Trauma Flashcards
TRAUMA AND STRESSOR RELATED DISORDERS
Reactive attachment disorder
Disinhibited social engagement disorder
Post-traumatic stress disorder
Acute stress disorder
Adjustment disorders
The absence of adequate caregiving during childhood
A diagnostic requirement of reactive attachment disorder and disinhibited social engagement disorder.
Social neglect
Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregiver manifested by child rarely seeking comfort when distressed or rarely responding to comfort when distressed
Reactive attachment disorder
RAD requires persistent social and emotional disturbance characterized by at least two of the following:
Minimal social and emotional responsiveness to others
Limited positive affect
Episodes of unexplained irritability, sadness, or fearfulness even during nonthreatening interactions with adult caregivers
With RAD diagnosis, a Child has experienced a pattern of extremes of insufficient care as evidenced by:
Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiver adults
Repeated changes of primary caregivers (e.g. – foster care)
Rearing in unusual settings that limit opportunities for selective attachments (institutions with high child to caregiver ratios)
When is disturbance of RAD noted/evident?
Before 5 years of age
For the dx of RAD, the child must have a developmental age of at least
9 months old
The prevalence of RAD is…
Unknown and uncommon (less than 10%)
A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits two of the following:
— Reduced/absent reticence in approaching or interacting with unfamiliar adults
— Overly familiar verbal or physical behavior (not within culturally or age appropriate bounds)
— Diminished or absent checking back with adult after venturing away, even in unfamiliar settings
— Willingness to go off with an unfamiliar adult with minimal or no hesitation
DISINHIBITED SOCIAL ENGAGEMENT DISORDER
The behaviors of DISINHIBITED SOCIAL ENGAGEMENT DISORDER are not limited to impulsivity but include
socially disinhibited behavior
DISINHIBITED SOCIAL ENGAGEMENT DISORDER —
A child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
Child has a developmental age of at least 9 months
Social neglect or deprivation in form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiver adults
Repeated changes of primary caregivers
Rearing in unusual settings (granted this care is presumed to be responsible for the disturbed behavior)
Prevalence of DISINHIBITED SOCIAL ENGAGEMENT DISORDER
Unknown; in high risk populations (i.e.-foster care or raised in institutions), only in 20% of children and rarely seen in other clinical settings
Risks of DISINHIBITED SOCIAL ENGAGEMENT DISORDER
Environmental and functional consequences
Environmental risks of DISINHIBITED SOCIAL ENGAGEMENT DISORDER
the disorder persists even in children whose caregiving environment becomes improved
Functional consequences of DISINHIBITED SOCIAL ENGAGEMENT DISORDER
impairs ability to relate interpersonally to adults and peers
DIAGNOSTIC CRITERIA (adults, adolescents, and children older than 6) involves exposure to actual or threatened death, serious injury, or sexual violence in 1 or more way
PTSD
Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the event evidenced by 2 or more:
Inability to remember an important aspect of the traumatic event (typically due to dissociative amnesia and not other factors such as head injury, alcohol, or drugs)
Persistent and exaggerated negative beliefs or expectations of oneself
Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead to the blame of self or others
Diminished interest or participation in significant activities
Persistent inability to experience positive emotions (happiness, satisfaction, love feelings)
Alterations in arousal and reactivity associated with the traumatic event beginning or worsening as evidenced by 2 after the event
Irritable behavior and angry outbursts with little or no provocation (physical aggression towards people or objects)
Reckless or self-destructive behavior
Hypervigilance
Exaggerated startle response
Problems with concentration
Sleep disturbance\
Prevalence of PTSD
Higher among veterans and others whose vocation increases the risk of traumatic exposure (police, firefighters, emergency medical personnel)
Highest rates found among survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide
Development and course of PTSD
can occur at any age after the first year of life; duration of symptoms varies but a complete recovery can be made in 3 months; for older adults, declining health, worsening cognitive functioning, and social isolation may exacerbate PTSD symptoms
childhood emotional problems by age 6
Temperamental PRE-TRAUMATIC FACTORS
lower SES (socioeconomic status); lower education; exposure to prior trauma; childhood adversity; cultural characteristics; lower intelligence; minority racial/ethnic status; and a family psychiatric history
Environmental PRE-TRAUMATIC FACTORS
female gender and younger age at the time of trauma exposure
Genetic and physiological PRE-TRAUMATIC FACTORS
severity (dose) of the trauma(greater the magnitude of trauma, greater the likelihood of PTSD), perceived life threat, personal injury, interpersonal violence
Environmental PERITRAUMATIC FACTORS
severity (dose) of the trauma(greater the magnitude of trauma, greater the likelihood of PTSD), perceived life threat, personal injury, interpersonal violence
PERITRAUMATIC FACTORS for military personnel
negative appraisals, inappropriate coping strategies, and development of acute stress disorder
Temperamental POSTTRAUMATIC FACTORS
subsequent exposure to repeated upsetting reminders, adverse life events, or financial or other trauma-related losses; social support (family stability) is a protective factor that moderated outcome after trauma
Environmental POSTTRAUMATIC FACTORS
GENDER DIAGNOSTIC ISSUES of PTSD
more prevalent among females than males across the lifespan
Suicide risks for PTSD
increased risk and PTSD is associated with suicidal ideations and suicide attempts
Acute stress disorder involves
Exposure to actual or threatened death, serious injury, or sexual violation in 1 or more way
The disturbance causes clinically significant distress and impairment in social, occupational, or other important areas of functioning
The disturbance is not attributable to the physiological effects of a substance
Exposure to actual or threatened death, serious injury, or sexual violation in 1 or more way for acute stress disorder
Directly experiencing the event
Witnessing in person the event
Learning the event occurred
Experiencing repeated or extreme exposure to aversive details; does not apply to exposure through electronic media, TV, movies, pictures unless exposure is work related
Presence of 9 or more symptoms from the 5 categories for acute stress disorder
Intrusion symptoms
Negative mood
Dissociative symptoms
Avoidance symptoms
Arousal symptoms
Prevalence of acute stress disorder
identified in less than 20% of cases following traumatic event that do not involve interpersonal assault; 13-21% of motor vehicle accidents; 14% of mild traumatic brain injury; 19% of assault; 10% of severe burns; 6-12% of industrial accidents.
High rates 20-50% are reported following interpersonal traumatic events including assault, rape, and witnessing a mass shooting
Development and course of acute stress disorder
cannot be diagnosed until 3 days after a traumatic event
Acute stress disorder risks
Temperamental
Environmental
Genetic and physiological
prior mental disorder, high levels of negative affectivity, greater perceived severity of the traumatic event, and an avoidant coping style
Temperamental risks of acute stress disorder
history of prior trauma; individual must be exposed to a traumatic event
Environmental risks of acute stress disorder
Functional consequences of acute stress disorder
Impaired functioning in social, interpersonal, or occupational domains has been shown across survivors of accidents, assault, and rape who develop acute stress disorder
Generalized withdrawal from many situations that are perceived as potentially threatening (no-show for medical appointments, not driving, absenteeism from work)
