Trauma And Stress Relsted Disirder Flashcards
What is stress?
The unpleasant emotional experience that is triggered by various stimuli, but specifically when a person perceives demands greater than resources
What are the components of stress?
Physiological, psychological and behavioral components
Illustrate the physiological components of stress
Physiological: increased heart rate, blood pressure, and pulse rate; sweating muscle tension, teeth clenching, shortness of breath ,etc.
Illustrate the psychological component of stress
Anxiety, dysphoria, anger, irritability, inattention, memory loss, reduced confidence, disinterest
Illustrate the behavioral component of stress
Social withdrawal, change in sleep/eating patterns, aggression, conduct disturbance, drug use
What is a stressor?
Events that cause stress
This depends on how a person perceives it and how a person can handle it
Explain the physiological Basis of Stress
-stressors activate the Amygdala(fear center), which stimulates the Hypothalmic-Putuitary-Adrenal (HPA) Axis and cause release of the hormone cortisol and adrenaline
What 2 hormones are responsible for physiological/emotional changes associated with stress and anxiety?
Cortisol and adrenaline
Why are some people more vulnerable to stress than others?
This is due to physiological make up and life experiences
How does therapy attempt to deal with stressors?
The goal of therapy is to assist vulnerable people in becoming more resilient to stressors by increasing their coping skills
List treatment of Stress-Related Proglems
- General Strategies
- Relaxing training
- Cognitive therapy
- Medications
Describe general strategies for treatment of stress related problems
- having knowledge
- being prepared for adversity(having an action plan did stressful situation )
- utilizing social support
Describe the relaxation training as a treatment if stress
PMR, diaphragmatic breathing): Patient is shown how to release muscle tension and slow breathing rate to reduce anxiety
Describe Cognitive therapy as a treatment for stress
Patient learns to have a productive internal dialogue (I.e. to think about things in a more adaptive framework)
Describe medication as a treatment for stress
Benzodiazepines, antidepressants :
Medications help to diminish the acute intense feelings of stress that disrupts problem-solving
Why is stress to some degree useful?
Since stress serves as a motivator ( for flight-fight or prepare )
What is Yerkes-Dodson Law?
Low and high levels of stress are associated with low performance levels
There is an optimal level with medium stress bringing the highest level of performance
What DSM diagnostic categories related to stressors?
- Post-traumatic Stress Disorder
- Acute Stress Disorder
- Adjustment Disorders
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
For these disorders, a judgement is made that the person’s reaction to a stressor is excessive
What does traumatic mean?
Actual or threatened death or series injury or sexual violence
What are the diagnostic criteria of PTSD?
Exposure to a traumatic stressor:
Exposure may include direct experience of event, witnessing event, experiencing repeated exposure to aversive details, or learning about event to close family or friend
Therefore, the 4 types of symptoms MUST develop at any time in the future
What are the 4 types PTSD symptoms?
- Intrusion symptoms
- Avoidance Symotoms
- Negative Alterations in Cognitive and Mood
- Alterations in Arousal and Reactivity
What are the intrusion symptoms of PTSD?
- dreams
- recollections
- feeling event reoccur
- psychological or physiological distress when encounters symbols
What are the avoidance symptoms of PTSD?
Symptoms such as avoidance of thoughts, places, or conversations, that are reminders of event
What are the Negative Alternations in Cognition and Mood symptoms?
Symptoms such as persistent:
- negative beliefs/expectations
- negative emotional states
- inability to experience positive emotion
- diminished interest/ participation in activities
- detachment from others
- dissociative amnesia
Give the Alterations in Arousal and Reactivity symptoms
Symptoms such as
- sleep disturbance
- irritable and angry out bursts
- reckless or self-destructive behavior
- concentration problems
- hyper vigilance
- exaggerated startle response
Describe the duration and onset
Duration: symptoms must last more than one month
Onset: Symptoms usually begin within 3 months of the trauma but can begin ANYTIME in the future
What are the vulnerable populations of PTSD?
Vulnerable Populations: PTSD often occurs in young adults but can happen to anyone at any age.
Orthopedic patients have a high rate of PTSD
What are the diagnostic criteria of Acute Stress Disorder?
- Numerous PTSD-like symptoms develop from the PTSD symptom categories(e.g. intrusive symptoms, avoidance, etc.
- duration of the disorder Is 3 days to 1 month after trauma exposure
Differentiate PTSD and ASD
ASD: symptoms start and resolve within the first 30 days after the trauma
PTSD: Symptoms start anytime after trauma and last more than 30 days
What are 2 ways to treat PTSD and ASD?
- psychotherapy
- Pharmological
How can psychotherapy be used for treatment of PTSD and ASD?
- Psychotherapy in general(e.g. for support)
- Behavioral psychotherapy (e.g., exposure or desensitization techniques to diminish fear response)
Discuss pharmological treatments for PTSD and ASD?
- Benzodiazepines(for short-term response)
- Antidepressants (e,g., SSRIs, TCAs)
What is Adjustment disorder?
Development of significant and disproportional emotional/behavioral symptoms in direct response to an identifiable psychological stressor(e.g. divorce)
- symptoms do not represent normal bereavement.
- Once the stressor or consequences are terminated, the symptoms do not persist for more than 6 months
What causes Adjustment Disorder?
Causation is inferred by acute onset(symptoms develop within 3 months of stressor onset ) and brief duration (symptoms are expected to resolve within a few months after stressor termination is possible)
What are Adjustment subtypes?
- with depressed mood
- with anxiety
- with disturbance of conduct(externalizing behaviors)
- with mixed anxiety and depressed mood
- with mixed substances of emotion and conduct
- unspecified(other maladaptive responses)
What may cause Adjustment Disorder to be undiagnosed?
-If enough symptoms are present following the stressor such that another disorder’s diagnostic criteria are met (e.g. depression), then that other disorder is diagnosed, NOT adjustment disorder
What is the ONLY circumstance when Adjustment disorder diagnosed?
Adjustment disorder only diagnosed if there is a casual stressor AND no other disorder explains the symptoms
How is adjustment disorder be treated?
- psychotherapy (e,g, learning of coping therapies)
- involvement in support groups
Treatment may involve crisis intervention:
- hospitalization
- psychotropic
What is Reactive Attachment Disorder?
Child has a history has a history of extremely insufficient care, causing:
- Inhibited, emotionally withdrawn behavior toward adult caregivers
- Social and emotional disturbance(symptoms emerge before age 5)
- Patterns of extremes of insufficient care
- The criteria are not met for autism spectrum disorder
- The child has a development age of atleast 9 months
Social and emotional disturbance is a symptom of Reactive Attachment Disorder, explain
Social/emotional disturbance such as:
- minimal social/emotional responsiveness to others
- limited positive effect
- Unexplained irritability, sadness, fearfulness during interactions with adult caregivers
Symptoms emerge before age 5
One of the diagnostic criteria of Reactive Attachment Disorder(RAD) is pattern if extremes of insufficient care, explain
Patterns of extremes of insufficient care such as:
- Social neglect or deprivation- persistent lack of having basic emotional needs for comfort, stimulation and affection from caregiving adults
- Repeated changes in primary caregivers(e.g. frequent changes in foster care)
- Rearing in unusual settings that severely limit opportunities to form attachments (e.g. institutions with high child-caregiver ratios)
When does Reactive Attachment Disorder(RAD) become persistent?
Persistent: present for more than 12 months
What is the outcome of a Reactive Attachment Treatment(RAD)?
Variable(death, misconduct, normal)
What is a short-term treatment of Reactive Attachment Disorder(RAD)?
Medical support of any associated physical neglect
What are long therm treatments if Reactive Attachment Disorder (RAD)?
- Psychotherapy
- Parental education, training and support
- Residential treatment programs
- Enriched environment with strict, consistent rules
- Goals are to build self-esteem and empathy
What is Disinhibited Social Engagement Disorder (DSED)?
Child has a history of extremely insufficient care(e,g. Social Neglect, repeated changes in caregivers)
What are the symptoms of Disinhibited Social Engagement Disorder?
- A child approaches and interacts with unfamiliar adults and exhibits disinhibition (e.g. lack of reticence to approach, willing to leave with, overly familiar behavior with strangers j
- A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults atleast 2 of certain circumstances
- the behaviors in criteria A are not limited to impulsitivity (as in ADHD) but include socially Disinhibited behavior
- Extreme patterns in from a certain list of criteria
One symptom of Disinhibited Social Engagement Disorder (DSED) is to actively approach and interact with unfamiliar adults(criteria A), explain
Symptom: (criteria A)a pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least 2 of the following:
- Reduced of absent reticence in approaching and interacting with unfamiliar adults
- Overly familiar verbal or physical behavior(not age appropriate )
- Diminished or absent checking back with adult caregiver after venturing off, even in unfamiliar settings
- Willingness to go off with an unfamiliar adult with minimal or no hesitation
What is the difference of DSED and RAD?
DSED kids can have NORMAL attachment to caregivers- the problem in DSED is unmodulated and indiscriminate social behavior
How can. DSED be treated?
Psychotherapy
What are the adult manifestations of DSED?
Unknown
