PSYCH

• Trauma & Stressor-Related Disorder


  A disturbing pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with a traumatic event such as a natural disaster, combat, or an assault
• PTSD


  A person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror
• Subcategories of PTSD

  • Reexperiencing trauma
  • Avoidance
  • Negative cognition or thoughts
  • Hyperarousal
• Reexperiencing trauma


  Through memories, dreams, flashbacks, or reactions to external cues about the event and therefore avoids stimuli associated with the trauma
• Avoidance


  The person reports losing a sense of connection and control over his or her life
• Negative cognition or thoughts


  The person seeks comfort, safety, and security, but can actually become increasingly isolated over time, which can heighten the negative feelings he or she was trying to avoid
• Hyperarousal


  The victim feels a numbing of general responsiveness and shows persistent signs of increased arousal such as insomnia, hyperarousal or hypervigilance, irritability, or angry outbursts
• Related disorders: PTSD

  • Adjustment disorder
  • Acute stress disorder
  • Reactive attachment disorder (RAD)
  • Disinhibited social engagement disorder (DSED)

  
• Adjustment disorder


  A reaction to a stressful event that causes problems for the individual. The person has more than the expected difficulty coping with or assimilating the event into his or her life
• Acute stress disorder


  This occurs after a traumatic event and is characterized by reexperiencing, avoidance, and hyperarousal that occur from 3 days to 4 weeks following a trauma. It can be a precursor to PTSD
• Reactive attachment disorder (RAD)


  Occurs before the age of 5 in response to the trauma of child abuse or neglect, called grossly pathogenic care
• Disinhibited social engagement disorder (DSED)


  The child exhibits unselective socialization, allowing or tolerating social interaction with caregivers and strangers alike
• Etiology of PTSD


  Causative trauma or event that occurs prior to the development of PTSD. The effects of the trauma at the time, such as being directly involved, experiencing physical injury, or loss of loved ones in the event, are more powerful predictors of PTSD for most people

  
• DSM-5 diagnostic criteria: Posttraumatic Stress Disorder

  • Exposure to actual or threatened death, serious injury, or sexual violence
  • Presence of intrusion symptoms
  • Persistent avoidance of stimuli
  • Negative alterations in cognitions and mood
  • Marked alterations in arousal and reactivity
  • Duration of the disturbance is more than 1 month
  • The disturbance causes clinically significant distress or impairment
  • The disturbance is not attributable to the physiological effects of a substance or another medical condition

  
• PTSD can be diagnosed at any age
• Traumatic events such as natural disasters are not clustered in any particular age group. Elder people who fall and fracture a hip can experience PTSD
• The current population of elders includes veterans of World War II who experienced PTSD, though it was not recognized as such at the time
• Veterans of the Vietnam War, now in their 60s, are among some of the first people to be diagnosed with PTSD
• Many among the elderly population have impaired quality of life from PTSD, including a negative impact on physical functioning and general health
• Chronic PTSD may be associated with premature aging and dementia
• Community-based care: PTSD client and family education

  • Ask for support from others
  • Avoid social isolation
  • Join a support group
  • Share emotions and experiences with others
  • Follow a daily routine
  • Set small, specific, achievable goals
  • Accept feelings as they occur
  • Get adequate sleep
  • Eat a balanced, healthy diet
  • Avoid alcohol and other drugs
  • Practice stress reduction techniques
• Dissociative disorder


  A subconscious defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory. Have the essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception
• Types of dissociative disorders

  • Dissociative amnesia
  • Dissociative identity disorder
  • Depersonalization/derealization disorder
• Dissociative symptoms are seen in clients with PTSD
• Survivors of abuse who have dissociative disorders are often involved in group or individual therapy in the community to address the long-term effects of their experiences
• Therapy for clients who dissociate focuses on reassociation, or putting the consciousness back together. This specialized treatment addresses trauma-based, dissociative symptoms
• Clients with dissociative disorders may be treated symptomatically, that is, with medications for anxiety or depression or both if these symptoms are predominant
• Clients with PTSD and dissociative disorders are found in all areas of health care, from clinics to primary care offices. The nurse is most likely to encounter these clients in acute care settings only when there are concerns for personal safety or the safety of others or when acute symptoms have become intense or overwhelming and require stabilization

  
• Treatment in acute care is usually short-term, with the client returning to community-based treatment as quickly as possible
• Assessment data


  • Flashbacks or reexperiencing the traumatic event(s)
  • Nightmares or recurrent dreams of the event or other trauma Sleep disturbances (e.g., insomnia, early awakening, or crying out in sleep)
  • Depression
  • Denial of feelings or emotional numbness
  • Projection of feelings
  • Difficulty in expressing feelings
  • Anger (may not be overt)
  • Guilt or remorse
  • Low self-esteem
  • Frustration and irritability
  • Anxiety, panic, or separation anxiety
  • Fears—may be displaced or generalized (as in fear of men by survivors who have been raped by men)
  • Decreased concentration
  • Difficulty expressing love or empathy
  • Difficulty experiencing pleasure
  • Difficulty with interpersonal relationships, marital problems, and divorce
  • Abuse in relationships
  • Sexual problems
  • Substance use
  • Employment problems
  • Physical symptoms

  
• Expected outcome: Immediate

  • The client will identify the traumatic event within 24 to 48 hours
  • The client will demonstrate decreased physical symptoms within 2 to 3 days
  • The client will verbalize the traumatic event and associated feelings within 3 to 5 days

  
• Flashbacks


  Reexperiencing the traumatic event(s)
• Symptoms of flashbacks/reexperiencing


  • Nightmares or recurrent dreams of the event or other trauma
  • Sleep disturbances (e.g., insomnia, early awakening, or crying out in sleep)
• Depression


  Denial of feelings or emotional numbness
• Emotional responses to trauma

  • Projection of feelings
  • Difficulty in expressing feelings
  • Anger (may not be overt)
  • Guilt or remorse
  • Low self-esteem
  • Frustration and irritability
• Psychological effects of trauma

  • Anxiety, panic, or separation anxiety
  • Fears—may be displaced or generalized (as in fear of men by survivors who have been raped by men)
  • Decreased concentration
  • Difficulty expressing love or empathy
  • Difficulty experiencing pleasure
  • Difficulty with interpersonal relationships, marital problems, and divorce
  • Abuse in relationships
  • Sexual problems
  • Substance use
  • Employment problems
• Physical symptoms of trauma

  • Physical symptoms
• The client will identify the traumatic event within 24 to 48 hours
• The client will demonstrate decreased physical symptoms within 2 to 3 days
• The client will verbalize the need to grieve loss(es) within 3 to 4 days