Lecture 6 Flashcards
Trauma
A deeply distressing disturbance or experience, that now has its mental effects. Can be the event itself or the consequences of the event.
Trauma exposure
Exposure to actual or threatened death, serious injury of sexual violence. Can be direct (to you or an important other) or indirect (witnessing or repeated confrontation to details of the event).
Life-events checklist (LEC-5)
A list of 16 traumatic events to assess exposure to potential trauma.
Traumatic events on a global scale
- 70% of the people experience 1 or more traumatic events.
- 30% of these people experience 3 or more traumatic events.
- Most often reported is ‘other trauma’
- Second most reported is ‘accident/injuries’
- There are different predictors for TE exposure (gender, age, being married, educational years, being a student, prior trauma)
- Successful recovery from trauma is an important predictor for later treatment success.
- There are large cultural differences on people’s willingness to disclose and labelling.
(Forced) migration
Can cause multiple, prolonged and ongoing (traumatic) stress, also after resettlement.
Different types of trauma exposure
- Type 1: single accident.
- Type 2: more systematic and frequent types of traumatic events.
Polyvictimisation
Exposure to multiple, adverse (potentially traumatic) events is common, but in some groups more than in others:
- Higher in people who experiences childhood adversities. These people have a risk of 40% of polyvictimisation.
- Sexual revictimisation happens in 50% op people.
- Intersectionallity: if you are multiple-marginalised, this increases your chance of polyvictimisation.
Marginalised identity
An identity that causes, or has historically caused a person to be disproportionally subject to discrimination, harassment or other negative treatment.
Intersectionality and trauma
Trauma does not occur in a vacuum: it occurs in the personal, social and often political context of the person and their intersecting identities (ethnicity, class, body size, religion, language etc.). A certain set of marginalised identities gives you a higher chance of being exposed to trauma.
Traumatic stress
Umbrella term for people’s reactions to adverse, potentially traumatic events. Can be peri-traumatic of post-traumatic.
Peri-traumatic stress
What happens during or immediately after the event (within 6 hours).
Post-traumatic stress
What happens in the post-acute phase after the event (after 6 hours).
Biological stress response
There are 2 systems to activate the fight-or-flight response:
1. SAM: fast system, activated within seconds. Stimulates the adrenal glands to produce adrenaline.
2. HPA: slower system, activated after minutes. Stimulates the production of cortisol to suppress the immune system and prolong the stress response. Restabalises itself after a certain time.
Stress reactions
- Recurrent images
- Avoiding reminders
- Heightened emotional state
- Numbness
- Watchfulness
- Irritability
- Anger
These symptoms are often very prevalent within the first month, and stay in 20% of the people. In some they develop into PTSD.
Posttraumatic trajectories
There are different ways in which people respond to traumatic events:
- Resilience: modal stress response, minimal symptoms and stays the same. Most common.
- Chronic: high symptoms and no natural recovery.
- Recovery: stress response at first, but then recovery.
- Delayed: no stress response at first, but later on.
Trajectories in PTSD
The trajectories in PTSD differ a lot, but all the trajectories go down over time (less symptoms).
Oppression as chronic stress
Oppression is any type of systemic/prolonged discrimination, that is specifically directed towards individuals with marginalised identities. This is considered to be a chronic stressor and can alter the neurobiological systems for fear responsivity, prolong the stress response and cause vulnerability in responding to subsequent adversity. It can also cause barriers to access health care (direct of indirect).
Psycho-bio-social model (for PTSD)
Personal, social and cultural factors influence your:
- Defense
- Coping
- Social support
This influences the way you deal with trauma exposure:
Trauma –> negative appraisals –> emotional and neuroendocrine response –> PTSD.
DSM criteria for PTSD
A. Traumatic event
B. Re-experiencing
C. Avoidance
D. Negative mood and cognition alterations
E. Arousal and reactivity alterations
F. Symptoms last more than 1 month
G. Social and occupation impairment
H. Not better explained by something else
Acute stress disorder
High acute stress symptoms that last within 1 month.
Predictors for PTSD
- Sociodemographic: indigenous to a country, being female, lower SES
- Pre-trauma: disease history, psychiatric (family) history, childhood trauma
- Post-trauma: any psychological disorder.
Cultural competence
The ability to collaborate effectfully with individuals from different cultures. Causes better health outcomes!
Ritualised expressions
Expressions that are produced voluntarily.
Why disorders are different in different cultures
- There are differences in the social stigma associated with having mental problems. Therefore a disorder can be experienced the same way, but not expressed the same way.
- The symptoms of depression may be experiences the same in different cultures, but more attention can be paid to certain symptoms.
- The symptoms of depression can be experienced differently.
