Exam 2 study guide-- Ch 16 Trauma, Stress-related and Dissociative Disorders

What psychiatric disorders fall under the DSM-5 trauma umbrella?

Post-traumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), Adjustment Disorders, Reactive Attachment Disorder (RAD), and Disinhibited Social Engagement Disorder (DSED)

In the DSM-5 Criteria for PTSD in individuals older than 6 years to adults, in what ways can exposure to actual or threatened death, serious injury, or sexual violence occur?

Direct experience, witnessing events in person

Learning that a close relative/friend experienced actual/threatened death (violent or accidental) or sexual violence

Extreme indirect exposure to aversive details (e.g., first responders)

 In the DSM-5 Criteria, what intrusive symptoms may be associated with traumatic events?

Recurrent distressing memories, nightmares, flashbacks, and intense psychological or physiological distress when exposed to reminders

 In the DSM-5 Criteria, what provides evidence of persistent avoidance of stimuli?

Detachment, Feelings of emptiness and numbing 

Avoidance of or attempts to avoid distressing internal experiences such as memories, thoughts, or feelings related to the trauma. 

Avoidance of or attempts to avoid external cues, including people, places, activities, objects, or situations that trigger distressing thoughts or feelings about the trauma

In the DSM-5 Criteria, what negative alterations may be seen in mood and cognition associated with the traumatic event(s)?

Inability to recall key trauma features, persistent/exaggerated negative beliefs about oneself or the world, distorted self/other blame, persistent negative emotions (fear, anger), diminished interest in activities, detachment, and inability to experience positive emotions

 In the DSM-5 Criteria, what evidence of marked arousal or reactivity may be associated with the traumatic event(s)?

Two or more of the following six symptoms:

Irritable behavior and angry outbursts

Reckless or self-destructive behavior

Hypervigilance

Exaggerated startle response

Problems with concentration

Sleep disturbance

How long must symptoms of PTSD be present to meet the criteria for PTSD?

More than 1 month

What is depersonalization?

An extremely uncomfortable feeling of being an observer of one's own body or mental status

Feelings of unreality, detachment, or unfamiliarity with parts of self or the whole self are features of this disorder

What is derealization?

The focus is on the outside world; it is the recurring feeling that one's surroundings are unreal or distant

How may spontaneous or intrusive memories be different in children under 6 years old?

Being expressed through repetitive, non-verbal play, behavioral changes, or emotional reactivity rather than just distressing thoughts

Which gender is more likely to experience PTSD?

Men

What is dissociation, and what is occurring physiologically in response to trauma when it occurs?

An unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation.

Body "auto pilot."

Results in disturbances in memory, consciousness, self-identity, and perception

What is resilience as it relates to mental health?

Positive adaptation or the ability to maintain or regain mental health despite adversity

 What is an Adverse Childhood Experience (ACE)?

Potentially traumatic events occurring before age 18, including abuse, neglect, and household dysfunction (e.g., divorce, addiction).

 In what ways are children with potential trauma or stress disorders assessed?

Through assessing their safety, general appearance, socialization, activity level, speech coordination, motor function, affect, manner of relating to intellectual function, thought processes, thought content, and characteristics of play.

Questions and Observation!!!

What is the essential assessment data when looking at potential PTDS and trauma?

Nightmares/night terrors

Intrusive traumatic thoughts and memories

Re-experiencing or flashbacks

Numbing

Avoidance of stimuli associated with the traumatic event

Presence of self-injurious behaviors

Somatic symptoms- headache, stomachache, pain, difficulty concentrating

Trauma interventions for children with PTSD.

Establish trust

Use developmentally appropriate language to explore feelings

Teach relaxation techniques

Help the child identify and cope with feelings through expression through art and play

Involve caretakers unless they are cuase of the trauma

Educate the child about the grief process and response to trauma

Assist parents with resolving any of their emotional distress

What is EMDR, and how may it help with trauma or PTSD?

Eye movement desensitization and reprocessing

People are encouraged to think about the traumatic event while also focusing on other stimulation

First-line treatment for traumatized children (used for adults too)

Helps process and integrate traumatic memories

reaction attachment disorder (RAD)

involves internalizing, inhibited behavior (withdrawal)

Disinhibited social engagement disorder (DSED)

involves externalizing, disinhibited behavior (indiscriminate friendliness)

 What are the possible triggering events for PTSD in adults?

Military combat, hostage, prisoner of war

Crime-related events (bombing, assault, mugging, rape)

Natural disasters (Floods, tornadoes, earthquakes)

Human disasters (car, airline, or train accident)

What comorbidities may be seen with PTSD in adults?

Major depressive disorder

Anxiety disorders

Sleep disorders

Disassociative disorders

Substance use

What psychoeducation may be helpful in patients with PTSD?

Explaining that symptoms are normal reactions to abnormal events, identifying specific triggers, and teaching coping mechanisms to manage distress

CBT

EMDR

What drug class is evidence-based for use in PTSD symptoms?

SSRIs (selective serotonin reuptake inhibitors)

Which two drugs within the above class are FDA-approved specifically to treat PTSD?

Sertraline (Zoloft) and Paroxetine (Paxil)

What FDA off-label drug classes may help with PTSD symptoms

Other antidepressants such as Fluoxetine (Prozac), venlafaxine (effexor), Nefazodone (Serzone), imipramine (Tofranil), and phenelzine (Zardil)

What is Acute Stress Disorder, and how does the time frame for symptoms differ from PTSD?

ASD may develop after exposure to a highly traumatic event

Diagnosed 3 days to 1 month after the traumatic event

 How is Adjustment Disorder different from Acute Stress Disorder?

Adjustment Disorder follows any stressor (e.g., job loss, divorce) with functional impairment. Can be diagnosed immediately or within 3 months of exposure. ASD requires exposure to extreme trauma involving actual/threatened death, serious injury, or sexual violence. Diagnosed 3 days to 1 month after the traumatic event.

When do Dissociative Disorders typically occur, and what purpose do these serve for the patient?

After significant adverse experiences or trauma. It is a defense mechanism that protects the person against overwhelming anxiety through emotional separation.

 What is a dissociative fugue?

A temporary state where a person has memory loss (amnesia) and ends up in an unexpected place.

What are the risk factors for DID?

Severe sexual, physical, or psychological trauma in childhood

What are several assessment questions a nurse may ask if a dissociative disorder is suspected?

Can the pt remember recent and past events?

Is the pts memory clear and complete or partial and fuzzy?

Is the patient aware of gaps in memory?

Do the pts memories place the self with a family, in school, or in an occupation?

Does the pt ever lose time or have blackouts?

Does the pt ever find themselves in places with no idea how they got there?

What are the general guidelines for assessing a patient with a dissociative disorder?

Establish Safety First

Comprehensive History

Identify Symptoms

Medical/Neurological Rule-Out

Use Standardized Tools

Establish Alliance

Involve Others

What is Prolonged Exposure Therapy (PET)

Highly effective, evidence-based psychotherapy (typically 8-15 sessions) for PTSD that helps individuals gradually face trauma-related memories and avoided situations in a safe environment

How may PET help those with PTSD

Reduces Avoidance

Processes Trauma

Improves Daily Functioning

Long-term Relief

Patients with dissociative disorders are often misdiagnosed with

depression, schizophrenia, or BPD