Week 2: Trauma (BIPC)

the trauma continuum

type 1 trauma: single incident

type 2: multiple

type 3: multiple pervasive traumas from early age that continue over length of time

trauma results in...

actual brain changes

physiological stress response

-recalibrates brain's alarm system

-increases stress hormone activity

-alters systems that filter essential and non-essential functions (blood flow)

trauma responses

-fight

-flight

-freeze

-flop (loose instead of stiff like freeze)

-friend (people-pleasing)

-fawn

the spectrum of physiologic stress responses

-range from protective to damaging

-protective: we react before we realize

-damaging: caused by over-activation of the stress response system (replaying scenarios in our heads)

the range between protective and damaging is...

the level, intensity and complexity of trauma

ACE

Adverse Childhood Experiences

-does not tell the whole story for development and individual stress reactivity

Bio-psycho-social connection to Development and individual stress reactivity

-certain negative life experiences at young ages can increase risk of health complications and illness later in life

-ex.) parent with health issues, imprisonment, violence

other developmental and individual factors of stress reactivity

-stressors outside of household (community violence, racism)

-protective factors (supportive communities)

-individual differences

-individual attachment styles

types of individual attachment styles

-secure

-anxious/ambivalent-insecure

-avoidant-insecure

-disorganized-insecure

types of individual attachment styles: secure

caregiver is responsive, accepting and sensitive to child

types of individual attachment styles: anxious/ambivalent-insecure

-caregiver is inconsistent, unreliable

-child becomes needy, attention seeking, distrustful

types of individual attachment styles: avoidant-insecure

-caregiver rejects child's needs, minimizes their feelings, refuses to help

-child tries to hide negative emotions

types of individual attachment styles: disorganized-insecure

-caregivers teach child to fear them: ridicule, scare

-child becomes parentified and self reliant

common stressors across the lifespan

-life transitions (marriage, moving, graduation)

-losses (death, money)

-illness or injury

-increased responsibilities at home/work

chronic stress can....

shorten our lifespan

how can we as providers help a patient with stressors?

-recognize

-understand

-provide education

-normalize

-realize

-give resources

Helping with stressors: recognize

recognize that trauma is an embodied experience and pt will continue to live with it

Helping with stressors: understand

understand stress and trauma's physiological effects

Helping with stressors: normalize

normalize the sx and behaviors of our bodies' responses to stress and trauma

Helping with stressors: realize

realize that multiple factors influence a stress response

trauma diagnoses

-PTSD

-acute stress disorder

-reactive attachment disorder

-adjustment disorder

PTSD

direct or indirect exposure to traumatic event followed by sx

PTSD: DSM 5 criteria

1. Stressor required

2. sx in all categories:

-intrusion

-avoidance

-negative thoughts/mood

-changes in arousal and reactivity

3. PLUS sx 1+ month with functional impairment/distress

PTSD: intrusion

flashbacks, memories

PTSD: avoidance

purposeful resistance to talking/thinking/feeling

PTSD: negative changes in thoughts or mood

-all or nothing feelings

-cannot separate self-view from mood

PTSD: changes in arousal and reactivity

-reckless

-self-destructive

-easily startled

PTSD: diagnosis

sx persistent x1 month and cause functional impairment

PTSD: who is at risk?

-combat veterans AND general population

-2x more likely in females

-Latinos, AA have higher incidence

PTSD: treatment

-trauma informed counseling and therapy

-support groups

-yoga, meditation

-meds: SSRI's

Acute stress disorder: general

-similar to PTSD: sx after a traumatic event

-differences: duration, dissociation

Acute stress disorder vs PTSD: duration

PTSD cannot be diagnosed until 1 month; ASD is minimum of 3 days and max 1 month

Acute stress disorder vs PTSD: dissociation

ASD sx tend to involve depersonalization, disorientation and dissociation

Acute stress disorder: diagnosis

-sx persist minimum of 3 days and up to a month

-9 sx from 5 categories

Acute stress disorder: what are the categories of sx?

1. intrusion

2. avoidance

3. negative mood

4. dissociation

5. arousal

(need 9 sx from these categories per DSM 5)

Acute stress disorder: treatment

-they may not seek psych treatment immediately

-first responders can: make sure basic needs are met, let the pt breathe naturally, tell them the facts, make sure to support their story, turn them towards services

Reactive Attachment Disorder

-childhood stress disorder caused by neglect

-seen between 9 months- 5 years old

-seen in avoidant-insecure and disorganized-insecure attachment styles

Reactive Attachment Disorder: how do children react?

-display emotional withdrawal from caregiver

-do not seek or respond to their comfort, even when upset

Reactive Attachment Disorder: treatment

-trauma-informed and attachment therapies

-caregiver support

-parent-child therapy

-support services for educational/developmental delays

Adjustment Disorder

-emotional or behavioral sx in response to a stressor within 3 months of onset

-type of stressor varies between children/adults (everyone is at risk)

-6 subtypes

Adjustment Disorder: the 6 subtypes

-depressed mood

-anxiety

-mixed depressed mood & anxiety

-disturbance of conduct

-mixed disturbance of emotions & conduct

-unspecified

Adjustment Disorder: diagnosis

sx start within 3 months of stressor but does not last more than 6 months

not related to grief

Adjustment Disorder: additional DSM 5 criteria

-distress is out of proportion with stressor

-impairment in social, occupational or other functioning

Adjustment Disorder: treatment

-short term support group

-brief counseling & therapy

-school support as needed

-rarely medical intervention

-activity engagement

Suicide prevention hotline

1-800-273-TALK (8255)

trauma stewardship

secondary trauma experienced by those who care for others

vicarious trauma

emotional residue of exposure to stories of trauma