Trauma, Stress-Related, and Dissociated Disorders Flashcards
what is a trauma?
events in life- extraordinary intensity or severity beyond stress of everyday life- person perceives as harmful or life threatening- causes severe emotional shock and may have long lasting psychological effects
what is a trauma brain?
traumatized brain perceives presence of danger almost everywhere
what is the thinking brain?
prefrontal cortex- personality, decisions, memory, information processing- translator of emotion- should control amygdala
what is the survival brain?
amygdala- midbrain, brain stem, and limbic system- our autopilot- breathe, heartbeat, digest food, and fight-flight-freeze-faster
what happens to the amygdala when trauma occurs?
it hyperactives it
what is the mediator of the brain?
thalamus- receives all sensory information (sights, sounds, smells, tastes, touch)- relays to both thinking and survival brain
what are example of trauma disorders?
posttraumatic stress disorder
attachment disorders
acute stress disorder
adjustment disorder
what are examples of attachment disorders?
reactive attachment disorder
disinhibited social engagement disorder
what is PTSD?
exposure to actual or threatened death, serious injury, or sexual violence- person responded with intense fear, helplessness, or horror
what can be brought on by indirect exposure?
loved ones or friends experience the trauma
EMS/police/ED nurses
what is a flashback?
feels or acts as if event recurring- physical sensations of terror
what happens when a person with PTSD persistently avoids stimuli associated with trauma?
avoid distressing memories, thoughts, feelings
avoid external reminders- peoples, places, conversations, activities, objects, situtations
what are the cognition issues with people with PTSD?
inability to recall aspects of trauma
negative beliefs of self, others, and world
blame self or others
fear, horror, anger, guilt, shame
decreased interest in usual activities
feelings of detachments, estrangement from others
restriction in feelings- can’t feel happiness, satisfcation, love
what are the arousal and reactivity issues with people with PTSD?
hypervigilance and exaggerated startle response
persistent high levels of anxiety or arousal
irritable/angry outbursts
trouble concentrating
sleep issues
guilt common
what are other signs and symptoms of PTSD?
may have dissociate symptoms
generalized numbing- feeling detached from others, empty inside
significant distress or impairment in functioning, trust a common issue; sense of foreshortened future
often present for care of somatic symptoms
what are the comorbidities of PTSD?
depression
substance abuse
anger
aggressive behavior
relationship problems
what is dependent on the severity of the PTSD?
the duration of the trauma, the knowledge/readiness to experience the trauma, and the place the trauma happened
what is the experience of PTSD?
severity and duration
extent of preparation
exposure to death; number affected
control over recurrence
location (familiar environment, home, foreign country?
what is the isolation defense mechanisms?
splitting off of emotional components of a thought
may be temporary or long-term
what is the repression defense mechanisms?
involuntary exclusion of a painful or conflictual thought, impulse, or memory from awareness
what is the assessment for PTSD in children?
reduced play
repetitive play- includes aspects of events
social withdrawal
negative emotions- fear, guilt, anger, horror, sadness, shame, confusion
negative thoughts to self- “bad person”
detachment/estrangement from others
irritable, aggressive, self-destructive behavior
sleep disturbance, problems concentrating, hypervigilance
what are the nursing diagnosis for the PTSD in children?
risk for development delay
risk for impaired attachment
what is reactive attachment disorder?
inhibited- emotionally withdrawn behavior
does not seek comfort when distressed abnormally
what is the cause of the attachment disorder?
lack of bonding with primary caregiver by age 8 months
what is the disinhibited social engagement disorder?
remarkably friendly and confident
no normal fear of strangers
no normal boundaries with those not known
unfazed by separation with adult caregivers- attaching to everyone yet not really attaching to anyone
what are the genetic risk factors of PTSD?
prenatal exposure to maternal stress
altered DNA in brain- methylation-control production of stress hormone-prevents brain from governing response to stress
protective= parental nurturing
absence of nurturing= increased high risk behaviors as teens
what are the neurobiological risk factors of PTSD in childhood?
< age 5
trauma disrupts integration of neuronal networks in limbic system
brain will dissociate- disconnection of thoughts, emotions, sensations, and behaviors- connected with the memory
what are the psychological factors in childhood PTSD?
attachment theory- early relationship infant- caretaker
schemas- formed early
what are the environmental risk factors of childhood PTSD?
neuroplasticity- experiences reorganize neural pathways
parent models behaviors
cushion effect- family stability
what are adverse childhood experiences/ “The ACE effect”?
changes in neuruobiological, epigenetic, and adaptive stress hormone responses in developing brain
allostatic overload of nervous system= exaggerated inflammatory respoonses
what happens if the score is greater than four the for the ACE effect?
increases the likelihood of developing:
tobacco abuse/substance abuse & addiction
obseity
sedentary lifestyle
depression
suicide attempts
multiple sex partners/STI
what are the comorbidities associated with adverse childhood experiences?
anxiety
depression
suicidal ideation
PTSD
independent risk factor for cardiovascular disease
delayed development
what are the PTSD treatment in children?
stable/stabilization- safe predictable environment with structure and detailed schedule
reduce arousal and regulate emotions
developmental skill catch up- teach coping skills to deal with trauma
widen the “Window of tolerance”- balancing arousal-help to self regulate
if possible, involve the family
improve relationships and connections with others
therapies used: CBT and EMDR- family, group, play, therapeutic gaming, therapeutic drawing, mindfulness
medications: no FDA approved- SSRI may help
what are the goals of therapy for treating PTSD?
manage anxiety
increase self-esteem
improve ability to cope
what are the PTSD treatment in adults?
CBT/group/self-help
exposure therapy- stop avoidance behavior- regain control
establish a therapeutic relationship- nonjudgmental acceptance and empathy, assist in managing arousal- safe predictable environment, and gently express that person is not responsible for what happened
what are some medications for the treatment of adulthood PTSD?
SSRIs- may help with anxiety and depression
symptoms
clonidine (catapres)- address hyperarousal and intrusive symptoms
prazosin (minipress)- used for nightmares and sleep disturbances
propranolol (indarel)- hyperarousal and panic
new trial- MDMA- ectasy
what is bilateral stimulation?
used of visual, auditory or tactile external stimuli occurring in a rhythmic side-to-side pattern
e.g. tapping, drawing, butterfly hug, and EMDR
what does EMDR stand for?
eye movement desensitization and reprocessing
what is EMDR?
psychotherapy for PTSD/ASD
eye movement cause a decrease in imagery vividness and distress and increase memory access
concentrate on emotion or sensation surrounding traumatic event- client focus eye movement on therapist’s fingers- moving from left ot right
how many EMDR sessions would someone with PTSD need?
5-12 sessions
what is video game therapy?
“serious games”- phrase referring to any game whose main purpose is other than entertainment
educate user or help solve a problem
virtual reality exposure therapy
what is pet therapy?
animals can directly influence a person’s mental and physical well-being
what have pets been known to do?
reduce death rate from recurrence of heart attack
lower blood pressure, which can occur as a result of simply petting a dog or cat
enhance mood and improve social interaction among nursing home clients
diminish depression
emotional support animals
what is trauma-informed care?
we should explain why we’re asking sensitive questions
we should explain why we need to perform a physical exam, especially if involves breast/genitals
what are the four components of trauma-informed care?
realize
recognize
respond
resist
what is dissociative disorders?
after trauma
interruption of consciousness
unconscious defense mechanism- protective
what can dissociate disorders lead to?
can lead to disturbances in memory, consciousness, self-identity, perception
intact reality testing- not delusion/hallucinations
what is depersonalization?
characterized by persistent feelings of unreality, detachment from oneself or one’s body, thought, feelings, sensations, and actions
observing oneself from outside body
what is derealization?
alteration in perception of external environment
objects or people in environment may seem altered in shape or size
environment automated or mechanical- unreal or distant
what is dissociative amnesia?
inability to recall important personal info that is too extensive to be explained by ordinary forgetfulness, substance, or neurological or medical condition
what is localized amnesia?
unable to recall incidents associated with traumatic events
what is selective amneisa?
can recall only certain incidents associated with event for specific period after event
what is generalized amnesia?
amnesia for identity and life history
what is dissociative fugue?
a sudden, unexpected travel away from customary place of daily activities or bewildered wandering
unable to recall some or all of past
assumption of new identity common
what is the treatment for depersonalization-deralization disorder?
medications- antidepressants (clomipramine), mood stabilizers, anticonvulsants, and antipsychotics
insight psychotherapy
CBT
what is the treatment for dissociative amnesia ?
supportive psychotherapy
sponteanous
what is dissociative identity disorder?
two or more distinct personalities
only 1 personality evident of a time
1 is dominant- blocks access to trauma
what is switching?
transition from one personality to another usually sudden, often dramatic and usually precipitated by stress
what are the side effects of switching with DID?
rapid eye blinking
changes in voice or facial expression
disruption in train of thought
what are the psychological risk factors of dissociated disorder?
primitive ego defense mechanism
childhood physical, sexual, emotional abuse, traumatic life event
what are the biological risk factors for dissociative disorder?
altered communication between brain due to massive release of neurotransmitters during threat-inhibits connection
temporal lobe epilepsy
what are the assessments for the dissociative disorder?
need to allow the patient to become comfortable with to be able to receive accurate info during the history gathering
accurate history: life events history abuse, recent injury, history of temporal lobe epilepsy, and is memory clear or fuzzy
must assess for suicide risk/self-harm
impact on family
always refer to therapist
may seek helps for anxiety/depression symptoms
what is the goal of the dissociative identity disorder?
optimize function and potential
what is the integration vs collaboration treatment?
if integration= become total of all feelings, experiences, memories, skills, talents
what is the intensive long-term psychotherapy treatment for DID?
abreaction
awareness of other personalities
may need periods of hospitalizations
usually do not do well in inpatient psych units, so are usually in specialized unit
what is abreaction?
remember with feeling/re-experiencing the trauma
what are common nursing diagnoses for clients with dissociative disorders include?
disturbed thought processes; impaired memory
powerlessness
ineffective coping
risk for suicide
disturbed personal identity
disturbed sensory perception
what is the goal for dissociative disorder treatment?
restoring normal thought processes- integrate and link neuronal networks that have become disconnected
what are the nursing interventions for dissociative disorder?
grounding techniques
what are grounding techniques?
increase body awareness and mindfulness- shower, deep breathing, touch fabric on chair, exercise, stomp feet- helps keep person in present
what are dissociative disorder treatments?
EMDR
CBT
exposure therapy
hypnotherapy
neurofeedback
may use antidepressants, antianxiety medications
