Trauma Stressor-Related Dissociative Disorders

based on an understanding of vulnerabilities and triggers in psychiatric patients who has histories that include violence and victimization

• abusing others 
• developing dysfunctional patterns in close interpersonal relationships

persistent experiencing of a highly traumatic even that involved actual or threatened death or serious injury to self or others, to which the individual responded with intense fear, helplessness, or horror

• reduction in play 
• repetitive play that included aspects of traumatic event
• social withdrawal
• negative emotions (fear, guilt, horror, sadness, shame, or confusion)
• blame themselves 
• feeling of detachment 
• irritable
• aggressive or self-destructive behavior
• sleep disturbance 
• problems concentrating
• hypervigilance

• no normal fear of strangers
• unfazed with separated from primary caregiver
• willing to go off with unknown people

consistent pattern of inhibited, emotionally withdrawn behavior and who rarely direct attachment behaviors toward any adult caregivers

nearly 100%

700,000

68

45%

26%

1%

reacts

• start 1 month to years after event
• 1. flashbacks
• 2. avoidance
• 3. increased arousal
• 4. mood instability

• 8 of following: during or after event-dx: 3 days to 1 month later)
• sense of numbing 
• derealization
• memory loss of event
• intrusive thoughts
• bad dreams/sleep disturbed
• recurring of event in the mind
• intense physiological response
• avoidance of thoughts/feelings of event
• hypervigilence/ increased startle
• irritable/angry/aggressive
• restless/agitated

1st 5 years of life

• right
• processes social-emotional info
• promoting attachment functions
• regulating body functions
• supporting the individual in coping with stress
• *early attachment relationships important for healthy development

10-18 months

hyperarousal in the SNS is balanced by the PNS

• prefrontal cortex 
• serves as the translator of the emotion so that the amygdala can be modulated

• trauma 
• more intense the arousal, less likely it is that the experience will be processed

the more vulnerable to pathophysilogical changes they are

• hypothalamic pituitary adrenal axis 
• results in dissociation

disconnection of thoughts, emotions, snesations, or behaviors connected with memory, wiht some dissociation considered a normal experience for most people, such as when we "space out" duringa movie, however severe dissocation: mindflight =significant trauma

• dysregulates cortisol 
• too much or too little

state of malleability of the developing brain that can increase vulnerability to adverse life experiences

increased awareness of one's own biases and of the patient's needs

positive adaption, ability to maintain or regain mental health despite advesity

• 1. risk for impaired parent/child attachment
• 2. risk of delayed development

all instances of suspected abuse of a minor child to the local child protective services

• safety/stability
• stop self destructive behavior 
• educate about trauma and its effects

• reducing arousal
• regulate emootion 
• find comfort measures
• overcoming avoidance
• improving attention
• decreasing dissociation
• working/transforming memories

• developmental skill catch up
• nuturing self awareness
• social skills training
• value system developed
• teach how to cope with trauma
• support systems

• balance of SNS and PNS arousal 
• kids tend to have a problem either being hyperarousal or hypoarousal

relationship and connection with others

relaxation techniques: restores sense of control over thoughts/feelings

• cognitive-behavioral
• eye movement desensitization and reprocessing

processes traumatic memories through a specific 8 phase protocol that allows the person to think about the traumatic even while attending to other stimulation, eye movements, audiotones, or tapping

• 1. re-experiencing the trauma through recurrent intrusive collections of the event, flashbacks
• 2. avoidance of stimuli associated with trauma
• 3. persistent symptoms of increased arousal (irriability, sleeping difficulty, difficulty concentrating, hypervigilance )
• 4. alterations in mood ...chronic depression

dissociative experiences during which the event is relived, and the person behaves as though they are experiencing the event at that time

exaggerated startled response

• 23
• more likely in females
• greater incidence in sexual assault on women or women who have a past mental health problem

• fluoxetine  (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

TCAs

3 days to 1 month after traumatic event

• subjective feeling of numbing
• derealization 
• inability to remember at least one important aspect of event
• intrusive distressing memories of the event
• recurrent distressing dreams
• feeling asif the event is recurring
• intense prolonged distress/physiological reactivity
• avoidance of thoughts of event
• sleep distrubances
• hypervigilance
• irritable
• angry or agressive behavior
• agitation/restlessness

• posttrauma syndrome manifest by...
• agression
• HA
• intrusive dreams
• diaster
• abuse..

reflecting on and discussing a stressful experience, within 12-48 hours, offered as group intervention

• precipated by stressful event
• may not be as severe/ or considered traumatic
• dx: immediately or within 3 months
• treatment: antidepressants

• after traumas, person responds to stress with a severe interruption of consciousness 
• *disturbed memory, cosciounessness, self id, and perception
• unconscious defense mechanism

flashbacks

focus on oneself

focus is on outside world. one's surrounding's are unreal or distant

inabilyt to recall important personal info often the result of a truama or severe stress

sudden, unexpected travel away from customary locale and an inability to recall one's id and info about some or all of one's past

two or more distinct pesonality states recurrently take over the behavior

distinct personality that recurrently takes control of the behavior of a person with dissociative idenity disorder

• stomping feet 
• taking shower
• holding an ice cube
• exercisng
• deep breathing
• counting beads
• touchin fabric on a chair