Chapter 13 MH

experiences that are extraordinary in intensity or severity
stressors well beyond the stress of daily life

abuse or illness

war
terrorist attack
natural disaster

all people may experience anxiety, insomnia, difficulity coping, grief, etc.
but most people work through experiences and return to usual levels of coping -> high level of coping makes easier to prevent PTSD
some individuals have problems coping, managing stress and emotions, or resuming ADLS

disturbing pattern of behavior demonstrated by someone who has experienced, witnessed, or been confronted with traumatic event
event posed actual or threatened death or serious injury

intense fear
helplessness
terror
has to be greater than one month of symptoms = PTSD, may not show for years

reexperiencing the trauma -> dreams or intrusive, recurrent throughts
persistant avoidance -> can't stand fireworks = avoid stimuli of fireworks
negative cognition/thoughts
being on guard/hyperarousal -> experienced child abuse

reaction to stressful event that causes problems for individual
symtoms developing within a month, lasting no more than 6 months
don't have full range of symptoms

reexperiencing, avoidance, hyperarousal
occurs 3 days to 4 weeks after trauma
can be precursor to PTSD

occurs befoe the age of 5
doesn't develop healthy attachment to caregiver
don't socialize well
don't have appropriate reactions

has to be causative trauma
associated with event exposure rather than personal characteristics
lack of social support, peritrauma dissociation, previous psychiatric history/personality factors can increase risk

PTSD is a universal phenomenon
political oppression = alienation/lower levels of resilience and poorer long-term outcomes
stronger sense of self and cultural identitiy = less frequently diagnosed with PTSD, better long-term outcomes

adolescents are more likely to develop PTSD than are children or adults

age
gender
type of trauma
repeated trauma

counseling and therapy (individual or group)
medications (especially targeting specific issues)
cognitive-behavioral therapy (CBT) and specialized therapy -> most evidenced based
exposure therapy -> used to combat avoidance behaviors
relaxation techniques
adaptive disclosure -> type CBT military developed to offer intense, specific, short-term therapy for active-duty military
cognitive processing therapy
community-based care
mental health promotion

subconscious defense mechanism used to prevent recognition of a horrific or traumatic event
can occur during and after events
becomes easier with repeated use
onset can be sudden or gradual
can be seen in clients with PTSD

disruption in usually integrated functions of consciousness, memory, identitiy, environmental perception -> brain goes on lockdown & doesn't want to process

relationships
ability to function (activities of daily living)
ability to cope

1. dissociative amnesia -> no memory of event or who they are, very rare
2. dissociative idendity disorder -> number one risk factor is childhood sexual abuse, two or more distinct identities or personality states that recurrently take control of their behavior
3. depersonalization -> don't think you are real like thinking your arm isn't real derealization disorder -> can have these symptoms without having disorder, don't believe everything around you is real

individual therapy
group therapy -> focus in therapy is on reassociation
medications
goals of treatment
- improve quality of life
- improve functional abilities
- reduces symptoms

not necessary or desirable for client to detail specific events of abuse or trauma -> don't need to relive
general appears is often hyperalert, may have discomfort with physical closeness, may appear anxious or agitated

can range from passivve to angry, frightened, agitated, hostile

experience nightmares, flashbakcs, intrusive thoughts, hallucinations, self-destructive thoughts, fantasies

oriented to reality except during flashback
memory gaps
intrusive thoughts/ideas of self-harm

may report little idea of relationship between trauma and symptoms
others may be quite knowledgeable
others may be quiet knowledgeable
decision-making ability may be impaired

low self-esteem
see self as worthless

problems with authority
close relationships difficut or impossible

difficulty sleeping
change in appetite
alcohol and drug use -> self-medication

risk of suicide/self-harm
ineffective coping
overwhelming stress and emotions
difficulty managing emotions
chronic low self-esteem
helpless, hopeless feelings -> biggest red flag for suicide

disturbed sleep pattern
sexual dysfunction
social isolation
not eating or overeating

physical safety -> #1 outcome - patient will refrain from hurting themselves
ability to distinguish self-harm ideas from actions
demonstration of healthy, effective stress management
nondestructive expression of emotions
social support system

discuss self-harm thoughts
help develop a plan for going to a safe place
use grounding techniques
validate client's fears but increase contact with reality
teach deep breathing and relaxation techniques
use distraaction techniques
refers to client as "survivor" rather than "victim"
establish social support system in community

are helpful with dissociation or flashback
remind the person they are: in the present, an adult, safe
increase contact with reality
diminish the dissociative experience by focusing on current experiences
focus the client in the present

deal with own personal feelings about traumatic events, abuse, and natural disasters
convey empathy
remain nonjudgemental