#643 - inappropriate intense anger . . . what does it say? read out loud 2nd paragraph
However you already know the secret . . . you can . . . at any time . . . my anger I've kiked doors, smashed things, broken things,it hurts people and hurts me . . attracts lower
chose the right and see everything thru a filter of love . .. I will never stop striving to be Christlike.
written by the defendant . . . 2/14/07 16:58 - 4:58pm . . .
story involving defendant she discussed receiving candy and underwear on this same day . . . yes she discussed receiving underwear . . .
included in one of these symptoms in borderline pd . .
a gift is a positive thing but we are seeing negative things here . . .
intense and interpersonal relationships
I would say I can't make that relation without more information
Dr.Samuels said PTSD and you disagree
I did (I do)
who does the typing and revew of th report
I do
any errors
they are mine
exhibit #544 - his conclusion and diagnosis . . .clearly under criteria for PTSD . . . if an individual making that assessment fall short under C or d for PTSD
falls short according to this . . . it falls short in D and I have to review C but I think it falls short
why not a case of PTSD . . .
in terms of the DSM
4 primary categories . . .symptoms look for in PTSD . . .presence person experienced a strong traumatic event - horror, fear. . .
2nd category - re-experiences symptoms
3rd - avoidance (avoid truma)
4th is increased arousal . . . - a change of arousal . . newly ability to become angry - becoming hypersensitive . . have an excited response with a jolt.
a is presence of traumatic event cause strong sense of horror/fear
Dr. Sam said she got PTSD result from the killing way she descreibes it she felt fear . . .she met criteria for A.
what if 2 intruders came in . . .
if that is what he based his diagnosis on that would be inaccurate
what if it is an event that didn't occur - wouldn't that automatically do away with PTSSD.
yes- all questions specific to that event that caused the trauma . .. .
trauma if none then doesn't that make PTSD
can it be based on a made up event?
It cannot be based on a made up event!!!
ALV says JA got PTSD from abuse from TA . . .
no physical abuse . . . if those events did not occur . . .
similar to before if the event isn't true then the PTSD would not apply
I would agree it would meet criteria for A if the murder triggered trauma
re=experiencing event - criteria B
5 symptoms listed and one or more must be met (1 of 5 must be met)
first symptom - re-experiencing - symptm B -
have to reference back know category as a whole but want to be sure . .. first - recurrent and intrusive distressing recollections.
symptom - thoughts about the trauma keeps invading their mind bothers them . . . think about it a lot.
she thought about it but not @ level we see with PTSD.
not uncommon to think about it but so traumatized by event it causes disruption in everyday . . .
in her journals or interviews indicate distress recollections? no
2nd recurrent distressing dreams of the event -
having nightmares and dreams about what happened - frequently recurrent
she said sh wsa having some dreams but not recurrent
dreams of the event discussed?
no
acting or feeling if the traumatic event were re-occurring - reliving it - you can see with PTSD they re-enact the episode - reliving it.
killing TA is triggering event
carry out the killing cause her distress?
no
intense psychological distress @ exposure to cues - shortened version . . . when there is cues of the trauma . . anything related to tA - talking about him, symbols or signs related to him cause signs and symptoms of the distress . . . strong intense
not seen with JA.
discuss what happened between TA and JA yes. . she didn't have this strong intense distress she was exposing herself to that . . she writing journal about it - there are cues she s walking towards . . . .going to the funeal
psysiological reactivity to to cues of the traumatic event . . . visceral response . . beating heart, sweating, (throw up) . . physical response
a note to her Atty but other than that nothing else
section C - avoidance
how many symptoms to chose from 7, . . .3 or more
efforts to avoid thoughts, feelings and conversations associated with the trauma
similar to stuff highlighted before - she was writing about it quite a bit in her journals
objection
sustained
lets be more specific - wriing in her journals . .
she writing a lot about TA - saying good things
after the killing
efforts to avoid activity/places or people
associated with the trauma - these are all associatied with the trauma
does not meet this criteria . . . she went to his memorial service, wrote a letter to hs family . . . surrounding herself
how about sending 20 iris to his gma
that would be one
taling to mutual friends
does she meet that criteri - she was not putting effort to avoid the
inability to recall important aspect of the trauma
(*****dING DING DING)
when people are exposed to traumatic events they have acute recall but lose aspects of the traumatic event.
based her report alone . . . . Dr. D does not agree that she meets criteria but based upon JA's report only yes
when people experience traumatic event . . . not like what we ate for breakfast . . .times people become hypervigilent focus . .
don't believe JA because way she report the memory loss . . . not usual in what we see
she reported several hour gapin her memory
not how it typically works. . .traumatic events . . tend to lose small aspects of the incident . .. when there is a traumatic head injury or substance abuse issue ...
time too long of a gap one problem
traumatic memory -the more people talk they tend to gain more - that is what we do in treatment . . . that is not pattern JA displayed
she indicated to Dr. D she went to go and grab the knife . . .memory was absent until put knife in dishwasher or not . . ..until he hit Hoover dam
she told Dr. Samuels in his report that she remembers getting rid of the weapons . . . Dr. D saw her after Dr. Sam . . . . usually gain little bits more and more as you talk . . she should have a little more memory when seeing me not less
another aspect . . . what JA reported to Dr. D . . when reached Hoover dam . . .a little blood on her hand . . I knew this meant that I killed him . . .how do you know that if you have no memory? . . she said I knew I did . . . .that is impossible or illogical you would not think a little blood on my hand . . . not first thing I killed someone
markedly decreased interest . . . .stop engaging in the world . . stop doing things they enjoyed . .. JA spent time with friends she had wanted to attend school
noindication of ?anti-donia?/
humping on Ryan . . . Borderline personality DO . .. idealized or devalue people . . . JA just engaged in a killing and then go have a romantic encountered a flip occurred . . devaluing and idealizing . . . . she was at the point of devalue - despising
detatchment from others or estrangement - feeling like can't be around people . . estranged from them . . .
doesn't meet this criteria . . . related to go to social acts . . going to memorial, gonna go camping at one point . . .
restricted range of affect
a blunted level of affect . . . . may not have feelings of love during that time no kind of drastic emotions . . .
she talks about how much she loved TA after the killing -
sense of forshortened future
people with PTSD have difficult time seeing their future will be like . . so involved with their trauma - not talk about themselves out side trauma .. . things like dating
saw in her journal she talked about courting other men . . she had a job
so B & C are not met
this diagnosis of pTSD is not appropriate
lets talk about D - there are 5 must meet 2
increased arousal - difficulty falling or staying asleep -
when she got to jail . . . had trouble falling asleep in jail - not related to trauma just a change in environment
irritablility or anger . .
consistent highlighted before is much more personality . . . we would see this as increased after the trauma not as a pattern seen in her entire life
difficulty concentrating -
ability to maintain/sustain attention . . . she struggles with being clumsy . . . .after the trauma event this is not a new symptom - doesn't meet this criteria
hypervigilence - tendency of hyper aware . . . protective . . .make self look around make sure safe . . . .
saw videos of JA . . . it was not present in her
exaggerated startle response - tendency to get startled very easy - exaggerated jerk . . startle response.
did you see this with defendant . . . I was lucky to have video . . .times door slamming and noise - would have seen that kind of symptom
she does not have PTSD
Dr. Carp - PTSD consstent with abuse
familiar with adjustment d/o -
a change in behavior happened in change in environment
with Ms. ARias I did diagnose her ..
objection
Dr Samuels did not give her this diagnosis . . .
memory issues involved in this case . . . JA indicated she has a very large memory gap the night of the killing . . .
are you familiar with fight or flight regarding memory
a fear response occurs in fear situation fear stimulus - cause fear body protect self . . .our body sweats . . . . evolution if tiger bits on it will slide off easier - it becomes secondary (memory) because we are trying to protect self
@ times they act very different . . . brain doesn' act in the same way normally does . .. frontal lobe . . we plan . . .organize planful behavior not what a dog might do . . . no higher order behaviors seen . .
did you see any higher order behaviors in the fight or flight memory loss
Objection
Approach