27. Trauma and PTSD Flashcards
types of trauma
- physical: bodily injury
- psychological: overwhelming stressful event that threatens survival and sense of security
capacity to withstand stress and catastrophe
resilience
characteristics of resilience
- develops over time
- culmination of multiple internal and external factors
- reduces impact of risk factors
- enhances ability to “bounce back” and recover from stress experiences
What decreases as resilience increases
stronger resilience = less likely a person will experience reactions that lead to maladaptive behaviors and outcomes
what is resilience related to
- positive self-concept and self-worth
- feeling of being in control of one’s life
- feelings of power
3 resilient behaviors
- positive problem solving
- meaningful communication
- effective coping skills
development of PTSD symptoms after exposure to trauma from 3 days to 1 month after traumatic event; may progress to PTSD
acute stress disorder
emotional or behavior symptoms in response to a stressful event that does not meet criteria for PTSD; sxs may seem out of proportion to stressor and usually resolve after situation resolves
adjustment disorder
child is culturally inappropriate and overly familiar with strangers; usually dx in childhood
disinhibited social engagement disorder (children)
inability to develop positive attachments to caregivers because of prior social neglect; inhibited, emotionally withdrawn behavior toward caregiver (usually occurs when caregiver changes frequently)
reactive attachment disorder (children)
development of intrusive, dissociative, mood, cognitive, or hyperarousal sxs following exposure to a traumatic event
post traumatic stress disorder (PTSD)
3 groups of adverse childhood experiences
- abuse (emotional, physical or sexual)
- household challenges (substance abuse, mental illness in household, divorce)
- neglect (emotional or physical)
types of traumatic events that lead to PTSD
- directly experienced
- witnessed
- learned about from others
- repeated exposure to adverse events
T/F: most people who experience a traumatic event don’t develop PTSD
True
clinical course of PTSD
- sxs develop several days after event and must last at least 1 month
- sxs may develop 3-6 months after event (delayed-onset)
- 1/3 of people w/ PTSD develop chronic sxs
- sxs fluctuate in intensity w/ time and worsen during periods of stress
diagnostic criteria for PTSD
- intrusive sxs
- avoidance of person, place, or object that are reminders of event
- negative mood and cognitions (negative thoughts associated w/ event)
- hyperarousal w/ hyper vigilance for at least 1 month
- aggressive, reckless, or self-destructive behavior
- sleep disturbances
involuntary appearance of thoughts, memories, or dreams of trauma events (cues that symbolize or resemble original event)
intrusion
examples of intrusions
- flashbacks
- nightmares
- dissociative reactions
feeling or acting as if the event is reoccurring
dissociative reactions
examples of dissociative reactions
- derealization (feelings of unreality)
- depersonalization (experience of self or environment is strange or unreal)
- periods of disengagement from environment during stress (spacing out)
- alterations in bodily perceptions
- emotional numbing
- out-of-body experiences
- amnesia about abuse-related memories
How does mood alter after a traumatic event
- becomes more irritable
- episodes of explosive anger, fear, guilt, or shame
- person often has difficulty experiencing positive emotions (happiness or love)
How does cognition alter after a traumatic event
- exaggerative negative beliefs or expectations about oneself, others, and the world
- may believe that nobody can be trusted or that they are a terrible person
characteristics of hyperaurousal
- person is hypervigilant for signs of danger
- startles easily
- reacts irritably to small annoyances
- sleeps poorly
- overreacts to others -> causes others to avoid the person -> maintains state of hyperarousal
epidemiology of PTSD
- women twice as likely as men to experience PTSD
- high percentage of people w/ PTSD are veterans
- childhood cancer survivors have an increased risk
Triggers for PTSD in men
- fire/disasters/accidents
- assaults
- combat
- being held captive
Triggers for PTSD in women
- child abuse
- sexual or physical abuse
- traumatic events prior to age 18
PTSD sxs in children
- bedwetting after being toilet trained
- forgetting how or being unable to talk
- acting out scary event during playtime
- being unusually clingy w/ parent or other adult
PTSD sxs in adolescents
- may show sxs like adults
- develop disruptive, disrespectful, or destructive behaviors
- feel guilty for not prevent injury or death
biological factors for PTSD
include neurobiological (fear conditioning) and genetics interacting w/ environment
What may be an underlying cause of hyperarousal
behavioral sensitization (aka kindling)
collaborative interventions for PTSD
- pharmacology: SSRI, Benzos, and Prazosin (off-label for nightmares)
- cognitive behavioral therapy
- meditation
- family therapy
- group therapy
- psychodynamic psychotherapy
- eye movement desensitization and reprocessing (EMDR)
What safety issues should be assessed in pts w/ PTSD
- self injury
- aggression towards others
- substance abuse
- suicide
physical assessment of PTSD
- physical needs (sleep, substance use, pain, somatic experiences)
- safety needs (suicide and aggression)
- original trauma and natures
- specific physical sxs and emotional and behavioral consequences
- length of time patient’s PTSD has been present
psychosocial assessment of PTSD
- severity of PTSD sxs on daily life
- presence of mood and cognitive sxs
- presence of intrusive thoughts, avoidance behaviors, and arousal behaviors
strength assessment of PTSD
- health
- supportive relationships
- economic stability
- motivation
- resilience
nursing interventions for PTSD
- establish trust in relationship w/ pt
- physical health
- medications
- substance abuse
- relaxation
- stress reduction
- support groups
therapy that helps people face and control their fear by exposing them to the trauma in a safe way
exposure therapy
therapy that helps people make sense of their bad memories by reframing their experiences in a more realistic way (may feel shame or guilt about something not their fault)
cognitive restructuring
therapy that helps people understand why recovery from traumatic events has been difficult and how sxs of PTSD affect daily life; focus on identifying how traumatic experiences changed thoughts and beliefs and influenced current feelings and behaviors
cognitive processing therapy
therapy that teaches a person how to reduce anxiety; helps people look at memories in a healthy way
stress inoculation training
