WEEK 4: Trauma Flashcards
define crisis
is a situation or event which causes emotional or cognitive stress to those involved
define trauma
is any disturbing experience that results in significant feelings of fear, confusion, and dissociation that negatively impact an individual’s behaviors, attitudes, or functioning
define disaster
is an incident or event that could end human life or cause health-related harm, requiring immediate response in resources and workforce
natural disaster examples
Hurricanes & Earthquakes
human disaster examples
Mass Shootings or Violence in the Community, War, or Terrorism
examples of adverse or traumatic events (5)
Natural disasters
Human-caused disasters
Events or experiences
Poverty
Racism, discrimination, and oppression
trauma-related disorders: effects of trauma
Altered ability to function mentally, physically, socially & spiritually
Disruption of well-being
manifestations of trauma exposure
Intense fear
Feelings of confusion
Dissociation
Disruptive emotions
types of trauma
acute
chronic
complex
system-induced
vicarious
historical
acute trauma
A single traumatic event that is limited in time (such as car accident, natural disaster).
chronic trauma
Exposure to multiple and/or persistent traumatic events (such as abuse, social-emotional neglect, isolation, poverty, or hunger).
complex trauma
Exposure to chronic trauma that also distorts the individual’s fundamental sense of self (persistent social inequity, racism, discrimination due to sexual orientation or gender identity).
system-induced trauma
Trauma that is experienced during movement through organizational systems (such as foster care or juvenile detention).
vicarious trauma (aka also called what)
Also called secondary trauma, it is an indirect trauma that results from engaging with victims of trauma. (Health care personnel during COVID-19, first responders after 9/11 or Hurricane Katrina).
historical trauma
Psychosocial distress resulting from trauma or adversity passed down through generations of groups of people who share an identity, affiliation, or circumstance.
Theoretical Framework: Bowlby’s Attachment Theory
John Bowlby (1969) Framework
Attachment Relationships
Caregivers – parents
Occur during Infancy into early childhood
Necessary for survival and brain development
Early Childhood and Attachment Relationships: Brain Development
essential for survival and development
Studies have shown that infants and parents are hardwired for connection and adaptation, and that dopamine and oxytocin are released in the brain during infant bonding, reinforcing the brain’s central reward system
Bowlby’s Attachment Theory: Stages of Attachment
birth to 3 months
6 weeks to 7 months
7 months to 11 months
24 months and beyond
Bowlby’s Attachment Theory: Stages of Attachment
Birth to 3 months (pre-attachment stage)
This stage involves the infant forming a bond with a parent or caregiver or objects such as a blanket. The infant has not yet learned to differentiate between object and person.
Bowlby’s: 6 weeks to 7 months
ability to socialize
no evidence of separation anxiety
7 months to 11 months: Bowlby’s
distinguishes difference in parents and strangers
separation anxiety
24 months and beyond: Bowlby’s
Generally, after displaying attachment to a particular adult, the child has the ability to form attachments. This begins to expand to multiple attachments with individuals who become regularly involved in the child’s life, such as grandparents or a sibling.
Polyvagal Theory
traumatic event
sympathetic nervous system
dorsal vagus nerve “information superhighway”
ventral vagus nerve (safety is needed)
fight/flight/freeze/etc response
Trauma and the Autonomic Nervous System: parasympathetic nervous system
parasympathetic nervous system
CONSTRICT pupils
stimulated saliva
slows heart rate
relaxes everything
stimulates digestion
Trauma and the Autonomic Nervous System: sympathetic nervous system
DILATES pupils
inhibits saliva
relaxes bronchi
INCREASES heart rate
inhibits digestion
stimulates glucose response
produces adrenaline
Trauma Response and Polyvagal Theory
Sympathetic: FLIGHT OR FIGHT (first response)
Dorsal vagus; FAINT OR FREEZE (second line of defense)
Ventral vagus: FAWN OR social engagement (unconscious use of social skills to appease)
types of stress
positive
tolerable
toxic
positive stress
normal response
Anxiety about the first day of school, for example, or getting a vaccine can generate a positive stress response.
tolerable stress
body’s “alarm” system. If activated in a child, this level of stress can be “buffered” by a supportive relationship with an adult, such as a parent. This support system acts as a protective factor for the child and allows the brain and other organs of the body time to recover.
toxic stress
frequent stimulation of that stress
Normalizes fear and trauma
Stress-induced chronic changes
The prolonged activation of the HPA leads to
chronic inflammation, therefore increasing an individual’s risk for trauma-related disorders and medical comorbidities
Manifestations of Toxic Stress: Children and Adolescents (developmental)
developmental delays
Manifestations of Toxic Stress: Children and Adolescents (behaviors)
engaging in a risky behavior
Manifestations of Toxic Stress: Children and Adolescents (physiological/physical)
risk for autoimmune disesae
Manifestations of Toxic Stress: Children and Adolescents (mental health concerns)
suicide attempts
Manifestations of Toxic Stress: Adults (behavioral)
risk of intimate partner violence
Manifestations of Toxic Stress: Adults (mental health)
substance use
suicide attempts
depression
repeated toxic stress: Neuroplasticity
the brain’s ability to adapt, and change based on developing new neural pathways in response to positive or negative experiences.
Manifestations of Toxic Stress: Adults (phyisological/phyiscal)
ischemic heart disease or increased risk for infection
repeated toxic stress: Adverse childhood experiences (ACEs)
Negative experiences in the areas of abuse, neglect, and/or household dysfunction that occur during childhood.
Changes in brain structure
Alterations in physical and mental health
In the setting of toxic stress…
the amygdala, also known as the brain’s fear detection system, becomes dysfunctional, causing strong fear-based and emotional responses such as shame, fear, or terror
fear learning
Persistent fear response and a history of trauma change the brain, resulting in an inability to reduce memories of fear or an inability to reinforce the memories where safety and security were learned this is known as fear learning
Fear extinction
occurs when the brain’s neural circuitry acts as a braking system, helping to restore equilibrium and a sense of safety. The amygdala communicates the fear-producing impulses created from toxic stress or traumatic events to the hippocampus. The hippocampus acts as a vault, creating and storing the memory of the event for retrieval when exposed to similar stimuli in the future
common risk factors for mental health and trauma related
family history
chronic medical conditions
substance use
Poor nutrition
Poor sleep
Traumatic event
Abuse (physical, sexual, neglect, violence)
common protective factors for mental health and trauma related
Secure attachment as a child
Emotional self-regulation
Healthy diet, exercise, and sleep
Economic/financial security
Access to support systems
Stable household
Good health
Learned positive coping skills
Belief they can impact or change their situation; sense of hope
Meeting developmental and cognitive milestones
Access to resources such as health care and education
The 10 PACEs
Parent/caregiver unconditional love
Spending time with a best friend
Volunteering or helping others
Being active in a social group
Having a mentor outside of the family
Living in a clean, safe home with enough food
Having opportunities to learn
Having a hobby
Being active or playing sports
Having routines and fair rules at home
For an individual to receive a trauma- and stress-related diagnosis…
the specific criterion must be met as outlined in the DSM-5-TR.
define PTSD
chronic manifestations can last for years
adjustment disorder: define
Occurs within three months of a stressor and lasts up to 6 months following the resolution of trauma.
define acute stress disorder
Manifestations last three days or up to one month.
define Disinhibited social engagement disorder
child acts inappropriately, is overly familiar with strangers
define: Reactive attachment disorder
child is withdrawn from adults and other caregivers
Disaster Management Cycle
pre-disaster (prevents/preparedness)
disaster (disaster impact)
post-disaster (recover and response)
question: what type of trauma is it when a patient has a history of being sexual abused and discriminated against?
complex
The single causative factor for developing a trauma-related disorder is
experiencing or witnessing a traumatic event
Traumatic events include
childhood maltreatment,
interpersonal violence,
chronic exposure to adverse childhood events, or
witnessing the loss of life or limb
childhood maltreatment
Abuse, neglect, or exploitation of individuals under 18 years of age.
interpersonal violence
physical, sexual, or emotional abuse. This is a form of intentional force, power, or threat enacted against another person. This violence results when the relationship between a child and adult (or two adults) erodes, trust is betrayed, and physical, sexual, or psychological harm occurs including neglect
Types of Childhood Maltreatment
Violent or excessive punishment
Neglect
Emotionally or physically absent parents/caregivers
Bullying
Interpersonal violence at home, school, or community
Factors Resulting in Increased Risk of Experiencing Violence or Abuse
Having a disability
Living in institutional care and deprived of liberty
Living in extreme poverty
Unaccompanied or separated from family including migrants, refugees, and asylum seekers
Facing discrimination for their sexual orientation or gender identity
Belonging to marginalized social or ethnic groups
Living with other social and economic disadvantages
Being a woman or child
Which of the following can be implicated in perpetuating interpersonal violence against children?
parents
caregivers
peers
and educators
Adverse childhood experiences (ACEs)
harmful childhood experiences that stem from childhood neglect, abuse, parental substance misuse, untreated familial mental illness, or having an incarcerated family member
Adverse childhood experiences have been linked to
increased likelihood of chronic illnesses, sexually transmitted diseases, mental illness, and premature death
Research suggests that those with the greatest risk for developing PTSD are
women who have experienced four or more ACEs or have a history of interpersonal violence
A nurse is working in a pediatric unit caring for a 5-year-old client. The client history reveals that the child and her mother were victims of domestic violence who recently fled their home. The mother expresses concern that her daughter’s experience with trauma has “ruined her forever. There’s no way she will ever heal from this.”
The nurse explains that with healthy and loving relationships, the child can develop resilience and heal. This is because the brain can create new neural pathways in the presence of a healthy and loving relationship. Which of the following concepts has the nurse provided education on?
neuroplasticity
Vulnerable populations for trauma
poverty, oppression, discrimination, racism, sexual or gender orientation, immigration, language barriers, higher disease burden, lack of access to health care, lack of access to education, or low health literacy
Historical trauma can be illustrated as
invisible “soul wounds’’ on the collective psyche or conscience, suggesting that these wounds have become a part of the survivor’s trauma and will follow future generations
collective psyche
A term developed by psychologist Carl Jung which describes the part of the unconscious memory that is common to humankind. It contains inherited ideas or other cultural phenomena and is considered an accumulation of primitive human ideas and images.
Medical and Mental Health Comorbidities: ACEs and Trauma-Related Disorders
medical and mental health comorbidities
Medical and Mental Health Comorbidities: ACEs and Trauma-Related Disorders (medical comorbidities)
asthma, allergies, cardiovascular disease, type 2 diabetes mellitus, traumatic brain injury, cerebrovascular accidents, obesity, sexually transmitted illnesses, skeletal fractures, cancer, liver disease, and chronic lung disease.
Medical and Mental Health Comorbidities: ACEs and Trauma-Related Disorders (mental health comorbidities)
depression, completed suicide, suicidal ideation, anxiety, aggression or conduct disorder, obsessive-compulsive disorder, bipolar disorder, alcohol use disorder, substance use disorders, and language and developmental delay.
A child’s or young adolescent’s initial presentation of having experienced trauma may be evident in
nightmares or through reexperiencing expressed during play
Reactive attachment disorder (RAD)
Diagnosed before age 5: early childhood or infancy after 9 months of age.
Absence of adequate caregiving during childhood.
Typically results in a child becoming withdrawn from adults or other caregivers due to unmet needs.
Could be caused by lack of touch or attention from caregivers.
The child is unable to relate to others.
The child does not turn to an attachment figure (parent) for comfort or social interaction.
Disinhibited social engagement disorder (DSED)
Diagnosed during childhood after 9 months of age.
Absence of adequate caregiving during childhood.
Displays overly familiar behaviors toward strangers (or those relatively unfamiliar to them) without regard for appropriate social boundaries.
Unable to relate to others.
Post-traumatic stress disorder (PTSD)
Manifestations persist for more than 1 month.
Closely connected to an anxiety response.
Manifestations create distress and impair ability to function in social and occupational roles.
Acute stress disorder (ASD)
Manifestations consistent with PTSD.
Acute with manifestations lasting three days to one month after the traumatic event.
Closely connected to an anxiety response.
Adjustment disorder (AD)
Emotional and behavioral manifestations in response to an identifiable stressor within three months of exposure that do not last more than six months.
Related manifestations do not meet the criteria for other stress-related disorders and are not an exacerbation of a known mental health disorder.
Adjustment disorder manifestations
mood or behavior in response to identifiable stressors
Adjustment disorder is associated with a high risk for attempted and completed suicide
THREADS: PTSD (not having it)
A resilient child has strong THREADS.
Thinking and developing brain
Hope (to deal with present situation)
Regulation (able to self-regulate)
Efficacy (able to react to situation)
Attachment (healthy relationships)
Development (mastery of tasks and skills)
Social context/support (safe, supportive people and places)
FRAYED: PTSD in kids
A child can become FRAYED by traumatic experiences.
Fits, frets, fear
Regulation disorder
Attachment problems
Yawning/yelling
Educational delays
Defeat & dissociation
parenting education is what type of prevention?
primary prevention
