Ch 16 Trauma, Stress-related & Dissociative Disorders

Question 1

Persistent re-experiencing of highly traumatic events that involve actual/threatened death/serious injury to self or others

Intense fear, helplessness or horror, irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, & hypervigilance

Answer 1

PTSD

Trauma & stress-related disorders

Question 2

Developed after exposure to a highly traumatic events; must have 8 of 14 symptoms

Sense of numbing, derealization, inability to remember one important aspect of the event, intrusive distressing memories of event, recurrent distressing dreams, feeling as the event is recurring, intense prolonged distress, avoidance of thoughts or feelings about the event, sleep disturbances, hypervigilance, irritable/angry/aggressive behavior, exaggerated startled response & agitation or restlessness

Answer 2

Acute Stress Disorder

Trauma & stress-related disorders

Question 3

Milder, less specific version of ASD & PTSD; however event may not be as severe & nay not be considered traumatic

Hallmarks- cognitive, emotional & behavioral symptoms that negatively impact functioning
Depression, guilt, anxiety, anger, distress, social withdrawal, work/school inhibition

Answer 3

Adjustment Disorders

Trauma & stress-related disorders

Question 4

Consistent pattern of inhibited, emotionally withdrawn behavior; caused by lack of bonding experiences by 8 mth.

Child rarely directs attachment behaviors toward any adult careigver

Answer 4

Reactive Attachment Disorder (Rare)

Trauma & stress-related disorders

Question 5

Demonstrate no normal fear of strangers, seen unfazed in response to separation from a primary caregiver

Usually willing to go off w/ people who are unknown to them

Answer 5

Disinhibited social Engagement Disorder (Rare)

Trauma & stress-related disorders

Question 6

Presence of two or more distinct personality states that recurrently take control of behavior

Usually not aware of alters, perplexed by lost time & unexplained events, each alter has own memories, behavioral patterns & social relationships

Answer 6

DID

Dissociative Disorders

Question 7

Inability to recall important personal info, autobiographical memory is available but not accessible

(Dissociative Fugue)
Sudden, unexpected travel away from the customary locale & inability to recall one’s identity & info about some or all of the past
Fugue state- tend to lead rather simple lives

Answer 7

Dissociative Amnesia
(specify dissociative fugue)

(Dissociative Disorders)

Question 8

Depersonalization the focus is on oneself; feelings of being an observer of one’s own body or mental process
Derealization the focus on the outside work; recurring feelings that one’s surrounding are unreal or distant

May feel mechanical, dreamy, or detached from the body

Answer 8

Depersonalization
Derealization D.

(Dissociative Disorders)

Question 9

developing brain that can increase vulnerability to adverse life experiences

Answer 9

neuroplasticity

Question 10

positive adaptation, or the ability to maintain or regain mental health despite adversity

Answer 10

resilience

Question 11

ensures survival of species

Answer 11

attachment

Question 12

term that means a balance between sympathetic & parasympathetic arousal

Answer 12

window of tolerance

Question 13

Establish trust & safety
Use developmentally appropriate language to explore feelings
Teach relaxation techniques before trauma exploration
Help ID & cope with feelings w/ art & play
Involve parents or caretakers if appropriate (1:1)
Educate about grief process & response to trauma
Assist parents in resolving their own emotional distress
Coordinate with social workers PRN

Answer 13

Interventions for a child with PTSD

Question 14

Hx- time of onset, frequency, course, severity, level of distress & degree of functional impairment
Assess- suicidal or violent ideation, family & social support, insomnia, social withdrawal, functional impairment, current life stressors, meds, past medical & psychiatric hx

Answer 14

Assessment for PTSD

Question 15

Reassurance that reactions to trauma are common
Reactions do not indicate personal failure or weakness
Inform many ways that trauma can present- interpersonal problems with family/friends, occupational problems, &/or substance abuse/alcohol
Facilitate recognition of problems
Instructions in relaxation techniques
Avoidance of caffeine & alcohol

Answer 15

Education for PTSD

Question 16

Trauma-focused psychotherapy
Cognitive restructuring
EMRD
Brief psychodynamic psychotherapy
Imagery
Relaxation techniques
Hypnosis
Group Therapy

Answer 16

Advance Practice Interventions for PTSD

Question 17

Establish therapeutic relationships
Help problem solve
Connect to support groups
Educate about ASD
Coordination of care with others
Ensuring & maintaining safety 
Monitoring response &/or adherence to treatment
critical incident stress debriefing (CISD)

Answer 17

Nursing Interventions for acute stress disorder (ASD)

Question 18

CBT
Specialized protocols for EMDR
EMDR Protocol for Recent Critical Incidents
Recent Event Protocol
Recent Traumatic Episode Protocol

Answer 18

Advance Practice for acute stress disorder (ASD)

Question 19

Physical exam
Electroencephalography
Imaging studies
Specific questions to ID dissociative symptoms
lapses in memory person may not be aware of
Identity, memory, consciousness, life events, mood, suicide risk, & impact of disorder
Pt ability to ID themselves
Changes in voice, behavior & dress may signal an alter & also referral to self as “we”
Memory
1. remember recent & past events
2. memory clear & complete or partial & fuzzy
3. aware of gaps in memory
4. do memories place them with family, in school or work
5. ever lose time or have blackouts
6. find themselves in places with no idea how they got there
Hx
1. wearing clothes you didn’t buy
2. stranger greet & talk to you like old friends
3. ability to engage in tasks changes
4. differing sets of memories from childhood

Answer 19

Assessments for Dissociative Disorders

Question 20

Provide undemanding, simple routine
Ensure pt. safety by providing safe, protected environment & frequent observation
Confirm identity of pt. & orientation to time & place
Encourage pt. to do things for self & make decisions about routine tasks
Monitor patient for signs of drug dependence
Teach patients and family about medications
Assist w/ major decision making until memory returns
Support pt. during exploration of feelings surrounding the stressful events
Do not flood pt. with data regarding past events
Allow pt. to progress at own pace as memory is recovered
Provide support through empathetic listening during disclosure of painful experiences
Teach pt. grounding techniques suck as taking a shower, deep breathing, touching fabric on chair, exercising or stomping feet
Accept pt. expression of negative feelings
Teach stress-reduction methods
If pt. does not remember significant other, work with involved parties to reestablish relationships

Answer 20

Nursing Interventions for Dissociative Disorders

Question 21

CBT
Psychodynamic psychotherapy
Exposure therapy
Modified EMDR
Hypnotherapy
Neuro-feedback
Ego state therapy
Somatic therapies

Answer 21

Advanced Practices for Dissociative Disorders

Question 22

disturbances in perception, sensations, autonomic regulation & movement are common

Dance Movement Therapists

Answer 22

Somatic Therapy