Chapter 7. Posttraumatic Stress Disorder PTSD

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1 Chapter 7 Posttraumatic Stress Disorder PTSD >***Post-Traumatic Stress Disorder - (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat*** >***PTSD has been in existence since the beginning of mankind under names such as soldier s heart named after American Civil War - Railroad Spine named after series of railroad crashes combat fatigue/shell shock named after WWI and WW II*** >***Many emotional crises are rooted in PTSD*** >***Suicide and drug/alcohol abuse are the end products of attempting to cope with trauma - however the traumatic experience i.e. rape, battering, physical violence hostage situations and large scale crisis natural and manmade disasters precipitate the disorder*** >***BASIC DEFINITION - the maladaptive adjustment to a traumatic event*** >***Vietnam Veterans syndrome, abused child syndrome, and battered woman syndrome have all come to be identified as manifestations of PTSD *** >***Psychic trauma process initiated by an event that confronts an individual with an acute, overwhelming threat*** ***Acute Stress Disorder*** symptomatic response to a traumatic experience that occurs for a minimum of two (2) days and maximum of four (4) weeks that occurs within one (1) month of the event, when the victim emotionally attempts to seal off some features of the traumatic experience

2 ***Chronic*** symptoms occur months or years after traumatic experience and may include 1. anxiety uneasiness, fear or worry 2. depression loss of interest, mood swings 3. substance abuse 4. hypervilgilance - behaviors whose purpose is to detect threats 5. intrusive-repetitive thoughts involuntary ideas or images ***PTSD Categorization*** a complex and troublesome disorder with require categorization 1. exposure to a trauma of actual or threatened death or serious bodily injury 2. persistent experiencing of the trauma i.e. flashbacks 3. avoidance of feelings associated with the trauma i.e. avoids activities and people 4. persistent symptoms of nervous system arousal not experience before trauma i.e. sleep disorders 5. impairment of social, occupational or any area of living i.e. marital problems and/or chemical abuse ***PTSD is also found children and symptoms are similar with noticeable differences*** 1. children don't have symptoms that they are reliving the past 2. children relive the trauma by repetitive play 3. nightmares are of monsters and rescuing others 4. fears that they will not reach adulthood *** Conflicting Diagnosis*** >>> occurs when those diagnosed with PTSD often have companion disorders 1. depression 2. anxiety 3. organic mental and substance abuse disorders > >> crisis interventions workers must always attempt to determine if the individual has been exposed to trauma<<<

3 ***PTSD - Preexisting Psychopathology*** 1. social service agencies and the VA did not perceive PTSD as a mental illness, because PTSD was a result of a man-made war or domestic violence 2. perception was that PTSD was a result of a preexisting character disorder 3. PTSD was misdiagnosed and those with PTSD suffered victimization by a rigid mental health system 4. often turned to self help groups, with others in the group suffering with PTSD 5. after political lobbying the VA and other mental treatment professionals began researching and developing treatment approaches for PTSD ***Psychological Responses of PTSD*** 1. brain acts as a wet hormonal gland 2. exposure to severe stress (threat) activates functions that deal with emergencies 3. intense and continuous stress (threat) can cause permanent physical changes to brain 4. changes to brain can cause physical and psychological duress long after event which explains why people struggle to get over PTSD ***Maladaptive Patterns Characteristic of PTSD*** 1. Death Imprint - traumatic experience provided a clear picture of one s death 2. Survivor s Guilt - due to surviving incident(s) or not preventing the death of another 3. Desensitization exposure to continuous violence/threat undermines empathy of concern for violence and/or victims 4. Estrangement relationships are of little value in the scheme of things 5. Emotional Enmeshment continuous struggle to move forward after the traumatic experience and an inability to find any significance in life ***Treatment Components*** 1. Processing and coming to terms with experience 2. Controlling both psychological and biological stress reactions 3. Reestablishing social and interpersonal connections

4 ***Treatment Process*** 1. Assessment a) current symptoms (depression) b) present problems (D&A abuse) c) interpretation of event (depends on current political and social environment Vietnam/Irag domestic violence) 2. Structured Interview _ a) best diagnostic tool to determine if PTSD exists b) examine impact of PTSD on social and occupational functioning 3. Self reports - Trauma gram Questionnaire a) efficient in terms of time and costs and is self constructed by allowing individual to grade (1 to 10) significance of trauma b) allows for expedient clarification and number of specific trauma(s) 4. Overview/Review of Assessmenta) PTSD victims have few interpersonal relationships b) Contacts with people reminiscent of traumatic evens c) Very reluctant to discuss event causing trauma ***Phases of Recovery*** 1) Outcry phase fight/flight to life threatening situations, physical condition experienced why did event happen 2) Denial - victim protects emotional well-being 3) Intrusive-Repetitive - nightmares- mood swings, attempts at burying event(s) 4) Reflective Transition - victim develops a perspective of trauma and develops positive forward looking attitude 5) Integration- survivor successfully integrates experience with other events and restores sense of continuity to life ***Treatment*** 1) Groups - > 1 st type - preventing groups - groups for short termed and acute distress > 2nd type debriefing groups - trauma specific for victims of similar trauma (support groups)

5 ***Intervention Strategies for Children*** 1) Interviewing (assessing) allows victim to talk about experience and allows crisis worker to discuss trauma with the victim and parents and educate both for the need of counseling 2) Instruments specific clinical scales have been develop for children 3) Projective Techniques - triage assessment may be necessary to determine the underlying PTSD which causes acting out ***PTSD - Interviewing and Assessment*** 1) requires poise, skill and finesse to discover an individual s past trauma which later manifests itself in PTSD 2) crisis workers must be ready to assist a victim who eventually will bear up to the trauma that caused the PTSD 3) crisis worker must be ready to experience their own PTSD which inadvertently lead them to assist victims of PTSD, because anyone can fall victim to PTSD The Required Text, Power Point presentation and Manual were referenced in the preparation of this RACC Canvas lecture: Richard K. James, PH. D & Burl Gillilard, PH. D Crisis Intervention Strategies 2013, th edition - Cengage Learning

Stress Disorders. Stress and coping. Stress and coping. Stress and coping. Parachute for sale: Only used once, never opened.

Stress Disorders. Stress and coping. Stress and coping. Stress and coping. Parachute for sale: Only used once, never opened. Stress Disorders Parachute for sale: Only used once, never opened. Stress and coping The state of stress has two components: Stressor: event creating demands Stress response: reactions to the demands Stress