Trauma Flashcards
Trauma may result from witnessed events resulting in emotional or psychological impact, such as _____.
witnessing abuse
Psychological trauma may result from experiencing physical trauma, such as ______ (2).
- Traumatic brain injury
- Vehicle accidents
Psychological trauma may result from a single episode or be continuous and complex, for example _____ (2).
- Refugees
- Lengthy hospitalization
Examples of global traumatic events (6)
- War
- Economic upheaval
- Mass murder
- Natural disaster
- Epidemics
- Assassination
Health effects of adverse childhood experiences (4)
- Obesity
- Early onset smoking→COPD
- IV drug use
- Suicide attempts
List the trauma and stressor Related Disorders (5)
- Acute Stress
- Adjustment
- Disinhibited Social Engagement
- Posttraumatic Stress
- Reactive Attachment
Reactive attachment disorder: diagnostic criteria symptom clusters (3)
(“Sullen Girl”)
- Consistent pattern of inhibited, emotionally withdrawn Behavior toward adult caregivers (x2)
- Social and emotional disturbance (x2)
- Extremes of insufficient care (x1)
Criteria for reactive attachment disorder: requires both of these _____.
Child rarely or minimally seeks or responds to comfort when distressed
Children with reactive attachment disorder must have two of these persistant social and emotional disturbances (3)
- Minimal social and emotional responsiveness others
- Limited positive affect
- Episodes of unexplained irritability, sadness or fearfulness in non-threatening interactions with adult caregivers
Children with reactive attachment disorder will experience at least one of the following patterns of extremes of insufficient care (3):
- Lack of having basic emotional needs for comfort, simulation and affection met by adult caregivers
- Repeated changes of primary caregivers (foster kids or lots of Nannies)
- Rearing in unusual settings that severely limit opportunities to form selective attachments
Reactive attachment disorder signs are evident between the age of _____ & _____.
- 9 months
- 5 years old
(10% of severely neglected children)
Reactive attachment disorder treatment (4)
- Medical & psychiatric Care
- Parent education/adequate caretaking
- Parents psychiatric treatment
- Legal intervention
What is a major difference between Disinhibited Social Engagement Disorder and Reactive Attachment disorder?
- Disinhibited Social Engagement Disorder: Child approaches and interacts with unfamiliar adults
- Reactive Attachment Disorder: Child is unable to seek or respond to comfort of caregivers
(Both must be at least 9 months (developmentally) and have an extreme of insufficient care)
Disinhibited Social Engagement Disorder: pattern of behavior in which the child actively approaches and interacts with unfamiliar adults will exhibit two of the following 3 behaviors:
- approaches unfamiliar adults without reserve
- overly familiar verbal or physical behavior with unfamiliar adult
- willingness to go with unfamiliar adults or wander off w/out checking back
Disinhibited social engagement disorder is not limited to ______ and reactive attachment disorder must be differentiated from _______.
- impulsivity
- autism
How is the treatment of Disinhibited Social Engagement Disorder different from Reactive Attachment Disorder?
- same as RAD, except w/o legal or medical care
- Psychiatric Care: child & parent
- Parent education
- Adequate caretaking
PTSD: men is usually ______-related; women is usually ______-related.
- combat
- rape or assault
PTSD co-morbid disorders:
- Anxiety
- MDD
- SUD
PTSD crieria: for more than 1 month, the following cluster of symptoms are exhibited (associated w/traumatic event):
- Intrusion sx (x1)
- Avoidance of stimuli (x1)
- Negative alterations in cognition & mood (x2)
- Altered arousal or reactivity (x2)
PTSD may result from exposure to actual or threatened death, serious injury or sexual violence in one or more of the following ways: (4)
- Direct experience
- Repeated exposure to events
- Witnessing event in person
- Learning of event that happened to loved one
List the 5 intrusion sx that may be experienced in PTSD
(dx criteria x1)
- recurrent, involuntary, intrusive memories
- recurrent dreams
- Dissociative flashbacks
- Intense psychological stress when cued
- Physiological reactivity when cued
(cues are external or internal stimuli that resemble an aspect of the traumatic event)
List the 2 examples of persistent avoidance of stimuli associated w/the traumatic event in PTSD.
(dx criteria x1)
- avoid memories, thoughts, feelings associated
- avoid external reminders (people, places, conversations, acvities, objects)
List the 6 alterations in arousal & reactivity sx that may be experienced in PTSD
(dx criteria x2)
- Irritable behavior & angry outbursts (little to no provocation)
- reckless, self-destructive behavior
- hypervigilance
- exaggerated startle response
- difficulty concentrating
- sleep disturbance
List the 7 negative alterations in cognitions & mood sx that may be experienced in PTSD
(dx criteria x2)
- Inability to remember an aspect of the event
- cognitive distortions → self-blame
- exaggerated negative belief or expectation about the world, oneself or others
- negative emotional state
- inabilty to experience positive emotions
- feel detached or estranged from others
- decreased interest or participation in significant activities
PTSD: 1st line trmt
- SSRI & SNRI
- Therapy: group, family, CBT, imaginal
PTSD: 2nd line trmt
- Prazosin (nightmares & hypervigilance)
- BZD
(experimental: stellate ganglion block for military PTSD)
Describe Imaginal Therapy (used to treat PTSD).
- Patient writes a narrative of what happened to them
- Desensitize them gradually by using relaxation techniques before and after reading the narrative
EMDR
Eye movment desensitization & reprocessing
(experimental, but “strongly recommended” per VA & DOD)
Acute Stress Disorder may result from exposure to threat, serious injury or sexual violence in one or more of the following ways: (4)
the same as PTSD; the difference is timeline - this is dx within the 1st month
(direct experience, repeated exposure, learning of a loved one’s trauma, witnessing a traumatic event)
Acute Stress Disorder Dx Criteria: 9 sx from 5 categories. What are the 5 categories?
- intrusion
- negative mood
- dissociation
- avoidance
- arousal
(begins or worsens after the traumatic event occured)
List the 5 intrusion sx that may be experienced in Acute Stress Disorder
(dx criteria 9 of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)
the same intrusion sx as PTSD
(memories, dreams, flashback, psychological distress & physiological rxns to cues)
How are the negative mood sx in Acute Stress Disorder different than those seen in PTSD?
(dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)
- Both have the inability to experience positive emotions, but PTSD also has an exaggerated negative belief or expectation about the world, oneself or others & negative emotional state
2 dissociative sx in Acute Stress Disorder
(dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)
- altered sense of reality of surroundings or self
- inability to remember aspect of event
2 avoidance sx in Acute Stress Disorder
(dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)
Same as PTSD
(avoids memories, thougths, feelings & external reminders that trigger them)
5 arousal sx of Acute Distress Disorder
(dx criteria req. 9 out of the 5 categories: intrusion, negative mood, dissociation, avoidance, and arousal)
- Same as PTSD, but without reckless or self-destructive behavior…
(Irritable behavior and angry outbursts, Hypervigiliance, Exaggerated startle response, Problems w/ concentration & sleep)
In addition to impairment in important areas of a patients life, Acute Distress Disorder also prevents them from _______ (2).
- pursue necessary tasks (i.e. obtaining assistance)
- mobilizing personal resources by telling their support system (family/friends) about it
Acute Stress Disorder: causes (5)
- Assault, rape, witnessing mass shooting (50%)
- MVA (20%)
- Assault (20%)
- TBI (14%)
- Industrial accident (12%)
- Severe burns (10%)
(less than 20% if event is not involving physical assault)
Acute Stress Disorder: Treatment (2)
- Relxation training
- BZD (short-course)
(beta-blockers may help)
___% of Acute Stress Disorder Cases progress to PTSD
80%
