Trauma and Stressor Related Disorders

Exam 3

trauma

event outside everyday experience that would be distressing to almost anyone

Posttraumatic Stress Disorder

must experience exposure to a serious traumatic event, must experience symptoms from one of four clusters

• reexperiencing

• avoidance

• negative alterations in cognitions and mood

• arousal and reactivity

lasts for at least one month following trauma or has a delayed onset

In children 6 and under, the cognitive/mood clusters are combined

reexperiencing

intrusive symptoms that begin after traumatic event, includes disturbing memories of the traumatic event, recurrent distressing trauma-related dreams, prolonged or intense psychological distress or physiological reactions in response to cues that are reminders of the event, or dissociative reactions

Dissociation

alterations in self-awareness, depersonalization, derealization, may act or feel as if traumatic event were reoccurring

avoidance

persistent efforts to avoid trauma-related thoughts or feelings, reaction may also include avoidance of external stimuli associated with trauma

Negative alterations in cognitions and mood

difficulty in remembering important aspects of traumatic event, distorted thoughts about causes or consequences of traumatic event, exaggerated negative beliefs or expectations

arousal or reactivity

irritable behavior and angry outbursts, reckless behavior, heightened vigilance, exaggerated startle responses, concentration difficulties, sleep disturbances

Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)

absence of adequate caregiving during childhood, for children 9 months to 6 years

must be established that child has experienced extremes of insufficient care and is evidenced by one or more of the following:

• persistent lack of having caregivers provide for basic needs such as affection, comfort, and stimulation

• repeated changes of primary caregivers— thus limiting opportunities to form stable attachments

• rearing in unusual situations that severely limit opportunities to form attachments

Reactive Attachment Disorder (RAD)

children who display extremely underdeveloped attachments to their adult caregivers, displays persistent inhibited and withdrawn behavior toward adult caregivers, rarely seeks comfort and when comfort is offered child rarely responds

child displays a persistent social/emotional disturbance that is characterized by symptoms such as minimal social and emotional responsiveness, limited positive affect, and unexplained fearfulness, irritability, or sadness

Disinhibited Social Engagement Disorder (DSED)

child displays a pattern of culturally inappropriate, overly familiar behavior toward strangers, fail to check back with caregiver when venturing away or when in unfamiliar settings, and willing to go off with an unfamiliar adult

epidemiology

¼ - 2/3 of children are exposed to trauma in their youth, about 1/3 develop PTSD, higher than traumatized adults, higher among girls

treatment

CBT with parent involvement, trauma-focused CBT

psychoeducation, parenting skills, relaxation skills, affective modulation, cognitive coping, trauma narration, in vivo mastery of trauma reminders, conjoint child-parent sessions, enhancing safety and future developmental trajectory

PPRACTICE

child abuse and neglect

any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm

maltreatment

abuse and neglect — acts of commission and omission

physical abuse, sexual abuse, neglect, and emotional abuse (psychological maltreatment)

neglect is most common

Maltreatment Prevalence

In order- Neglect, physical abuse, sexual abuse, other, psychological maltreatment, medical neglect

14% of maltreatment victims experienced multiple forms

Factors Contributing to Maltreatment

characteristics of abuser, characteristics of child, parenting practices, parent- child interactional processes, social/cultural influences

Posttraumatic stress symptoms (PTSS)

considerable distress and interference with functioning after traumatic event, 20-30% have persistent symptoms

separation difficulties and dependent behaviors, depressed mood, loss of interest in activities, irritability, anxiety, grief, and angry or aggressive outbursts

developmental course of PTSD

Symptoms decrease over time, initial attempts to cope affect prognosis, social and cultural issues

consequences of maltreatment

adverse outcomes, physical injury, sexually transmitted diseases, fatalities

half of fatalities due to abuse are younger than 1

Interventions for maltreatment

CBT with parent involvement, TF-CBT

Nurse-Family Partnership (NFP) and Safe Environment for Every Kid (SEEK): health professionals provide education to low-income mothers. NFP is up to 2 yrs and SEEK is for children 0-5.

Incredible Years (IY): addresses child management skills, child-parent relationships, emotion regulation, and facilitating social support