms, the client is empowered to create coping strategies that are more positive, giving the client a more accurate sense of themselves (Ferentz, 2015, p. 21).  The client needs a more accurate sense of themselves if indeed dissociative identity disorder has taken hold of the trauma survivor.  Accepting one another in the spirit of Christ brings praise to God (Romans 15:7, NIV).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Boyd, J. E., Protopopescu, A., O’Connor, C., Neufeld, R. W. J., Jetly, R., Hood, H. K., . . .

McKinnon, M. C. (2018). Dissociative symptoms mediate the relation between PTSD

symptoms and functional impairment in a sample of military members, veterans, and first

responders with PTSD. European Journal of Psychotraumatology, 9(1), 1463794-16.

doi:10.1080/20008198.2018.1463794

Chu, J. A. (2011). Rebuilding shattered lives: Treating complex PTSD and

dissociative disorders. (2nd ed.). Hoboken, NJ: John Wiley & Sons.

Ferentz, L. (2015). Treating self-destructive behaviors in trauma survivors. (2nd ed.). New York:

Routledge.

Friedman, M. J. (2015). Posttraumatic and acute stress disorders. (6th ed.). New York, NY:

Springer International Publishing. ISBN: 9783319150659.

Haagen, J. F. G., van Rijn, A., Knipscheer, J. W., van der Aa, N., & Kleber, R. J. (2018). The

dissociative post-traumatic stress disorder (PTSD) subtype : A treatment outcome cohort

study in veterans with PTSD. British Journal of Clinical Psychology, 57(2), 203-222.

doi:10.1111/bjc.12169

Sanderson, C. (2013). Counseling skills for working with trauma: Healing from child sexual

abuse, sexual violence, and domestic abuse. Philadelphia, PA: Jessica Kingsley

Publishers.

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