PTSD and Dissociative Disorders and Anxiety disorders

Increased epinephrine and decreased intestinal motility is associated with the sympathetic or the parasympathetic system?

The sympathetic nervous system. Sympathetic activation stimulates the adrenal medulla to release epinephrine into circulation and diverts blood flow away from the gastrointestinal tract, thereby decreasing digestive peristalsis and motility.

Would your pupils constrict or dilate with a sympathetic response?

The pupils dilate (mydriasis). Sympathetic stimulation contracts the pupillary dilator muscle, allowing increased light intake to enhance threat detection and situational awareness.

What is Posttraumatic Stress Disorder (PTSD)?

A maladaptive psychiatric syndrome developing in response to exposure to actual or threatened death, serious injury, or sexual violence of extreme magnitude, with symptom persistence for more than 1 month causing clinically significant functional impairment.

What is Acute Stress Disorder (ASD)?

A stress syndrome presenting with intrusion, dissociative, avoidance, and hyperarousal symptoms similar to PTSD, with symptom duration ranging from 3 days to a maximum of 1 month post-trauma.

What is adjustment disorder?

An exaggerated emotional or behavioral reaction to ordinary life stressors arising within 1 month of stressor onset and resolving within 6 months once the stressor or its consequences terminate.

What is Reactive Attachment Disorder (RAD)?

An early childhood disorder developing prior to age 5 as a consequence of grossly pathogenic care, abuse, or severe neglect, characterized by inhibited, emotionally withdrawn behavior toward caregivers with minimal positive affect.

What is Disinhibited Social Engagement Disorder (DSED)?

An early childhood disorder secondary to severe neglect occurring before age 5, marked by inappropriate, overly familiar interactions with unfamiliar adults.

What is the symptom duration that distinguishes Acute Stress Disorder from PTSD?

Acute Stress Disorder involves trauma symptoms lasting less than 1 month post-event, whereas PTSD involves a disturbance pattern lasting over 1 month (or starting 3 or more months after trauma).

What is adaptive disclosure?

An 8-session combat-specific therapy for veterans with PTSD to address unhelpful beliefs.

What is depersonalization?

Feeling detached from oneself or one's own body.

What is derealization?

Feeling that the external environment or event isn't real.

What is dissociation?

A subconscious defense mechanism blocking painful memories or trauma from awareness.

What are dissociative disorders?

A group of disorders involving disruptions in memory, identity, consciousness, or perception, such as dissociative identity disorder and amnesia.

What is exposure therapy?

A behavioral technique where the client deliberately deliberately confronts avoided trauma triggers.

What are grounding techniques?

Reorienting exercises to pull a dissociating client back into the present, safe reality.

What is hyperarousal?

A chronic fight-or-flight state characterized by irritability, hypervigilance, insomnia, and outbursts.

What are repressed memories?

Deeply buried subconscious memories of severe trauma, often related to childhood abuse.

Why is a client recovering from trauma referred to as a "survivor" instead of a "victim"?

To empower them and shift their self-perception from a helpless victim to a strong survivor.

In Lazarus's Cognitive-Transactional Model, what is primary appraisal?

The initial cognitive evaluation of an encounter to classify it as irrelevant, benign-positive, or stressful (evaluated as a harm/loss, threat, or challenge).

In Lazarus's model, what is secondary appraisal?

The assessment of available personal, social, and environmental coping resources, determining what actions can be taken to mitigate the stressor.

In Lazarus's model, what is reappraisal?

Ongoing cognitive reassessment incorporating new incoming environmental data and feedback regarding the efficacy of employed coping strategies.

What individual mediating factors govern stress appraisal and response intensity?

Age, cognitive development, developmental maturity, physical and mental health status, prior trauma exposure, environment, and social support systems.

What can happen if physiological homeostasis fails because of persistent threat appraisal?

It overactivates physiological systems, induces chronic wear and tear, and can lead to death.

What are some objective and subjective physical signs of stress?

No eye contact, silence, fidgeting, talking too much, restlessness, and increased blood pressure, heart rate, and respiratory rate.

What is primary prevention for stress-related conditions?

Community-wide health promotion strategies designed to foster psychological resilience before stress occurs, such as school stress-management curricula and workplace wellness programs.

What is secondary prevention for stress-related conditions?

Early identification, screening, and rapid intervention during periods of acute stress to prevent progression to chronic disorders, such as utilizing standardized screening tools like the LEC-5.

What is tertiary prevention for stress-related conditions?

Long-term clinical treatment, rehabilitation, and symptom stabilization for established chronic psychiatric disorders, such as trauma-focused psychotherapy and pharmacological maintenance.

What is Criterion A for PTSD diagnosis in individuals older than 6 years?

Exposure to actual or threatened death, serious injury, or sexual violence through experiencing, witnessing, learning about it happening to a close family member/friend, or experiencing repeated extreme exposure to aversive details.

What are intrusion symptoms under Criterion B for PTSD?

Recurrent intrusive memories, distressing dreams, dissociative reactions or flashbacks, intense psychological distress to internal/external triggers, and marked physiological reactivity.

What does persistent avoidance under Criterion C for PTSD involve?

Avoidance of distressing memories, thoughts, or feelings, and avoidance of external reminders like people, locations, or objects associated with the trauma.

What do negative alterations in cognition and mood under Criterion D for PTSD include?

Inability to recall important aspects of the event, persistent exaggerated negative beliefs, distorted cognitions causing inappropriate blame, pervasive negative emotional states, diminished interest in activities, detachment, and an inability to experience positive emotions.

When can PTSD symptom onset occur?

Symptom onset can be immediate or delayed by 3 months or more post-trauma.

How do adolescents with PTSD typically manifest symptoms?

Through high impulsivity, aggression, risk-taking, extreme anger, academic disruption, substance misuse, and suicide risk.

How do children often incorporate trauma responses?

Through repetitive trauma-reenactment play.

What can trigger acute PTSD in older adults?

Traumatic physical injuries, such as falls resulting in hip fractures.

What is a long-term correlation of chronic PTSD in late life?

Premature cognitive decline and dementia.

What are expected immediate outcomes for a hospitalized client with PTSD within 2 to 4 days?

Demonstrate reduced somatic tension within 2 to 3 days and achieve at least 4 hours of uninterrupted sleep per night within 3 to 4 days.

What is a priority nursing action for promoting safety in a client with PTSD?

Assess suicide risk and self-harm ideation, and collaborate with the client to develop an explicit plan for retreating to a safe environment during severe distress.

How should a nurse intervene during a dissociative flashback episode?

Apply grounding techniques to reorient the client to present time and place, validate emotional fear while anchoring to reality, and encourage postural changes without grabbing or physically restraining them.

What is the role of supportive touch in caring for a PTSD client?

Offer supportive touch only if previously authorized by the client.

What distraction techniques can be instructed during heightened distress?

Deep diaphragmatic breathing, muscle relaxation, exercise, listening to music, and engaging in hobbies.

What is the first-line psychotherapeutic framework for restructuring maladaptive trauma beliefs in PTSD?

Cognitive Behavioral Therapy (CBT).

What is prolonged exposure therapy?

Controlled, gradual exposure to avoided trauma cues to extinguish conditioned fear reactions.

What is adaptive disclosure?

A specialized military-developed CBT protocol designed for active-duty personnel dealing with moral injury and combat trauma.

What is Cognitive Processing Therapy (CPT)?

Structured therapy targeted at resolving stuck points related to trust, safety, and self-blame in combat and sexual assault survivors.

What are the first-line pharmacological treatments for PTSD?

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).

What unconscious psychological defense mechanism buffers the ego against intolerable trauma by disconnecting awareness, memory, or identity?

Dissociation.

What is Dissociative Identity Disorder (DID)?

Disruption of identity manifested by the presence of two or more distinct personality states along with recurrent gaps in daily recall and autobiographical memory.

What are key assessment cues for autonomic hyperarousal in a client with PTSD?

Elevated blood pressure, increased heart rate, tachypnea, hypervigilance, and exaggerated startle responses.

What subjective data might a client with PTSD report regarding sleep disturbances?

Severe insomnia, early morning awakening, and crying out or experiencing nightmares during sleep.

What emotional and behavioral assessment findings are typical of emotional numbing in PTSD?

A flat affect, denial of feelings, and difficulty identifying or expressing emotions.

What objective behavioral cues may indicate a client is experiencing acute stress?

Avoiding eye contact, silence, fidgeting, talking too much, or displaying restlessness.

What is the primary difference in diagnostic criteria regarding symptom duration between Acute Stress Disorder and PTSD?

Acute Stress Disorder symptoms last from 3 days up to 1 month post-trauma, whereas PTSD symptoms persist for more than 1 month.

How does Adjustment Disorder differ from PTSD in its precipitating stressor and presentation?

Adjustment Disorder involves an exaggerated reaction to ordinary life stressors (like financial strain or divorce) rather than actual or threatened death, serious injury, or sexual violence.

What differentiates Dissociative Amnesia from ordinary forgetfulness?

Dissociative Amnesia involves an inability to recall vital personal biographical data typically precipitated by a traumatic or catastrophic event, exceeding ordinary forgetfulness.

How do presentation and diagnostic criteria differ between Dissociative Identity Disorder and Depersonalization/Derealization Disorder?

Dissociative Identity Disorder features two or more distinct personality states with memory gaps, whereas Depersonalization/Derealization Disorder involves detachment from oneself or unreality of surroundings with intact reality testing.

What are the three levels of prevention strategies for stress-related conditions?

Primary prevention (community-wide resilience building), secondary prevention (early screening and crisis intervention), and tertiary prevention (long-term clinical treatment and rehabilitation).

What is an example of a secondary prevention strategy for stress and trauma?

Utilizing standardized screening tools such as the Life Events Checklist (LEC-5) for early identification and rapid intervention.

What is a primary nursing safety action when assessing a client with severe PTSD?

Assessing suicide risk and self-harm ideation and collaborating on a plan to retreat to a safe environment during severe distress.

How should a nurse physically interact with a client experiencing a dissociative flashback?

Encourage postural changes without grabbing or physically restraining them, offering supportive touch only if previously authorized.

What nursing intervention is used to pull a dissociating client back to the present reality?

Grounding techniques that reorient the client to present time, place, and safe surroundings.

What relaxation exercises should a nurse instruct a client to use during heightened distress?

Deep diaphragmatic breathing and progressive muscle relaxation.

What planned distractions can a nurse suggest to help a client manage heightened stress?

Engaging in physical exercise, listening to music, or participating in hobbies.

What is the purpose of Cognitive Behavioral Therapy (CBT) in treating trauma?

It serves as a first-line framework for restructuring maladaptive trauma beliefs.

What does Prolonged Exposure Therapy involve as a treatment option for PTSD?

Controlled, gradual exposure to avoided trauma cues to extinguish conditioned fear reactions.

What is the primary goal of Cognitive Processing Therapy (CPT)?

Targeting and resolving stuck points related to trust, safety, and self-blame in trauma survivors.

What specialized therapy pairs bilateral sensory stimulation with trauma recall?

Eye Movement Desensitization and Reprocessing (EMDR).

What is the primary psychotherapeutic goal when treating Dissociative Disorders?

Reassociation—the reintegration of fragmented memory systems and consciousness into a unified identity.

What class of medications is considered first-line pharmacological management for PTSD?

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).

Why might atypical antipsychotics like risperidone be used adjunctively in PTSD treatment?

To help control severe hyperarousal and intrusive thoughts.

What therapeutic communication technique helps a nurse validate a client's fear while keeping them anchored?

Validating emotional fear while explicitly anchoring the client to the safe reality of the present environment.

What communication approach helps build trust and acceptance with a trauma client?

Listening actively, encouraging the client to acknowledge and accept emotional states rather than suppressing them, and avoiding judgment.

How can a nurse help a client break down overwhelming daily challenges?

Instructing the client to deconstruct large tasks into small, measurable, and achievable daily goals.

What nursing strategy promotes self-esteem and reframes a client's self-perception?

Referring to the client as a "survivor" rather than a "victim" to reinforce personal resilience.

How can nurses encourage social support integration for clients recovering from trauma?

Soliciting assistance from trusted family members, avoiding social isolation, and participating actively in community-based trauma support groups.

What lifestyle and health routines should a nurse educate a PTSD client to prioritize?

Prioritizing sleep hygiene, balanced nutrition, establishing a structured daily routine, and completely avoiding alcohol and non-prescribed substances.

What immediate nursing outcome is expected regarding sleep for a hospitalized PTSD client within 3 to 4 days?

Achieving at least 4 hours of uninterrupted sleep per night.

What community-level nursing outcome is important for long-term recovery in stress and trauma disorders?

Integrating the traumatic experience into daily living outside the healthcare facility and maintaining consistent contact with community support systems.