Externalizing Behaviors: Stress Flashcards
Stress: General (3)
- A mentally or emotionally disruptive or upsetting condition occurring in response to adverse external influences
- A state of extreme difficulty, pressure, or strain
Definition:
- Stress is a function of three elements:
i. Demand of the situation as they present themselves
ii. Reaction of the person and how they relate to the situation
iii. Individual’s ability to cope with the challenge and adapt to the situation
Common childhood stressors (6)
- School stressors
a. Grades, being a “failure”, disappointing teachers - Parent/family stressors
a. Disappointing family, anxiety over parental worries (finances, etc.) - Sibling stressors
- Interpersonal stressors
a. Being liked/fitting in, problems with friends - Personal stressors
a. Looks/appearance, being overweight, desire to excel at activities - Environmental stressors
a. Disturbing media reports, unsafe neighborhoods
i. Ex: nuclear war
Susceptibility to stress (4)
- Gender: No gender difference in terms of social adequacy, academics, economics
* Girls are more worried about family, personal appearance, the future, classmates and personal health - Temperament: Easy versus difficult
- Development
- Age: Children in middle/late childhood and early adolescence have greater stress levels
Behavioral symptoms of stress (8)
- Short-term behavioral problems (mood swings, bedwetting, changes in sleep pattern)
- Depression
- Defying authority or bullying other children
- Self-punishment behaviors (i.e. head-banging)
- Changes in academic performance
- Overreactions to minor problems or hysterical behavior
- Emotional eating
- Low self-esteem
Manifestations of Stress: Somatic Symptoms (6)
- Chronic, recurrent abdominal pain
- Tension-type headaches
- Encopresis
- Nocturnal enuresis
- Recurrent backaches or neck pain
- Increased risk of contracting common illnesses
Consequences of Chronic Stress and Poor Coping: Physical Effects (2)
- Increased risk for immunological deficits
2. Increased problems with chronic and recurrent pain
Consequences of Chronic Stress and Poor Coping: Mental Effects (4)
- Increased risk of developing behavior problems
- Higher risk of psychological pathology in late adolescence/ adulthood
- More adjustment problems
- Decreased ability to concentrate in school
Toxic Stress (3)
- Frequent activation of stress without the buffering protection of an adult
a. Child abuse
b. Maternal or paternal depression
c. Parental drug use - MRI showed changes in brain architecture that occurred in impoverished children with depression but not those without impoverishment
- Chronically elevated glucocorticoid levels
a. May help explain difficult to treat asthma and URI
b. Leads to hypertension, hyperglycemia and obesity in adolescents
Overcoming stress (2)
- Whitehall study demonstrated that low social class contributed in poor health outcomes and was not mitigated if you were wealthy as an adult
- Studies suggest that need to intervene before age 3 year or even in utero to prevent brain changes
Trauma and Stressor-Related Disorders (5)
DSM-5 brings together anxiety disorders that are preceded by a distressing or traumatic event
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder (new)
- PTSD (includes PTSD for children 6 years and younger)
- Acute Stress Disorder
- Adjustment Disorders
PTSD Symptoms in Children (5)
- Re-experience trauma via play
- Loss of recent acquired developmental growth
- Believe future is limited
- Omen formation - predict events
- Separation Issues, anxiety, fearfulness
PTSD Prevalence (4)
- Afflicts 7.8% of overall population
- Affects about 7.7 million American adults
- Can occur at any age, including childhood
- Previously thought more common in women
DSM V Criteria for Post Traumatic Stress Disorder (>6 years): Definition of traumatic events (5)
- Serious threat to integrity and/or life
- Serious injury - self / others
- Sudden loss
- Physical / Sexual violence/abuse
- Disasters
DSM V Criteria for Post Traumatic Stress Disorder (>6 years)
- Exposed to an actual or threatened death, serious injury or sexual violence
a. The person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of others.
b. Learning that a traumatic event occurred to a close family member or friend that even must be accidental or violent
c. Experiencing repeated or extreme exposure to aversive details of traumatic event - Presents of one or more of the following intrusions symptoms associated with the traumatic event.
a. Traumatic event is persistently re-experienced in one (or more) of the following:
i. Recurrent and intrusive distressing memories of the event, including images, thoughts or perceptions
ii. Recurrent distressing dreams of the event
iii. Dissociative reactions (flashbacks)
iv. Intense or prolonged psychological distress at exposure to internal or external cues
v. Marked physiological reactions - Persistent avoidance of stimuli associated with traumatic events
a. Avoidance of or efforts to avoid distressing memories, thoughts, or feeling about traumatic event
b. Avoidance of or effort to avoid external reminders associated with event - Negative alterations in cognition and mood associated with the traumatic event or worse after the traumatic event
a. Inability to remember an important aspect of the traumatic event.
b. Persistent and exaggerated negative beliefs - Marked alterations in arousal or reactivity associated with traumatic event
a. Irritable behavior and angry outburst
b. Hypervigilance
c. Reckless or self destructive behavior
d. Exaggerated startle response
e. Problems with concentration
f. Sleep disturbance
PTSD Treatment (5)
- Psychotherapy with focus on mastery
- Psychotherapy with focus on control
- Play Therapy
- Family Therapy
- Medications
a. NONE approved for use
b. Beta Blockers
c. SSRIs
Trauma and Stressor-Related Disorders: Acute Stress Disorder (4)
- Stressor criterion in DSM -5
- Criterion requires being explicit whether qualifying traumatic events were experienced directly, witnessed, or experienced indirectly.
- DSM-IV Criterion A2 regarding reaction to the event- “the person’s response involved intense fear, helplessness, or horror” – has been eliminated
- Persistently re-experiencing the event in at least one of the following ways:
i. Recurrent images, thoughts, dreams,
ii. Illusions, flashback episodes
iii. Sense of reliving the experience; or distress on exposure to reminders of the traumatic event
Trauma and Stressor-Related Disorders: Adjustment Disorders (2)
- Adjustment Disorders are redefined as an array of stress-response syndromes occurring after exposure to a distressing event.
- Adjustment Disorder subtypes are unchanged
i. With depressed mood
ii. With anxiety
iii. With disturbance of conduct
Trauma and Stressor-Related Disorders: Changes in PTSD Criteria (5)
Four symptom clusters
1. Re-experiencing
- Avoidance
- Persistent negative alterations in mood and cognition
- Arousal: describes behavioral symptoms
- DSM-5 more clearly defines what constitutes a traumatic event
a. Sexual assault is specifically included
b. Recurring exposure, that could apply to first responders
Acute Stress Disorder Marked symptoms of anxiety or increased arousal (6)
- Difficulty sleeping
- Irritability
- Poor concentration
- Hypervigilance
- Exaggerated startle response
- Motor restlessness
Acute Stress Disorder Time (3)
i. A minimum of 2 days
ii. A maximum of 4 weeks
iii. Occurs within 4 weeks of the traumatic event.
Response to trauma: bodily function: sleep (Central Cause and Symptoms)
Central Cause: stimulation of reticular activating system
Symptoms: difficulty falling asleep and staying asleep; nightmares
Response to trauma: bodily function: eating (Central Cause and Symptoms)
Central Cause: inhibition of satiety center, anxiety
Symptoms: rapid eating, lack of satiety, food hoarding, loss of appetite
Response to trauma: bodily function: toileting (Central Cause and Symptoms)
Central Cause: increased sympathetic tone, increased catecholamines
Symptoms: constipation, encopresis, enuresis, regression of toileting skills
Dissociation: more common with (4), response (4), misidentification and/or comorbid with (3)
More common with:
- Females
- Young children
- Ongoing trauma/pain
- Inability to defend self
Response:
- Detachment
- Numbing
- Compliance
- Fantasy
Misidentification and/or comorbid with:
- Depression
- ADHD inattentive
- Developmental delay
Arousal: more common with (4), response (4), misidentification and/or comorbid with (5)
More common with:
- Males
- Older children
- Witness to violence
- Inability to fight or flee
Response:
- Hypervigilance
- Agression
- Anxiety
- Exaggerated response
Misidentification and/or comorbid with:
- ADHD
- ODD
- Conduct disorder
- Bipolar disorder
- Anger management difficulty
Infant Response to Trauma: Impact on Working Memory, Impact on Inhibitory Control Impact on cognitive Flexibility
Impact on Working Memory:
-Difficulty acquiring developmental milestones
Impact on Inhibitory Control:
-Severe temper tantrums, fights with older children, attachment may be affected
Impact on cognitive Flexibility:
-Easily frustrated
School-Aged Response to Trauma: Impact on Working Memory, Impact on Inhibitory Control Impact on cognitive Flexibility
Impact on Working Memory:
-Difficulty with school skills, loss of details can lead to confabulations seen as lying
Impact on Inhibitory Control:
-Frequent trouble in school fighting with classmates
Impact on cognitive Flexibility:
-Organizational difficulties; looks like ADHD
Adolescent Response to Trauma: Impact on Working Memory, Impact on Inhibitory Control Impact on cognitive Flexibility
Impact on Working Memory:
-Trouble keeping school work and home work organized; confabulation issues; academic difficulties
Impact on Inhibitory Control:
-Impulsive actions threaten health; leads to problem with legal officials
Impact on cognitive Flexibility:
-Difficulty with tasks of young adulthood
