Lecture 6

Question 1

Trauma

Answer 1

A deeply distressing disturbance or experience, that now has its mental effects. Can be the event itself or the consequences of the event.

Question 2

Trauma exposure

Answer 2

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).

Question 3

Life-events checklist (LEC-5)

Answer 3

A list of 16 traumatic events to assess exposure to potential trauma.

Question 4

Traumatic events on a global scale

Answer 4

• 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.

Question 5

(Forced) migration

Answer 5

Can cause multiple, prolonged and ongoing (traumatic) stress, also after resettlement.

Question 6

Different types of trauma exposure

Answer 6

1. Type 1: single accident.
2. Type 2: more systematic and frequent types of traumatic events.

Question 7

Polyvictimisation

Answer 7

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.

Question 8

Marginalised identity

Answer 8

An identity that causes, or has historically caused a person to be disproportionally subject to discrimination, harassment or other negative treatment.

Question 9

Intersectionality and trauma

Answer 9

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.

Question 10

Traumatic stress

Answer 10

Umbrella term for people’s reactions to adverse, potentially traumatic events. Can be peri-traumatic of post-traumatic.

Question 11

Peri-traumatic stress

Answer 11

What happens during or immediately after the event (within 6 hours).

Question 12

Post-traumatic stress

Answer 12

What happens in the post-acute phase after the event (after 6 hours).

Question 13

Biological stress response

Answer 13

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.

Question 14

Stress reactions

Answer 14

• 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.

Question 15

Posttraumatic trajectories

Answer 15

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.

Question 16

Trajectories in PTSD

Answer 16

The trajectories in PTSD differ a lot, but all the trajectories go down over time (less symptoms).

Question 17

Oppression as chronic stress

Answer 17

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).

Question 18

Psycho-bio-social model (for PTSD)

Answer 18

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.

Question 19

DSM criteria for PTSD

Answer 19

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

Question 20

Acute stress disorder

Answer 20

High acute stress symptoms that last within 1 month.

Question 21

Predictors for PTSD

Answer 21

• Sociodemographic: indigenous to a country, being female, lower SES
• Pre-trauma: disease history, psychiatric (family) history, childhood trauma
• Post-trauma: any psychological disorder.

Question 22

Cultural competence

Answer 22

The ability to collaborate effectfully with individuals from different cultures. Causes better health outcomes!

Question 23

Ritualised expressions

Answer 23

Expressions that are produced voluntarily.

Question 24

Why disorders are different in different cultures

Answer 24

• 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.

Question 25

Depression

Answer 25

Most diagnosed disorder in the West. Less prevalent in Asian cultures.

Question 26

Anxiety disorder

Answer 26

More prevalent in collectivistic societies, because people are more involved with each other.

Question 27

Schizophrenia

Answer 27

Is diagnoses worldwide, but different types of schizophrenia differ per country

Question 28

Suicide

Answer 28

• Almost never occurs is Islamic cultures.
• Suicide in the West often occurs because of hopelessness due to a disorder.
• In Japan, suicide often occurs to show that you take responsibility and to retain honour.
• The more connections with traditional culture, the lower the suicide rate (own political bodies, cultural facilities etc.)