Unit 6 Trauma and Stress Related Disassociate Disorders Chapter 16 Flashcards
What type of incidents is an example of trauma?
- Witnessing murder
- witnessing death
- physical assault
- combat (veterans)
- sexual abuse
- accidents (plane, car)
- natural disasters
- child abuse
What is the #1 treatment for patients who have PTSD?
A. Operational conditioning therapy
B. Trauma focused cognitive behavioral therapy
C.Eye movement desensitization and reprocessing (EMDR)
D. Cognitive Behavioral Therapy
C.Eye movement desensitization and reprocessing (EMDR)
FROM BOOK
-eye movement desensitization and reprocessing (EMDR) therapy as first-line treatments for the treatment of traumatized children
This method involves moving your eyes a specific way while you process traumatic memories. EMDR’s goal is to help you heal from trauma or other distressing life experiences.
Name 2 Trauma associative disorder
- Posttraumatic stress disorder (PTSD)
- Acute stress disorder
- Adjustment disorder
Attachment Disorders - Reactive attachment disorder
-Disinhibited social engagement disorder
What type of traumas are associated with Dissociative disorders?
- Dissociative amnesia *Depersonalization/derealization disorder
- Dissociative identity disorder(2 personalities)
Which of the following behavior of a 6 year old child is associated with Reactive attachment disorder?
A. The child exhibits clingy behavior to parent.
B. The child exhibits emotional withdrawn behavior from parents.
C. The child seeks consolation from parents when crying
D. The child trust his parents
B. The child exhibits withdrawn behavior from parents.
Children with reactive attachment disorder have a consistent pattern of inhibited and emotionally with- drawn behavior. The child rarely seeks comfort or responds to comfort with adult caregivers when distressed.
Which of the following behavior of a 6 year old child is associated with Disinhibited social engagement disorder.?
A. The child exhibits no fear of strangers and is extremely friendly.
B. The child exhibits emotional withdrawn behavior from parents.
C. The child does not seek consolation from parents when crying.
D. The child does not trust his parents.
disinhibited social engagement disorder.
A. The child exhibits no fear of strangers and is extremely friendly.
Children with this disorder demonstrate no normal fear of strangers. They seem to be unfazed in response to separation from a primary caregiver. Younger children may allow unfamiliar people to pick them up, feed them, or play with them. These children tend to be overly friendly and are usually willing, or even eager, to go with someone they do not know.
What is the treatment plan for Attachment Disorders
*Treatment always involves both the child and the caregivers in individual and family therapy.
* A primary goal of care is to strengthen the relationship between the child and caregiver.
*A safe and stable living environment is also essential to improving attachment behaviors.
Risk factors for Attachment disorders
*Risk factors for attachment disorder include institutional living situations, as previously discussed.
*Frequently changing foster homes or experiencing shifts in primary caregivers also puts a child at risk.
*Impaired parenting due to severe psychiat- ric problems, criminal behavior, or substance use disorders also disrupts essential bonding experiences.
*Prolonged separation from caregivers or parents due to such events as extended hospitalization also puts children at risk for attachment disorders.
*Without treatment, attachment disorders may have lifelong consequences, including lack of trust or not feeling secure in friendships and partnerships.
What are types of Child abuse?
Experience traumatic events w/o the strength and coping mechanisms to
defend themselves
Those abused and neglected by caretakers/adults are at great risk for
developing physical and psychological problems.
Neglect – Ingestion of medication (overdose), not providing medical care,
unfit living environment
Physical abuse – physical injury
Sexual abuse – forcing a child to witness, act, fondle and/or sexual
intercourse
Those who have experienced abuse, are at risk for abusing others.
Who is the #1 Perputrator of Child Abuse?
A. Mother
B. Relative
C. Baby sitter
D. Grandparents
A. Mother
Post Traumatic Stress Disorder criteria according to the DSM-5
Exposure to actual or threatened death, serious injury, or sexual
violence in one or more of the following ways:
Directly experiencing, witnessing, learning of the event ,
The even must have been violent ,accidental, with threat of perceived
death
Repeated or extreme exposure
Intrusion symptoms associate with traumatic event
Persistent avoidance of stimuli associated with the trauma
Negative alterations in cognitions and mood associated with the
traumatic events
Alterations in arousal and reactivity(vets with fireworks [{{hyperactivity{{
How is Post Traumatic Stress Disorder manifested in children?
Posttraumatic stress disorder (PTSD) in preschool children may manifest as a reduction in play—play that includes aspects of the traumatic event, social withdrawal, and negative emo- tions such as fear, guilt, anger, horror, sadness, shame, or con- fusion.
How is PTSD mainly manifested in children?
A. increase in play with friends
B. reduction in play with friends or family
C. Social inclination
D. excitability
B. reduction in play with friends or family
Posttraumatic stress disorder (PTSD) in preschool children may manifest as a reduction in play—play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or con-fusion.
Children may blame themselves for the traumatic event.
In addition, there may be a feeling of detachment or estrangement from others and diminished interest or participation in significant activities. Often, there is irritability, aggressive or self-destructive behavior, sleep disturbances(NIGHTMARES), problems concentrating, and hypervigilance.
What is they key idea of the Attachment Theory
Attachment Theory - the theory describes
the importance and the dynamics of the
infant : caregiver relationship and how this
early relationship can affect the individual
throughout their life. (positively and
negatively.
Influences Reactive Detachment Disorder and Disinhibited Social Engagement
Which of the following is a protective factor when it comes to stress?
A. a 12 year old child without friends.
B. A 9 year old son who has a close relationship with his mother.
C. a patient who has undergone a crisis with no family support
D. A child with mono phobia
B. A 9 year old son who has a close relationship with his mother.
External (environmental) factors can support or add more stress
Parental Modeling
Cultural expectations
Stabile/Nurturing Environment vs Chaotic/Non-nurturing
Adverse Childhood experiences
Resilience
S/S of PTSD FOR CHILDREN
Collecting Data - Interviewing, observing, screenings, interacting
History from multiple sources
Assessing for posttraumatic symptoms:
Nightmares
Night terrors
Hallucinations
Intrusive Traumatic thoughts and memories
Reexperiencing or flashbacks of trauma
Traumatic reenactments in play
Self-injurious behaviors
Dramatic Mood swings, rage, numbing, avoidance
Somatic Symptoms – headache, stomachache
What medication is used to treat nightmares with patients with PTSD?
A. Alprazolam
B. Buspirone
C. Prazosine
D. Amtriptiline
C. Prazosine
Interventions for Children with PTSD
Establish trust and safety through a therapeutic relationship
Use developmental language and teaching tools
Pharmacotherapy (SSRI)
Usually accompanies therapy – best results
Advanced Practice
Eye Movement Desensitization and Reprocessing (EMDR)
Cognitive Behavioral Therapy
Trauma Focused Cognitive Behavioral Therapy
How would you evaluate the treatment and interventions are effective in PTSD?
Treatment is effective when..
The child’s safety is maintained.
Anxiety has been reduced and stress is handled in a healthy way.
Emotions and behavior are appropriate.
The child achieves normal developmental milestones for age
The child can seek out adults for nurturing and help when needed.
PTSD IN Adults
Persistent, reexperiencing of a highly traumatic event that involves actual or
threatened death or serious injury to self or others – individual responds with
intense fear, helplessness or horror.
Might be brought on by indirect exposure – loved one has terminal cancer
First responders – repeated or extreme exposure to trauma
Examples of PTSD-inducing events include:
* Military combat, prisoner-of-war experience, or being taken
hostage
* Crime-related events, such as bombing, assault, mugging, or
rape
* Natural disasters, such as floods, tornadoes, and earthquakes
* Human disasters, such as automobile, airline, and train accidents
What is Flashbacks according to PTSD
. Re-experiencing the trauma through recurrent intrusive rec- ollections of the event or dreams about the event. Flashbacks are dissociative experiences during which the event is relived
along with vivid sensory input.
What is Avoidance according to PTSD
Avoidance of stimuli associated with the trauma, causing the
individual to avoid talking about the event or avoid activities, people, or places that arouse memories of the trauma. This avoidance is accompanied by feelings of detachment, emptiness, and numbing.
What is Hypervigilance according to PTSD
Persistent symptoms of increased arousal, as evidenced
by irritability, difficulty sleeping, difficulty concentrating,
hypervigilance, or exaggerated startle response.
** What is Alterations in mood according to PTSD**
Alterations in mood, such as chronic depression, negative appraisals, and lack of interest in previously pleasurable
activities (APA, 2013).
What is an indicated outcome for a patient with PTSD?
A. increase anxiety
B. decrease positive coping skills
C. Improve coping mechanisms
D. ability to withstand negative stimuli
C. Improve coping mechanisms
Outcomes Identification
Manage Anxiety
Increase Self-esteem
Improve ability to cope
Should medication and therapy be combined together?
A. Yes
B. No
A. Yes
Medicating children and adults works best when combined with another treatment, such as EMDR therapy or cognitive behavioral therapy (CBT).
Psyschotherapy + Pharmacology
Eye movement desensitization and reprocessing (EMDR)
EMDR therapy is an evidence-based therapy used to treat children and adults (Wheeler, 2014). EMDR therapy helps peo- ple process traumatic memories. People are encouraged to think about the traumatic event while also focusing on other stimu- lation, such as eye movements, audio tones, or tapping.
eye movement desensitization and reprocessing (EMDR) therapy as first-line treatments for the treatment of traumatized children
Cognitive Behavioral Therapy
CBT uses a range of strategies—such as psychoeducation, behavior modification, cognitive therapy, exposure therapy, and stress management—to help the child manage behavior and change maladaptive beliefs and thoughts.
Psychopharmacology
Psychopharmacology
Antidepressants, Antianxiety
Clonidine (Catapress) – hyperarousal
Which of the following symptoms that Clonidine treat with patients in PTSD?
A. hypotension
B.bradycardia
C. hyperarousal
D. hypoarousal
C. hyperarousal
MONITOR FOR..
-HYPOTENSION
-BRADYCARDIA
-ORTHOSTATIC HYPOTENSION
When is treatment effective with a patient experiencing PTSD?
- The patient recognizes symptoms as related to the trauma
- The patient is able to use newly learned strategies to manage
anxiety - The patient experiences no flashbacks or intrusive thoughts about the traumatic event
- The patient is able to sleep adequately without nightmares
- The patient can assume usual roles and maintains satisfying interpersonal relationships
What is Acute Stress Disorder
Acute stress disorder (ASD) may develop after exposure to a highly traumatic event, such as those listed in the prior section on PTSD. ASD is diagnosed 3 days to 1 month after the trau- matic event. To be diagnosed with ASD, the individual must display 8 out of the following 14 symptoms either during or after the traumatic event:
What is the main difference between acute stress disorder vs PTSD?
ASD symptoms may last for a minimum of 30 days , those symptom must bE treated and evaluated in those 30 day before it converts to PTSD
S/S of ASD
To be diagnosed with ASD, the individual must display 8 out of the following 14 symptoms either during or after the traumatic event:
- A subjective sense of numbing
- Derealization (a sense of unreality related to the environment) * Inability to remember at least one important aspect of the
event - Intrusive distressing memories of the event
- Recurrent distressing dreams
- Feeling as if the event is recurring
- Intense prolonged distress or physiological reactivity * Avoidance of thoughts or feelings about the event
- Sleep disturbances(NIGHTMARES)
- Hypervigilance
- Irritable, angry, or aggressive behavior
- Exaggerated startle response
- Agitation or restlessness
What is the #1 treatment for Acute stress disorder?
A. Psychotherapy
B. Paroxetine
C. Buspirone
D. Buproprione
A. Psychotherapy
Nursing Assessment for ASD
Furthermore, this population is more likely to experience derealization, which makes a person less secure in the environment. These problems result in a need for for a non-rushed and reassuring approach to assessment.
Nursing Implementation for ASD
The nurse’s role in caring for a patient with ASD involves pri- marily establishing a therapeutic relationship with the person, helping the person to problem solve, connecting the person to supports such as family and friends, educating about ASD, coordination of care through collaboration with others, ensur- ing and maintaining safety, and monitoring response and/or adherence to treatment.
Nursing outcomes for ASD
- Reduced response to trauma
- Improved adaptation
- Decreased anxiety
Which of the following statements is an example of a patient experiencing Adjustment disorder?
A. the patient has retired at 65 after working for 30 years straight
B. The patient who has recently experienced a traumatic car incident
C. The patient witnessing the death of his dog.
D. The patient being a victim of physical abuse.
A. the patient has retired at 65 after working for 30 years straight
What is Adjustment disorder
A milder, less specific version of ASD and PTSD is adjustment disorder. Like ASD and PTSD, it is precipitated by a stressful event.
What is an example of Adjustment disorder
However, the event—
*including retirement,
*chronic illness,
*or a breakup—may not be as severe and may not be considered a traumatic event.
Adjustment disorder may be diagnosed immediately or within 3 months of exposure.
s/s of adjustment disorder
Symptoms of adjustment disorder run the gamut of all forms of distress, including guilt, depression, anxiety, and anger. These feelings may be combined with other manifestations of distress, including physical complaints, social withdrawal, impaired occupational function, and academic decline.
-Losing a loved one due to death may result in a specific type of adjustment disorder.
What type of drug can be used with a patient manifesting anxiety and depressive symptoms?
Depressive symptoms associated with adjustment disorders are generally treated with antidepressants, and anxiety symptoms are treated with benzodiazepines.
Goal of Psychotherapy
The standard intervention for adjustment disorders is psychotherapy, which may include reality orientation, crisis inter- vention, family therapy, or group treatment. The goal of any of these interventions is to encourage verbalization of emotions related to the stressors.
What is Dissociation Disorders
Dissociative disorders occur after significant adverse expe- riences and traumas. The predominant response is a severe interruption of consciousness. Dissociation is an unconscious defense mechanism that protects the individual against over- whelming anxiety through an emotional separation. However, this separation results in disturbances in memory, conscious- ness, self-identity, and perception.
Types of Dissociative Disorders
- Dissociative amnesia *Depersonalization/derealization disorder
- Dissociative identity disorder(2 personalities)
What is Dissociative Amnesia
Dissociative amnesia is marked by the inability to recall important personal information, often of a traumatic or stress- ful nature; this lack of memory is too pervasive to be explained by ordinary forgetfulness.
Inability to recall important personal information, often of a traumatic or
stressful event.
Might be the entire event or selective information
Phrases associated with dissociative amnesia
“I don’t remember what happened after he slapped me”
” I don’t remember where I live”
” I don’t remember what happened”
Dissociative Fugue
Sudden unexpected travel and an inability to recall one’s identity and information
about some or all their past.
May assume a whole new identity
After a few weeks to a few months, they may remember their former identities
and then may become amnesic to the identities they had
What is Depersonalization
Depersonalization – periods of feeling disconnected or detached from one’s body and thoughts
Example: watching yourself in a movie or dream
What is Derealization
periods of feeling detached from one’s surroundings; people and objects around you may seem unreal
Example: familiar objects appear strange and unfamiliar
In derealization, the focus is on the outside world. It is the recurring feeling that one’s surroundings are unreal or distant. The person may feel like she is walking around in a fog, bubble, or dream. It may feel like there is an invisible veil between her and the rest of the world. Visual distortions are manifested in blurriness, changes in the visual field (widened or narrowed), and altered size of objects. Auditory distortions include the muting or heightening of sound.
“I’m invisible when I navigate the world”
Is this Derealization or Depersonalization?
Derealization
It may feel like there is an invisible veil between her and the rest of the world. Visual distortions are manifested in blurriness, changes in the visual field (widened or narrowed), and altered size of objects. Auditory distortions include the muting or heightening of sound.
“I feel like I’m watching myself through a window”
Is this Derealization or Depersonalization?
Depersonalization
Depersonalization is an extremely uncomfortable feel- ing of being an observer of one’s own body or mental processes. Feelings of unreality, detachment, or unfamiliarity with parts of self or the whole self are features of this disorder. A patient may feel detached from his entire self, aspects of himself, including feelings, thoughts, body parts, or sensations.
Is Depersonalization and derealization permanent?
A. yes
B. No
B. No
Depersonalization and derealization are often short-lived and go away on their own without treatment can be caused by susbstance abuse
What is Dissociative Identity Disorder
Presence of 2 or more distinct personality states that recurrently take
control of behavior
Alternate Personality or Alt
Has its own pattern of perceiving, relating to, and thinking about the self and
the environment
Each Alt is a complex unit – individual memories, behavioral patterns, and
social relationships
Risk factor for DID
Severe sexual, physical or psychological trauma in childhood
Dissociation is the most
primitive defense mechanism
-hard to diagnose due to duration of switching or transitioning
Alter differences In DID
-Each alter is a complex unit with its own memories, behav- ioral patterns, and social relationships that dictate how the per- son acts when that personality is dominant. Often, the original or primary personality is moralistic, while the alters are pleasure- seeking and nonconforming.
-The alter personalities may behave as individuals of a different sex, race, or religion. The dominant hand and the voice may also be different. Intelligence and even electroencephalographic (EEG) findings may also be altered.
Is the suicide risk high for pt’s with DID
A. yes
B. No
Suicide risk is extremely high—up to 70% of outpatients with this disorder have attempted suicide (APA, 2013). Assessment of previous suicide behavior may be extremely difficult due to the presence of more than one personality state.
Planning phases for DID patient
Phase 1: Establishing safety, stabilization, and symptom reduction
Phase 2: Confronting, working through, and integrating trau- matic memories
Phase 3: Identity integration and rehabilitation
With a patient with DID disorder report to saying they deserved the sexual abuse?
A. Yes
B. No
A. Yes
Psychoeducation
About the Dx
Coping Skills
Stress Management
** Normalizing experiences “tainted”, “deserved it”**
What is the priority therapy treatment for patients with DID?
a. Aversion therapy
b. Stress-reduction therapy
c. Cognitive behavioral therapy
d. Short-term classical analysis therapy
c. Cognitive behavioral therapy
Pharmacological Interventions
are like PTSD tx.
Therapy: CBT, EMDR
