Flashcards in Trauma and stress disorders Deck (77):
1
What are the four major reactions to trauma?
-Anxiety and fear
-Dysphoria and anhedonia
-Anger and aggression
-Dissociation
2
What is reactive attachment disorder?
-Pattern of inhibited and emotionally withdrawn behavior toward adult caregivers, after a child has experience extreme of insufficient care
-Persistent social and emotional disturbance
3
What causes reactive attachment disorder? (3)
-Lack of emotional needs for comfort, stimulation, and affection
-Repeated changes in primary caregivers
-Living in settings with limited opportunities to form attachments with caregivers
4
True or false: developmental delays commonly occur with reactive attachment disorders
True
5
What indicates a better prognosis with reactive attachment disorder? (2)
With excellent caregiving environment following the neglect, and help received at an earlier age
6
What is disinhibited social engagement disorder? What are the 4 characteristics of their behavior?
-Child actively approaches and interacts with unfamiliar adults, and exhibits 2+ of:
-Lack of reticence in approaching
-Overly familiar verbal or physical behavior
-Diminished checking with adult caregiver
-Willingness to go off with unfamiliar adult w/o hesitation
7
What percent of severely neglected kids develop disinhibited social engagement?
20%
8
Which is more common: disinhibited social engagement disorder or reactive attachment disorder? Which has a worse prognosis?
Disinhibited social engagement disorder x2
9
At what age will disinhibited social engagement disorder not develop (assuming adequate care prior to that point)?
If older than 2 years
10
Which is an externalizing and which an internalizing response to a lack of appropriate care: disinhibited social engagement disorder and reactive attachment disorder?
Internalizing = RAD
Externalizing = DSED
11
What is the treatment for RAD or DSED? (2)
-Family therapy if appropriate
-Psychosocial interventions to address unmet basic needs
12
What are the diagnostic criteria for PTSD, in terms of exposures (4)?
Exposure to:
-Direct experience
-Direct witness it
-Learning event occurred to a close person
-Repeated personal exposure to aversive details of traumatic events
13
What are the symptoms of PTSD? (5)
-Recurrent intrusive memories, dreams or dissociated flashbacks
-Psychological distress with internal or external cues
-Physiological rxns to internal or external cues
-Avoidance of memories
14
What are the five major categories of symptoms for PTSD?
1. exposure to actual or threatened death etc
2. Intrusive symptoms
3. Persistent avoidance
4. Negative alterations in cognitions
5. Alterations in arousal and reactivity
15
What are the negative alterations in cognition and mood associated with PTSD? (6)
-Unable to recall important aspects of trauma
-Exaggerated negative beliefs/expectations
-Distorted cognitions about cause or consequences
-Persistent negative emotional state
-Feelings of estrangement/detachment
-Inability to experience positive emotions
16
What is the duration for PTSD to meet the diagnostic criteria?
More than 1 month
17
What are the two major dissociative symptoms with PTSD?
-Depersonalization (you're not human)
-Derealization (nothing is real)
18
PTSD can occur at any age after what?
1 year
19
Symptoms of PTSD usually occur within what timeframe after the event?
3 months, but can be years
20
What are the risk factors for PTSD?
-Severity/duration of trauma
-Prior exposure to trauma
21
Is female or male sex a risk factor for the development of PTSD?
Female
22
Is lower or higher intelligence a risk factor for PTSD? Higher or lower income?
Lower intelligence
Lower income
23
What fraction of adults with PTSD will have remission within 12 months?
1/2
24
What is the treatment for PTSD in terms of trauma focused CBT? (3)
Trauma focused CBT:
-anxiety management
-Confrontation of traumatic memories
-Reworking distorted cognitions
25
What is the pharmacotherapy for PTSD?
-SSRIs/SNRIs
-Prazosin (reduces dreams)
26
What is the role of benzos in the treatment for PTSD?
Do not use
27
What is the foundation for psychotherapy for PTSD?
Exposing people to the trauma in a therapeutic manner
28
What is the MOA of prazosin? What is the use of treatment in PTSD?
-Alpha-1 antagonist
-Reduces nightmares
29
Within what timeframe is starting of treatment and early social support particularly effective in treating PTSD?
Within 3 months
30
Is a high level of functioning pre-trauma a good or bad prognostic indicator for PTSD?
Good
31
What is the central characteristic for complex PTSD?
Chronic trauma involving totalitarian control for an extended period of time (months to years)
32
What are the cognitive effects of complex PTSD?
Intense preoccupation with the perpetrator (attachment to the perpetrator)
33
What are the affected regulation problems with complex PTSD?
Persistent dysphoria--chronic suicidality
34
What are the consciousness problems with complex PTSD?
Amnesia for trauma experience; transient dissociative episodes
-Feel crazy
35
What are the self perception problems with complex PTSD?
Helplessness, shame and guilt
Defiled, stigmatized, an unlike other people
36
What should never be done with complex PTSD?
Try to control them
37
What is the appropriate approach to complex PTSD?
Gentle, and supportive
38
What type of medical history is characteristic for complex PTSD?
A lot of various somatic complaints, with confusing presentations
39
What is acute stress disorder?
Timeframe of anxiety within 1 month following event--more than 1 month = PTSD
40
What are the general categories of acute stress disorder diagnostic criteria?
1. Intrusive symptoms
2. Negative mood
3. Dissociative symptoms
4. Avoidance
5. Arousal symptoms
41
What is the timeframe in which acute stress disorder occurs in?
3 days after event to less than 1 month (more than 1 month is PTSD)
42
What percent of people get acute stress disorder following exposure to trauma? When does it increase markedly?
Less than 20%
If done on purpose, much more prevalent
43
What is the treatment for acute stress disorder?
Similar to PTSD--secondary prevention of PTSD
44
What are the current goals with acute stress disorder?
Normalize symptoms and reactions, and facilitate positive coping strategies
45
What are adjustment disorders?
Emotional or behavioral symptoms in response to an identifiable stressors (but not significant trauma) occurring within 3 months of stressors onset
46
What are the s/sx of adjustment disorder? (2)
-Distress is out of proportion to the severity or intensity
-impairment in social work
47
When is the timeframe for diagnosing adjustment disorder?
Must RESOLVE within 6 months
48
What is the general prognosis with adjustment disorders?
Generally good
49
What is the prevalence of adjustment disorders?
2-8%
50
What is the role of support groups with adjustment disorders?
Helpful
51
What is the treatment for adjustment disorder? (3)
Psychotherapy
-reduce the stressor
-improving healthy coping
-Optimize support
52
How can you encourage resilience with adjustment disorders?
-Faith or spirituality
-humor
-Role models
-Social support
-Life's mission
53
What are dissociative disorders? (BASK model)
Separation of:
-Behavior
-Affect
-Sensation
-Knowledge
54
True or false: some amount of dissociation can be normal
True
55
What is the stepwise examples of dissociation?
-Finding yourself dressed in clothes you don't remember putting on
-Feeling as though you are standing next to yourself, watching
-Looking in a mirror and not recognizing yourself
56
What is dissociative identity disorder? (3)
-Disruption of identity--2 or more personality states involving discontinuity in sense of self and agency (split personality disorder)
-Gaps in recall of events
-Distress and/or impairment across one's life
57
What must you always be certain of prior to diagnosing dissociative identity disorder?
Not a normal part of accepted cultural or religious practices
58
What is dissociative personality disorder strongly associated with?
Child abuse
59
True or false: auditory hallucinations is an exclusion criteria for dissociative personality disorder
False--common and may be confused with psychosis
Antipsychotics will not affect this however
60
What is the usual female presentation of dissociative identity disorders? Males?
Females = dissociative states
Males = violent or criminal
61
What is the usual cause of dissociative disorder?
Strongly associated with severe child abuse
62
What are the 3 major s/sx of reactive attachment disorder?
-Minimal social/environmental responsiveness to others
-Limited positive affect
-Unexplained irritability/sadness/fearfulness
63
How old must a child be to be diagnosed with reactive attachment disorder?
9 months, and began before 5
64
What causes disinhibited social engagement disorder?
Lack of a consistent caregiver or not having emotional needs met
65
What are the two major ways to distinguish between auditory hallucinations 2/2 dissociative personality disorder, and those from psychosis?
Psychosis = voices from outside, and will respond to antipsychotics
Dissociative personality disorder = voices from within, and will not response to antipsychotics
66
What is the treatment for dissociative personality disorder?
-Standard PTSD treatment
-Psychotherapy
67
What is dissociative amnesia? What must be true for this to be diagnosed?
-Inability to recall important autobiographical info, usually of a traumatic or stressful nature
-is distressing
68
What is the treatment for generalized amnesia?
Similar to DID
69
What is depersonalization disorder?
Being an outside observer with respect to one's own thoughts or feelings
70
What is derealization disorder?
Being outside observer with respect to surroundings
71
True or false: In both derealization and depersonalization disorders, reality testing is not intact
False--is intact
72
True or false: occasional feelings of derealization or depersonalization is common
True
73
What is the mean age of onset of derealization or depersonalization disorder?
16
74
What is the prevalence of of derealization or depersonalization disorder
1-2%
75
Which gender is more affected with of derealization or depersonalization disorder?
Equal
76
What is the common history prior to of derealization or depersonalization disorder?
Emotional abuse and neglect
77