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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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RTS identifies three stages of psychological trauma a rape survivor goes through: the acute stage, the outer adjustment stage, and the renormalization stage.
The acute stage occurs in the days or weeks after a rape. Durations vary as to the amount of time the victim may remain in the acute stage. The immediate symptoms may last a few days to a few weeks and may overlap with the outward adjustment stage.
According to Scarse, there is no "typical" response amongst rape victims. However, the U.S. Rape Abuse and Incest National Network (RAINN) asserts that, in most cases, a rape victim's acute stage can be classified as one of three responses: expressed ("He or she may appear agitated or hysterical, [and] may suffer from crying spells or anxiety attacks"); controlled ("the survivor appears to be without emotion and acts as if 'nothing happened' and 'everything is fine'"); or shock/disbelief ("the survivor reacts with a strong sense of disorientation. They may have difficulty concentrating, making decisions, or doing everyday tasks. They may also have poor recall of the assault"). Not all rape survivors show their emotions outwardly. Some may appear calm and unaffected by the assault.
Behaviors present in the acute stage can include:
- Diminished alertness.
- Numbness.
- Dulled sensory, affective and memory functions.
- Disorganized thought content.
- Vomiting.
- Nausea.
- Paralyzing anxiety.
- Pronounced internal tremor.
- Obsession to wash or clean themselves.
- Hysteria, confusion and crying.
- Bewilderment.
- Acute sensitivity to the reaction of other people.
Symptoms of genophobia can be feeling of panic, terror, and dread. Other symptoms are increased speed of heartbeat, shortness of breath, trembling/shaking, anxiety, sweating, crying, and avoidance of others.
Symptoms show considerable variation but usually include:
An initial state of "DAZE" with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, disorientation. Followed either by further withdrawal from the surrounding situation to the extent of a dissociative stupor or by agitating and over activity.
Stress ulceration is a single or multiple fundic mucosal ulcers which often gives upper gastrointestinal bleeding developed during the severe physiologic stress of serious illness.
Ordinary peptic ulcers are found commonly in the “gastric antrum and the duodenum” whereas Stress ulcers are found commonly in “fundic mucosa and can be located anywhere within the stomach and proximal duodenum”.
The diagnosis of PTSD was originally developed for adults who had suffered from a single event trauma, such as rape, or a traumatic experience during a war. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, and a disruption in attachment to their primary caregiver. In many cases, it is the child's caregiver who caused the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child’s development.
The term developmental trauma disorder (DTD) has also been suggested. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be characterized by subjective events like betrayal, defeat or shame.
Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD. Cook and others describe symptoms and behavioural characteristics in seven domains:
- "Attachment" – "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states"
- "Biology" – "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
- "Affect or emotional regulation" – "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
- "Dissociation" – "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
- "Behavioural control" – "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
- "Cognition" – "difficulty regulating attention, problems with a variety of 'executive functions' such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with 'cause-effect' thinking, and language developmental problems such as a gap between receptive and expressive communication abilities."
- "Self-concept" – "fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".
Symptoms of PTSD generally begin within the first 3 months after the inciting traumatic event, but may not begin until years later. In the typical case, the individual with PTSD persistently avoids trauma-related thoughts and emotions, and discussion of the traumatic event, and may even have amnesia of the event. However, the event is commonly relived by the individual through intrusive, recurrent recollections, flashbacks, and nightmares. While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder).
Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.
This can become a pervasive way of relating to others in adult life described as insecure attachment. The diagnosis of dissociative disorder and PTSD in the current DSM-5 (2013) do not include insecure attachment as a symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.
Six clusters of symptoms have been suggested for diagnosis of C-PTSD:
- alterations in regulation of affect and impulses;
- alterations in attention or consciousness;
- alterations in self-perception;
- alterations in relations with others;
- somatization;
- alterations in systems of meaning.
Experiences in these areas may include:
- Difficulties regulating emotions, including symptoms such as persistent dysphoria, chronic suicidal preoccupation, self injury, explosive or extremely inhibited anger (may alternate), or compulsive or extremely inhibited sexuality (may alternate).
- Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
- Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings.
- Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, seeking approval from the perpetrator, a sense of a special relationship with the perpetrator or acceptance of the perpetrator's belief system or rationalizations.
- Alterations in relations with others, including isolation and withdrawal, persistent distrust, anger and hostility, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
- Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.
- Disconnection from surroundings accompanied by feelings of terror and confusion.
There can be many different reasons for why people develop genophobia. Some of the main causes are former incidents of sexual assaults or abuse. These incidents violate the victim’s trust and take away their sense of right to self-determination. Another possible cause of genophobia is the feeling of intense shame or medical reasons. Others may have the fear without any diagnosable reason.
Posttraumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk for suicide and intentional self-harm.
Most people who have experienced a traumatic event will not develop PTSD. People who experience interpersonal trauma (for example rape or child abuse) are more likely to develop PTSD, as compared to people who experience non-assault based trauma such as accidents and natural disasters. About half of people develop PTSD following rape. Children are less likely than adults to develop PTSD after trauma, especially if they are under ten years of age. Diagnosis is based on the presence of specific symptoms following a traumatic event.
Prevention may be possible when therapy is targeted at those with early symptoms but is not effective when carried out among all people following trauma. The main treatments for people with PTSD are counselling and medication. A number of different types of therapy may be useful. This may occur one-on-one or in a group. Antidepressants of the selective serotonin reuptake inhibitor type are the first-line medications for PTSD and result in benefit in about half of people. These benefits are less than those seen with therapy. It is unclear if using medications and therapy together has greater benefit. Other medications do not have enough evidence to support their use and in the case of benzodiazepines may worsen outcomes.
In the United States about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life. In much of the rest of the world, rates during a given year are between 0.5% and 1%. Higher rates may occur in regions of armed conflict. It is more common in women than men. Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks. During the World Wars study increased and it was known under various terms including "shell shock" and "combat neurosis". The term "posttraumatic stress disorder" came into use in the 1970s in large part due to the diagnoses of U.S. military veterans of the Vietnam War. It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III).
Survivor guilt (or survivor's guilt; also called survivor syndrome or survivor's syndrome) is a mental condition that occurs when a person believes they have done something wrong by surviving a traumatic event when others did not. It may be found among survivors of murder, terrorism, combat, natural disasters, epidemics, among the friends and family of those who have died by suicide, and in non-mortal situation. The experience and manifestation of survivor's guilt will depend on an individual's psychological profile. When the "Diagnostic and Statistical Manual of Mental Disorders IV" (DSM-IV) was published, survivor guilt was removed as a recognized specific diagnosis, and redefined as a significant symptom of post traumatic stress disorder (PTSD).
Women's fear of crime refers to women's fear of being a victim of crime, independent of actual victimization. Although fear of crime is a concern for people of all genders, studies consistently find that women around the world tend to have much higher levels of fear of crime than men, despite the fact that in many places, and for most offenses, men's actual victimization rates are higher. Fear of crime is related to perceived risk of victimization, but is not the same; fear of crime may be generalized instead of referring to specific offenses, and perceived risk may also be considered a demographic factor that contributes to fear of crime. Women tend to have higher levels for both perceived risk and fear of crime.
In women's everyday lives, fear of crime can have negative effects, such as reducing their environmental mobility. Studies have shown that women tend to avoid certain behaviors, such as walking alone at night, because they are fearful of crime, and would feel more comfortable with these behaviors if they felt safer.
Fear of intimacy is generally a social phobia and anxiety disorder resulting in difficulty forming close relationships with another person. The term can also refer to a scale on a psychometric test, or a type of adult in attachment theory psychology.
The fear of intimacy is the fear of being emotionally and/or physically close to another individual. This fear is also defined as “the inhibited capacity of an individual, because of anxiety, to exchange thought and feelings of personal significance with another individual who is highly valued”. Fear of intimacy is the expression of existential views in that to love and to be loved makes life seem precious and death more inevitable. It often results from past traumas such as rape or childhood sexual abuse. Fear of intimacy is also related to the fear of being touched .
People with this fear are anxious about or afraid of intimate relationships. They believe that they do not deserve love or support from others. Fear of intimacy has three defining features: content which represents the ability to communicate personal information, emotional valence which refers to the feelings about personal information exchanged, and vulnerability signifying their regard for the person they are intimate with. Bartholomew and Horowitz go further and determine four different adult attachment types: “(1) Secure individuals have a sense of worthiness or lovability and are comfortable with intimacy and autonomy; (2) preoccupied persons lack this sense of self-worthiness yet view others positively and seek their love and acceptance; (3) fearful people lack a sense of lovability and are avoidant of others in anticipation of rejection; (4) dismissing persons feel worthy of love yet detach from others whom they generally regard as untrustworthy”.
Courtship disorder is a theoretical construct in sexology in which a certain set of paraphilias are seen as specific instances of anomalous courtship instincts in men. The specific paraphilias are biastophilia (paraphilic rape), exhibitionism, frotteurism, telephone scatologia, and voyeurism. According to the "courtship disorder hypothesis", there is a species-typical courtship process in human males consisting of four phases, and anomalies in different phases result in one of these paraphilic sexual interests. That is, instead of being independent paraphilias, this theory sees these sexual interests as individual symptoms of a single underlying disorder.
Sexual sadism disorder is the condition of experiencing sexual arousal in response to the extreme pain, suffering or humiliation of others. Several other terms have been used to describe the condition, and the condition may overlap with other conditions that involve inflicting pain. It is distinct from situations in which consenting individuals use mild or simulated pain or humiliation for sexual excitement. The words "sadism" and "" are derived from Marquis de Sade.
Lesbophobia (sometimes lesbiphobia) comprises various forms of negativity towards lesbians as individuals, as couples, or as a social group. Based on the categories of sex, sexual orientation, lesbian identity, and gender expression, this negativity encompasses prejudice, discrimination, and abuse, in addition to attitudes and feelings ranging from disdain to hostility. As such, lesbophobia is sexism against women that intersects with homophobia and vice versa.
Hybristophilia is a paraphilia in which sexual arousal, facilitation, and attainment of orgasm are responsive to and contingent upon being with a partner known to have committed an outrage, cheating, lying, known infidelities or crime, such as rape, murder, or armed robbery. The term is derived from the Greek word ὑβρίζειν "hubrizein", meaning "to commit an outrage against someone" (ultimately derived from ὕβρις "hubris" "hubris"), and "philo", meaning "having a strong affinity/preference for". In popular culture, this phenomenon is also known as "Bonnie and Clyde Syndrome".
Many high-profile criminals, particularly those who have committed atrocious crimes, receive "fan mail" in prison that is sometimes amorous or sexual, presumably as a result of this phenomenon. In some cases, admirers of these criminals have gone on to marry the object of their affections in prison.
Hybristophilia is accepted as potentially lethal, among other such paraphilias including, but not being limited to, asphyxiophilia, autassassinophilia, biastophilia, and chremastistophilia.
Symptoms of a dissociative fugue include mild confusion, and once the fugue ends, possible depression, grief, shame and discomfort. People have also experienced a post-fugue anger.
Erotophobia is a term coined by a number of researchers in the late 1970s and early 1980s to describe one pole on a continuum of attitudes and beliefs about sexuality. The model of the continuum is a basic polarized line, with erotophobia (fear of sex or negative attitudes about sex) at one end and erotophilia (positive feelings or attitudes about sex) at the other end.
The word erotophobia is derived from the name of Eros, the Greek god of erotic love, and Phobos, Greek (φόβος) for "fear".
Characteristic injuries associated with AHT include retinal bleeds, multiple fractures of the long bones, and subdural hematomas (bleeding in the brain). These signs have evolved through the years as the accepted and recognized signs of child abuse. Medical professionals strongly suspect shaking as the cause of injuries when a young child presents with retinal bleed, fractures, soft tissue injuries or subdural hematoma, that cannot be explained by accidental trauma or other medical conditions.
Retinal bleeds occur in around 85% of AHT cases; the type of retinal bleeds are particularly characteristic of this condition, making the finding useful in establishing the diagnosis. While there are many other causes of retinal bleeds besides AHT, there are usually additional findings (eyes or systemic) which make the alternative diagnoses apparent.
Fractures of the vertebrae, long bones, and ribs may also be associated with AHT. Dr. John Caffey reported in 1972 that metaphyseal avulsions (small fragments of bone had been torn off where the periosteum covering the bone and the cortical bone are tightly bound together) and "bones on both the proximal and distal sides of a single joint are affected, especially at the knee".
People after AHT may display irritability, failure to thrive, alterations in eating patterns, lethargy, vomiting, seizures, bulging or tense fontanels (the soft spots on a baby's head), increased size of the head, altered breathing, and dilated pupils.
The cause of the fugue state is related to dissociative amnesia, ("DSM-IV Codes 300.12") which has several other subtypes: selective amnesia, generalised amnesia, continuous amnesia, and systematised amnesia, in addition to the subtype "dissociative fugue".
Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), dissociative amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, "DSM-IV Codes 291.1 & 292.83") or a neurological or other general medical condition (e.g., amnestic disorder due to a head trauma, "DSM-IV Codes 294.0"). It is a complex neuropsychological process.
As the person experiencing a dissociative fugue may have recently suffered the reappearance of an event or person representing an earlier life trauma, the emergence of an armoring or defensive personality seems to be for some, a logical apprehension of the situation.
Therefore, the terminology "fugue state" may carry a slight linguistic distinction from "dissociative fugue", the former implying a greater degree of "motion". For the purposes of this article then, a "fugue state" occurs while one is "acting out" a "dissociative fugue".
The DSM-IV defines as:
- sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past
- confusion about personal identity, or the assumption of a new identity
- significant distress or impairment
The "Merck Manual" defines "dissociative fugue" as:
In support of this definition, the "Merck Manual" further defines dissociative amnesia as:
Survivor guilt was first identified during the 1960s. Several therapists recognized similar if not identical conditions among Holocaust survivors. Similar signs and symptoms have been recognized in survivors of traumatic situations including combat, natural disasters, terrorist attacks, air-crashes and wide-ranging job layoffs. A variant form has been found among rescue and emergency services personnel who blame themselves for doing too little to help those in danger, and among therapists, who may feel a form of guilt in the face of their patients' suffering.
Stephen Joseph, a psychologist at the University of Warwick, has studied the survivors of the capsizing of the MS "Herald of Free Enterprise" which killed 193 of the 459 passengers. His studies showed that 60 percent of the survivors suffered from survivor guilt. Joseph went on to say: "There were three types: first, there was guilt about staying alive while others died; second, there was guilt about the things they failed to do – these people often suffered post-traumatic 'intrusions' as they relived the event again and again; third, there were feelings of guilt about what they did do, such as scrambling over others to escape. These people usually wanted to avoid thinking about the catastrophe. They didn't want to be reminded of what really happened.
Sufferers sometimes blame themselves for the deaths of others, including those who died while rescuing the survivor or whom the survivor tried unsuccessfully to save.
Functional somatic syndrome is a term used to refer to physical symptoms that are poorly explained. It encompass disorders such as chronic fatigue syndrome, fibromyalgia, chronic widespread pain, temporomandibular disorder, irritable bowel syndrome, lower back pain, tension headache, atypical face pain, non-cardiac chest pain, insomnia, palpitation, dyspepsia, and dizziness. General overlap exists between this term, somatization, and somatoform.
Abusive head trauma (AHT), commonly known as shaken baby syndrome (SBS), is an injury to a child's head caused by someone else. Symptoms may range from subtle to obvious. Symptoms may include vomiting or a baby that will not settle. Often there are no visible signs of trauma. Complications include seizures, visual impairment, cerebral palsy, and cognitive impairment.
The cause may be blunt trauma or vigorous shaking. Often this occurs as a result of a caregiver becoming frustrated due to the child crying. Diagnosis can be difficult as symptoms may be nonspecific. A CT scan of the head is typically recommended if a concern is present. While retinal bleeding is common, it can also occur in other conditions. Abusive head trauma is a type of child abuse.
Educating new parents appears to be beneficial in decreasing rates of the condition. Treatment occasionally requires surgery, such as to place a cerebral shunt. AHT is estimated to occur in 3 to 4 per 10,000 babies a year. It occurs most frequently in those less than five years of age. The risk of death is about 25%. The diagnosis may also carry legal consequences for the parents.