Trauma and Stressor-Related, Dissociative and Somatic Symptom Disorders
In this unit, you will review the trauma- and stressor-related disorders, including reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorder. You will also explore the dissociative and somatic disorders.
Trauma- and Stressor-Related Disorders
The trauma- and stressor-related disorders include disorders diagnosed when a person develops psychological distress in response to an extreme traumatic or stressful event. Not everyone who experiences a trauma develops PTSD or an adjustment disorder. When a client does meet diagnostic criteria for one of the trauma- and stressor-related disorders like PTSD, it is important to assess for co-occurring mental disorders, including major depression, substance use, and panic disorder. Many people diagnosed with PTSD may also be experiencing relationship problems, and couples or family therapy can be an important part of the treatment plan.
A client may experience a disruption of consciousness, memory, identity, emotion, or behavior as a reaction to an extreme traumatic or stressful event. Emotional, physical and sexual abuse, and neglect as a child have been linked to the development of a dissociative disorder. When assessing an adult who presents with dissociative symptoms, it is important to consider the client’s childhood experiences.
Somatic Symptom and Related Disorders
There are many ways in which a client’s physical symptoms or medical condition will become a focus during the diagnosis and treatment planning stage. The DSM-5 has several sections that address the interaction between mental disorders and physical conditions. A comprehensive DSM-5 assessment includes other medical conditions that impact a client’s presenting problem.
Clients may have medical conditions that are impacting their psychological state or producing symptoms (for example, hypothyroidism causing depressive symptoms). Examples of these conditions are described in the chapter “Other Mental Disorders,” starting on page 707, from Section II of the DSM-5. During the diagnostic process with a client, it is important to assess whether an underlying medical condition can better account for the symptoms he or she is reporting (such as anxiety, depression, or psychosis). This means that you may need to get permission to consult with the client’s physician.
In some cases, a client’s mental disorder can impact a current medical condition (for example, anorexia impacting a heart condition). The diagnostic process for this can be found in “Psychological Factors Affecting Other Medical Conditions,” starting on page 322 of the DSM-5, in the “Somatic Symptom and Related Disorders” chapter in Section II.
Some clients present physical symptoms as a main focus for treatment, without having a diagnosed medical condition that accounts for the appearance or severity of these symptoms. In these cases, you may consider one of the diagnoses in the chapter “Somatic Symptom and Related Disorders” from Section II of the DSM-5. It will be important to rule out malingering (page 726) and factitious disorder (pages 324–326), where the client produces the symptoms for the sole purpose of being seen as a patient or for external incentives.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
To successfully complete this learning unit, you will be expected to:
1. Identify the symptoms observed in a client who is experiencing posttraumatic stress disorder.
2. Develop a treatment plan for working with a client diagnosed with posttraumatic stress disorder.
3. Develop a DSM-5 diagnosis for a client presenting multiple symptoms and issues.
4. Discuss the influence of the counselor’s own values and biases on the diagnostic and treatment process with clients who have both psychological and physical symptoms.
Unit 6 Study 1
Use your Abnormal Psychology text to complete the following:
• Read the material about “Posttraumatic Stress Disorder and Acute Stress Disorder,” on pages 110–118 of Chapter 5, “Trauma, Anxiety, Obsessive-Compulsive, and Related Disorders.”
• Read Chapter 6, “Somatic Symptom and Dissociative Disorders,” pages 150–173.
• Review Figure 15.5 on page 459.
Use the library to read Ford, Russo, and Mallon’s 2007 article, “Integrating Treatment of Posttraumatic Stress Disorder and Substance Use Disorder,” from Journal of Counseling and Development, volume 85, issue 4, pages 475–490. This article informs this unit’s first discussion regarding PTSD.
Review the main diagnoses of the following chapters from Section II of the DSM-5:
• “Trauma- and Stressor-Related Disorders,” pages 265–290.
• “Dissociative Disorders,” pages 291–307.
• “Somatic Symptom and Related Disorders,” pages 309–327.
Optional – Readings
Refer to Optional Readings for Principles of Psychopathology for a list of additional articles about the mental disorders and current issues regarding assessment, diagnosis, and treatment you are studying in this unit.
Unit 6 – Trauma and Stressor-Related, Dissociative, and Somatic Symptom Disorders
Davis, R. G., Ressler, K. J., Schwartz, A. C., Stephens, K. J., & Bradley, R. G. (2008). Treatment barriers for low-income, urban African Americans with undiagnosed posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), 218–222.
Margolin, G., & Vickerman, K. A. (2007). Posttraumatic stress in children and adolescents exposed to family violence: I. Overview and issues. Professional Psychology: Research and Practice, 38(6), 613–619.
Pole, N., Best, S. R., Metzler, T., & Marmar, C. R. (2005). Why are Hispanics at greater risk for PTSD? Cultural Diversity and Ethnic Minority Psychology, 11(2), 144–161.
Putnam, S. E. (2009). The monsters in my head: Posttraumatic stress disorder and the child survivor of sexual abuse. Journal of Counseling and Development, 87(1), 80–89.
Sherman, M. D., Blevins, D., Kirchner, J., Ridener, L., & Jackson, T. (2008). Key factors involved in engaging significant others in the treatment of Vietnam veterans with PTSD. Professional Psychology: Research and Practice, 39(4), 443–450.
Arnd–Caddigan, M. (2006). Transference and countertransference in the treatment of adult survivors of abuse with a somatoform disorder. Clinical Social Work Journal, 34(3), 293–302.
du Plock, S. (2008). Living ME: Some reflections on the experience of being diagnosed with a chronic “psycho–somatic” illness. Existential Analysis, 19(1), 46–57.
Fleming, C. M. (1996). Cultural formulation of psychiatric diagnosis: Case No. 01. An American Indian woman suffering from depression, alcoholism, and childhood trauma. Culture, Medicine and Psychiatry, 20(2), 145–154.
Johnson, S. K. (2008). Psychosocial and cognitive factors in medically unexplained illness. In Medically unexplained illness: Gender and biopsychosocial implications. Washington, DC: American Psychological Association.
Lim, R. F., & Lin, K. (1996). Cultural formulation of psychiatric diagnosis: Case No. 03: Psychosis following Qi–gong in a Chinese immigrant. Culture, Medicine and Psychiatry, 20(3), 369–378.
Preece, J., & Sandberg, J. G. (2005). Family resilience and the management of fibromyalgia: Implications for family therapists. Family Therapy: An International Journal, 27(4), 559–576.
Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Posttraumatic Stress Disorder Diagnosis
Review the case study on page 114 as well as the treatment information for PTSD beginning on page 117 of the Abnormal Psychology text as resources for this discussion and consider a treatment plan for the client.
Use this outline to draft your treatment plan for the client:
Brief Treatment Plan
1. Brief description of the client.
2. Presenting symptoms.
3. Key issues.
4. Short-term goals (should be observable).
5. Long-term goals.
6. Recommended treatment approach. (Choose from counseling or therapy approaches that have established support in the literature for treating PTSD, and explain why you believe this would be an effective approach for the client.)
7. Three specific interventions or techniques drawn from your recommended approach that you would use to help the client reach the short- or long-term goals you noted. (Provide a brief description of the technique and state how it would help the client move toward the goal.)
8. Systemic considerations: Discuss other people to be included in the client’s treatment process. Be sure to explain how including this person would be helpful.
Cite two resources to support your treatment recommendations. These resources should be peer-reviewed articles, books about PTSD, or Web sites about PTSD that you have reviewed.
Discussion 2: 1 page needed with minimum of 250 words and 2 references.
Clients with Psychological and Physical Symptoms
Review the media The Vignette of Richard. For this discussion, address the following:
The Vignette of Richard
Richard is a 47-year-old man who has been referred for counseling by his physician, Dr. Abrams. Dr. Abrams has been seeing Richard frequently over many years for a variety of physical complaints including joint pain, weakness in his fingers, dizziness, constipation, and headaches. Although Richard does have a medical diagnosis of ulcers and has been diagnosed with anemia in the past, Dr. Abrams has found no evidence of any illness or condition that would account for these symptoms over the years. Richard does not drink or use substances, and he is not currently taking any medications.
Richard also worries that he has a disease like AIDS or hepatitis, and every time he feels sick he believes it is a sign of a more serious illness. Dr. Abrams has repeatedly reassured him that he does not have these diseases, but Richard does not believe him and demands more tests be performed.
Richard is extremely distressed, has alienated most of his friends, and has lost three jobs in the past several years because of absences due to illness or medical appointments. Currently, Richard lives in the basement apartment of his parents’ house, and has not been able to find steady work. He spends most of his days on the Internet researching medical conditions or in chat rooms with others who have similar problems. He often feels anxious.
In the first counseling session, Richard describes his history of physical symptoms in great detail, presents files of medical procedures and tests, and starts to cry, saying he is probably going to die of a “horrible disease.” He resists any deeper exploration of his emotions or thoughts, saying, “This is not all in my head!”
1. Describe what somatic symptom diagnosis you would consider giving to Richard. Consider also the possibility of a co-occurring substance use disorder impacting Richard’s physical and psychological symptoms. List the additional questions you would ask to obtain the information you would need to rule out a co-occurring disorder and be sure of your somatic symptom diagnosis.
2. Describe some of the treatment goals, both long term and short term, you would have in working with this client.
3. Describe the personal reactions you might have when working with a client who presents with a combination of physical and psychological symptoms. Include a discussion of your own assumptions and beliefs about the relationship between mental disorders and medical conditions.
Support your ideas with references to the course texts, articles from this learning unit, articles from the Optional Readings for Principles of Psychopathology list, or articles from peer-reviewed journals that you locate in the library.