ch 16 (EX 3)Trauma, Stressor-Related, and Dissociative Disorders

exam 3

trauma related disorders

• traumatic life events associated w/ a wide range of psychiatric & other medical disorders.

• Understanding of long-term effects of trauma expanded.

trauma-informed care

Trauma-informed care is a treatment framework that involves recognizing and responding to the effects of all types of trauma

attachment disorders 

Reactive attachment disorder: reactive attachment disorder have a consistent pattern of inhibited and emotionally withdrawn behavior.

Disinhibited social engagement disorder: demonstrate no normal fear of strangers. They seem to be unfazed in response to separation from a primary caregiver.

PTSD 

PTSD in kids:  may manifest as a reduction in play, play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion. 

PTSD in adults: characterized by persistent re-experiencing of a highly traumatic event. This event involves actual or threatened death or serious injury to self or others.

Acute stress disorder

characterized by persistent re-experiencing of a highly traumatic event. This event involves actual or threatened death or serious injury to self or others.

• is diagnosed 3 days to 1 month after the traumatic event.

adjustment disorder

adjustment disorders is psychotherapy, which may include reality orientation, crisis intervention, family therapy, or group treatment.

• may be diagnosed immediately or within 3 months of exposure.

Precipitated by stressful event

symptoms: guilt, depression, anxiety, anger

reactive attachment disorder 

Consistent pattern of inhibited, emotionally
withdrawn behavior; unresponsive to
caregiver efforts to offer comfort in distress

Risk factors: Neurobiology & environment

disinhibited social engagement disorder

No normal fear of strangers; seemingly
unfazed by separation from primary caregiver

Risk factors: Neurobiology & environment

Clinical picture in PTSD (manifestations)

• reduction in play or play reflecting aspects of the trauma.

• Self-blame, detachment, estrangement, loss of interest in significant activities.

• Mood changes, sleep disturbances, hypervigilance , loss of concentration.

Risk factors

Neurobiological

• Trauma dysregulates neural pathways that integrate emotional regulation and arousal.

• Triggers hypoaroused state leading to dissociation

• polyvgal theory: suggests that the autonomic nervous system is not limited to a fight-or-flight response to threat. Instead, there are actually three different responses

Risk factors Cont. 

Environmental factors 

• Children’s neuroplasticity: dependense on adults and systems. 

• external factors that support or add stress 

• resilience 

neuroplasticity (malleability) of the developing brain that increases vulnerability to adverse life experiences.

Implementation stages 

Stage 1: provide safety and stabilization 

Stage 2: Reduce arousal and regulate emotion through symptom reduction and memory work 

Stage 3: catch up on developmental and social skills; develop a value system

Psychological therapies

eye movement desensitization and reprocessing (EMDR) therapy as first-line treatments for the treatment of traumatized children

cognitive behavioral therapy (CBT).

Biological treatments

Pharamacotherapy combined w/ EMDR therapy or CBT

Target symptoms & comorbidities like ADHD or MDD

PTSD in adults 

examples of PTSD-inducing events 

Military combat or hostage situations 

crime related events 

natural disasters 

human disasters (accidents) 

PTSD in adults

Flashbacks: Re-experiencing the trauma

Avoidance of stimuli associated w/ trauma

Persistent symptoms of increased arousal (hypervigilance)

Alterations in mood

Assessments & implementation for PTSD

Primary care PTSD Screen

PTSD Checklist

Implementation: Use same stage model of treatment used for kids

Health teaching & promotion

Treatment modalities for PTSD in adults 

Biological treatment: Antidepressants [(Nefazodone (Serzone), imipramine (Tofranil), and phenelzine Nardil)

SSRIs (sertraline (Zoloft) and paroxetine (Paxil) are FDA approved for the treatment of PTSD.)

psychological therapies PTSD in adults

Components of exposure and or cognitive restructuring and EMDR therapy.

Acute stress disorder Diagnosis

8 or more of the following during/after traumatic event

• subjective sense of numbing

• derealization

• inability to remember at least one important aspect of event

• intrusive distress memories of event

• Recurrent distressing dreams

• feeling as the event is recurring

• intense prolonged distress/ physiological reactivity

Treatment Modalities for Acute stress disorder 

• CBT

• Specialized protocols for EMDR therapy

• EMDR protocol for recent critical incidents (EMDR-PRECI)

• Recent traumatic Episodes Protocol (R-TEP)

Dissociative Amnesia

is marked by the inability to recall important personal information, often of a traumatic or stressful nature; this lack of memory is too pervasive to be explained by ordinary forgetfulness.

Depersonalization/Derealization Disorder

Depersonalization is an extremely uncomfortable feeling of being an observer of one’s own body or mental processes. Feelings of unreality, detachment, or unfamiliarity with parts of self or the whole self are features of this disorder.

derealization, the focus is on the outside world. It is the recurring feeling that one’s surroundings are unreal or distant.

Dissociative identity disorder

dissociative identity disorder is the presence of two or more distinct personality states that recurrently take control of behavior.

Risks factors: Biological (genetic, neurobiological) Environmental (response to acute overwhelming trauma)

Dissociative disorder (cultural) 

• syndromes include piblokto, native people of the Arctic

• frenzy witchcraft among the Navajo

• amok among Western Pacific natives.

Dissociative fugue

subtype characterized by sudden, unexpected travel and inability to recall one’s identity/information about the past

cognitive distortion

an insistence that the alters inhabit separate bodies and are unaffected by the actions of one another.

each alter has own pattern of (perceiving, relating to, and thinking about the self and environment)

Dissociative Identity Disorder Treatment modalities 

Pharmacotherapy: antidepressant medication, anxiolytics, and antipsychotics, dissociative amnesia or fugue after treatment with intravenous benzodiazepines.

Psychological therapies: CBT, psychodynamic psychotherapy, exposure therapy, modified EMDR therapy, hypnotherapy, neurofeedback, ego state therapies, somatic therapies, and medication

Somatic therapy: specific type of somatic psychotherapy, sensorimotor psychotherapy, combines talking therapy with body-centered interventions and movement to address the dissociative symptoms inherent in trauma