Trauma, Stressor-related, and Dissociative Disorders Chapter 16 Trauma, Stressor-related, and Dissociative Disorders Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Trauma-Related Disorders in Children Clinical Picture Posttraumatic stress disorder in preschool children Reactive attachment disorder Disinhibited social engagement disorder Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Trauma-related Disorders in Children (Cont.) Epidemiology Comorbidity Biological factors Genetic Neurobiological Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Trauma-related Disorders in Children (Cont.) Psychological factors Attachment theory Environmental factors Cultural considerations Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Application of the Nursing Process Assessment Developmental assessment Nursing diagnoses Outcomes identification Implementation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study A child has been traumatized by a history of violence. The nurse plans to assess the child’s mental health. What are some things that should be assessed? Broad categories to assess include safety, general appearance, socialization, activity level, speech, coordination and motor function, affect, manner of relating, intellectual function, thought processes and content, and characteristics of play. Symptoms such as uncontrollable rage, somatic symptoms, posttraumatic symptoms (e.g., nightmares, night terrors, disturbing hallucinations, intrusive traumatic thoughts and memories, re-experiencing or flashbacks, traumatic re-enactments, and self-injurious behaviors), as well as negative symptoms (e.g., numbing and avoidance). Somatic symptoms may manifest as headaches, stomach aches, or pain; memory problems include amnesia, forgetfulness, difficulty concentrating, and trance states. Comorbid conditions should be assessed. Developmental testing should be done. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Application of the Nursing Process (Cont.) Interventions Advanced practice interventions Psychopharmacology Evaluation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study (Cont.) What are some interventions the nurse could use with this child who has been traumatized? Teach deep breathing techniques. Soothing strategies might also include warm baths, singing, redirecting, distraction, listening to music, guided imagery, and using a low, calming voice. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Trauma-Related Disorders in Adults Posttraumatic stress disorder (PTSD) Re-experiencing of the trauma Avoidance of stimuli associated with trauma Persistent symptoms of increased arousal Alterations in mood Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Trauma-Related Disorders in Adults (Cont.) Adjustment disorder Precipitated by stressful event Debilitating cognitive, emotional, and behavioral symptoms that negatively impact normal functioning Responses to stressful event may include combinations of depression, anxiety, and conduct disturbances Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Trauma-Related Disorders in Adults (Cont.) Epidemiology Comorbidity Psychological factors Polyvagal theory Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Disorders Occur after significant adverse experiences/traumas Individuals respond to stress with severe interruption of consciousness Unconscious defense mechanism Protects individual against overwhelming anxiety through emotional separation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Disorders (Cont.) Depersonalization/derealization disorder Dissociative amnesia Dissociative identity disorder Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Disorders (Cont.) Epidemiology Comorbidity Etiology Biological factors Genetic Neurobiological Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Disorders (Cont.) Psychological factors Environmental factors Cultural considerations Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Depersonalization/Derealization Disorder Depersonalization—focus on self Derealization—focus on outside world Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Amnesia Inability to recall important personal information Often of traumatic or stressful nature Dissociative fugue Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Identity Disorder Presence of two or more distinct personality states Each alternate personality (alter) has own pattern of Perceiving Relating to and Thinking about the self and environment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Disorders Assessment History Moods Impact on patient and family Suicide risk Self-assessment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Dissociative Disorders Implementation Interventions Psychoeducation Pharmacological interventions Advanced practice interventions Somatic therapy Evaluation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions A nurse assesses a patient diagnosed with dissociative identity disorder. Which finding would likely be part of the patient’s history? Travel to a foreign country Physical or sexual abuse Thyroid dysfunction Eating disorder ANS: B   Also, define dissociative fugue related to distracter A. REF: 315-316 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.