Levture 11 Flashcards
Acute stress disorder
Occurs following trauma in about 10–20% of children
Categorized as trauma/stress related
Shorter duration than ptsd
Can go on to be diagnosed with ptsd up to 80%
1 Month following trauma
DSM-5 Criteria for Acute Stress Disorder
Exposure to actual or threatened death, serious injury, or sexual violation in 1 or more of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to others.
Learning that the event(s) occurred to a close family member or close friend.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse).
Need trauma exposure
(B) Presence of 9 or more of the following symptoms from any of the 5 categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred:
Intrusion Symptoms
Recurrent, involuntary, intrusive distressing memories of the traumatic event(s).
Recurrent distressing dreams with content/effect related to the event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
Intense or prolonged psychological distress or physiological reactions in response to internal/external cues that symbolize resemble the traumatic event(s).
Negative Mood
Persistent inability to experience positive emotions
Dissociative Symptoms
An altered sense of the reality of one’s surroundings or oneself
Inability to remember an important aspect of the traumatic event(s)
Avoidance Symptoms
Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Arousal Symptoms
Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep).
Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Hypervigilance.
Problems with concentration.
Exaggerated startle response.
(D) The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
(C) Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.
(E) The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) and is not better explained by brief psychotic disorder.
Dissociation can be useful- turns into maladaptive
Adjustement disorder
Lifetime prevalence is 11–18%
Acute short term
Experience life change or stressful event-cant deal with it
Event doesn’t classify as z trauma a- moving, lose job
DSM-5 Criteria for Adjustment Disorder
The development of emotional or behavioral symptoms in response to an
identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
These symptoms or behaviors are clinically significant, as evidenced by 1 or both of the following:
Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
Significant impairment in social, occupational, or other important areas of functioning.
The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
The symptoms do not represent normal bereavement.
Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Specify whether:
With depressed mood: Low mood/tearfulness/feelings of hopelessness are predominant.
With anxiety: Nervousness/worry/jitteriness/separation anxiety is predominant.
With mixed anxiety + depressed mood: Combo of depression and anxiety is predominant.
With disturbance of conduct: Disturbance of conduct is predominant.
With mixed disturbance of emotions + conduct: Emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
Unspecified: Maladaptive reactions that are not classifiable as 1 of the specific subtypes
PTSD
Symptoms can occur in anyone after trauma
Ptsd- persistent and causes impaired functioning
Don’t have to directly experience-can hear or witness
Includes symptoms in the following 4 core features:
PTSD symptoms usually begin within the first 3 months following the trauma
DSM-5 Criteria for Post-Traumatic Stress Disorder
Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it happened to others.
Learning that the event(s) happened to a close relative or close friend.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Presence of 1 or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Recurrent, involuntary and intrusive distressing memories of the traumatic event(s).
Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
4 core features- receive unique criteria
Needs 1 of each grouping
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by 1 or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 or more of the following:
Inability to remember an important aspect of the traumatic event(s)
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g. “I am bad,” “No one can be trusted,” ”The world is completely dangerous; “My whole nervous system is permanently ruined”).
Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 or more of the following:
Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
Reckless or self-destructive behavior.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Specify if: With Dissociative Symptoms: The individual’s symptoms meet the criteria for PTSD, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes of body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant or distorted).
Specify if: With Delayed Expression: If the diagnostic threshold is not exceeded until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance
(e.g., medication, alcohol) or another medical condition.
PTSD in Young Children
Some symptoms of PTSD can be expressed differently in children:
Nightmares instead of waking flashbacks
Daytime recall expressed through repetitive drawing and play focused on trauma-related themes
Regressive behavior, antisocial or aggressive behavior, and destructive behavior
Adapted for those 6 and under
Use play re-enactment
Experience avoidance
DSM-5 Criteria for PTSD for Children 6 and Under
In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence in 1 or more of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to other, especially primary caregivers.
Learning that the traumatic event(s) occurred to a parent or caregiving figure.
Presence of 1 or more of the following intrusive symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be experienced as play reenactment.
Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: It may not be possible to ascertain that the frightening content is related to the traumatic event(s).
Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Such trauma-specific reenactment may occur in play.
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Marked physiological reactions to reminders of the traumatic event(s).
1 or more of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):
Persistent Avoidance of Stimuli
Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of the traumatic event(s).
Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event(s).
Negative Alterations in Cognitions
Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
Markedly diminished interest or participation in significant activities, including constriction of play.
Socially withdrawn behavior.
Persistent reduction in expression of positive emotions.
Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 or more of the following:
Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects (including extreme temper tantrums).
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
The duration of the disturbance is more than 1 month.
The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or with school behavior.
The disturbance is not attributable to the physiological effects of a substance
(e.g., medication or alcohol) or another medical condition.
Specify if: With dissociative symptoms: The individual’s symptoms meet the criteria for post-traumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following:
Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts) or another medical condition (e.g., complex partial seizures).
Specify if: With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Prevalence of PTSD
Prevalence: 3.7% for boys, 6.3% for girls ages 12 to 17 years
75% of youth with PTSD have a comorbid diagnosis:
depression and/or substance abuse
Women have higher rates of ptsd than males
Course of ptsd
In general, there are declines in PTSD prevalence and symptom severity over the first 3 to 6 months
After 6 months there is less marked
improvement
Timing of childhood trauma is important
Severity and earlier age at trauma= most likely to develop ptsd and. Is more severe
Brain development during trauma
Associated problems
PTSD can become a chronic psychiatric disorder, persisting for decades and in some cases for a lifetime
Cycle-of-violence hypothesis
Social earning approach
See violent behaviour across generations
Abused as child often go on to abuse others as adult forms understanding of self and others at youn age= maladaptive view of self and others
Trauma PTSD may in some cases co-occur with or lead to other challenges:
Mood and affect disturbances
Sexual adjustment
Unhealthy relationships
Mood and affect disturbance
Symptoms of depression, emotional distress, and suicidal ideation are common
Teens with a history of maltreatment have a higher risk of substance abuse
Childhood sexual abuse is associated with elevated risk for eating disorders (e.g., anorexia nervosa, bulimia nervosa)
Dissociation
Sexual Adjustment
Traumatic sexualization
35% of preschoolers who have been sexually abused show age-inappropriate sexual behaviors
Sexual behavior as a “means to an end”:
May attempt to sexualize other
interpersonal relationships
Sexual behavior as a source of fear, guilt, disgust, shame, and confusion:
Distorted views about the body
Low sexual arousal, intrusive flashbacks
Unhealthy relationships
Severe and wide-ranging problems with interpersonal adjustment
Misread intentions of peers/teachers as more hostile than they actually are
Less skill in recognizing or responding to distress in others
When combined with a history of family violence, dating violence in adolescence is a strong predictor of intimate violence during early adulthood and marriage
Adolescence may be an “initiation period” for violent dynamics in intimate partnerships
Long-Term Criminal Consequences of Child Maltreatment
Experienced child maltreatment
27% arrested as juveniles
42% arrest records as adults
2x greater odds of arrest for a sex crime
No maltreatment
17% arrested as juveniles
33% arrest records as adults
Experienced child abuse/ neglect before age 12
