Trauma and Stress-Related Disorder

Posttraumatic stress disorder (PTSD)

A pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with a traumatic event, characterized by intense fear, helplessness, or terror.

Trauma

A traumatic event such as a natural disaster, combat, or an assault that poses actual or threatened death or serious injury.

Reexperiencing

Symptoms of PTSD that involve recurrent and intrusive thoughts, dreams, or flashbacks of the traumatic event.

Avoidance

Symptoms of PTSD that involve avoiding stimuli associated with the trauma, such as places, people, or situations that may trigger memories of the event.

Hyperarousal

Symptoms of PTSD that include persistent signs of increased arousal, such as insomnia, irritability, or hypervigilance.

Chronic

PTSD is typically chronic in nature, with symptoms fluctuating in intensity and severity, becoming worse during stressful periods.

Comorbidity

Many clients with PTSD develop other psychiatric disorders, such as depression, anxiety disorders, or alcohol and drug abuse.

Adjustment disorder

A reaction to a stressful event that causes problems for the individual, typically characterized by difficulty coping or assimilating the event into their life.

Acute stress disorder

Occurs after a traumatic event and is characterized by reexperiencing, avoidance, and hyperarousal, lasting from 3 days to 4 weeks.

Reactive attachment disorder (RAD)

A disorder occurring before the age of 5 in response to child abuse or neglect, characterized by disturbed inappropriate social relatedness.

Disinhibited social engagement disorder (DSED)

A disorder occurring before the age of 5 in response to child abuse or neglect, characterized by unselective socialization and lack of hesitation in approaching or talking to strangers.

Etiology

The cause or origin of a disorder, in the case of PTSD, it is associated with event exposure rather than personal characteristics.

Intrusion symptoms

Symptoms associated with PTSD that involve distressing memories, dreams, flashbacks, or dissociative reactions related to the traumatic event.

Avoidance symptoms

Symptoms associated with PTSD that involve avoiding distressing memories, thoughts, or external reminders of the traumatic event.

Negative alterations in cognitions and mood

Symptoms associated with PTSD that involve persistent negative beliefs, distorted cognitions, negative emotional state, diminished interest or participation in activities, feelings of detachment or estrangement, and inability to experience positive emotions.

Arousal and reactivity symptoms

Symptoms associated with PTSD that involve irritable behavior, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance.

Cultural considerations

The impact of culture on the experience, treatment, and recovery of PTSD, with strong cultural identity and allegiance to culture being positive factors for resilience.

Counseling or therapy

The indicated treatment for PTSD, which can be tailored to the individual's cultural background and may include individual or group therapy.

Medications

Some medications may contribute to successful resolution of PTSD, especially when targeting specific issues such as insomnia.

CBT

Cognitive-behavioral therapy, a common and successful type of therapy for PTSD that focuses on changing negative thoughts and behaviors associated with the traumatic event.

Exposure therapy

A treatment approach for PTSD that involves confronting feared emotions, situations, and thoughts associated with trauma instead of avoiding them.

Adaptive disclosure

A specialized CBT approach for active-duty military personnel with PTSD that incorporates exposure therapy and the empty chair technique.

Cognitive processing therapy

A therapy approach for PTSD that involves examining and challenging erroneous beliefs and regaining more balanced ways of appraising the world and oneself.

Medications

Used to treat symptoms of PTSD such as insomnia, anxiety, and hyperarousal, with selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) being the most effective.

Elder considerations

PTSD can be diagnosed at any age, including in the elderly population, and can have negative impacts on physical functioning and general health.

Community-Based Care

Most care for PTSD is provided on an outpatient basis, including individual therapy, group therapy, and self-help groups.

Client and Family Education

Suggestions for self-care interventions to promote physical and emotional well-being in individuals with PTSD.

Mental Health Promotion

Dealing with trauma soon after it occurs can help prevent pathologic responses, and effective treatment requires accurate professional diagnosis.

Dissociative disorders

Disorders characterized by disruptions in consciousness, memory, identity, or environmental perception, often seen in clients with PTSD.

Dissociative amnesia

Inability to remember important personal information, often of a traumatic or stressful nature.

Dissociative identity disorder

Displaying two or more distinct identities or personality states that recurrently take control of behavior, accompanied by the inability to recall important personal information.

Depersonalization/derealization disorder

Persistent or recurrent feelings of detachment from mental processes or body (depersonalization) or sensation of being in a dream-like state with a foggy or unreal environment (derealization).

Treatment and Interventions

Therapy for dissociative disorders focuses on reassociation and improving quality of life, functional abilities, and reducing symptoms.

Short Hospital Treatment

Acute care treatment for PTSD and dissociative disorders is usually short-term, with the goal of stabilizing the client and transitioning them back to community-based treatment.

General Appearance and Motor Behavior

Clients with PTSD may appear hyperalert, react strongly to environmental noises, and exhibit anxious or agitated behavior.

Mood and Affect

Clients with PTSD may display a wide range of emotions, from passivity to anger, and may experience flashbacks or dissociative episodes.

Thought Process and Content

Clients with PTSD may have intrusive thoughts about the trauma, memory gaps, hallucinations, and self-destructive thoughts or impulses.

Sensorium and Intellectual Processes

Clients with PTSD are usually oriented to reality, but may not respond or communicate during flashbacks or dissociative episodes.

Judgment and Insight

Insight into the relationship between past trauma and current symptoms may vary depending on the client's progress in treatment.

Self-Concept

Clients with PTSD often have low self-esteem, believing they are bad, unworthy, or damaged by their abusive experiences.

Roles and Relationships

Clients with PTSD may have difficulty with authority figures, close relationships, and socializing due to trust issues, intrusive thoughts, and avoidant behavior.

Physiologic Considerations

Clients with PTSD may experience difficulty sleeping, overeating or lack of appetite, and may use substances to cope.

Nursing diagnoses

Common nursing diagnoses for clients with PTSD include risk of self-mutilation, risk of suicide, ineffective coping, posttrauma response, and chronic low self-esteem.

Powerlessness

The feeling of lacking control or influence over one's situation.

Disturbed sleep pattern

A nursing diagnosis that refers to disruptions in a client's normal sleep routine.

Sexual dysfunction

A nursing diagnosis that refers to difficulties or problems with sexual functioning.

Rape-trauma syndrome

A nursing diagnosis that refers to the psychological and emotional effects experienced by a client who has been sexually assaulted.

Spiritual distress

A nursing diagnosis that refers to a client's feelings of inner conflict or turmoil related to their spiritual beliefs or practices.

Social isolation

A nursing diagnosis that refers to a client's lack of social interaction or connection with others.

Grounding techniques

Techniques used to help a client who is dissociating or experiencing a flashback to regain a sense of present reality and safety.

Self-esteem

The client's perception and evaluation of their own worth and value.

Support people

Individuals in the client's life who provide emotional, practical, or social support.

Problem-solving skills

The ability to identify, analyze, and implement solutions to problems.

Community supports

Resources and services available in the community that can provide assistance, support, and diversion for the client.

Self-awareness issues

The need for nurses to recognize and address their own personal feelings when caring for individuals affected by traumatic events.

Empathy

The ability to understand and share the feelings of another person.

Survivor's guilt

Feelings of guilt experienced by individuals who have survived a traumatic event while others did not.

Nonjudgmental

Approaching the client without criticism or bias.

Counseling

A therapeutic process in which a trained professional helps individuals explore and address their emotional and psychological concerns.

Survivor's guilt

Feelings of guilt experienced by individuals who have survived a traumatic event while others did not.

Expressive therapy

Therapeutic approaches that use creative outlets such as art, music, or writing to help individuals express and process their emotions.