Flashcards in Trauma and stress disorders Deck (77):
What are the four major reactions to trauma?
-Anxiety and fear
-Dysphoria and anhedonia
-Anger and aggression
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-Pattern of inhibited and emotionally withdrawn behavior toward adult caregivers, after a child has experience extreme of insufficient care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
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
True or false: developmental delays commonly occur with reactive attachment disorders
What indicates a better prognosis with reactive attachment disorder? (2)
With excellent caregiving environment following the neglect, and help received at an earlier age
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
What percent of severely neglected kids develop disinhibited social engagement?
Which is more common: disinhibited social engagement disorder or reactive attachment disorder? Which has a worse prognosis?
Disinhibited social engagement disorder x2
At what age will disinhibited social engagement disorder not develop (assuming adequate care prior to that point)?
If older than 2 years
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
What is the treatment for RAD or DSED? (2)
-Family therapy if appropriate
-Psychosocial interventions to address unmet basic needs
What are the diagnostic criteria for PTSD, in terms of exposures (4)?
-Direct witness it
-Learning event occurred to a close person
-Repeated personal exposure to aversive details of traumatic events
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
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
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
What is the duration for PTSD to meet the diagnostic criteria?
More than 1 month
What are the two major dissociative symptoms with PTSD?
-Depersonalization (you're not human)
-Derealization (nothing is real)
PTSD can occur at any age after what?
Symptoms of PTSD usually occur within what timeframe after the event?
3 months, but can be years
What are the risk factors for PTSD?
-Severity/duration of trauma
-Prior exposure to trauma
Is female or male sex a risk factor for the development of PTSD?
Is lower or higher intelligence a risk factor for PTSD? Higher or lower income?
What fraction of adults with PTSD will have remission within 12 months?
What is the treatment for PTSD in terms of trauma focused CBT? (3)
Trauma focused CBT:
-Confrontation of traumatic memories
-Reworking distorted cognitions
What is the pharmacotherapy for PTSD?
-Prazosin (reduces dreams)
What is the role of benzos in the treatment for PTSD?
Do not use
What is the foundation for psychotherapy for PTSD?
Exposing people to the trauma in a therapeutic manner
What is the MOA of prazosin? What is the use of treatment in PTSD?
Within what timeframe is starting of treatment and early social support particularly effective in treating PTSD?
Within 3 months
Is a high level of functioning pre-trauma a good or bad prognostic indicator for PTSD?
What is the central characteristic for complex PTSD?
Chronic trauma involving totalitarian control for an extended period of time (months to years)
What are the cognitive effects of complex PTSD?
Intense preoccupation with the perpetrator (attachment to the perpetrator)
What are the affected regulation problems with complex PTSD?
Persistent dysphoria--chronic suicidality
What are the consciousness problems with complex PTSD?
Amnesia for trauma experience; transient dissociative episodes
What are the self perception problems with complex PTSD?
Helplessness, shame and guilt
Defiled, stigmatized, an unlike other people
What should never be done with complex PTSD?
Try to control them
What is the appropriate approach to complex PTSD?
Gentle, and supportive
What type of medical history is characteristic for complex PTSD?
A lot of various somatic complaints, with confusing presentations
What is acute stress disorder?
Timeframe of anxiety within 1 month following event--more than 1 month = PTSD
What are the general categories of acute stress disorder diagnostic criteria?
1. Intrusive symptoms
2. Negative mood
3. Dissociative symptoms
5. Arousal symptoms
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)
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
What is the treatment for acute stress disorder?
Similar to PTSD--secondary prevention of PTSD
What are the current goals with acute stress disorder?
Normalize symptoms and reactions, and facilitate positive coping strategies
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
What are the s/sx of adjustment disorder? (2)
-Distress is out of proportion to the severity or intensity
-impairment in social work
When is the timeframe for diagnosing adjustment disorder?
Must RESOLVE within 6 months
What is the general prognosis with adjustment disorders?
What is the prevalence of adjustment disorders?
What is the role of support groups with adjustment disorders?
What is the treatment for adjustment disorder? (3)
-reduce the stressor
-improving healthy coping
How can you encourage resilience with adjustment disorders?
-Faith or spirituality
What are dissociative disorders? (BASK model)
True or false: some amount of dissociation can be normal
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
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
What must you always be certain of prior to diagnosing dissociative identity disorder?
Not a normal part of accepted cultural or religious practices
What is dissociative personality disorder strongly associated with?
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
What is the usual female presentation of dissociative identity disorders? Males?
Females = dissociative states
Males = violent or criminal
What is the usual cause of dissociative disorder?
Strongly associated with severe child abuse
What are the 3 major s/sx of reactive attachment disorder?
-Minimal social/environmental responsiveness to others
-Limited positive affect
How old must a child be to be diagnosed with reactive attachment disorder?
9 months, and began before 5
What causes disinhibited social engagement disorder?
Lack of a consistent caregiver or not having emotional needs met
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
What is the treatment for dissociative personality disorder?
-Standard PTSD treatment
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
What is the treatment for generalized amnesia?
Similar to DID
What is depersonalization disorder?
Being an outside observer with respect to one's own thoughts or feelings
What is derealization disorder?
Being outside observer with respect to surroundings
True or false: In both derealization and depersonalization disorders, reality testing is not intact
True or false: occasional feelings of derealization or depersonalization is common
What is the mean age of onset of derealization or depersonalization disorder?
What is the prevalence of of derealization or depersonalization disorder
Which gender is more affected with of derealization or depersonalization disorder?
What is the common history prior to of derealization or depersonalization disorder?
Emotional abuse and neglect