Title: Trauma- and Stressor-Related Disorders
1Trauma- and Stressor-Related Disorders
- University of Manoa
- Anna Weihl, Christine Keanu, Genevieve Parks,
Patricia Kaleiwahea -
-
2Trauma- and Stressor- Related Disorders
- This chapter includes disorders in which exposure
to a traumatic or stressful event is listed
explicitly as a diagnostic criterion. - These include
- Adjustment Disorders
- Reactive Attachment Disorder
- Disinhibited Social Engagement Disorder
- Other specified Trauma- and Stressor-Related
Disorder - Unspecified Trauma- and Stressor-Related Disorder
- Posttraumatic Stress Disorder
- Acute Stress Disorder
- we will mainly be talking about these two
disorders tonight
3Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Adjustment Disorders
- Diagnostic Criteria
- A. The development of emotional or behavioral
symptoms in response to an identifiable
stressor(s) occurring within 3 months of the
onset of the stressor(s) - B. These symptoms or behaviors are clinically
significant, as evidenced by one or both of the
following - 1. Marked distress that is out of proportion to
the severity or intensity of the stressor, taking
into account the external context and the
cultural factors that might influence symptom
severity and presentation. - 2. Significant impairment in social,
occupational, or other important areas of
functioning. - C. The stress-related disturbance does not meet
the criteria for another mental disorder and is
not merely and exacerbation of a preexisting
mental disorder - D. The symptoms do not represent normal
bereavement - E. Once the stressor or its consequences have
terminated, the symptoms do not persist for more
than an additional 6 months
4Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Diagnostic Features
- Prevalence
- Development and Course
- Risk and Prognostic Factors
- Culture-Related Diagnostic Issues
- Functional Consequences of Adjustment Disorders
- Differential Diagnosis
- Comorbidity
5Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Other specified Trauma- and Stressor-Related
Disorder (page 289) - Symptoms are characteristic of a trauma- and
stressor-related disorder, but do not meet the
full criteria for any of the trauma- and
stressor-related disorders diagnostic class. - This diagnose used in situations in which the
clinician chooses to record other specified
trauma- and stressor-related disorder followed
by specific reason. (e.g., persistent complex
bereavement disorder.) - Unspecified Trauma- and Stressor-Related Disorder
(page 290) - Same as above except clinician chooses not to
specify the reason the criteria are not met due
to insufficient information to make specific
diagnose. (e.g., in emergency room settings.)
Anna
6Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Reactive Attachment Disorder (page 265)
- Reactive Attachment Disorder (RAD) 313.89
- Characterized by a pattern of markedly disturbed
and developmentally inappropriate attachment
behaviors, in which a child rarely or minimally
turns preferentially to an attachment figure for
comfort, support, protection, and nurturance. - The essential feature is absent or grossly
underdeveloped attachment between child and
putative caregiving adults. - Children with RAD are believed to have the
capacity to form selective attachments. However,
because of limited opportunities during early
development, they fail to show the behavioral
manifestations of selective attachments (i.e.
when distressed they show no consistent effort to
obtain comfort, support, nurturance, or
protection from caregivers and they do not
respond more than minimally to comforting efforts
of caregivers). - RAD is associated with the absence of expected
comfort seeking and response to comforting
behaviors. - Child with RAD emotion regulation capacity is
compromised, and they display episodes of
negative emotions of fear, sadness, or
irritability that are not readily explained. - A diagnosis of RAD should not be made in children
who are developmentally unable to form selective
attachments. Thus the child must have a
developmental age of at least 9 months.
7Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Reactive Attachment Disorder Continued(page 265)
- The prevalence of RAD is unknown but relatively
rarely seen in clinical settings. RAD is often
found in young children exposed to severe neglect
before being placed in foster care. However,
even in this population the disorder is uncommon
and occurs in less than 10 of those children. - There is no standard treatment for RAD, however
it often includes Individual counseling,
education of parents and caregivers about the
condition, parenting skills classes, family
therapy, medication for other conditions that
may be present (such as depression, anxiety,
etc.), special education services, and
residential or inpatient treatment for children
with more-serious problems or who put themselves
or others at risk of harm. - There are some controversial treatment practices
that should be noted as they can be
psychologically and physically damaging and have
led to accidental deaths. These practices
include re-parenting/re-birthing/holding
therapy, tightly wrapping, binding or holding
children, withholding food or water, forcing
child to eat or drink, and yelling, tickling or
pulling limbs, triggering anger that finally
leads to submission. - Heres a video clip on holding therapy
http//www.youtube.com/watch?vOdWhcyz6KbY
8Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Disinhibited Social Engagement Disorder
- Diagnostic Criteria
- A. A pattern of behavior in which a child
actively approaches and interacts with unfamiliar
adults and exhibits at least two of the
following - 1. Reduced or absent reticence in approaching
and interacting with unfamiliar adults - 2. Overly familiar verbal or physical behavior
- 3. Diminished or absent checking back with adult
caregiver after venturing away, even in
unfamiliar settings - 4. Willingness to go off with an unfamiliar
adult with minimal or no hesitation - B. The behaviors in Criterion A are not limited
to impulsivity (as in attention-deficit/hyperactiv
ity disorder) but include socially disinhibited
behavior - C. The child has experienced a pattern of
extremes of insufficient care as evidenced by at
least one of the following
9Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- 1. Social neglect or deprivation in the form of
persistent lack of having basic emotional needs
for comfort, stimulation, and affection met by
caregiving adults - 2. Repeated changes of primary caregivers that
limit opportunities to form stable attachments - 3. Rearing in unusual settings that severely
limit opportunities to form selective attachments - D. The care in Criterion C is presumed to be
responsible for the disturbed behavior in
Criterion A - E. The child has a developmental age of at least
9 months - Specify
- Persistent- the disorder has been present for
more than 12 months - Current severity Disinhibited social engagement
disorder is specified as severe when the child
exhibits all symptoms of the disorder, with each
symptom manifesting at relatively high levels
10Overview of the Diagnostic Category of Trauma-
and Stressor-Related Disorders
- Diagnostic Features
- Associated Features Supporting Diagnosis
- Prevalence
- Development and Course
- Risk and Prognostic Factors
- Functional
- Differential Diagnosis
- Comorbidity
11Descriptions for Acute Stress Disorder
- Diagnostic Criteria
- A.) Client must have been exposed to actual
threatened death, serious injury, or sexual
violation in one (or more) of the following ways - 1.) directly experiencing the traumatic event(s)
- 2.) witnessing, in person, the event(s) as it
occurred to others - 3.) learning that the event(s) occurred to a
close family member or close friend. - 4.) experiencing repeated or extreme exposure to
aversive details of the traumatic event(s). - B.) Also, there must be the presence of nine (or
more) of the following symptoms from any of the
five categories of intrusion, negative mood,
dissociation, avoidance, and arousal, beginning
or worsening after the traumatic event(s)
occurred. (there are 14 symptoms listed in the
nine categories) - Specifiers None listed
Coding and recording
procedures None listed -
12Descriptions for Acute Stress Disorder,
continued.
- Diagnostic Features
- development of characteristic symptoms lasting
from 3 days to 1 month following exposure to one
or more traumatic events, (traumatic event
examples are listed, some stressful events do not
possess the severe and traumatic components, but
may lead to adjustment disorder diagnose
instead), - typically involves an anxiety response that
includes some re-experiencing or reactivity of
traumatic event (e.g., strong emotional,
physiological, anger, or aggressive responses at
traumatic reminder). - Witnessing or learning of traumatic events are
limited to close relatives or close friends,
which must have been violent or accidental
(listed is some examples of witnessed/learning
events) - Traumatic event being re-experienced, intrusive
memories (various ways listed) - Distressing dreams
- Flashbacks
- Psychological distress or physiological
reactivity
13Descriptions for Acute Stress Disorder,
continued.
- Diagnostic Features continued
- Depersonalization, de-realization (detached sense
of oneself, in a daze) - Avoidance of trauma stimuli (refuse to discuss
trauma, excessive alcohol use at mention of
trauma, avoiding interacting if reminds of
trauma) - Sleep onset and maintenance (nightmares)
- Quick temper with little provocation,
irritability - Concentration difficulties, memory difficulties,
staying focused difficulties - Jumpiness, heightened startle response
- Panic attacks, chaotic or impulsive behavior
(children may display separation anxiety) - Associated Features Supporting Diagnosis
- Catastrophic or extremely negative thoughts about
heir role in traumatic event, or to the event
itself or future likelihood of harm - Acute grief reactions or post-concussive symptoms
14Descriptions for Acute Stress Disorder,
continued.
- Prevalence
- Varies according to the nature of the event and
the context in which it is assessed. - Development and course
- Cannot be diagnosed until 3 days after a
traumatic event - May or may not progress to PTSD after 1 month
(half who develop PTSD initially presented Acute
Stress Disorder) - Symptoms can worsen during the initial month
- Re-experiencing can vary across development,
(children can report differently than adults) - Functional Consequences
- Impaired functioning in social, interpersonal or
occupational, also sleep, energy levels and
capacity to attend to tasks. - Avoidance, withdraw, and nonattendance.
15Descriptions for Acute Stress Disorder,
continued.
- Risk and Prognostic Factors
- Temperamental- having prior mental health, higher
levels of negativity affectivity, greater
perceived severity of traumatic event(s),
avoidance coping style, and/or having
catastrophic appraisals of the traumatic event
are strong predictors of acute stress disorder. - Environmental- if been exposed to traumatic
event(s), and/or has an history of prior
trauma(s), greater chances of developing acute
stress disorder. - Genetic and Physiological- Females are at
greater risk, and/or elevated reactivity before
trauma(s) is another predictor of an increased
risk of developing acute stress disorder after a
trauma. - Culture-Related Diagnostic Issues
- Varies cross-culturally, particularly with
respect to dissociative symptoms, nightmares,
avoidance, and somatic symptoms.
16- Gender-Related Diagnostic Issues
- More prevalent in females than males, maybe due
to sex-linked neurobiological differences in
stress response, or the likelihood of possibility
of exposure to high conditional risk trauma(s)
(e.g., rape, other interpersonal violence) - Differential Diagnosis
- Adjustment disorders diagnose given when
criteria doesnt meet acute stress disorders
Diagnostic Criteria A.) - Panic disorder although common in acute
disorder, panic disorder is diagnosed only if
panic attacks are unexpected, there is anxiety
about future attacks, or there are maladaptive
changes in behavior associated with fear of dire
consequences of the attacks. - Dissociative disorder in absence of
characteristics of acute stress disorder, severe
dissociative responses can be diagnosed as
de-realization/depersonalization disorder, or if
severe amnesia, dissociative amnesia may be
indicated. - Posttraumatic stress disorder if symptoms
persist more than 1 month and meet criteria for
PTSD, (acute stress must occur 1 month after
trauma, and resolve with-in that 1 month period),
criteria is then changed from acute stress to
PTSD.
17- Differential Diagnosis continued.
- Obsessive-compulsive disorder recurrent
intrusive thoughts, but not related to an
experienced traumatic event, compulsions are
usually present, and other symptoms of acute
stress disorder are typically present. - Psychotic disorder flashbacks must be
distinguished from illusions, hallucinations, or
other perceptual disturbances, which may occur in
schizophrenia, other psychotic disorders,
depressive or bipolar disorder w/ psychotic
features, a delirium, substance/medication-induced
disorders, and psychotic disorders due to
another medical condition. Flash are
distinguished by being directly related to
traumatic experience and by occurring in the
absence of other psychotic or substance-induced
features. - Traumatic brain injury (TBI) symptoms for a
brain injury from traumatic event(s), and
symptoms previously termed post-concussive can
overlap with symptoms of acute stress disorder,
however re-experiencing and avoidance are
characteristics of acute stress disorder where as
persistent disorientation and confusion are more
specific to TBI. Also, symptoms of acute stress
disorder persist for up to only 1 month following
trauma exposure.
18Acute Stress Disorder/YouTube Video
- http//www.youtube.com/watch?vAl1A0t1vWzk
- (1 minute, 55 seconds)
19EBP for Acute Stress Disorder??
- Psychotherapeutic Interventions
- Cognitive behavior therapy
- Patient utilization of existing support network
- Psychological debriefing
- Single-session therapy
- Eye movement desensitization and reprocessing
(EMDR) - Reactive eye dilation desensitization and
reprocessing (REDDR) - Hypnotherapy
- Desensitization
- Relaxation exercises
- Internet based therapies
- Stress inoculation
- Imagery rehearsal
- Prolonged exposure techniques
- Case management
- Group therapies including present-centered and
trauma-focused group therapies - Optimism training
- Goal setting and achievement
- Biofeedback
- Multiple channel exposure therapy
- Assertiveness training
- Outward Bound group recreational therapies
- http//www.nrepp.samhsa.gov/
20Eye Movement Desensitization and Reprocessing
(EMDR)
- Eye Movement Desensitization and Reprocessing
(EMDR) is said to be an effective
psychotherapeutic approach for treatment of
traumatic memories. - It is an empirically supported integrative
psychotherapeutic approach for treatment of
Post-Traumatic Stress Disorder (PTSD) (Van der
Hart, Nijenhuis, Solomon, 2010). It is not only
used to treat Post-Traumatic Stress Disorder but
any other disturbing event that the individual
finds him-self unable to move through in a
healthy way. - EMDR involves a neurobiological process that
helps the individual reprocess a traumatic or
disturbing event into an experience that can be
remembered without pain (Shapiro, Forrest,
2004). - One of the goals and objectives in treatment is
to use EMDR to resolve disturbing events
(trauma), the identification and utilization of
resources, and for future scripting. - Basically, by processing negative cognitions
through EMDR, an increased ability to
self-regulate emotional responses is seen. - http//www.youtube.com/watch?vKpRQvcW2kUM
214 Literature Reviews on the EBP EMDR for ASD
- 1.) Kutz, et. al, 2008, found that a single
session of modi?ed and abridged protocol of EMDR
was found to provide complete relief for 50 and
substantial relief for another 27 of acutely
stressed patients, most of whom had been exposed
to an isolated traumatic event. While the
standard EMDR protocol is geared as a
comprehensive approach for chronic patients with
multiple accumulating issues, this single-session
abridged protocol was effective for focused
symptom relief in the early phases. - 2.) The American Journal of Psychiatry, et. al,
2004, compared EMDR with no treatment, cognitive
behavior therapy, exposure approaches (not
involving in vivo exposure), variants of EMDR
(e.g., dismantling studies), and nonspecific
treatments. EMDR was more effective than no
treatment and comparable to other active
treatments.
224 Literature Reviews on the EBP EMDR for ASD
continued
- 3.) An article in the Wiley Inter Science
Journal, 2009, found that symptom reduction has
been shown to be comparable over treatment with
EMDR and the 6-month follow-up, EMDR had the
superior outcome. In studies that had diagnosis
as an outcome measure, between 77 and 90 of
EMDR patients no longer met diagnostic criteria
for PTSD at the end of treatment. - 4.) Researchers found that only trauma-focused
CBT and EMDR produced significant clinical
improvements, and no major differences were found
between the two in head-to-head comparison
studies (Kennedy, et. al., 2007).
23Posttraumatic Stress Disorder YouTube Video
- http//www.bing.com/videos/search?qGeorgeCarlin
PtsdFormVQFRVPviewdetailmid9B6B008519D3B7220
36E9B6B008519D3B722036E
24PTSD ETIOLOGY/CRITERIA
- PTSD is an anxiety disorder that develops in
response to - Exposure to actual or threatened death, serious
injury, or sexual violence by directly
experiencing, witnessing the event, learning that
the traumatic event happened to a close family
member or friend, and experiencing repeated
exposure - THOSE AT-RISK INCLUDE
- People who have been in a natural disaster, such
as a tidal wave, earthquake, tornado or tsunami. - Anyone who have been raped or physically or
sexually abused. - Anyone who have witnessed or been a part of a
life-threatening event. - Anyone with military combat experience or even
civilians who have been injured in war.
25PTSD ETIOLOGY/CRITERIA
- Presence of one (or more) of the following
symptoms associated with the traumatic events,
beginning after the traumatic event(s) occurred - Re-experiencing the event involuntarily through
distressing memories(flashbacks) - Re-experiencing nightmares or distressing dreams
in which it is related to traumatic event. - Dissociative reactions(flashbacks) where
individual feels or acts as if the traumatic
event was recurring. - Intense or prolonged psychological distress at
exposure to internal or external cues that
symbolize or resemble an aspect of the traumatic
event(s) - Marked physiological reactions such as Numbness,
Insomnia, Lack of concentration.
26PTSD ETIOLOGY/CRITERIA
- Persistent avoidance of stimuli associated with
the traumatic event(s) - Avoiding people, places, conversations, etc. that
arouse distressing memories of traumatic event. - Avoiding distressing memories, thoughts, or
feelings about or associated with the traumatic
event. - Negative alterations in cognitions and mood
associated with the traumatic event(s), beginning
or worsening after the traumatic event(s)
occurred. - Marked alterations in arousal and reactivity
associated with the traumatic event. - Duration of the disturbance is more than 1 month.
- Disturbance causes clinically significant
distress or impairment in relationships with
parents, siblings, peers, or other caregivers. - Disturbance is not attributable to the
physiological effects of a substance(medication
or alcohol) or another medical condition.
27Prevalence
- Projected lifetime risk of PTSD rates higher
among veterans as well as police, firefighters,
emergency medical personnel (jobs high risk) - Projected lifetime risk for PTSD at age 75 years
is 8.7(U.S.) - Twelve-month prevalence among U.S. adults is 3.5
- Europe and most Asian, African, and Latin
American countries have lower estimates of
.5-1.0 - Highest rates are found among survivors of rape,
military combat, and ethnically or politically
motivated internment and genocide.
28Development and course
- Any age (beginning after the 1st year of life)
- Symptoms begin approximately 3 months after
traumatic event - Abundant evidence for what DSM-IV called
delayed onset now called delayed expression
which is a delay in meeting full criteria - ½ of adults will experience complete recovery
within 3 months - Symptoms for some lasts more than 12 month and
for others more than 50 years
29Functional Consequences
- PTSD ASSOCIATED WITH
- High levels of social, occupational, and physical
disability - Considerable economic costs
- Impaired functioning across social,
interpersonal, developmental, educational,
physical health, and occupational domains - Poor social and family relationships, work
absences, lower income, lower educational and
occupational success. - High levels of medical utilization
30Evidence Based Practices Pharmacotherapy
- Post-Traumatic Stress Disorder in Women
- SSRIs (Selective serotonin reuptake
inhibitor)remain a first-line pharmacotherapy for
PTSD, although mood stabilizers, newer
antidepressants, atypical antipsychotics and
adrenergic agents have some evidence for
efficacy. SSRIs were the first class of
psychotropic drugs discovered and are the most
widely prescribed antidepressants in many
countries. - CBT, although randomized, comparative studies do
not provide evidence for superiority of one
intervention over another - Exposure therapy and cognitive processing have
been demonstrated to work well in women with PTSD
following adult victimization or childhood abuse.
31Evidence Based Practices Pharmacotherapy
- CURRENT STATUS OF PHARMACOTHERAPY FOR PTSD
- AN EFFECT SIZE ANALYSIS OF CONTROLLED STUDIES
- Findings suggested that serotonergic
antidepressants for the treatment of PTSD are
effective and of a relative advantage - Effective medications for conditions
characterized by pervasive anxiety, intrusive
thoughts, and avoidance (PTSD) may have strong
but extreme selectivity for blocking reuptake of
serotonin over norepinephrine. - Serotonergic agents for treatment of PTSD is
encouraged
32Evidence Based Practices CBT EMDR
- A Community-Based study of EMDR and Prolonged
Exposure - Pilot study which compared prolonged exposure and
EMDR - 22 patients from a university based clinic
serving rape and crime victims - Results showed that both approaches produced
significant reduction in PTSD and depression
symptoms - Success was faster with EMDR with 7 of 10 of the
participants having 70 reduction in PTSD
symptoms as compared to PE which was 2 of 10 - EMDR better tolerated by participants thus having
lower drop out rate - However patients who remained in PE had reduction
of PTSD scores as well - Results of this study suggest that both PE and
EMDR equally effective in reducing symptoms of
PTSD and depression
33Evidence Based Practices CBT Prolonged Exposure
- Treatment choice for PTSD
- Study on 273 women with varying degrees of trauma
history and subsequent PTSD symptoms. - All participants were given the same sexual
assault scenario and three treatment options to
choose from which included Sertraline(SER),
prolonged exposure(PE), or no treatment.
Question if this happened to you, what would you
do - Treatment choice, reaction to treatment options,
and treatment credibility were examined. - Women were more likely to choose PE for treatment
of chronic PTSD.
34Description for Culture Women
- Overview Forging Research Priorities for
Womens Mental Health - By Nancy Felipe Russo
- Prevalence Rates
- - Frequencies and patterns of mental disorder
are vastly different for women and men. - - The NIMH Epidemiological Catchment Area
Program found that there are substantial
gender differences in prevalence rates of
lifetime diagnoses (a) women clearly
predominate in diagnoses of major depressive
episodes, agoraphobia, and simple phobia,
whereas men predominate in antisocial
personality disorder and alcohol
abuse/dependence (b) women are more likely
than men to have received a diagnosis of
dysthymia, obsessive-compulsive,
schizophrenia, somatization disorder, and
panic disorder and (c) no gender differences
in manic episode or cognitive impairment.
35Description for Culture Women
- Utilization Rates
- - There are marked differences between men and
women in the utilization of mental health
services, differences that vary with type of
facility. - - For inpatient facilities, women make up a
greater proportion of admissions than men in
nonfederal general hospitals and private mental
hospitals men predominate in admission to
state and county mental hospitals and Veterans
Administration hospitals. - - For outpatient facilities, female clients
predominate. - Diagnosis Related to Gender, Marital Status and
Ethnicity - - There are gender differences in diagnosis
that vary by marital status and race/ethnicity
and that cannot be explained by biomedical
models. - - The relationships among gender, marital
status, and psychological disorder depends on
the psychological disorder and vary with
ethnicity.
36Description for Culture Women
- Overview Forging Research Priorities for
Womens Mental Health - By Nancy Felipe Russo
- Diagnosis and Service Delivery
- - Patterns of mental disorder vary markedly
for men and women whether data from community
surveys or from patient populations are used. - - According to community surveys, women
predominantly are diagnosed with the more
severe forms of psychiatric disorders but
according to service delivery research, men
predominate in the more intensive community
treatment settings (residential and partial
care vs. outpatient). The question remains does
this represent a desirable outcome of treating
females in less restrictive settings or does
it show that females are underserved.
37Description for Culture Women
- Overview Forging Research Priorities for
Womens Mental Health - By Nancy Felipe Russo
- Multiple Roles and Womens Mental Health
- - Women typically have multiple roles that
they are fulfilling (mother, wife, employee,
etc.) and this can affect their mental health. - - Parenting is one caretaking role that
affects women more than men. According to
McBride (1988), parenthood, particularly when
children are young, increases the symptoms of
psychological distress for women whether or not
they work outside the home and the symptoms
appear to increase with the number of children
living in the home.
38Description for Culture Women
- Prevalence of Civilian Trauma and Posttramatic
Stress Disorder in a Representative National
Sample of Women - By Resnick, H.S., et al.
- The study assessed prevalence of crime and
noncrime civilian traumatic events, lifetime
posttraumatic stress disorder (PTSD), and PTSD in
the last six months amongst a sample of 4,008
U.S. adult women. - The study found that lifetime exposure to any
type of traumatic event was 69, whereas exposure
to crimes that included sexual or aggravated
assault or homicide of a close relative or friend
occurred among 36. - The overall prevalence of PTSD was 12.3
lifetime and 4.6 within the past 6 months. - The rate of PTSD was significantly higher among
crime versus noncrime victims (25.8 vs. 9.4). - History of incidents that included direct
threat to life or receipt of injury was a risk
factor for PTSD in women.
39Description for Culture Women
- Trauma Exposure and Posttraumatic Symptoms in
Hawaii Gender, Ethnicity, and Social Context - By Klest, B., Freyd, J.J., Foynes, M.M.
- This was a longitudinal cohort study of 833
members of an ethnically diverse group in Hawaii,
who were surveyed about their personal exposure
to several types of traumatic events,
socioeconomic resources and mental health
symptoms. - Findings were that men and women are exposed to
similar rates of trauma overall. However, women
report more exposure to traumas high in betrayal
and men report exposure to more traumas lower in
betrayal. - Trauma exposure was predictive of mental health
symptoms. Neglect, household dysfunction, and
high betrayal traumas predicted symptoms of
depression, anxiety, PTSD, dissociation, and
sleep disturbance. Lower in betrayal traumas
predicted PTSD and dissociation symptoms. - Results suggest that more inclusive definitions
of trauma are important for gender equity.
40Description for Culture Women
- Although women are exposed to proportionately
fewer traumatic events in their lifetime than
men, they have a higher lifetime risk of PTSD
(Seedat, Stein, and Carey, 2005) - Studies show risk factors for PTSD in women
include - - higher incidents of sexual assault and
intimate partner violence. - - peritraumatic dissociation (dissociation
that occurs at the time of a trauma) is a strong
predictor of PTSD - - pregnancy, traumatic childbirth, pregnancy
loss - - neurobiological dysregulation resulting from
sensitization to stress hormones - (epinephrine and cortisol)
- - concurrent PTSD and increased alcohol use is
seen significantly more in women
41Description for Culture Women
-
- Resilience and Recovery
- Resilience reflects the ability to maintain
stable equilibrium - Recovery connotes a trajectory in which normal
functioning temporarily gives way to symptoms of
depression, PTSD, or other - Creating a therapeutic alliance building trust
- Client-centered
- Validation
- Non-threatening
- Holistic - looking at various aspects of a
womans life and environment - (Seedat, et.al., 2005 Olff, Draijer, Langeland,
Gersons, 2007 Grieger, Fullerton, Ursano,
2003)
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