Trauma Stressor-Related Dissociative Disorders

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  1. trauma-informed care
    based on an understanding of vulnerabilities and triggers in psychiatric patients who has histories that include violence and victimization
  2. children who have been abused are at risk for
    • abusing others 
    • developing dysfunctional patterns in close interpersonal relationships
  3. PTSD
    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
  4. PTSD in kids
    • 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
  5. disinhibited social engagement disorder
    • no normal fear of strangers
    • unfazed with separated from primary caregiver
    • willing to go off with unknown people
  6. reactive attachment disorder
    consistent pattern of inhibited, emotionally withdrawn behavior and who rarely direct attachment behaviors toward any adult caregivers
  7. percentage of children that will get PTSD who witness parent's murder or sexual assault
    nearly 100%
  8. how many child reports in 2010 for abuse/neglect
  9. 2010 neglect %
  10. 2010 abuse/neglect
  11. 2010 multiple types abuse
  12. 2010 sexual abuse
  13. personality traits may dictate how each unique child
  14. PSTD
    • start 1 month to years after event
    • 1. flashbacks
    • 2. avoidance
    • 3. increased arousal
    • 4. mood instability
  15. Acute stress disorder
    • 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
  16. most rapid phase of brain development
    1st 5 years of life
  17. which brain hemisphere develops first
    • 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
  18. neural connections between limbic and prefrontal cortex begin when
    10-18 months
  19. normal stress response
    hyperarousal in the SNS is balanced by the PNS
  20. Neural circuits connect the amygdala to the
    • prefrontal cortex 
    • serves as the translator of the emotion so that the amygdala can be modulated
  21. what can dysregulate integration of neural networks
    • trauma 
    • more intense the arousal, less likely it is that the experience will be processed
  22. the more a person feels helpless/out of control due to traumatic event
    the more vulnerable to pathophysilogical changes they are
  23. following exposure to violence/trauma, PNS triggers hypoaroused state with dysregulation of the
    • hypothalamic pituitary adrenal axis 
    • results in dissociation
  24. 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
  25. dissociation causes intrusive symptoms such as flashbacks
    • dysregulates cortisol 
    • too much or too little
  26. neuroplasticity
    state of malleability of the developing brain that can increase vulnerability to adverse life experiences
  27. working with children from diverse backgrounds requires
    increased awareness of one's own biases and of the patient's needs
  28. resilence
    positive adaption, ability to maintain or regain mental health despite advesity
  29. two priority nursing dx for trauma
    • 1. risk for impaired parent/child attachment
    • 2. risk of delayed development
  30. Nurses are mandated to report what
    all instances of suspected abuse of a minor child to the local child protective services
  31. Stage 1 of trauma treatment model
    • safety/stability
    • stop self destructive behavior 
    • educate about trauma and its effects
  32. stage 2 of trauma treatment model
    • reducing arousal
    • regulate emootion 
    • find comfort measures
    • overcoming avoidance
    • improving attention
    • decreasing dissociation
    • working/transforming memories
  33. stage 3 of trauma treatment model
    • developmental skill catch up
    • nuturing self awareness
    • social skills training
    • value system developed
    • teach how to cope with trauma
    • support systems
  34. window of tolerance
    • balance of SNS and PNS arousal 
    • kids tend to have a problem either being hyperarousal or hypoarousal
  35. most important healing ingredient
    relationship and connection with others
  36. help a child do what before talking about traumatic event
    relaxation techniques: restores sense of control over thoughts/feelings
  37. first line of treatment for traumatized kids
    • cognitive-behavioral
    • eye movement desensitization and reprocessing
  38. eye movement desen. 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
  39. PTSD in kids
    • 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
  40. flashbacks
    dissociative experiences during which the event is relived, and the person behaves as though they are experiencing the event at that time
  41. hypervigilance
    exaggerated startled response
  42. average onset for PTSD
    • 23
    • more likely in females
    • greater incidence in sexual assault on women or women who have a past mental health problem
  43. SSRIs
    • fluoxetine  (Prozac)
    • paroxetine (Paxil)
    • sertraline (Zoloft)
  44. What do you prescribe if SSRIs fail?
  45. When is acute stress disorder diagnosed
    3 days to 1 month after traumatic event
  46. dx for actue stress: 8 out of 14
    • 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
  47. appropriate nursing dx for acute stress
    • posttrauma syndrome manifest by...
    • agression
    • HA
    • intrusive dreams
    • diaster
    • abuse..
  48. debriefing
    reflecting on and discussing a stressful experience, within 12-48 hours, offered as group intervention
  49. adjustment disorder
    • precipated by stressful event
    • may not be as severe/ or considered traumatic
    • dx: immediately or within 3 months
    • treatment: antidepressants
  50. Dissociative disorder
    • after traumas, person responds to stress with a severe interruption of consciousness 
    • *disturbed memory, cosciounessness, self id, and perception
    • unconscious defense mechanism
  51. positive symptoms of dissociation
  52. depersonalization
    focus on oneself
  53. derealization
    focus is on outside world. one's surrounding's are unreal or distant
  54. dissoactive amnesia
    inabilyt to recall important personal info often the result of a truama or severe stress
  55. dissociatvie fugue
    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
  56. dissoacitev id disorder
    two or more distinct pesonality states recurrently take over the behavior
  57. alternate personality
    distinct personality that recurrently takes control of the behavior of a person with dissociative idenity disorder
  58. grounding techniques for dissoaction
    • stomping feet 
    • taking shower
    • holding an ice cube
    • exercisng
    • deep breathing
    • counting beads
    • touchin fabric on a chair
Card Set:
Trauma Stressor-Related Dissociative Disorders
2015-02-22 23:07:53
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