trauma and stress-related disorders

stressors

can be any event–either witness firsthand, experienced personally or experienced by a close family member—that increases physical or psychological demands on an individual—-significant enough that they may pose a threat, whether real or imagined—any event, force, or condition that results in physical or emotional stress

• Most common are combat and physical/sexual assault****even if it seems minor to you doesn’t mean it is minor to others—everyone is different and, thus, handles stress differently

rape

forced sexual intercourse or other sexual act committed without an individual’s consent

• Occurs in ⅕ women and 1/71 men—this statistic may not be accurate because there are many victims who do not report their assault

health psychology

biopsychological approach

 study how psychological behavior and social factors influence physical health, illness and healthcare

trauma

 any disturbing experience that results in significant fear, helpness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning

Traumatic events include those caused by

human behavior and often challenge an individual’s view of the world as a just, safe, and predictable place—trauma can also refer to physical injury 

• violence—crime/war

• Rape

• Human trafficking, slavery, or torture

• Natural disastor

• Domestic violence

• child/elder abuse or neglect

• Accident or witness to an accident—even if you have no part in it, it is still awful to witness

diagnostic criteria for PTSD

exposure to actual or threatened death, serious injury, or sexual violence in one (or more of the following ways)

• directly experiencing the event

• witnessing the event

• learning that the event occurred to a close friend or family member

• experiencing repeated or extreme exposure to aversive details of the traumatic events

the diagnostic criteria for PTSD DOES NOT apply to _____

 exposure through electronic media, television, movies, or pictures, unless the exposure is work related

intrusion symptoms

things you don’t anticipate and/or want to think about

• recurrent distressing dreams

• intrusive and involuntary distressful memories

• dissociative reactions such as flashbacks

****and other stuff

diagnosing PTSD includes the following

• intrusion symptoms

• persistent avoidance of stimuli associated with the traumatic event

• negative alterations in cognitions and mood associated

• Increased arousal and reactivity (jumping at unexpected noises)

the duration of the disturbance for PTSD is more than ____

one month at least——-the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Complex PTSD is in the _____

ICD but not in the DSM-5

****prolonged trauma (trafficking, long-term abuse)----similar symptoms, but may also include:

• Feelings of worthlessness, shame and guilt

• Problems controlling emotions

• Finding it hard to feel connected with other people

• Relationship problems in general

due to the fact that 30 days after the traumatic event, ASD______

 becomes PTSD (or the symptoms remit) the comorbidity of ASD with other disorders has not been studied

Acute Stress Disorder

*** puts you at risk for ptsd but does not coexist at the same time (provisional)———mostly the same as PTSD , however the arousal symptoms are slightly different

• the disturbance is 1 days to 1 month after trauma exposure—-symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria

• prevalence varies according to the type of event—--higher rates were usually found following interpersonal traumatic events (rape, assault, etc)

Therapy to treat PTSD (and Acute Stress)

***Cognitive behavioral Therapy

***Dialectical Behavior therapy

dialectical behavior therapy

practices mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness

-Combining acceptance and change

-building a life worth living

adjustment disorders

the development of emotional or behavioral symptoms in response (s) occurring within 3 months of the onset of the stressor (s)

• marked distress that is out of proportion to the severity/intensity of the stressor taking into account the external context and the cultural factors that might influence symptoms severity and presentation

• significant impairment in a social, occupation, or other important areas of functioning

once the stressor or its consequences have been terminated for an Adjustment Disorder, the _____

the symptoms do not persist for an additional 6 months

specifiers for Adjustment disorder

• With depressed mood

• With anxiety with mixed anxiety and depressed mood

• With disturbances of conduct (behavior)

• With mixed disturbances of emotion and conduct

• Unspecified

Acute Adjustment Disorder

less than 6 months

persistent (chronic) adjustment disorder

if there is a chronic stressor the symptoms may last for longer than 6 months

treatment for Adjustment Disorder

***CBT

***Interpersonal therapy (IPT)

***Solution-focused brief therapy

Stress management techniques with support groups and lifestyle modifications —- and medication

prolonged grief disorder

the death, at least 12 months ago, of a person who was close to the bereaved individual

******for children or adolescents, at least 6 months ago

Since the death, the development of a persistent grief response characterized by “

• Intense yearning/longing for the deceased person.

• Preoccupation with thoughts or memories of the deceased person *****in children and adolescents, preoccupation may focus on the circumstances of the death

symptoms of prolonged grief disorder

• identity disruption

• marked sense of disbelief about the death

• avoidance of reminder that the person is dead

• intense emotional pain

• difficulty reintegrating into one’s relationships and activities after the death

• emotional numbness

• feeling that life is meaningless

• intense loneliness as a result of the death

the duration and severity of bereavement in prolonged grief disorder clearly_____

exceed expected social, cultural, or religious norms for the individual’s culture and context

treatment for prolonged grief disorder included ____

grief-focused CBT, IPT, and mediations (antidepressants with therapy)——support groups!!!

reactive attachment Disorder

a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers manifested by:

• the child rarely or minimally seeking comfort when distressed

• the child rarely or minimally responds to comfort when distressed

In Reactive Adjustment Disorder, there is a persistent social and emotional disturbance such as_____

• minimal social and emotional responsiveness to others

• limited positive affect

• episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers

RAD children has experienced a pattern of extreme or insufficient care evidenced by ____

• social neglect or deprivation in the form of persistent lack of basic emotional needs for comfort, stimulation, and affection met by caregiving adults

• repeated changes of primary caregivers that limit opportunities to form stable attachments

• rearing unusual setting that severely limit opportunities to form selective attachments

early intervention for RAD children before the age of ____

two is significant for treatment and it takes:

• Takes very specialized care with people who know what they are doing

• Play therapy 

• Attachment-based family therapy

• CBT

• Medications—antidepressants or antianxiety to manage symptoms (children have a higher risk of suicidal ideation if they take antidepressants—works differently for the brains of kids)

• Parenting education

Hypothalamic-Pituitary-Adrenal (HPA) axis

involved in the fear producing response and some speculate that a dysfunction within this axis is to blame for the development of trauma symptoms

Amygdala

serves as the integrative system that essentially elicits the physiological response to a traumatic/stressful environmental situation——-heightened reactivity in stressul situations

First, the amygdala sends the fear response to the _____

HPA axis to prepare the body for “fight or flight”

Second, the HPA releases_____

 cortisol and epinephrine to help the body to prepare for a response appropriate for a dangerous situation

epinephrine

causes increase in blood pressure, heart rate, alertness, and increased muscle tension

cortisol

responsible for returning the body back to homeostasis once the dangerous situation is resolved

those with PTSD show a diminished_____

fear distinction, explaining why individuals with PTSD experience and increased startle response and exaggerated sensitivity to stimuli associated with their trauma

pre-existing conditions such as depression and/or anxiety increases someone’s likelihood of developing _____

PTSD or other stress disorders because these individuals may be more prone to  ruminating and repeatedly analyzing the traumatic event, which is bringing more attention to the event

Psychological Debriefing

a way to negate the potential development of PTSD

requires individuals who have recently experienced a traumatic event to discuss or process their thoughts and feelings related to the event within 72 hours–includes:

pyschological debriefing steps

1, Identifying the facts (what happened?) 

2. Evaluating the individual’s thoughts and emotional reaction to the events leading up to the event, during the event, and then immediately following 

3. Normalizing the individual's reaction to the event

 4. Discussing how to cope with these thoughts and feelings, as well as creating a designated social support system (Kinchin, 2007).  

Bucharest Early Intervention Project

***studied the romanian orphanages—-Found that group foster care was better for the children than institutinalization

• Symptoms of RAD decreased significantly in children removed to foster care

neglect is the most common form of_____

child maltreatment in the US with 75% of all cases of maltreatment reported to child protection