Trauma Flashcards
Trauma (DSM5)
The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
Trauma (ICD10)
A stressful life event or situation (or either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone
Types of trauma
Type 1 - discrete, time limited single incident
Type 2- repeated, protracted and anticipated interpersonal trauma
Risk of disorder due to trauma
Psychosis Anxiety Personality disorder PTSD Relationship problem Depression Substance misuse Alcohol abuse Sleep problem
Diagnosing PTSD-criteria A
The person was exposed to : death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows (one required)
-direct exposure or witnessing in person
-indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involve actual or threatened death, it must have been violence or accidental
-repeated or extreme indirect exposure to aversive details of the event, usually in the course of professionals duties (ie collecting body parts,repeatedly exposed to details of child abuse)
This does not include indirect nonprofessional exposure through media
Diagnosing PTSD criteria B
The traumatic event is persistently re-experienced in the following way (1 required)
Recurrent, involuntary, and intrusive memories
Traumatic nightmare
Dissociative reaction (flashback) which may occur on a continuum from brief episode to complete loss of consciousness
Intense or prolonged distress after exposure to traumatic reminder
Marked physiologic reactivity after exposure to trauma-related stimuli
Diagnosing PTSD -criteria C
Persistent effortful avoidance of distressing trauma-related stimuli after the event (1required)
Trauma related thoughts or feelings
Trauma-related external reminder (people, place, conversation, object, activity, situation)
Diagnosing PTSD -criteria D
Negative alterations in cognition and mood that began or worsened after the traumatic event (2 required)
Inability to recall key features of traumatic events
Persistent and often distorted negative belief and expectations about oneself or the world (the world is horrible)
Persistent distorted blame of self or others for causing the traumatic event or for resulting consequence
Persistent negative trauma-related emotion (fear, anger, guilt, shame)
Markedly diminished interest in (pre traumatic) significant activities
Feeling alienated from others
Constricted affect; persistent inability to experience positive emotions
Diagnosing PTSD -criteria E
Trauma-related alterations in arousal and reactivity (2 required)
Irritable or aggressive behaviour Self-destructive or reckless behaviour Hypervigiliance Exaggerated startle response Problems in concentration Sleep disturbances
Diagnosing PTSD
Criteria F-G
Criteria F: persistence of symptoms (in criteria B,C,D,E) for more than a month
Criteria G: significant symptom-related distress or functional impairment
Criteria H: disturbance is not due to medication, substance use, or other illness
Measure of PTSD
Trauma screening questionnaire
PTSD diagnostic scale
Post Traumatic Cognition inventory
Impact of event scale
Clinical administered PTSD scale
Dissociative experience scale
Internal shame scale
How common is PTSD
40-56% people will experience at least one traumatic event in their life time
Lifetime prevalence rates for PTSD are 5% men and 10% for women
94% of people would intrusion, nightmare or flashback a week after rape
Rates of current PTSD in individuals with a severe mental illness are approximately 30-50%
Co-morbidity with PTSD
79-88% of people with PTSD comorbid another disorder
Depression Anxiety disorder Psychosis Sleep problem Substance misuse Suicidality or self harm Physical health problem
Course of PTSD after rape
94% at 1 week
65% at 1 month
47% at 3 months
Treating PTSD -NICE guideline
De-briefing should NOT be used
Watchful waiting if trauma within 4 months
Trauma-focused psychological therapy (CBT) should be offered on an individual out patient basis
Trauma-focused therapy should be offered regardless of time lapsed since trauma
Drug treatment should NoT be used as a routine first line treatment
