ATI Ch 12, Trauma And Stressor Related Disorders Flashcards
What is acute stress disorder (ASD)?
Exposure to traumatic events causes anxiety, detachment, and other manifestations about the event for at least 3 days but for not more than 1 month following the event.
ASD is characterized by symptoms that occur shortly after a traumatic event.
What is posttraumatic stress disorder (PTSD)?
Exposure to traumatic events causes anxiety, detachment, and other manifestations about the event for longer than 1 month following the event. Manifestations can last for years.
PTSD symptoms can include flashbacks, nightmares, and severe anxiety.
What triggers an adjustment disorder?
A stressor triggers a reaction causing changes in mood and/or dysfunction in performing usual activities.
The stressor and effects are less severe than with ASD or PTSD.
What is depersonalization in the context of dissociative disorders?
The feeling that a person is observing one’s own personality or body from a distance.
It is often experienced during stress and is part of depersonalization/derealization disorder.
What is derealization?
The feeling that outside events are unreal or part of a dream or that objects appear larger or smaller than they should.
Derealization is also part of depersonalization/derealization disorder.
What characterizes dissociative amnesia?
Inability to recall personal information related to traumatic or stressful events.
The amnesia can be of events of a certain period of time or just certain details.
What is dissociative fugue?
A type of dissociative amnesia in which the client travels to a new area and is unable to remember one’s own identity and at least some of one’s past.
It can last weeks to months and usually follows a traumatic event.
What is dissociative identity disorder?
Client displays more than one distinct personality, with a stressful event precipitating the change from one personality to another.
This disorder was previously known as multiple personality disorder.
True or False: Acute stress disorder can last for more than one month.
False
ASD symptoms must occur for at least 3 days but not more than 1 month.
Fill in the blank: Adjustment disorder is characterized by a reaction to a _______.
[stressor]
The reaction causes changes in mood and/or dysfunction in performing usual activities.
How long can manifestations of PTSD last?
For years.
PTSD symptoms can persist long after the traumatic event.
What is a common response to stress in depersonalization/derealization disorder?
Temporary change in awareness displaying depersonalization, derealization, or both.
These experiences can be distressing and impact daily functioning.
What is reactive attachment disorder (RAD)?
The child does not turn to an attachment figure for comfort or social interaction, resulting in withdrawal from adults or caregivers.
Diagnosed before age 5, typically after 9 months of age.
What characterizes disinhibited social engagement disorder (DSED)?
Displays overly familiar behaviors toward strangers without regard for appropriate social boundaries.
Results from inadequate caregiving during childhood and diagnosed after 9 months of age.
What should nurses monitor for in children to prevent trauma reactions?
Physical and sexual abuse, which can lead to ASD or PTSD.
Suspected cases should be reported to the proper authorities promptly.
What occupations have a high incidence of PTSD?
Military and first responders.
Clients in these occupations should receive support and treatment before severe trauma reactions occur.
What are health promotion measures to prevent PTSD during a traumatic incident?
Be aware of breaks, rest, adequate water, and nutrition.
Also provide emotional support, encourage staff support, debrief, encourage expression of feelings, and use counseling resources.
What are adverse childhood experiences (ACEs)?
Experiences that can result in psychological and behavioral manifestations in children.
They create stigma and barriers to accessing safe and supportive relationships.
Who is at greatest risk for developing trauma-related disorders?
Women who have experienced four or more ACEs or have a history of interpersonal violence.
ACEs are a significant risk factor for trauma-related disorders.
Fill in the blank: Reactive attachment disorder is diagnosed before age ______.
5
True or False: Disinhibited social engagement disorder is diagnosed before 9 months of age.
False
DSED is diagnosed during childhood after 9 months of age.
What does ASD stand for?
Acute Stress Disorder
ASD is related to the immediate response following a traumatic event.
What does PTSD stand for?
Post-Traumatic Stress Disorder
PTSD can develop after experiencing or witnessing a traumatic event.
What types of events can lead to ASD and PTSD?
- Motor vehicle crash
- Sexual assault
- Physical abuse
- Natural disasters (e.g., fire, storm)
- Man-made experiences (e.g., terrorism)
- Occupational exposure (e.g., medical personnel, law enforcement)
- Traumatic events experienced by family members or close friends
These events can be severe or less severe.
What is a common risk factor associated with PTSD?
Risk for other disorders, including:
* Dissociative disorders
* Anxiety
* Depression
* Substance use disorders
PTSD can have wide-reaching effects on mental health.
What factors influence the severity of trauma in ASD and PTSD?
- Duration of the experience
- Amount of personal threat
- Familiarity of the surroundings
These factors can affect an individual’s response to trauma.
What are individual vulnerabilities that can affect ASD and PTSD outcomes?
- Past coping mechanisms
- Personality
- Preexisting mental disorders
Individual differences can influence how trauma is processed.
What can lead to insufficient treatment following trauma?
- Client social supports
- Societal attitudes
- Cultural influences
These factors can hinder recovery from traumatic experiences.
What characterizes adjustment disorder?
- Lifelong difficulty accepting change
- Difficulty with social skills or coping strategies
Adjustment disorder involves an exaggerated response to stressors.
What are common findings expected in ASD and PTSD?
- Intrusive memories
- Flashbacks
- Nightmares
- Avoidance of reminders
- Attempts to avoid thinking about the event
These symptoms can significantly impact daily functioning.
What is a flashback in the context of ASD and PTSD?
A dissociative reaction where the client feels the traumatic event is recurring in the present
Flashbacks can be triggered by stimuli that remind the individual of the trauma.
True or False: Adjustment disorder can only occur after severe traumatic events.
False
Adjustment disorder can be triggered by less severe stressors, such as relationship breakups or job loss.
Fill in the blank: A pattern of life-long difficulty accepting change is indicative of _______.
Adjustment disorder
This pattern can lead to stress responses that are out of proportion to the actual stressor.
What types of trauma are associated with dissociative disorders?
- Traumatic life events
- Childhood abuse or trauma
These experiences can lead to significant psychological effects.
What are common mood alterations in anxiety or depressive disorders?
Anger, irritability, decreased interest in activities, detachment from others, inability to experience positive emotions
Includes feelings of responsibility for negative events.
What are some dissociative manifestations?
Amnesia, derealization, depersonalization
These can affect a person’s sense of self and reality.
What behavioral manifestations may occur in individuals with mood disorders?
Aggression, irritability, hypervigilance, inability to focus, sleep disturbances, destructive behavior
Destructive behavior can include suicidal thoughts.
What is an adjustment disorder?
A condition characterized by depression, anxiety, and changes in behavior
Behavior may include arguing or driving erratically.
What is depersonalization/derealization disorder?
Reports of feeling detached from one’s own body or feeling that one’s environment is unreal
This disorder affects the perception of self and surroundings.
What defines dissociative amnesia?
Lack of memory that can range from specific details to the client’s entire lifetime
This can severely impact personal identity.
What is dissociative identity disorder?
A condition where a client displays two or more separate personalities
Each personality can be distinct and different.
What are some diagnostic procedures for ASD, PTSD, and adjustment disorder?
Screening tools, tests for anxiety and depression, asking about suicidal ideation, mental status examination
Tools include the Primary Care PTSD Screen and the PTSD Checklist.
What diagnostic procedures are used for dissociative disorders?
Physical assessment, electroencephalogram, x-ray studies, screening for substance use, mental status examination
These procedures help rule out physical trauma.
Fill in the blank: Dissociative disorders can include _______.
depersonalization/derealization disorder, dissociative amnesia, dissociative identity disorder
Each disorder has unique characteristics.
True or False: Hypervigilance is a behavioral manifestation of mood disorders.
True
Hypervigilance includes heightened startle responses.
What should be assessed for gaps or contradictions in memory?
Recent and remote memory
Assessing memory is crucial in identifying potential cognitive issues.
What family and occupational difficulties should be checked?
Family and occupational difficulties
Understanding these difficulties can provide context for a client’s emotional state.
What should be asked about to understand a client’s mental state?
Occurrence of stressful events
Stressful events can significantly impact mental health.
What mental health conditions should be assessed in clients?
Depression, mood shifts, and anxiety
Assessing these conditions is essential for effective care.
What screening tools are used for assessment?
- Dissociative Disorders Interview Schedule
- Cambridge Depersonalization Scale
- Somatoform Dissociation Questionnaire
- Dissociative Experience Scale
These tools help in evaluating dissociative symptoms.
What does trauma-informed care involve?
Care management that regards the impact of trauma
It addresses emotional, psychological, and physiological needs.
What are universal trauma precautions?
- Acknowledge and assume everyone has experienced trauma
- Consider tone of voice, eye contact, and body language
- Respect culture, gender, race, ethnicity, and sexual orientation
- Support client choices
- Minimize noise levels
- Practice self-care
These precautions create a safer environment for clients.
What should be established with clients to encourage sharing feelings?
A therapeutic relationship
A strong relationship fosters trust and openness.
What type of environment should be provided for clients?
A safe, nonthreatening, routine environment
Stability can help clients feel secure.
What should be assessed in clients for safety?
Suicidal ideation
Assessing suicidal thoughts is critical for client safety.
What strategies can be used to decrease anxiety?
- Music therapy
- Guided imagery
- Massage
- Relaxation therapy
- Breathing techniques
Multiple strategies enhance the effectiveness of anxiety reduction.
How should treatment involve children?
Involve caregivers and use age-appropriate strategies
Techniques like play and art can help children express themselves.
What should be done during dissociative periods?
Help the client make decisions to lower stress
Supporting decision-making can help manage dissociative symptoms.
What technique can be used to encourage grounding?
Having the client clap hands or touch an object
Grounding techniques help clients stay connected to the present.
What information should be avoided giving to clients about past events?
Too much information to prevent increased stress
Limiting information can help protect the client’s mental state.
What should clients practice to manage anxiety?
Strategies to reduce anxiety
Regular practice can build coping skills.
What should clients do with negative feelings?
Verbalize negative feelings and progress at their own pace
Allowing clients to express feelings is vital for emotional processing.
What are the major classes of antidepressants used to treat trauma- and stressor-related disorders?
Antidepressants
* Selective serotonin reuptake inhibitors
* Serotonin norepinephrine reuptake inhibitor
* Tricyclic antidepressants
* Monoamine oxidase inhibitor
* Noradrenergic and specific serotonergic antidepressant (NaSSA)
These classes include specific medications that target neurotransmitter systems in the brain.
Name five selective serotonin reuptake inhibitors (SSRIs).
Paroxetine, sertraline, fluoxetine, escitalopram, fluvoxamine
SSRIs are commonly prescribed for depression and anxiety disorders.
What is the serotonin norepinephrine reuptake inhibitor mentioned for treating trauma-related disorders?
Venlafaxine
Venlafaxine is effective in treating both depression and anxiety symptoms.
List two tricyclic antidepressants used for trauma-related disorders.
Amitriptyline, imipramine
Tricyclic antidepressants are older medications that can be effective but have more side effects.
What is the monoamine oxidase inhibitor mentioned?
Phenelzine
MAOIs require dietary restrictions due to potential interactions with certain foods.
What does NaSSA stand for and name one medication in this class.
Noradrenergic and specific serotonergic antidepressant; Mirtazapine
Mirtazapine can help with sleep and appetite in addition to mood.
What is the primary use of beta blockers in the treatment of trauma-related disorders?
Propranolol
* Decreases elevated vital signs
* Manifests anxiety, panic, hypervigilance, and insomnia
Propranolol is often used for performance anxiety and to reduce physical symptoms of anxiety.
What medication is a peripherally acting antiadrenergic?
Prazosin
Prazosin is particularly effective for nightmares and hypervigilance.
What is the centrally acting adrenergic medication mentioned?
Clonidine
Clonidine can help with anxiety and hyperarousal symptoms.
Are medications typically prescribed for adjustment disorder or dissociative disorders?
No, unless specific findings of depression or anxiety require treatment
Treatment for these disorders often focuses on therapy rather than medications.
What are the four subcategories of symptoms in PTSD according to DSM V-TR?
- Intrusion symptoms
- Persistent avoidance
- Negative cognition or thoughts
- Being on guard, or hyperarousal
See pg. 210 in Videbeck
What does the term ‘intrusion symptoms’ refer to in PTSD?
The person persistently reexperiences the trauma through memories, dreams, flashbacks, or reactions to external cues about the event
This includes experiencing distressing memories or nightmares related to the trauma.
What is meant by ‘persistent avoidance’ in PTSD?
Avoidance of stimuli associated with the trauma
This can include avoiding places, people, or situations that may trigger memories of the trauma.
How many negative cognition or thought symptoms are required for a PTSD diagnosis?
Two or more symptoms
Examples include distorted blame of self or others, persistent negative emotional state, or feelings of detachment.
What are some signs of increased arousal in PTSD?
- Insomnia
- Hyperarousal or hypervigilance
- Irritability
- Angry outbursts
These symptoms reflect a heightened state of anxiety and alertness.
What feelings do victims of PTSD report losing?
A sense of connection and control over their life
This disconnection can lead to feelings of isolation and helplessness.
What behavior may develop as a result of PTSD symptoms?
Avoidance behavior
This involves trying to avoid any places, people, or situations that may trigger memories of the trauma.
True or False: Individuals with PTSD often seek comfort, safety, and security.
True
However, they can become increasingly isolated over time.
Fill in the blank: Individuals with PTSD may experience _______ as a symptom.
[numbing of general responsiveness]
This can manifest as emotional detachment or loss of interest in activities.
What does trauma-informed care involve?
Care management that regards the impact of trauma for the client and addresses emotional, psychological, and physiological needs.
What are universal trauma precautions?
Assume everyone has trauma.
What elements should be considered in trauma-informed care?
- Tone of voice
- Eye contact
- Body language
- Respect for culture, race, gender, ethnicity, and sexual orientation
How should a client’s choices be treated in trauma-informed care?
Support client’s choices/autonomy when possible.
What should be minimized in a trauma-informed care environment?
Minimize noise levels.
Why is self-care important in trauma-informed care?
To practice self-care and reach out to others when needed.
What common responses do individuals experience after trauma?
- Anxiety
- Insomnia
- Difficulty coping
- Grief
- A variety of responses
What can happen to individuals who do not recover from trauma?
They may develop adjustment disorder, acute stress disorder, PTSD, or dissociative disorder.
True or False: Most individuals return to their usual levels of coping after experiencing trauma.
True
Fill in the blank: Trauma-informed care involves addressing a client’s _______ needs.
[emotional, psychological, physiological]
What is a key aspect of assessment data for clients with PTSD?
Health history reveals a history of trauma or abuse
This may include childhood abuse or abuse in current or recent relationships.
What is generally not necessary when assessing clients with PTSD?
In-depth discussion of specific events of the abuse or trauma
Detailed discussions typically occur during individual psychotherapy sessions.
What behaviors might a client with PTSD exhibit regarding general appearance?
Hyperalertness and startle response to small environmental noises
Clients may appear anxious or agitated.
How might a client with PTSD react to physical proximity?
They may require greater distance or personal space than most people
Clients can feel uncomfortable if the nurse is too close physically.
What physical behaviors might clients with PTSD display?
Difficulty sitting still, pacing, or moving around the room
Some clients may sit very still, curling up with arms around their knees.
What components are assessed in clients with PTSD?
Mood and affect, thought processing and content, sensorium and intellectual processes, judgement and insight, self-concept, roles and relationships, physiological considerations
Comprehensive assessment includes various psychological and physical aspects.
What is adjustment disorder?
A reaction to a stressful event that causes problems.
How does adjustment disorder differ from typical stress reactions?
It is more than the expected difficulty coping with or assimilating the event.
When do symptoms of adjustment disorder typically develop?
Within a month of the stressful event.
How long do the symptoms of adjustment disorder last?
No more than 6 months.
What happens after 6 months if adjustment has been successful?
The person either successfully adjusts or moves on to another diagnosis.
What is the most common and successful treatment for adjustment disorder?
Outpatient counseling or therapy.
What are the most common stressors associated with adjustment disorder?
- Financial stressors
- Relationship stressors
- Work-related stressors
What is the essential feature of dissociative disorders?
A disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception.
What is dissociation?
A subconscious defense mechanism.
What does dissociation protect?
The emotional effects of the traumatic event.
When can dissociation occur?
During and after the event.
What happens with repeated dissociation?
It becomes easier for the brain to dissociate.
What is dissociative amnesia?
The client cannot remember important personal information (usually of a traumatic or stressful nature)
Dissociative amnesia can lead to significant gaps in memory surrounding specific events.
What characterizes dissociative identity disorder?
The client displays two or more distinct identities or personality states that recurrently take control of their behavior, accompanied by the inability to recall important personal information
Formerly known as multiple personality disorder.
Define depersonalization/derealization disorder.
The client has a persistent or recurrent feeling of being detached from their mental processes or body (depersonalization) or experiences a dream-like state where the environment seems foggy or unreal (derealization)
The client is not psychotic or out of touch with reality.
How do dissociative disorders affect a person’s life?
They often interfere with the person’s relationships, ability to function in daily life, and ability to cope with the realities of the abusive or traumatic event
The impact varies greatly in intensity among individuals.
What are the possible onsets of dissociative disorders?
The onset may be sudden or gradual, transient, or chronic
This variability can affect treatment and recovery.
What occurs during a dissociative amnesia episode involving geographic relocation?
The client suddenly moves to a new geographic location with no memory of past events and often assumes a new identity
After recovery, the person has no memory of the dissociative state.
True or False: Clients with depersonalization/derealization disorder are out of touch with reality.
False
Clients maintain a connection to reality despite their experiences.
Fill in the blank: Dissociative disorders can vary greatly in _______ among different people.
[intensity]
This variability can influence the severity of symptoms and the approach to treatment.
What types of therapy are used in the treatment of dissociative disorders?
Group or individual therapy addressing the long-term effects of their experiences
Therapy focuses on reassociation or putting the consciousness back together.
What does specialized treatment for dissociative disorders address?
Trauma-based, dissociative symptoms
This treatment aims to help clients integrate their experiences.
What are the main goals of therapy for dissociative disorders?
Improved quality of life, improved functional abilities, and reduced symptoms
These goals guide the therapeutic process.
How may clients with dissociative disorders be treated symptomatically?
With medications for anxiety or depression or both if these symptoms are predominant
This approach targets the most pressing symptoms affecting the client.
Fill in the blank: Therapy for dissociative disorders focuses on _______.
[reassociation]
What are medications used for in trauma therapy?
Symptom management such as insomnia, anxiety, or hyperarousal
Medications help alleviate distressing symptoms associated with trauma.
Which classes of medications are considered most effective for trauma management?
SSRI, SSNRI
Specifically fluoxetine, paroxetine, sertraline, and venlafaxine are highlighted.
Name four specific medications that are effective in trauma therapy.
- Fluoxetine
- Paroxetine
- Sertraline
- Venlafaxine
These medications belong to the SSRI and SSNRI classes.
Is there strong evidence for the efficacy of benzodiazepines in trauma therapy?
No
Although benzodiazepines are widely used in clinical practice, evidence for their efficacy is lacking.
True or False: A combination of medications and CBT is more effective than either one alone.
True
Combining pharmacological therapy with cognitive behavioral therapy (CBT) enhances treatment outcomes.
