NURS 451 Trauma and Dissociative Disorders

when is acute stress disorder diagnosed?

3 days to 1 month after traumatic event.

how many symptoms will a pt with acute stress disorder experience?

8 of 14

what are sx of acute stress disorder?

◦Numbing

◦Derealization

◦Inability to remember at least one important aspect of the event

◦Intrusive distressing memories

◦Recurrent distressing dreams

◦Feeling as if the event is recurring

◦Intense prolonged distress or physiological reactivity

◦Avoidance of thoughts or feelings about the event

◦Sleep disturbances

◦Hypervigilance

◦Irritable, angry or aggressive

◦Exaggerated startle response

◦Agitation or Restlessness

what is adjustment disorder?

A milder, less specific version of ASD and PTSD.

what causes adjustment disorder?

Precipitated by a stressful event, but the event is not as severe and may not be considered traumatic.

◦Loss/grief

◦Retirement

◦Chronic Illness

◦Break-up

when is adjustment disorder diagnosed?

immediately or within 3 months

sx of adjustment disorder

◦Distress, guilt, depression, anxiety, anger. May include physical complaints, social withdrawal, impaired occupational functioning and academic decline.

reactive attachment disorder is A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:

1. The child rarely or minimally seeks comfort when distressed

2. The child rarely or minimally responds to comfort when distressed

reactive attachment disorder is A persistent social and emotional disturbance characterized by at least two of the following:

1. Minimal social and emotional responsiveness to others.

2. Limited positive affect.

3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

reactive attachment disorder is because The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:

1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.

2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care.)

3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).

PTSD population often experience:

Military Combat

Crime-related Events

Natural Disasters

Human Disasters

sx of PTSD

-Flashbacks

-Avoidance of stimuli associated with trauma

-Experience of persistent numbing of responses

-Persistent symptoms of increased arousal

-Symptoms of intrusion

-Nightmares

-Alterations in mood

PTSD secondary trauma COVID cognitive sx

-lowered concentration

-apathy

-rigid thinking

-perfectionism

-preoccupation with trauma

PTSD secondary trauma COVID emotional sx

-guilt

-anger

-numbness

-sadness

-helplessness

PTSD secondary trauma COVID behavioral sx

-withdrawal

-sleep disturbances

-appetite change

-hyper-vigilance

-elevated startle response

PTSD secondary trauma COVID physical sx

-increased HR

-difficulty breathing

-muscle and joint pain

-impaired immune system

-increased severity of medical concerns

question assessment for PTSD

When was the last time you struck out in anger?

Are you able to laugh and cry at appropriate times/situation?

How would you describe your mood right now?

Are you able to relax?

When was the last time you lost your temper, or said something without thinking first?

How do you sleep at night? Nightmares or repetitive dreams?

How is your memory?

Are you able to finish a task?

4 factors leading to post-traumatic growth

1. brutally honest optimism

2. perception of control over events

3. coping style

4. strong sense of self

5 domains of post-traumatic growth

1. personal strength

2. closer relationships

3. greater appreciation for life

4. new possibilities

5. spiritual development

definition of dissociative disorders

Interruption in the normally well-integrated continuum of a person's consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.

dissociative disorders are thought to be a

coping mechanism—an unconscious defense mechanism against trauma that protects the individual.

dissociative disorders - the traumatic event is

stripped of its emotional significance and affective content

dissociative disorders often associated with

extreme trauma, especially trauma experienced during childhood

primary cause of dissociative disorder appears to be

severe and prolonged trauma experienced during childhood

DD - an innate ability to

dissociate easily

DD - repeated episodes of

severe physical and sexual abuse

DD - lack of

supportive or comforting person to counteract abusive relative

DD - influence of

other relatives with dissociate symptoms or disorders

DD is what type of trauma?

complex

what is complex trauma?

- there are things that characterize it that are changing the brain:

1. Often going to have a very insecure or disorganized attachment (more often disorganized)

2. They live in chronic anxiety and terror - all of their energy is bent toward coping (lot of hiding, self-protecting, not learning or growing or maturing)

3. They grow up with this feeling of betrayal - there is no safe person in their life - am I lovable? Do I matter?

4. They develop a deep and abiding sense of shame - person always blames themselves

DD parts of brain

1.Regulating emotions and impulses - easily overwhelmed, self-destructive, often use addictions and self-harm - they have to do something destructive in order to have order or peace

2.The only way to get away is dissociation.

3.Self-identity - self destructive perceptions

4.Thoughts of abuser - control, fear, often take on the perpetrator's view of themselves (bond with perpetrator to survive); issues with intimacy long term

what is dissociative amnesia?

Inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.

dissociate amnesia may occur in what age?

any age group from children to adults

dissociative amnesia related to

trauma, memory may return spontaneously after the individual is removed from the stressful situation.

localized amnesia

failure to recall events during a circumscribed period of time, is the most common form of dissociative amnesia.

selective amnesia

Individual can recall some, but not all, of the events during a circumscribed period of time.

generalized amnesia

Complete loss of memory for one's life history. This is very rare.

-usually caused by head trauma/stroke

systematized amnesia

loss of memory for a specific category of information

continuous amnesia

Individual forgets each new event as it occurs

dissociative fugue

Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or for other important autobiographical information. Sometimes a new identity is assumed (though this is rare).

depersonalization

Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotion and/or physical numbing).

derealization

Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).

dissociative identity disorder

Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

cause of dissociative identity disorder

When children are experiencing prolonged trauma and disassociation, they don't know what to do with the emotions (guilt, shame), so sometimes these strong emotions take on their own personality/identity.

-not possession

sx of dissociative identity disorder

Alternate Personalities (Alters)

Usually ego-dystonic- they are unacceptable to the person's sense of self

May have:

Gaps in remote memory of personal life events

Lapses in dependable memory

Discovery of evidence of their everyday actions and tasks that they do not recall

dissociative disorder txs

-Psychotherapy

◦Clinicians should specialize in dissociation disorders

◦Assessment for hostile and suicidal behaviors

-Family & Group Therapy

-Hypnosis

◦May help recover repressed memories

◦May help control behaviors in this patient population such as self-mutilation

-Medications

◦Anxiolytics & Anti-depressants

◦Minimize medications b/c patient population is at risk for abuse

-PREVENTION is key

◦Intervention in abusive families

◦Treat children with dissociative symptoms ASAP

phase 1 of psychotherapy

Initial: mapping & uncovering individual's mental alterations /personalities

phase 2 of psychotherapy

treat traumatic memories and "fuse" alterations /personalities

phase 3 of psychotherapy

Phase 3: consolidating the patient's newly integrated personality