Trauma and Stressor-related disorders Flashcards
What are individual traumas/stressors?
- abuse
- illness
- victim of crime (robbery, etc.)
What are group traumas/stressors?
- War/terrrorist attack
- natural disaster
- community loss (death of prominent citizen)
What are the characteristics of stress/trauma?
- poor coping
- difficulty managing stress
- emotional difficulties
- difficulty resuming activities of daily life
- other symptoms: anxiety, insomnia, grief
What are psychiatric problems related to trauma/stress?
- adjustment disorder
- depression
- complicated grieving
- acute stress disorder
- posttraumatic stress disorder
- dissociative disorder
a disturbing pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with a traumatic event such as a natural disaster, combat or an assault
PTSD
What occurs when a person is experiencing PTSD?
- Intense memories of the trauma
- Dreams/nightmares
- Flashbacks
- Intense, recurrent, intrusive thoughts
- Emotional numbing
- Increased irritability
- Hyperarousal
What are the three major elements of PTSD?
- Dreams or intrusive, recurrent thoughts of the trauma
- Emotional numbing (feeling detached from others)
- Hyperarousal (being on guard, irritable) symptoms that arise from high levels of anxiety, including insomnia, irritability, anger, outbursts, watchfulness, suspiciousness, and distrustfulness
event that occurred <3 months
acute stress disorders
event occurred >3 months ago
PTSD
- chronic in nature with periods of exacerbation during increased stress
- can lead to other psychiatric disorders such as depression, anxiety, and substance abuse.
PTSD
a group of symptoms, such as stress, feeling sad, or hopeless, and physical symptoms that occur following a stressful life event; the reaction is stronger than would be expected for the event that occurred
adjustment disorder
occur before the age of 5 years in response to the trauma of child abuse or neglect, called grossly pathogenic care. The child shows disturbed, inappropriate social relatedness in most situations.
Reactive attachment disorder (RAD) and Disinhibited social engagement disorder (DSED)
exhibits minimal social and emotional responses to others, lacks a positive affect, and may be sad, irritable, or afraid for no apparent reason
reactive attachment disorder
exhibits unselective socialization, allowing or tolerating social interaction with caregivers and strangers alike. They lack the hesitation in approaching or talking to strangers evident in most children their age
Disinhibited social engagement disorder (DSED)
Risk factors for PTSD
- Directly involved in the traumatic event
- Experiences of physical injury
- Loss of loved one(s)
- Lack of social supports
- Pervious psychiatric history or personality factors
Adolescents suffering from PTSD have increased risk for the following:
Suicide Substance abuse Poor social supports Academic problems Health concerns
What are some PTSD treatment options?
- Psychotherapy (individual or group)
- Medications (antidepressants, anxiolytics, sleep aids)
- Self-help groups
- Exposure therapy
- Relaxation techniques
- Adaptive disclosure
- Cognitive processing therapy
- Mental health promotion
A subconscious defense mechanism used to prevent recognition of a horrific or traumatic event
*** phenomena involves detachment from realit- rather than a loss of reality as in psychosis
dissociation
*This allows the person to forget or remove himself or herself from the painful situation or memory of the situation
dissociation
how is dissociation characterized?
Disruption in integration disorders use dissociation, a defense mechanism, pathologically and involuntarily
What are the types of dissociative disorders?
- Dissociative amnesia
- Dissociative identity disorder (formerly multiple personality disorder):
- Depersonalization/derealization disorder:
The client cannot remember important personal information
Dissociative amnesia
The client displays two or more distinct identities or personalities
Dissociative identity disorder (formerly multiple personality disorder)
The client has a persistent or recurrent feeling of being detached from his or her mental processes or body
Depersonalization/derealization disorder
Dissociative disorder leads to disturbance in the following
*Relationships
*Ability to function (activities of daily living)
*Ability to cope
People with PTSD often experience dissociative symptoms
Treatment options for dissociative disorder
Individual therapy
Group therapy
Focus in therapy is on reassociation
Medications (antidepressants, anxiolytics)
What are the goals of treatment for dissociative disorder?
- Improve quality of life
- Improve functional abilities
- Decrease symptoms
- Can range from passive to angry, frightened, agitated, hostile
- Experience nightmares, flashbacks, intrusive thoughts, hallucinations, self-destructive thoughts, fantasies
- memory gaps; poor decision making
dissociative disorder
What are the outcome goals for dissociative disorder?
- Refer to patient as “survivor” rather than “victim”
- Identification of flashback triggers
- Encourage journaling of feelings
- Utilize distractions and relaxation techniques
Maladaptive or Dysfunctional Personality Traits
Irresponsible, not accountable for own actions Risk-taking, thrill-seeking behaviors Mistrust Exhibitionism Dependency Eccentric perceptions Negative behavior toward others Anger and/or hostility Irritable/labile moods Lack of guilt, remorse or emotionally cold, and uncaring Impulsive, poor judgment
is characterized by a pervasive pattern of depressive cognitions and behaviors
depressive behavior
is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance
passive-aggressive behavior
Temperament (harm avoidance, novelty seeking, reward dependence, persistence)
biologic theories
Character
Self-directedness (responsible, goal oriented)
Cooperativeness (integral part of society)
Self-transcendence (integral part of the universe)
Psychodynamic theories
Treatment for personality disorders?
- psychopharmacology
* group, individual therapies
Cognitive-perceptual distortions;antipsychotics
Affective symptoms and mood dysregulation; mood stabilizers and lithium
Aggression and behavioral dysfunction; anticonvulsants and mood stabilizers
Anxiety;
Psychopharmacology (symptom focused)
Examples of group, individual therapies?
Cognitive-behavioral therapies
Dialectical behavior therapy (borderline personality disorder)
Clinical picture: pervasive mistrust/suspiciousness; use of projection; conflict with authority
Nursing interventions: formal, business-like approach; involvement in plan of care; idea validation before action
paranoid personality disorder
characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings
Schizoid personality disorder:
Clinical picture: social detachment and interpersonal deficits; restricted emotions; intellectual
Affects 5% of the general population and more common in males than females
Odd appearance, and will decline to engage with other people when given an opportunity
Schizoid personality disorder:
Nursing interventions: focus on self-care, social skills, and improved community functioning
Schizoid personality disorder:
characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities
Schizotypal personality disorder:
Clinical picture:
social and interpersonal deficits, odd appearance, inability to respond to normal social cues, behavioral eccentricities
Schizotypal personality disorder:
Nursing interventions:
Focus is for clients to develop self-care and social skills and improved functioning in the community
Self-care, social skills, community functioning
Schizotypal personality disorder:
Odd appearance that causes others to notice them; clothes don’t fit, don’t match, and may be dirty; vague speech; anxiety around other people; remain in parents home well into adulthood
Schizotypal personality disorder:
Is characterized by a pervasive pattern of disregard for and violation of the rights of others, and by the central characteristics of deceit and manipulation
antisocial personality disorder
Assessment: Deceit/manipulation False emotions; no empathy Narrowed view of world Poor judgment; no insight Egocentric, but actually self-shallow and empty Relationships as serving own needs
antisocial personality disorder
is characterized by a pervasive pattern of unstable interpersonal relationships, self-image, and affect as well as marked impulsivity
borderline personality disorder
Unstable interpersonal relationships, self-image, and affect; marked impulsivity
Wide range of behavior, appearance
Dysphoric mood
Polarized extreme thinking (splitting); dissociation
Threats of self-harm
Clients then to use transitional objects
Social isolation
borderline personality disorder
Clinical picture: excessive emotionality and attention seeking; insincerity; center of attention; exaggeration of relationships
Histrionic personality disorder
Nursing interventions: feedback about social interactions; social skills training through role-playing; exploration of strengths, assets
****It may also help to discuss social situations to explore clients perception of others reactions and behavior. Teaching social skills and role-playing those skills in a safe, nonthreatening environment can help clients to gain confidence in their ability to interact socially.
Histrionic personality disorder
Clinical picture: grandiosity; need for admiration; lack of empathy; arrogant or haughty attitude; superior view; fragile, vulnerable self-esteem; ambitious
Narcissistic personality disorder
Nursing interventions: self-awareness skills to avoid anger and frustration; matter-of-fact approach; limit setting
Narcissistic personality disorder
50-75%of people with this are men; lack ability to empathize or sympathize with other; belittle or discredit the feelings of others
Narcissistic personality disorder
Clinical picture:
social discomfort; low self-esteem; hypersensitivity to negative evaluation
These clients are reluctant to do anything they perceived as risky, which for them is almost everything
Avoidant personality disorder
Nursing interventions: self-affirmations; positive self-talk; support and reassurance; reframing/decatastrophizing; social skills training
Avoidant personality disorder
Clinical picture:
need to be taken care of; submissive; clinging
Have tremendous difficulty making decisions
Clients perceive themselves as unable to function outside of a relationship with someone who can tell them what to do
Dependent personality disorder
Nursing interventions:
Clients may need assistance in daily functioning
Expression of feelings; autonomy/self-reliance; cognitive restructuring; problem solving
Dependent personality disorder
Clinical picture:
The demeanor of these clients is formal and serious and they answer questions with precision and much detail
perfectionism; formal, serious; orderliness a priority; problems with decision making, judgments; low self-esteem; harsh self-evaluations
Obsessive personality disorder
Nursing interventions:
Helping clients to accept or to tolerate less-than-perfect work or decisions made on time may alleviate some difficulties at work or home
different perspective view; cognitive restructuring; risk taking
Obsessive personality disorder
Clinical picture:
It occurs more often in people with relatives who have major depressive disorders
pervasive depressive cognitions and behaviors (less severe than major depression); pessimistic, negative thinking; low self-esteem
Depressive personality behavior
Nursing interventions:
safety; involvement in activities; factual feedback
Often seek treatment for their distress
Depressive personality behavior
Clinical picture:
They may appear cooperative, even ingratiating or sullen and withdrawn, depending on the circumstances
Their mood may fluctuate rapidly and erratically
Negative attitude, passive resistance to demands for adequate social and occupational performance; blaming of others
Passive-aggressive personality behavior
Nursing interventions:
Identification and expression of feelings
Passive-aggressive personality behavior
Elders with personality disorders are at increased risk for?
depression, suicide, and dementia
How are personality disorders organized?
Cluster A,B,C
What are the cluster A personality disorders?
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
What are the cluster B personality disorders?
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
What are the cluster C personality disorders?
Avoidant personality disorder
Dependent personality disorder
Obsessive personality disorder
medication for affective aggression
Lithium
Anticonvulsants
Low-dose antipsychotics
medication for predatory (hostility/cruelty)
Antipsychotics
Lithium
medication for emotional lability
Lithium
Carbamazepine (Tegretol)
Antipsychotics
medication for emotional detachment
SSRIs
Atypical antipsychotics
showing little or a slow-to-respond facial expression; few observable facial expressions
blunt affect
displaying a full range of emotional expressions
broad affect
showing no facial expression
flat affect
false sensory perceptions or perceptual experiences that do not really exis
hallucinations
displaying a facial expression that is incongruent with mood or situation; often silly or giddy regardless of circumstance
Inappropriate affect
rapidly changing or fluctuating, such as someone’s mood or emotions
labile
disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts
loose assoications
invented words that have meaning only for the client
neologisms
displaying one type of emotional expression, usually serious or somber
restricted affect
wandering off the topic and never providing the information requested
tangential thinking
What are the cluster A personality disorders?
paranoid, schizoid, Schizotypal
What are the cluster B personality disorders?
antisocial, borderline, histrionic, narcissistic
What are the cluster C personality disorders?
avoidant, dependent, obsessive
