Complex Trauma And Post Traumatic Stress Syndrome Flashcards
What is trauma? (Diagram slide 3)
- being in an accident, such as a road traffic accident, or an accident at work
- being the victim of violence, such as being physically or sexually assaulted, imprisoned or tortured
- witnessing violence towards another person or witnessing death
- being in a life-threatening situation, such as a war, a natural disaster, or a health emergency
Trauma
- an emotional wound or shock that creates substantial, lasting damage to the psychological development of a person OR an event or situation that causes great distress and disruption
Complex trauma
- chronic exposure to multiple traumatic incidents that occur within a relational system often in early childhood, which impact on development and self-awareness
- newer term/synonymous with toxic stress
- been exposed to continuous emotional maltreatment either directly or through observation of relational violence and absence of safe caregiving
- given the relational nature of this early trauma, the formation of a secure attachment is severely compromised
- many aspects of a child’s health physical and mental development rely on this primary source of safety and stability
Complex trauma diagram (slide 5)
- results from experiencing multiple or prolonged traumatic events
- chronic, physical, sexual, or emotional abuse in childhood
- ongoing physical or emotional neglect during childhood parentification
- homesite, physical, sexual, or emotional abuse
- witness or victim of community violence or war
- severe, bullying, harassment, or torture
- kidnapping, human trafficking, or forced labor
- caregiver or partner instability due to mental illness, substance abuse
- witnessing physical or emotional abuse between caregivers
Classifications of trauma
- acute trauma = results from a single event
- chronic = repeated and prolonged events
- complex trauma = exposure to varied and multiple traumatic events that are often interpersonal and invasive
Potentially traumatic experiences
- sexual abuse
- physical abuse
- emotional abuse
- neglect
- victims or witness to violence
- bullying
- natural disasters
- military trauma
- system-induced trauma
- unsafe/stable home environment
- parental drug/alcohol use
- parental mental illness
- incarceration
- lifelong medical diagnosis
*these experiences are transgenerational
Complex trauma
Fatal Injuries:
- severe head trauma, such as violently shaking an infant or small child = shaken baby syndrome
- forceful punching of the fist to the abdomen, chest, or head
- scalding
- intentional drowning
- suffocation
- poisoning
- starvation
Neglect:
- the deadliest form of child trauma
- death can occur by accidents due to the absence of supervision or abandonment and from failure to seek medical attention provided in cases of injury, illness, or a medical condition
Risk factures of complex trauma
Parental risk factors:
- young or single parent
- did not graduate from high school
- those who either were abused themselves as children or endured a severely dysfunctional home life
- difficulty providing quality care to a large number of dependent children
- low income, poor socio-economic status
- adults with psychiatric disorders such as depression and bipolar disorder are more likely to abuse children
- a common theme when interviewing abusive individuals is their unrealistic expectations of infant or child development (often they expect maturation of developmental milestones significantly beyond the age of the child, especially true for toilet training expectations
- perpetrator’s childhood = approximately 80% of offenders were themselves abused as children
- substance abuse = children in alcohol-abusing families are nearly 4 times more likely to be mistreated, almost 5 times more likely to be physically neglected and 10 times more likely to be emotionally neglected than children in non-alcohol-abusing families
- family support systems = other factors include the disintegration of the nuclear family and violence between other family members and the loss of child rearing support from the extending family members
- children at higher risk for abuse include infants who felt to be “overly fussy” as well as children with congenital anomalies, chronic/recurrent conditions, and chronic diseases, as well as learning disabilities, speech/language disorders, and intellectual disability
- specific “trigger” events that occur just before many fatal parental assaults on infants and young children include an infant’s inconsolable crying, feeding difficulties, a todder’s failed toilet training, and exaggerated parental perceptions of acts of “disobedience” by the child
- parent or caregiver characteristics that may increase child maltreatment include difficulty bonding with their newborn, involvement in criminal activity, and inability to provide quality nurturing their child
- Family income strongly correlates related to incidence rates. Children from families with annual income below $15,000 per year are more than 25 times more likely than children from families with annual income above $30,000 to be harmed or endangered by abuse or neglect. Poverty clearly predisposes to child abuse. However, it must be recognized that all data available can only be based on reported case. It is very likely that trauma exposure exists among other classes as well but those families are often protected by position and wealth and these their cases do not necessarily become part of a community’s child protective services system
- the less support you have and the extra work hours, the increase of stress
- multiple nonbiological, transient caregivers living in the home
- neglect and medical neglect are most often attributed to female caretakers, while sexual abuse is most often associated with male offenders
- young children are at risk = if the child is unwanted, 26% per 1,000 are abused under 1 year old
- adopted and foster children are at high risk (foster system is broken as people take advantage of it to make money)
Toxic stress
- “excessive activation of the stress response systems on a child’s developing brain, as well as the immune system, metabolic regulatory systems, and cardiovascular system”
- no buffering positive support to alleviate/ability to cope
- rug use
- deviant behavior/sexual
- your fight or flight response is always on
- cannot tamp down the response
- experiencing many ACEs, as well as things like racism and community violence, without supportive adults can cause toxic stress
- excessive activation of the stress-response system can lead to long-lasting wear-and-tear on the body and brain
ACE
- ACE = adverse child event
- physical or emotional abuse
- neglect
- caregiver mental illness
- household violence
- person reacts with fight or flight response instead of having executive function to react/process
- long-term effects on ability to cope
- hormonal changes more clearly impact health because of heightened cortisol levels
- dose response relationship
ACE diagram (slide 15)
- positive = brief increases in heart rate, mild elevations in stress hormone levels
- tolerable = serious, temporary stress responses, buffered by supportive relationships
- toxic = prolonged activation of stress response systems in the absence of protective relationships
Long-term health impacts of ACEs
- heart disease
- diabetes
- obesity
- depression
- substance abuse
- smoking
- poor academic achievement
- time out of work
- early death
We can reduce the effects of ACEs and toxic stress
*education
- for those who have experienced ACEs, there are a range of possible responses that can help, including therapeutic sessions with mental health professionals, meditation, physical exercise, spending time in nature, and many others
- the ideal approach, however, is to prevent the need for these responses by reducing the sources of stress in people’s lives (can happen by helping to meet their basic needs or providing other services)
- get kids in environments where they are nurtured and the basic needs are provided
- likewise, fostering strong, responsive relationships between children and their caregivers, and helping children and adults build core life skills, can help to buffer a child from the effects of toxic stress
Dealing with all these terms!
- this is still being researched, so many people use a variety of terms
- ACEs are a kind of trauma
- 10 ACEs have been studied, but not all possible ACEs have been studied
- complex trauma have multiple exposure to traumatic events or to toxic stress = it keeps coming and the body cannot recover to the baseline (always at heightened level)
- working to broaden the definition of trauma to be inclusive
- not only one-time events like sexual assaults OR a hurricane
- complex trauma and toxic stress can sometimes be changed interchangeably
How to break the cycle
Cycle:
- trauma
- changes in development
- functional impacts
- limited access to intervention
- barriers to participation
How to break the cycle:
- provide safety, predictability, and fun
- nurture skill development
- be a positive, caring role model
- provide normal routines
- provide choices
- stress management techniques
- model for family and others in the child’s life
Post traumatic stress disorder (PTSD)
- a complex health condition
- develop in response to a traumatic experience such as a life-threatening or extremely distressing situation that causes a person to feel intense fear, horror or a sense of helplessness
- can cause physical, mental, and emotional problems for a person
- often color it with other illnesses such as depression, panic disorders, obsessive-compulsive behaviors, specific phobias or fears, or substance abuse
Prevalence of PTSD
- can affect anyone regardless of the person’s age, sex, religion, culture or ethnicity
- 5.2 million Americans have PTSD
- 70% of adults have experienced at least one major trauma in their lives, and many of them develop PTSD
- one of 10 women will suffer from PTSD at some time in their lives
- women are about twice as likely as men to develop PTSD (may be due to the fact that women tend to experience interpersonal violence (such as domestic violence, rape, or abuse) more often)
- almost 17% of men and 13% of women have experienced more than 3 traumatic events in their lives
Prevalence in children of PTSD
- a few studies of the general population have been conducted that examine rates of exposure and PTSD in children and adolescents
- 15-43% of girls and 14-43% of boys have experienced at least one traumatic event in their lifetime
- 3-15% of girls and 1-6% of boys could be diagnosed with PTSD
- 90% of sexually abused children
- 77% of children exposed to a school shooting
35% of urban youth exposed to community violence develop PTSD
Identification and symptoms
- PTSD is caused when a person is exposed to a traumatic event
The traumatic experience can cause: - intense feelings of fear
- helplessness
- horror for the person’s life
The experience involved threatened or actual danger of physical harm or death (can happen to): - the person themselves
- someone they love
- even a complete stranger
6 common causes of PTSD: - physical abuse
- sexual abuse
- witnessing/experiencing a serious accident
- witnessing/experiencing a mass disaster
- war
- emotional abuse
- PTSD usually occurs within a couple months after the traumatic event but can even develop years after the event
- PTSD is diagnosed when the event causes the person to relive the experience and interferes with the person’s daily life
3 factors increase a child’s chance of developing PTSD: - severity of the trauma
- parental reaction to it
- physical proximity of the child to the event
