Tag: PTSD: Post-Traumatic Stress Disorder

What is a Flashback (Psychology)?

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Introduction

A flashback, or involuntary recurrent memory, is a psychological phenomenon in which an individual has a sudden, usually powerful, re-experiencing of a past experience or elements of a past experience.

These experiences can be frightful, happy, sad, exciting, or any number of other emotions. The term is used particularly when the memory is recalled involuntarily, especially when it is so intense that the person “relives” the experience, and is unable to fully recognise it as memory of a past experience and not something that is happening in “real time”.

Brief History

Flashbacks are the “personal experiences that pop into your awareness, without any conscious, premeditated attempt to search and retrieve this memory”. These experiences occasionally have little to no relation to the situation at hand. For those suffering post-traumatic stress disorder (PTSD), flashbacks can significantly disrupt everyday life.

Memory is divided into voluntary (conscious) and involuntary (unconscious) processes that function independently of each other. Theories and research on memory, dates back to Hermann Ebbinghaus, who began studying nonsense syllables. Ebbinghaus classified three distinct classes of memory: sensory, short-term, and long-term memory.

  • Sensory memory is made up of a brief storage of information within a specific medium (the line you see after waving a sparkler in your field of vision is created by sensory memory).
  • Short term memory is made up of the information currently in use to complete the task at hand.
  • Long term memory is composed of the systems used to store memory over long periods. It enables one to remember what happened two days ago at noon, or who called last night.

Miller (1962-1974) declared that studying such fragile things as involuntary memories should not be done. This appears to have been followed, since very little research has been done on flashbacks in the cognitive psychology discipline. However, flashbacks have been studied within a clinical discipline, and they have been identified as symptoms for many disorders, including PTSD.

Theoretical Accounts

Due to the elusive nature of involuntary recurrent memories, very little is known about the subjective experience of flashbacks. However, theorists agree that this phenomenon is in part due to the manner in which memories of specific events are initially encoded (or entered) into memory, the way in which the memory is organised, and also the way in which the individual later recalls the event. Overall, theories that attempt to explain the flashback phenomenon can be categorised into one of two viewpoints. The “special mechanism” view is clinically oriented in that it holds that involuntary memories are due to traumatic events, and the memories for these events can be attributed to a special memory mechanism. On the other hand, the “basic mechanism” view is more experimentally oriented in that it is based on memory research. This view holds that traumatic memories are bound by the same parameters as all other every-day memories. Both viewpoints agree that involuntary recurrent memories result from rare events that would not normally occur.

These rare events elicit strong emotional reactions from the individual, since they violate normal expectations. According to the special mechanism view, the event would lead to fragmented voluntary encoding into memory, thus making the conscious subsequent retrieval of the memory much more difficult. On the other hand, involuntary recurrent memories are likely to become more available, and these are more likely to be triggered by external cues. In contrast to this, the basic mechanism view holds that the traumatic event would lead to enhanced and cohesive encoding of the event in memory, and this would make both voluntary and involuntary memories more available for subsequent recall.

What is currently an issue of controversy is the nature of the defining criteria that make up an involuntary memory. Up until recently, researchers believed that involuntary memories were a result of traumatic incidents that the individual experienced at a specific time and place, while losing all the temporal and spatial features of the event during an involuntary recollection episode. In other words, people who suffer from flashbacks lose all sense of time and place, and they feel as if they are re-experiencing the event instead of just recalling a memory. This is consistent with the special mechanism viewpoint in that the involuntary memory is based on a different memory mechanism compared to the voluntary counterpart. Furthermore, the initial emotions experienced at the time of encoding are also re-experienced during a flashback episode, which can be especially distressing when the memory is of a traumatic event. It has also been demonstrated that the nature of the flashbacks experienced by an individual are static in that they retain an identical form upon each intrusion. This occurs even when the individual has learned new information that directly contradicts the information retained in the intrusive memory.

Upon further investigation, it was found that involuntary memories are usually derived from either stimuli that indicated the onset of a traumatic event, or from stimuli that hold intense emotional significance to the individual simply because they were closely associated with the trauma during the time of the event. These stimuli then become warning signals that, if encountered again, serve to trigger a flashback. This has been termed the warning signal hypothesis. For example, a person may experience a flashback while seeing sun spots on their lawn. This happens because he or she associates the spots with the headlights of the vehicle that he or she saw before being involved in a car accident. According to Ehlers and Clark, traumatic memories are more apt to induce flashbacks because of faulty encoding that cause the individual to fail in taking contextual information into account, as well as time and place information that would usually be associated with everyday memories. These individuals become sensitised to stimuli that they associate with the traumatic event, which then serve as triggers for a flashback, even if the context surrounding the stimulus may be unrelated. These triggers may elicit an adaptive response during the time of the traumatic experience, but they soon become maladaptive if the person continues to respond in the same way to situations in which no danger may be present.

The special mechanism viewpoint further adds to this by suggesting that these triggers activate the fragmented memory of the traumatic event, while the protective cognitive mechanisms function to inhibit the recall of the original memory. Dual representation theory enhances this idea by suggesting two separate mechanisms that account for voluntary and involuntary memories. The first of which is called the verbally accessible memory system and the latter of which is referred as the situationally accessible memory system.

In contrast to this, theories belonging to the basic mechanism viewpoint hold that there are no separate mechanisms that account for voluntary and involuntary memories. The recall of memories for stressful events do not differ under involuntary and voluntary recall. Instead, it is the retrieval mechanism that is different for each type of recall. In involuntary recall, the external trigger creates an uncontrolled spreading of activation in memory, whereas in voluntary recall, this activation is strictly controlled and is goal-oriented.

In addition, the basic mechanism’s involuntary recall for negative events, are also associated with memories of positive events. Studies have shown that out of the participants who suffer from flashbacks, about 5% of them experience positive non-traumatic flashbacks. They experience the same intensity level and has the same retrieval mechanism as the people who experienced negative and/or traumatic flashbacks, which includes the vividness and the emotion related to the involuntary memory. The only difference is whether the emotion evoked is positive or negative.

Cognition

Sensory Memory

Memory has typically been divided into sensory, short-term, and long-term processes. The items that are seen, or other sensory details related to an intense intrusive memory, may cause flashbacks. These sensory experiences that takes place right before the event, acts as a conditioning stimulus for the event to appear as an involuntary memory. The presence of the primer increases the likelihood of the appearance of a flashback. Just as the sensory memory can result in this, it can also help erase the connections between the memory and the primer. Counter conditioning and rewriting the memory of the events that are related to the sensory cue, may help dissociate the memory from the primer.

Short-Term Memory/Working Memory

There have been many suspicions that disruptive memories may cause deficiencies in short term memories. For people who suffer from flashbacks, the hippocampus that is involved with the working memory has been damaged, supporting the theory that the working memory could have also been affected. Many studies were conducted to test this theory and all results concluded that intrusive memory does not affect the short-term memory or the working memory.

Long-Term Memory

Out of the three types of memory processes, long-term memory contains the greatest amount of memory storage and is involved in most of the cognitive processes. According to Rasmuseen & Berntsen (2009), “long-term memory processes may form the core of spontaneous thought”. Thus, the memory process most related to flashbacks is long term memory. Additionally, other 2009 studies by Rasmuseen & Berntsen have shown that long term memory is also susceptible to extraneous factors such as recency effect, arousal, and rehearsal as it pertains to accessibility. Compared to voluntary memories, involuntary memories show shorter retrieval times and little cognitive effort. Finally, involuntary memories arise due to automatic processing, which does not rely on higher-order cognitive monitoring, or executive control processing. Normally, voluntary memory would be associated with contextual information, allowing correspondence between time and place to happen. This is not true for flashbacks. According to Brewin, Lanius et, al (2009), flashbacks, are disconnected from contextual information, and as a result are disconnected from time and place.

Episodic Memory

Episodic memory is a type of long-term memory where the involuntary memories are made up of intense autobiographical memories. As a version of declarative memory, this follows the same idea that the more personal the memory is, the more likely it will be remembered. Disruptive memories are almost always associated with a familiar stimulus that quickly becomes stronger through the process of consolidation and reconsolidation. The major difference is that intrusive thoughts are harder to forget. Most mental narratives tends to have varying levels of some type of emotions involved with the memory. For flashbacks, most of the emotions associated with it are negative, though it could be positive as well. These emotions are intense and makes the memory more vivid. Decreasing the intensity of the emotion associated with an intrusive memory may reduce the memory to a calmer episodic memory.

Neuroscience

Anatomy

Several brain regions have been implicated in the neurological basis of flashbacks. The medial temporal lobes, the praecuneus, the posterior cingulate gyrus and the prefrontal cortex are the most typically referenced with regards to involuntary memories.

The medial temporal lobes are commonly associated with memory. More specifically, the lobes have been linked to episodic/declarative memory, which means the damage to these areas of the brain would result in disruptions to declarative memory system. The hippocampus, located within the medial temporal regions, has also been highly related to memory processes. There are numerous functions in the hippocampus that includes aspects of memory consolidation. Brain imaging studies have shown flashbacks activating areas associated with memory retrieval. The praecuneus, located in the superior parietal lobe, and the posterior cingulate gyrus, have also been implicated in memory retrieval. In addition, studies have shown activity in areas of the prefrontal cortex to be involved in memory retrieval.

Thus, the medial temporal lobe, praecuneus, superior parietal lobe and posterior cingulate gyrus have all been implicated in flashbacks in accordance to their roles on memory retrieval.

Clinical Investigations

To date, the specific causes of flashbacks have not yet been confirmed. Several studies have proposed various potential factors. Gunasekaran et al. (2009) indicate there may be a link between food deprivation and stress on the occurrence of flashbacks. Psychiatrists suggest that temporal lobe seizures may also have some relation.

Conversely, several ideas have been discounted in terms of being a possible cause to flashbacks. Tym et al. (2009) suggest this list includes medication or other substances, Charles Bonnet syndrome, delayed palinopsia, hallucinations, dissociative phenomena, and depersonalization syndrome.

A study of the persistence of traumatic memories in World War II prisoners of war, investigates via the administration of surveys, the extent and severity of flashbacks that occur in prisoners of war. This study concluded that the persistence of severely traumatic autobiographical memories can last up to 65 years. Until recently, the study of flashbacks has been limited to participants who already experience flashbacks, such as those suffering from PTSD, restricting researchers to observational/exploratory rather than experimental studies.

There have also been treatments based on theories about the inner workings of the involuntary memory. The procedure involves changing the content of the intrusive memories and restructuring it so the negative connotations associated with it is erased. The patients are encouraged to live their lives and not focus on their disruptive memories, and are taught to recognise any stimulus that may start the flashbacks. The events related to the flashbacks still mostly exist in their mind, but the meaning and the way the person perceives it is now different. According to Ehlers, this method has a high success rate with patients who have suffered from trauma.

Neuroimaging Investigations

Neuroimaging techniques have been applied to the investigation of flashbacks. Using these techniques, researchers attempt to discover the structural and functional differences in the anatomy of the brain in individuals who suffer from flashbacks compared to those who do not. Neuroimaging involves a cluster of techniques, including computerised tomography, positron emission tomography, magnetic resonance imaging (including functional), as well as magnetoencephalography. Neuroimaging studies investigating flashbacks are based on current psychological theories that are used as the foundation for the research. One of theories that is consistently investigated is the difference between explicit and implicit memory. This distinction dictates the manner in which memories are later recalled, namely either consciously (voluntarily) or unconsciously (involuntarily).

These methods have largely relied on subtractive reasoning, in which the participant first voluntarily recalls a memory before recalling the memory again through involuntary means. Involuntary memories (or flashbacks) are elicited in the participant by reading an emotionally charged script to them that is designed to trigger a flashback in individuals who suffer from PTSD. The investigators record the regions of the brain that are active during each of these conditions, and then subtract the activity. Whatever is left is assumed to underpin the neurological differences between the conditions.

Imaging studies looking at patients with PTSD as they undergo flashback experiences have identified elevated activation in regions of the dorsal stream including the mid-occipital lobe, primary motor cortex, and supplementary motor area.[28] The dorsal stream is involved in sensory processing, and therefore these activations might underlie the vivid visual experiences associated with flashbacks. The study also found reduced activation in regions such as the inferior temporal cortex and parahippocampus which are involved in processing allocentric relations.[28] These deactivations might contribute to feelings of dissociation from reality during flashback experiences.

Relations to Mental Illness and Drug Use

Flashbacks are often associated with mental illness as they are a symptom and a feature in diagnostic criteria for PTSD, acute stress disorder, and obsessive-compulsive disorder (OCD). Flashbacks have also been observed in people suffering from bipolar disorder, depression, homesickness, near-death experiences, epileptic seizures, and substance abuse.

Some researchers have suggested that the use of some drugs can cause a person to experience flashbacks; users of LSD sometimes report “acid flashbacks”, while other studies show that the use of other drugs, specifically cannabis, can help reduce the occurrence of flashbacks in people with PTSD.

In Popular Culture

The psychological phenomenon has frequently been portrayed in film and television. Some of the most accurate media portrayals of flashbacks have been those related to wartime, and the association of flashbacks to PTSD caused by the traumas and stresses of war. One of the earliest screen portrayals of this is in the 1945 film Mildred Pierce.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Flashback_(psychology) >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Acute Stress Disorder?

Published on by Andrew Marshall2 Comments

Introduction

Acute stress disorder (ASD, also known as acute stress reaction, psychological shock, mental shock, or simply shock) is a psychological response to a terrifying, traumatic or surprising experience.

It may bring about delayed stress reactions (better known as post-traumatic stress disorder, PTSD) if not correctly addressed.

Refer to Combat Stress Reaction.

Plutchik Wheel
Plutchik Dyads

Brief History

The term “acute stress disorder” was first used to describe the symptoms of soldiers during World War I and II, and it was therefore also termed “combat stress reaction” (CSR). Approximately 20% of US troops displayed symptoms of CSR during WWII. It was assumed to be a temporary response of healthy individuals to witnessing or experiencing traumatic events. Symptoms include depression, anxiety, withdrawal, confusion, paranoia, and sympathetic hyperactivity.

The American Psychological Association (APA) officially included the term ASD in the DSM-IV in 1994. Before that, symptomatic individuals within the first month of trauma were diagnosed with adjustment disorder. According to the DSM-IV, acute stress reaction refers to the symptoms experienced immediately to 48 hours after exposure to a traumatic event. In contrast, acute stress disorder is defined by symptoms experienced 48 hours to one month following the event. Symptoms experienced for longer than one month are consistent with a diagnosis of PTSD.

Initially, being able to describe different ASRs was one of the goals of introducing ASD. Some criticisms surrounding ASD’s focal point include issues with ASD recognising other distressing emotional reactions, like depression and shame. Emotional reactions similar to these may then be diagnosed as adjustment disorder under the current system of trying to diagnose ASD.

Since its addition to the DSM-IV, questions about the efficacy and purpose of the ASD diagnosis have been raised. The diagnosis of ASD was criticised as an unnecessary addition to the progress of diagnosing PTSD, as some considered it more akin to a sign of PTSD than an independent issue requiring diagnosis. Also, the terms ASD and ASR have been criticised for not fully covering the range of stress reactions.

Types of ASD

Sympathetic (also known as “Fight or Flight” Response)

Sympathetic acute stress disorder is caused by the release of excessive adrenaline and norepinephrine into the nervous system. These hormones may speed up a person’s pulse and respiratory rate, dilate pupils, or temporarily mask pain. This type of ASD developed as an evolutionary advantage to help humans survive dangerous situations. The “fight or flight” response may allow for temporarily-enhanced physical output, even in the face of severe injury. However, other physical illnesses become more difficult to diagnose, as ASD masks the pain and other vital signs that would otherwise be symptomatic.

Parasympathetic

Parasympathetic acute stress disorder is characterised by feeling faint and nauseous. This response is fairly often triggered by the sight of blood. In this stress response, the body releases acetylcholine. In many ways, this reaction is the opposite of the sympathetic response, in that it slows the heart rate and can cause the patient to either regurgitate or temporarily lose consciousness. The evolutionary value of this is unclear, although it may have allowed for prey to appear dead to avoid being eaten.

Signs and Symptoms

The DSM-IV specifies that acute stress disorder must be accompanied by the presence of dissociative symptoms, which largely differentiates it from PTSD.

Dissociative symptoms include a sense of numbing or detachment from emotional reactions, a sense of physical detachment – such as seeing oneself from another perspective – decreased awareness of one’s surroundings, the perception that one’s environment is unreal or dreamlike, and the inability to recall critical aspects of the traumatic event (dissociative amnesia).

In addition to these characteristics, ASD can be present in the following four distinct symptom clusters;

  • Intrusion symptom cluster:
    • Recurring and distressing dreams, flashbacks, and/or memories related to the traumatic event.
    • Intense/prolonged psychological distress or somatic reactions to internal or external traumatic cues.
  • Negative mood cluster:
    • A persistent inability to experience positive emotions such as happiness, loving feelings, or satisfaction.
  • Avoidance symptom cluster:
    • The avoidance of distressing memories, thoughts, feelings (or external reminders of them) that are closely associated with the traumatic event.
  • Arousal symptom cluster:
    • Sleep disturbances, hyper-vigilance, difficulties with concentration, easily startled, and irritability/anger/aggression.

Potential Developments

There are a number of issues that can arise from acute stress. Depression, anxiety, mood disorders, and substance abuse problems can develop from acute stress. Untreated ASD can also lead to the development of PTSD.

Causes

There are several theoretical perspectives on trauma response, including cognitive, biological, and psycho-biological. While PTSD-specific, these theories are still useful in understanding acute stress disorder, as the two disorders share many symptoms. A recent study found that even a single stressful event may have long-term consequences on cognitive function. This result calls the traditional distinction between the effects of acute and chronic stress into question.

Pathophysiology

Stress is characterised by specific physiological responses to adverse or noxious stimuli.

Hans Selye was the first to coin the term “general adaptation syndrome” to suggest that stress-induced physiological responses proceed through the stages of alarm, resistance, and exhaustion.

The sympathetic branch of the autonomic nervous system gives rise to a specific set of physiological responses to physical or psychological stress. The body’s response to stress is also termed a “fight or flight” response, and it is characterised by an increase in blood flow to the skeletal muscles, heart, and brain, a rise in heart rate and blood pressure, dilation of pupils, and an increase in the amount of glucose released by the liver.

The onset of an acute stress response is associated with specific physiological actions in the sympathetic nervous system, both directly and indirectly through the release of adrenaline and, to a lesser extent, noradrenaline from the medulla of the adrenal glands. These catecholamine hormones facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviours often related to combat or escape.

Normally, when a person is in a serene, non-stimulated state, the firing of neurons in the locus ceruleus is minimal. A novel stimulus, once perceived, is relayed from the sensory cortex of the brain through the thalamus to the brain stem. That route of signalling increases the rate of noradrenergic activity in the locus ceruleus, and the person becomes more alert and attentive to their environment.

If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system. The activation of the sympathetic nervous system leads to the release of norepinephrine from nerve endings acting on the heart, blood vessels, respiratory centres, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis. Stress activates this axis and produces neuro-biological changes. These chemical changes increase the chances of survival by bringing the physiological system back to homeostasis.

The autonomic nervous system controls all automatic functions in the body and contains two subsections within it that aid the response to an acute stress reaction. These two subunits are the sympathetic nervous system and the parasympathetic nervous system. The sympathetic response is colloquially known as the “fight or flight” response, indicated by accelerated pulse and respiration rates, pupil dilation, and a general feeling of anxiety and hyper-awareness. This is caused by the release of epinephrine and norepinephrine from the adrenal glands. The epinephrine and norepinephrine strike the beta receptors of the heart, which feeds the heart’s sympathetic nerve fibres to increase the strength of heart muscle contraction; as a result, more blood gets circulated, increasing the heart rate and respiratory rate. The sympathetic nervous system also stimulates the skeletal system and muscular system to pump more blood to those areas to handle the acute stress. Simultaneously, the sympathetic nervous system inhibits the digestive system and the urinary system to optimise blood flow to the heart, lungs, and skeletal muscles. This plays a role in the alarm reaction stage. The parasympathetic response is colloquially known as the “rest and digest” response, indicated by reduced heart and respiration rates, and, more obviously, by a temporary loss of consciousness if the system is fired at a rapid rate. The parasympathetic nervous system stimulates the digestive system and urinary system to send more blood to those systems to increase the process of digestion. To do this, it must inhibit the cardiovascular system and respiratory system to optimise blood flow to the digestive tract, causing low heart and respiratory rates. The parasympathetic nervous system plays no role in acute stress response.

Studies have shown that patients with acute stress disorder have overactive right amygdalae and prefrontal cortices; both structures are involved in the fear-processing pathway.

Diagnosis

According to the DSM-V, symptom presentation must last for three consecutive days to be classified as acute stress disorder. If symptoms persist past one month, the diagnosis of PTSD is explored. There must be a clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes or days but may occur up to one month after the stressor. Also, the symptoms show a mixed and rapidly changing picture; although “daze” depression, anxiety, anger, despair, hyper-activity, and withdrawal may all be seen, no one symptom dominates for long. The symptoms usually resolve rapidly where removal from the stressful environment is possible. In cases where the stress continues, the symptoms usually begin to diminish after 24-48 hours and are usually minimal after about three days.

Evaluation of patients is done through close examination of emotional response. Using self-report from patients is a large part of diagnosing ASD, as acute stress is the result of reactions to stressful situations.

The DSM-V specifies that there is a higher prevalence rate of ASD among females compared to males due to higher risk of experiencing traumatic events and neurobiological gender differences in stress response.

Treatment

This disorder may resolve itself with time or may develop into a more severe disorder, such as PTSD. However, results of Creamer, O’Donnell, and Pattison’s (2004) study of 363 patients suggests that a diagnosis of acute stress disorder had only limited predictive validity for PTSD. Creamer et al. found that re-experiences of the traumatic event and arousal were better predictors of PTSD. Early pharmacotherapy may prevent the development of post-traumatic symptoms. Additionally, early trauma-focused cognitive behavioural therapy (TF-CBT) for those with a diagnosis of ASD can protect an individual from developing chronic PTSD.

Studies have been conducted to assess the efficacy of counselling and psychotherapy for people with acute stress disorder. Cognitive behavioural therapy, which includes exposure and cognitive restructuring, was found to be effective in preventing PTSD in patients diagnosed with acute stress disorder with clinically significant results at six-month follow-up appointments. A combination of relaxation, cognitive restructuring, imaginal exposure, and in-vivo exposure was superior to supportive counselling. Mindfulness-based stress reduction programmes also appear to be effective for stress management.

The pharmacological approach has made some progress in lessening the effects of ASD. To relax patients and allow for better sleep, Prazosin can be given to patients, which regulates their sympathetic response. Hydrocortisone has shown some success as an early preventative measure following a traumatic event, typically in the treatment of PTSD.

In a wilderness context where counselling, psychotherapy, and cognitive behavioural therapy is unlikely to be available, the treatment for acute stress reaction is very similar to the treatment of cardiogenic shock, vascular shock, and hypovolemic shock; that is, allowing the patient to lie down, providing reassurance, and removing the stimulus that prompted the reaction. In traditional shock cases, this generally means relieving injury pain or stopping blood loss. In an acute stress reaction, this may mean pulling a rescuer away from the emergency to calm down or blocking the sight of an injured friend from a patient.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Acute_stress_disorder >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Anosognosia?

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Introduction

Anosognosia is a condition in which a person with a disability is cognitively unaware of having it due to an underlying physical or psychological (e.g. PTSD, Stockholm syndrome, schizophrenia, bipolar disorder, dementia) condition.

Anosognosia can result from physiological damage to brain structures, typically to the parietal lobe or a diffuse lesion on the fronto-temporal-parietal area in the right hemisphere, and is thus a neuropsychiatric disorder. A deficit of self-awareness, it was first named by the neurologist Joseph Babinski in 1914. Phenomenologically, anosognosia has similarities to denial, which is a psychological defence mechanism; attempts have been made at a unified explanation. Anosognosia is sometimes accompanied by asomatognosia, a form of neglect in which patients deny ownership of body parts such as their limbs. The term is from Ancient Greek ἀ- a-, ‘without’, νόσος nosos, ‘disease’ and γνῶσις gnōsis, ‘knowledge’. It is also considered a disorder that makes the treatment of the patient more difficult, since it may affect negatively the therapeutic relationship.

Causes

Relatively little has been discovered about the cause of the condition since its initial identification. Recent empirical studies tend to consider anosognosia a multi-componential syndrome or multi-faceted phenomenon. That is it can be manifested by failure to be aware of a number of specific deficits, including motor (hemiplegia), sensory (hemianaesthesia, hemianopia), spatial (unilateral neglect), memory (dementia), and language (receptive aphasia) due to impairment of anatomo-functionally discrete monitoring systems.

Anosognosia is relatively common following different causes of brain injury, such as stroke and traumatic brain injury; for example, anosognosia for hemiparesis (weakness of one side of the body) with onset of acute stroke is estimated at between 10% and 18%. However, it can appear to occur in conjunction with virtually any neurological impairment. It is more frequent in the acute than in the chronic phase and more prominent for assessment in the cases with right hemispheric lesions than with the left. Anosognosia is not related to global mental confusion, cognitive flexibility, other major intellectual disturbances, or mere sensory/perceptual deficits.

The condition does not seem to be directly related to sensory loss but is thought to be caused by damage to higher level neurocognitive processes that are involved in integrating sensory information with processes that support spatial or bodily representations (including the somatosensory system). Anosognosia is thought to be related to unilateral neglect, a condition often found after damage to the non-dominant (usually the right) hemisphere of the cerebral cortex in which people seem unable to attend to, or sometimes comprehend, anything on a certain side of their body (usually the left).

Anosognosia can be selective in that an affected person with multiple impairments may seem unaware of only one handicap, while appearing to be fully aware of any others. This is consistent with the idea that the source of the problem relates to spatial representation of the body. For example, anosognosia for hemiplegia may occur with or without intact awareness of visuo-spatial unilateral neglect. This phenomenon of double dissociation can be an indicator of domain-specific disorders of awareness modules, meaning that in anosognosia, brain damage can selectively impact the self-monitoring process of one specific physical or cognitive function rather than a spatial location of the body.

There are also studies showing that the manoeuvre of vestibular stimulation could temporarily improve both the syndrome of spatial unilateral neglect and of anosognosia for left hemiplegia. Combining the findings of hemispheric asymmetry to the right, association with spatial unilateral neglect, and the temporal improvement on both syndromes, it is suggested there can be a spatial component underlying the mechanism of anosognosia for motor weakness and that neural processes could be modulated similarly. There were some cases of anosognosia for right hemiplegia after left hemisphere damage, but the frequency of this type of anosognosia has not been estimated.

Anosognosia may occur as part of receptive aphasia, a language disorder that causes poor comprehension of speech and the production of fluent but incomprehensible sentences. A patient with receptive aphasia cannot correct his own phonetics errors and shows “anger and disappointment with the person with whom s/he is speaking because that person fails to understand her/him”. This may be a result of brain damage to the posterior portion of the superior temporal gyrus, believed to contain representations of word sounds. With those representations significantly distorted, patients with receptive aphasia are unable to monitor their mistakes. Other patients with receptive aphasia are fully aware of their condition and speech inhibitions, but cannot monitor their condition, which is not the same as anosognosia and therefore cannot explain the occurrence of neologistic jargon.

Psychiatry

Although largely used to describe unawareness of impairment after brain injury or stroke, the term “anosognosia” is occasionally used to describe the lack of insight shown by some people with anorexia nervosa. They do not seem to recognise that they have a mental illness. There is evidence that anosognosia related to schizophrenia may be the result of frontal lobe damage. E. Fuller Torrey, a psychiatrist and schizophrenia researcher, has stated that among those with schizophrenia and bipolar disorder, anosognosia is the most prevalent reason for not taking medications.

Diagnosis

Clinically, anosognosia is often assessed by giving patients an anosognosia questionnaire in order to assess their metacognitive knowledge of deficits. However, neither of the existing questionnaires applied in the clinics are designed thoroughly for evaluating the multidimensional nature of this clinical phenomenon; nor are the responses obtained via offline questionnaire capable of revealing the discrepancy of awareness observed from their online task performance. The discrepancy is noticed when patients showed no awareness of their deficits from the offline responses to the questionnaire but demonstrated reluctance or verbal circumlocution when asked to perform an online task. For example, patients with anosognosia for hemiplegia may find excuses not to perform a bimanual task even though they do not admit it is because of their paralysed arms.

A similar situation can happen to patients with anosognosia for cognitive deficits after traumatic brain injury when monitoring their errors during the tasks regarding their memory and attention (online emergent awareness) and when predicting their performance right before the same tasks (online anticipatory awareness). It can also occur among patients with dementia and anosognosia for memory deficit when prompted with dementia-related words, showing possible pre-attentive processing and implicit knowledge of their memory problems. Patients with anosognosia may also overestimate their performance when asked in first-person formed questions but not from a third-person perspective when the questions referring to others.

When assessing the causes of anosognosia within stroke patients, CT scans have been used to assess where the greatest amount of damage is found within the various areas of the brain. Stroke patients with mild and severe levels of anosognosia (determined by response to an anosognosia questionnaire) have been linked to lesions within the temporoparietal and thalamic regions, when compared to those who experience moderate anosognosia, or none at all. In contrast, after a stroke, people with moderate anosognosia have a higher frequency of lesions involving the basal ganglia, compared to those with mild or severe anosognosia.

Treatment

In regard to anosognosia for neurological patients, no long-term treatments exist. As with unilateral neglect, caloric reflex testing (squirting ice cold water into the left ear) is known to temporarily ameliorate unawareness of impairment. It is not entirely clear how this works, although it is thought that the unconscious shift of attention or focus caused by the intense stimulation of the vestibular system temporarily influences awareness. Most cases of anosognosia appear to simply disappear over time, while other cases can last indefinitely. Normally, long-term cases are treated with cognitive therapy to train patients to adjust for their inoperable limbs (though it is believed that these patients still are not “aware” of their disability). Another commonly used method is the use of feedback – comparing clients’ self-predicted performance with their actual performance on a task in an attempt to improve insight.

Neurorehabilitation is difficult because, as anosognosia impairs the patient’s desire to seek medical aid, it may also impair their ability to seek rehabilitation. A lack of awareness of the deficit makes cooperative, mindful work with a therapist difficult. In the acute phase, very little can be done to improve their awareness, but during this time, it is important for the therapist to build a therapeutic alliance with patients by entering their phenomenological field and reducing their frustration and confusion. Since severity changes over time, no single method of treatment or rehabilitation has emerged or will likely emerge.

In regard to psychiatric patients, empirical studies verify that, for individuals with severe mental illnesses, lack of awareness of illness is significantly associated with both medication non-compliance and re-hospitalisation. Fifteen percent of individuals with severe mental illnesses who refuse to take medication voluntarily under any circumstances may require some form of coercion to remain compliant because of anosognosia. Coercive psychiatric treatment is a delicate and complex legal and ethical issue.

One study of voluntary and involuntary inpatients confirmed that committed patients require coercive treatment because they fail to recognise their need for care. The patients committed to the hospital had significantly lower measures of insight than the voluntary patients.

Anosognosia is also closely related to other cognitive dysfunctions that may impair the capacity of an individual to continuously participate in treatment. Other research has suggested that attitudes toward treatment can improve after involuntary treatment and that previously committed patients tend later to seek voluntary treatment.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Anosognosia >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Hypervigilance?

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Introduction

Hypervigilance is when the nervous system is inaccurately filtering sensory information and the individual is in an enhanced state of sensory sensitivity.

This appears to be linked to a dysregulated nervous system which can often be caused by traumatic events or post-traumatic stress disorder (PTSD).

Background

Normally, the nervous system releases stress signals in certain situations as a defence mechanism to protect one from perceived dangers. In some cases, the nervous system becomes chronically dysregulated, causing a release of stress signals that are inappropriate to the situation, creating inappropriate and exaggerated responses. Hypervigilance may bring about a state of increased anxiety which can cause exhaustion. Other symptoms include:

  • Abnormally increased arousal;
  • A high responsiveness to stimuli; and
  • A constant scanning of the environment.

In hypervigilance, there is a perpetual scanning of the environment to search for sights, sounds, people, behaviours, smells, or anything else that is reminiscent of activity, threat or trauma. The individual is placed on high alert in order to be certain danger is not near. Hypervigilance can lead to a variety of obsessive behaviour patterns, as well as producing difficulties with social interaction and relationships.

Hypervigilance is differentiated from dysphoric hyperarousal in that the person remains cogent and aware of their surroundings. In dysphoric hyperarousal, a person with PTSD may lose contact with reality and re-experience the traumatic event verbatim. Where there have been multiple traumas, a person may become hypervigilant and suffer severe anxiety attacks intense enough to induce a delusional state where the effects of related traumas overlap. This can result in the thousand-yard stare.

Hypervigilance can be a symptom of PTSD and various types of anxiety disorders. It is distinguished from paranoia. Paranoid diagnoses, such as can occur in schizophrenia, can seem superficially similar, but are characteristically different.

Symptoms

People suffering from hypervigilance may become preoccupied with scanning their environment for possible threats. They might ‘overreact’ to loud and unexpected noises, exhibit an overactive startle response or become agitated in highly crowded or noisy environments. They will often have a difficult time getting to sleep or staying asleep.

Sustained states of hypervigilance, lasting for a decade or more, may lead to higher sensitivity to disturbances in their local environment, and an inability to tolerate large gatherings or groups. After resolution of the situation demanding their attention, people exhibiting hypervigilance may be exhausted and require time to ‘recharge’ before returning to normal activities.

What is Avoidance Coping?

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Introduction

In psychology, avoidance coping is a coping mechanism and form of experiential avoidance.

It is characterized by a person’s efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Avoidance coping can lead to substance abuse, social withdrawal, and other forms of escapism. High levels of avoidance behaviours may lead to a diagnosis of avoidant personality disorder, though not everyone who displays such behaviours meets the definition of having this disorder. Avoidance coping is also a symptom of post-traumatic stress disorder (PTSD) and related to symptoms of depression and anxiety. Additionally, avoidance coping is part of the approach-avoidance conflict theory introduced by psychologist Kurt Lewin.

Literature on coping often classifies coping strategies into two broad categories: approach/active coping and avoidance/passive coping. Approach coping includes behaviours that attempt to reduce stress by alleviating the problem directly, and avoidance coping includes behaviours that reduce stress by distancing oneself from the problem. Traditionally, approach coping has been seen as the healthiest and most beneficial way to reduce stress, while avoidance coping has been associated with negative personality traits, potentially harmful activities, and generally poorer outcomes. However, avoidance coping can reduce stress when nothing can be done to address the stressor.

Measurement

Avoidance coping is measured via a self-reported questionnaire. Initially, the Multidimensional Experiential Avoidance Questionnaire (MEAQ) was used, which is a 62-item questionnaire that assesses experiential avoidance, and thus avoidance coping, by measuring how many avoidant behaviours a person exhibits and how strongly they agree with each statement on a scale of 1-6. Today, the Brief Experiential Avoidance Questionnaire (BEAQ) is used instead, containing 15 of the original 62 items from the MEAQ.

Treatment

Cognitive behavioural and psychoanalytic therapy are used to help those coping by avoidance to acknowledge, comprehend, and express their emotions. Acceptance and commitment therapy, a behavioural therapy that focuses on breaking down avoidance coping and showing it to be an unhealthy method for dealing with traumatic experiences, is also sometimes used.

Both active-cognitive and active-behavioural coping are used as replacement techniques for avoidance coping. Active-cognitive coping includes changing one’s attitude towards a stressful event and looking for any positive impacts. Active-behavioural coping refers taking positive actions after finding out more about the situation.

What is National PTSD Awareness Day?

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Introduction

National PTSD Awareness Day is a day dedicated to creating awareness regarding PTSD (Post Traumatic Stress Disorder).

Background

It is acknowledged annually on the 27th of June. The US Senate officially designated this day in 2010. In 2014 the Senate designated the whole month of June as PTSD Awareness Month.

In the US, 6.8% of adults will experience PTSD in their lifetimes with women twice as likely as men to experience it (10.4% to 5%) frequently as a result of sexual trauma. Veterans are another group highly likely to experience PTSD during their lives, with Vietnam War veterans at 30%, Gulf War veterans at 10%, and Iraq War veterans at 14%.

On this day, organisations that work with employees, consumers, and patients at risk for the condition work to get information about symptoms and treatments for it out to the public in the hopes that when more people know about the disease more people who suffer from it will get treatment. The US Department of Defence is one of the major organisations involved as June is full of days relating to the military.

Book: Eye Movement Desensitisation and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures

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Book Title:

Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures

Author(s): Francine Shapiro.

Year: 2018.

Edition: Third (3rd).

Publisher: Guildford Press.

Type(s): Hardcover and Kindle.

Synopsis:

The authoritative presentation of Eye Movement Desensitisation and Reprocessing (EMDR) therapy, this ground-breaking book – now revised and expanded – has enhanced the clinical repertoires of more than 125,000 readers and has been translated into 10 languages. Originally developed for treatment of posttraumatic stress disorder (PTSD), this evidence-based approach is now also used to treat adults and children with complex trauma, anxiety disorders, depression, addictive behaviour problems, and other clinical problems. EMDR originator Francine Shapiro reviews the therapy’s theoretical and empirical underpinnings, details the eight phases of treatment, and provides training materials and resources. Vivid vignettes, transcripts, and reproducible forms are included.

New to This Edition

  • Over 15 years of important advances in therapy and research, including findings from clinical and neurophysiological studies.
  • New and revised protocols and procedures.
  • Discusses additional applications, including the treatment of complex trauma, addictions, pain, depression, and moral injury, as well as post-disaster response.
  • Appendices with session transcripts, clinical aids, and tools for assessing treatment fidelity and outcomes.

EMDR therapy is recognised as a best practice for the treatment of PTSD by the US Departments of Veterans Affairs and Defence, the International Society for Traumatic Stress Studies, the World Health Organisation, the UK National Institute for Health and Care Excellence (NICE), the Australian National Health and Medical Research Council, the Association of the Scientific Medical Societies in Germany, and other health care associations/institutes around the world.

Book: Complex PTSD: From Surviving to Thriving

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Book Title:

Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma.

Author(s): Pete Walker.

Year: 2013.

Edition: First (1st).

Publisher: CreateSpace Independent Publishing Platform.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

I have Complex PTSD (CPTSD) and wrote this book from the perspective of someone who has experienced a great reduction of symptoms over the years. I also wrote it from the viewpoint of someone who has discovered many silver linings in the long, windy, bumpy road of recovering from CPTSD. I felt encouraged to write this book because of thousands of e-mail responses to the articles on my website that repeatedly expressed gratitude for the helpfulness of my work. An often echoed comment sounded like this: At last someone gets it. I can see now that I am not bad, defective or crazy…or alone!

The causes of CPTSD range from severe neglect to monstrous abuse. Many survivors grow up in houses that are not homes – in families that are as loveless as orphanages and sometimes as dangerous. If you felt unwanted, unliked, rejected, hated and/or despised for a lengthy portion of your childhood, trauma may be deeply engrained in your mind, soul and body. This book is a practical, user-friendly self-help guide to recovering from the lingering effects of childhood trauma, and to achieving a rich and fulfilling life. It is copiously illustrated with examples of my own and my clients’ journeys of recovering.

This book is also for those who do not have CPTSD but want to understand and help a loved one who does. This book also contains an overview of the tasks of recovering and a great many practical tools and techniques for recovering from childhood trauma. It extensively elaborates on all the recovery concepts explained on my website, and many more. However, unlike the articles on my website, it is oriented toward the layperson. As such, much of the psychological jargon and dense concentration of concepts in the website articles has been replaced with expanded and easier to follow explanations. Moreover, many principles that were only sketched out in the articles are explained in much greater detail.

A great deal of new material is also explored. Key concepts of the book include managing emotional flashbacks, understanding the four different types of trauma survivors, differentiating the outer critic from the inner critic, healing the abandonment depression that come from emotional abandonment and self-abandonment, self-reparenting and reparenting by committee, and deconstructing the hierarchy of self-injuring responses that childhood trauma forces survivors to adopt.

The book also functions as a map to help you understand the somewhat linear progression of recovery, to help you identify what you have already accomplished, and to help you figure out what is best to work on and prioritise now. This in turn also serves to help you identify the signs of your recovery and to develop reasonable expectations about the rate of your recovery. I hope this map will guide you to heal in a way that helps you to become an unflinching source of kindness and self-compassion for yourself, and that out of that journey you will find at least one other human being who will reciprocally love you well enough in that way.

Book: The Complex PTSD Workbook

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Book Title:

The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole.

Author(s): Arielle Schwartz.

Year: 2020.

Edition: First (1st).

Publisher: Sheldon Press.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Those affected by complex PTSD commonly feel as though there is something fundamentally wrong with them – that somewhere inside there is a part of them that needs to be fixed. Though untrue, such beliefs can feel extremely real and frightening. Difficult as it may be, facing one’s PTSD from unresolved childhood trauma is a brave, courageous act – and with the right guidance, healing from PTSD is possible.

Clinical psychologist Dr Arielle Schwartz has spent years helping those with C-PTSD find their way to wholeness. She also knows the territory of the healing firsthand, having walked it herself. This book provides a map to the complicated, and often overwhelming, terrain of C-PTSD with Dr. Schwartz’s knowledgeable guidance helping you find your way.

In The Complex PTSD Workbook, you’ll learn all about C-PTSD and gain valuable insight into the types of symptoms associated with unresolved childhood trauma, while applying a strength-based perspective to integrate positive beliefs and behaviours.

Examples and exercises through which you’ll discover your own instances of trauma through relating to PTSD experiences other than your own, such as the following:

  • Information about common PTSD misdiagnoses such as bipolar disorder, ADHD, anxiety disorders, major depressive disorder, and substance abuse, among others.
  • Explorations of common methods of PTSD therapy including somatic therapy, EMDR, CBT, DBT, and mind-body perspectives.
  • Chapter takeaways that encourage thoughtful consideration and writing to explore how you feel as you review the material presented in relation to your PTSD symptoms.

The Complex PTSD Workbook aims to empower you with a thorough understanding of the psychology and physiology of C-PTSD so you can make informed choices about the path to healing that is right for you and discover a life of wellness, free of C-PTSD, that used to seem just out of reach.

Book: PTSD F*cking Hurts (Write That Sh*t Down)

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Book Title:

PTSD Fcking Hurts (Write That Sht Down): A Guided Journal for Depression, PTSD, Mental Recovery, With Prompts to Help you through Emotional Healing, With Prompts and Activities.

Author(s): Sami’s Mental Health Journals.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback.

Synopsis:

A great Guided & Prompted Journal workbook for people suffering from PTSD or Complex PTSD (CPTSD). It is a perfect Journal for yourself if you are seeking a great book to help write down your thoughts. It will guide you throughout activities, Prompts, and questions you need to answer honestly in the journey of recovery, With space for notes.

It will also be a gift for someone who suffers from PTSD, or with having a hard psychologic experience.