Understanding the role of Acute Stress Disorder in trauma

Transcription

1 Understanding the role of Acute Stress Disorder in trauma Dr. Trina Hall Police Psychologist Dallas Police Department Lessons Learned: Unfolding the story of PTSD NAMI 2014 Fall Conference

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3 Trauma and Stressor Related disorders Acute stress disorder Post traumatic stress disorder

4 Prevalence of Exposure to Traumatic Events 50%-90% of general population are exposed to traumatic events during their lifetime. 75% of law enforcement personnel are exposed to traumatic events in their career. Most do not develop ASD or PTSD

5 What is the normal response to a traumatic event? anxiety, feeling revved up; emotional instability fatigue irritability hyper-vigilance trouble sleeping exaggerated startle response change in appetite feeling overwhelmed impatience isolation from family and friends shock nightmares somatic complaints

6 Acute Stress Disorder Criterion A: Directly experiencing the traumatic event Criterion B: Presence of at least 9 (or more)of the following symptoms from any of the 5 categories of: Intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred.

7 Acute Stress Disorder Criterion C: Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure. Looks at emotional reactions to a distressing event other than looking primarily at fear.

8 Intrusion Recurrent, involuntary, and intrusive distressing memories of the traumatic event Recurrent, distressing dreams of the event Dissociative reactions (flashbacks) where individual feels or acts as if the event were recurring Intense psychological or physiological distress in response to internal/external cues that represent aspects of the event

9 Negative Mood Persistent inability to experience positive emotions

10 A subjective sense of numbing, detachment, or absence of emotional responsiveness A reduction in awareness of his/her surrounding Disassociation

11 Disassociation Derealization Depersonalization Dissociative amnesia

12 Avoidance Avoids thoughts, feelings, or conversations associated with the trauma Avoids activities, places, or people that arouse recollection of the trauma Inability to recall an important aspect of the trauma Feelings of detachment or estrangement from others

13 Arousal Difficulty falling asleep Irritability or outbursts of anger Difficulty concentrating Hypervigilience Exaggerated startle response

14 Prevalence Rates for ASD Identified in less than 20% of cases following traumatic events that do not involve interpersonal assault Higher rates (20%-50%) are reported following interpersonal traumatic events, including assault, rape, and witnessing/involved a shooting

15 Prevalence Rates for ASD More prevalent in females than males Risk factors include: prior mental disorder, high levels of negative affectivity (neuroticism), greater perceived severity to traumatic experience, and avoidant coping styles.

16 Initial Assessment Factors affecting risk of onset of traumaticassociated illness Proximity to traumatic event Similarity to victim (actual versus vicarious experience) How helpless did the individual feel Extent of social support will greatly influence prognosis Exposure to stressors in past 6 months History and family history of mental illness

17 Difference between Acute Stress Disorder and PTSD ASD is more immediate, short term response to trauma. ASD is more associated with dissociative symptoms such as: Extreme emotional disconnection Difficulty experiencing pleasure Temporary or Dissociative Amnesia

18 Difference between Acute Stress Disorder and similar disorders Traumatic Grief Sudden unanticipated loss Distressing thoughts often related to longing Duration is a minimum of 2 months

19 Difference between Acute Stress Disorder and similar disorders Identifiable stressor within 3 months Depression, anxiety, and/or conduct are primary emotional and behavioral characteristics Adjustment Disorder

20 Treatment of Acute Stress Disorder Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy. Alternative treatment options include: Yoga Meditation

21 Questions

22 References Kessler, R.C., Sonnega, A., Bromet, E. Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and ageof-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, Kulka, R.A., Schlenger, W.E., Fairbank, J.A. Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study, New York: Brunner/Mazel. Tanielian, T. & Jaycox, L. (Eds.)(2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text revision). Washington, DC: Benner, A. (2000). Cop Docs. Psychology Today Nov/Dec2000, Vol. 33 Issue 6, p36, 4p, 1c Beutler, L. E., Nussbaum, P., & Meredith, K. (1988). Changing personality patterns of police officers. Professional Psychology: Research and Practice. Vol. 19 (5), Bisson, J. I., McFarlane, A. C., & Rose, S. (2000). Psychological debriefing. In E. F. Foa, T. M. Keane, & M. J. Friedman (Eds.) Effective treatments for PTSD (pp , ). New York: Guilford. Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I. Kurke, & E. M. Scrivner (Eds.), Police psychology into the 21st century (pp ). Hillsdale, NJ: Erlbaum.