Responses to Trauma Flashcards
What are some physical reactions to trauma?
Muscle tension Headaches Nausea Shakes and tremors Choking sensation Palpitations Dizziness
What are some trauma-related risk factors to mental illness?
Sudden, unexpected events Man-made rather than natural events Prolonged exposure Perceived threat to life Multiple deaths/mutilation Dose response relationship (proximity) Personally relevant factors- child involvement/ identification with the victim or family
What types of traumatic event may cause mental illness?
Rape-associated with highest incidence of PTSD
Combat exposure
Childhood neglect and physical abuse
Sexual abuse
Physical attack-threatened with weapon, kidnapped or held hostage
What happens when the limbic brain judges that neither fight or flight are possible and death or severe injury is inevitable?
It will evoke a freeze response
Describe freeze responses
To distant threat can be voluntary- stop, watch and listen pattern
When inescapable threat
-involuntary state of profound (reversible) motor inhibition
-especially when direct physical contact with predator/aggressor
What happens during a freeze response?
Body goes into shut down Altered state of reality The body becomes immobile Pain sensations are reduced An adaptive and protective last ditch response
What contributes to developing traumatic stress?
When the trauma is overwhelming
When there is a threat to body integrity/safety
When witnessing death/injury to a loved one
When in such situations one experiences intense
fear, helplessness or horror
What are the two types of trauma?
Type 1-simple
Type 2-complex
What are the symptoms of PTSD?
Cognitive disturbances-low self esteem, self blame, hopelessness, pre-occupation with threat
Mood disturbances/emotional dysregulation
Somatisation
Identity disturbance
Chronic interpersonal difficulties
Dissociation
Tension reduction activities
What happens in the resolution of the stress response?
Parasympathetic system kicks in: Muscles relax Skin becomes warm Pupils return to normal Attention can be refocused Heart rate slows Blood pressure is reduced Eat, digest and rest and growth can begin
What does the hippocampus do in the limbic brain?
Locates memories in the right time, place and context
What does the amygdala do in the limbic brain?
Stores emotionally charged memories, and connects to medial prefrontal cortex
What does the medial prefrontal cortex do?
Regulates emotional and fear responses
What is the cognitive model related to PTSD?
Suggests that PTSD arises if the person processes a traumatic event/consequences as if to generate a sense of current threat
Describe trauma memories
Easily triggered Difficult to translate into words Fragmented Affect laden Inability to recall some aspects of the trauma
What are some visual triggers?
Uniforms may be associated with torture
Black bin liners with body bags
What are some auditory triggers?
Christmas carol playing from radio of a car involved in a RTA around Christmas time triggered fireman called to site
What are some smell triggers?
Strong smell of tobacco/alcohol reminding a woman of rape
What are some taste triggers?
Never being able to stomach thin chicken flavoured soup again from a hostage situation
What are some kinaesthetic triggers?
Tensing when required to brake following RTA
Describe flashbacks in PTSD
Like being back in moment with associated sights, sounds, smell, feelings and emotions
Not conscious worries or ruminations
Intrude and engulf
Can last seconds to days
May be triggered by insomnia, tiredness of stress
Describe nightmares in PTSD
Occur commonly
No sense of safety
Sufferers delay going to sleep
Bedroom may be associated with nightmares, so sufferer sleeps on coach leading to poor sleep hygiene
May consist of event or variations
Wake up shouting, screaming and drenched in sweat or hot and trembling
Describe avoidance that occurs in PTSD
Person may refuse to talk about what happened for fear of being overwhelmed or lose control
May avoid people connected to trauma
May avoid place it happened, certain roads, weather or stop driving/working
Describe the increased arousal that occurs in PTSD
Hypervigilance
Sufferers can appear threatening to others
Exaggerated startle response to sounds/personal proximity
Irritability, bursts of anger and aggression
Vulnerability
Inability to sleep, poor concentration and memory
Keeping weapons to safeguard themselves
Describe the emotional numbing that occurs in PTSD
Detached from world
Unable to have loving feelings, feeling removed and alone
Loss of interest in hobbies, family and friends
Inability to look beyond the event or look forward to the future
Sufferer detaches themselves from loved ones
Describe the dissociation that occurs in PTSD
The mind’s way of walling off painful experience
Offers temporary relief
Person may feel like they are observing themselves from above
Or they may feel like it is not really happening
When is dissociation more likely to occur in PTSD?
If trauma is: Severe Prolonged Repeated/horrific/shaming If victim is very young
How may dissociation in PTSD present?
Dissociative flashbacks
Fugue states
Dissociative Identity Disorder
What are some indicators of dissociation?
Things look strange, colours may appear brighter/faded, tunnel vision
Sounds appear muted/far away/louder
Person may be rocking, tapping, twitching or grimacing
Things seem to move in slow motion
Feeling like a robot-functioning but not feeling
Feeling like an observer than participant
Describe re-enactment in PTSD
Recreating trauma
Putting themselves in dangerous situations similar to original event
Other risk taking behaviour
Conceptualised as attempt to master event
What conditions other than PTSD can occur in people post trauma?
Adjustment disorder Depression Anxiety disorder including panic disorder EUPD Dissociative disorder Somatisation Enduring personality change
What is the timeline of traumatic disorders post event
48 Hrs- Acute stress reaction
Up to 4wks- Acute stress disorder
Up to 3 months- Acute PTSD
Over 3 months- Chronic PTSD
What happens in acute stress disorder?
Dissociative symptoms- numbing, depersonalisation/realisation, detachment, amnesia
Persistent re-experiencing-intrusions, nightmares
Increased arousal-anxiety, alertness, poor sleep
How long must acute stress disorder last?
Within 1 month of trauma and lasting at least 2 days
What is the treatment for post trauma sufferers?
Debriefing should not be undertaken
If symptoms mild and present for less than 4 weeks- watchful waiting
Access appropriate support
Remove or manage continuing threat
What are some psychotherapeutic models for post trauma treatment?
Trauma focused CBT Eye Movement Desensitisation and re-programming (EMDR) Prolonged exposure Cognitive Processing Therapy Sensorimotor Therapy
What are some pharmacological treatments for post trauma sufferers?
Antidepressants
Paroxetine licensed for PTSD
Mirtazepine, amitriptyline or phenelzine can be used alternatively
Specialist alternatives- prazosin, atypicals or mood stabilisers
