Trauma and Stress Related Disorders Flashcards
What are trauma and stress related disorders?
Reactive attachment disorder
Disinhibited social engagement disorder
Posttraumatic stress disorder
Acute stress disorder
Adjustment disorders
What is social neglect?
The absence of adequate caregiving during childhood.
A diagnostic requirement of reactive attachment disorder and disinhibited social engagement disorder.
What is the diagnostic criteria for reactive attachment disorder?
Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregiver manifested by child rarely seeking comfort when distressed or rarely responding to comfort when distressed
The disturbance is evident before age 5 years
The child has a developmental age of at least 9 months
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
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 (foster care)
- Rearing in unusual settings that limit opportunities for selective attachments (institutions with high child to caregiver ratios)
What is disinhibited social engagement disorder?
A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 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
The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
- 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)
Child has a developmental age of at least 9 months
What is the diagnostic criteria for PTSD?
Adults, adolescents, and children older than 6
Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more way
Presence of 1or more of the intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred:
Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred:
Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the event evidenced by 2 or more:
Alterations in arousal and reactivity associated with the traumatic event beginning or worsening as evidenced by 2 after the event
Duration of disturbance is more than 1 month
Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Disturbance is not attributable to the physiological effects of a substance
Exposure to actual or threatened death, serious injury, or sexual violence in 1 or more way:
- Directly experiencing the traumatic event
- Witnessing in person the event as it occurred to others
- Learning that the traumatic event occurred to close family member or close friend (violent or accidental)
- Experiencing repeated or extreme exposure to aversive details of the traumatic event (1st responders collecting human remains; police exposed details of child abuse)
Presence of 1or more of the intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event
Distressing dreams related to the traumatic event
Dissociative reactions (flashbacks) in which the person feels or acts as if the event is recurring
Intense or prolonged psychological distress at exposure to internal or external cues
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events
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
What is the 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
What is the 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 moths; for older adults, declining health, worsening cognitive functioning, and social isolation may exacerbate PTSD symptoms
What are pre-traumatic factors of PTSD?
Temperamental: childhood emotional problems by age 6
Environmental: lower SES; lower education; exposure to prior trauma; childhood adversity; cultural characteristics; lower intelligence; minority racial/ethnic status; and a family psychiatric history
Genetic and physiological: female gender and younger age at the time of trauma exposure
What are peri-traumatic factors of PTSD?
Environmental: severity (dose) of the trauma(greater the magnitude of trauma, greater the likelihood of PTSD), perceived life threat, personal injury, interpersonal violence
For military personnel: being a perp, witnessing atrocities, or killing the enemy)
What are posttraumatic factors of PTSD?
Temperamental: negative appraisals, inappropriate coping strategies, and development of acute stress disorder
Environmental: 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
What are gender diagnostic issues with PTSD?
more prevalent among females than males across the lifespan
What is the suicide risk with PTSD?
increased risk and PTSD is associated with suicidal ideations and suicide attempts
What is the diagnostic criteria for acute stress disorder?
Exposure to actual or threatened death, serious injury, or sexual violation in 1 or more way
- Directly experiencing the event
- Witnessing in person the event
- Learning t he 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 below
- Intrusion symptoms
- Negative mood
- Dissociative symptoms
- Avoidance symptoms
- Arousal symptoms
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
What is the 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
What is the development and course of acute stress disorder?
cannot be diagnosed until 3 days after a traumatic event
