Notes on Trauma and Stress Disorders

Chapter 12: Trauma & Stress Disorders

Key Concepts of Trauma
  • Definition: Trauma involves exposure to actual or threatened harm, fear of death or injury, and is considered an extreme stressor.
  • Associated Disorders: Recent inclusions in the DSM include:
    • Acute stress disorder
    • Adjustment disorders
    • Post-Traumatic Stress Disorder (PTSD)
    • Reactive attachment disorder
    • Disinhibited social engagement disorder
  • Childhood Trauma Factors:
    • Actual or threatened death
    • Injury
    • Threat to physical integrity
  • Examples of Traumatic Events:
    • Major accidents
    • Natural disasters
    • Kidnapping
    • Physical assaults
    • War and violence
    • Sexual abuse
    • Child maltreatment
    • Exposure to domestic violence
    • Chronic child poverty
  • Risks: Children facing chronic stressors exhibit a higher risk of PTSD.
Trauma Reactions
  • Responses to Trauma:
    • Hyperresponsive (increased sensitivity)
    • Hyporesponsive (reduced responsiveness)
  • Allostatic Load: Refers to the wear and tear on biological systems due to chronic stress.
Child Maltreatment
  • Definition: Child maltreatment includes acts or omissions by caregivers resulting in serious harm or risk to the child.
  • Forms of Maltreatment:
    1. Physical abuse
    2. Neglect
    3. Sexual abuse
    4. Psychological abuse
  • Statistics: 1 in 4 girls and 1 in 20 boys face sexual abuse or assault.
  • Characteristics of Victimization:
    • Age: More common in children over 12, but younger children are at higher risk.
    • Sex: Equally affects boys and girls.
    • Ethnicity: Higher rates in Black, American Indian, Alaska Native, and mixed children due to historical trauma.
Types of Neglect
  • Forms of Neglect:
    1. Physical neglect (living in unsanitary conditions)
    2. Educational neglect (refusal to acknowledge learning needs)
    3. Emotional neglect (exposure to family violence)
  • Behavior Patterns in Neglected Children: Fluctuate between undisciplined behavior and extreme passivity.
History and Cultural Context of Abuse
  • Historical views of abuse as acceptable in familial structures, especially regarding authority, have evolved.
  • Current standards largely condemn abuse.
  • Many countries now have policies addressing child abuse and neglect.
Healthy Parenting and Caregiving
  • Characteristics of Healthy Parenting:
    • Understanding child development
    • Adequate coping skills
    • Enhanced development through stimulation
    • Secure attachment and communication
  • Caregiving Context:
    • Positive practices foster development; dysfunctional actions harm.
    • Relational disorders often occur in stressful situations.
Forms of Abuse
  • Physical Abuse: Involves intentional aggression or excessive punishment.
  • Psychological Abuse: Consistently harms emotional well-being.
  • Sexual Abuse: Ranges from inappropriate exposure to harmful sexual acts.
Victimization Rates and Causes
  • Rates: Higher among younger children, predominantly affect females.
  • Causes:
    • Neglectful parents often distance themselves emotionally.
    • Abusive parents may misinterpret normal child behavior.
    • Social factors contribute, including media portrayal of sex roles and cultural acceptances.
Trauma and Stressor Related Disorders in Childhood
  • Reactive Attachment Disorder (RAD):
    • Inappropriate attachment behaviors.
    • Lack of comfort-seeking and emotional expression.
    • Often results from impoverished care environments.
  • Disinhibited Social Engagement Disorder (DSED):
    • Excessive openness with strangers, lacks checking in with caregivers.
    • Similar origins as RAD, typically results from insufficient care.
PTSD Characteristics
  • Key Symptoms (for children >6 years):
    1. Intrusions of distressing thoughts or memories.
    2. Avoidance of reminders of the trauma.
    3. Distorted feelings or thoughts related to the trauma.
    4. Extreme heightened arousal and reactivity.
  • Prevalence: 6-month prevalence for 12-17-year-olds is 3.7% for boys and 6.3% for girls.
Associated Problems with PTSD
  • Course: Chronic PTSD can last for decades and cause varying symptoms over time.
  • Mood and Affect Disturbances: Include depression and suicidal thoughts, especially among maltreated children.
  • Behavioral Problems: Boys often show aggression; girls may internalize distress.
Long-term Implications and Relationships
  • Children from violent homes often replicate violent behavior in future relationships.
  • Increased risk of criminal behavior and perpetuating cycles of violence.
Factors Influencing Trauma Perception
  • Key Factors:
    • Developmental stage and pre-event characteristics.
    • Individual coping styles and cognitive appraisal of the threat.
Treatment and Prevention Strategies
  • Exposure-Based Therapy: Effective for reducing acute stress symptoms; often brief.
  • In-Depth Interventions: Essential for severe cases; focus on processing thoughts and feelings.
  • Prevention Efforts: Include parenting education and strategies to restore children’s sense of safety.
  • Training Programs: Target poor parenting practices to promote healthier caregiving.