Victim, Trauma and PTSD Dicky Pelupessy Faculty of Psychology, Universitas Indonesia Crisis Center, Faculty of Psychology, Universitas Indonesia The 11th ASEAN Course on Victimology and Victim Assistance Faculty of Law, Universitas Indonesia July 26, 2011

Outline of the presentation Trauma Traumatic event Impact of traumatic events to victims Post-Traumatic Stress Disorder (PTSD) Treatment

Trauma Meaning: wound Physical and Psychological wound

Psychological Trauma Human reactions to trauma-provoking events or traumatic events (Roberts, 2002). Accidents Childhood abuse Combat Criminal assault Rape Torture Natural disasters What else?...

Psychological Trauma Not reactions per se Technically refers to the event (Yule, 1999; Briere & Scott, 2006)

Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) American Psychiatric Association [APA] Trauma: …direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). (p. 463)

By definition, limited to events that “threatened death or serious injury, or other threat to one’s physical integrity” Roberts (2005); Briere & Scott (2002): include events that extremely upsetting and at least temporarily overwhelms the individual’s internal resources

Traumatic Event An event that is traumatic. An event that creates psychological wound. Single, multiple, or on-going event

Traumatic event Briere & Scott (2006)’s Major Types: . Natural disasters . Mass interpersonal violence . Large-scale transportation accidents . House or other domestic fires . Motor vehicle accidents . Rape and sexual assault

Traumatic event Briere & Scott (2006)’s Major Types (continued): . Stranger physical assault . Partner battery . Torture . War . Child abuse . Emergency worker to trauma

Roberts (2005)’s trauma-provoking events: . Violent crimes . Crisis-prone situations . Natural disasters . Accidents . Transitional or developmental events

Victim’s reactions to traumatic events Victims = directly and personally experiencing, witnessing, or learning from others (secondary trauma) Typical reactions immediately after the event: shock & denial Other common reactions: an unusual feeling of being easily startled, difficulty concentrating, outbursts of irritability, feelings of emotional numbness, recurrent anxiety over personal safety or the safety of loved ones, an inability to let go of distressing mental images or thoughts, anxiety about, and avoidance of, specific reminders of the event, feelings of helplessness, powerlessness, and lack of control, feelings of guilt, etc. It is a normal response to abnormal event!

Victim’s reactions to traumatic events Longer term reactions: flashbacks, physical symptoms, emotional problems (unpredictable emotions), and strained relationships. Revictimization: those who have experienced childhood abuse are considerably more like to be victimized again as adults (Classen et al., 2002; Tjaden & Thoennes, 2000)

Victim’s reactions to traumatic events Revictimization (continued) (1) the effects of childhood trauma that have lasted into adulthood (2) the effects of more recent sexual or physical assaults (3) the additive effects of childhood trauma and adult assaults (for example, flashbacks to both childhood and adult victimization experiences) (4) the exacerbating interaction of childhood trauma and adult assault, such as especially severe, regressed, dissociated, or self-destructive responses to the adult trauma

Victim’s reactions to traumatic events, if persist… A disorder, Post-Traumatic Stress Disorder (PTSD) Meeting DSM-IV Criteria for PTSD and the symptoms must last for more than a month and must significantly affect important areas of life (Yeager & Roberts, 2005) Main class of symptoms: Intrusive re-experiencing of the trauma Avoidant behaviors Increased psychological arousal (hyperarousal)

Prevalence of PTSD Not all people exposed to a traumatic event go on to develop PTSD Depends on: Individual differences The nature and severity of the traumatic event e.g. over 50% - the sinking of the cruise ship Jupiter (Yule et al., 1995); 15 to 50% - combat (Foy, 1992);

Prevalence of PTSD After Disaster (World Health Organization, 2005) Description After Disaster: 12 month prevalance rates Severe disorder (e.g., psychosis, severe depression, severely disabling form of anxiety disorder, etc) 3-4% Mild or moderate mental disorder (e.g., mild and moderate forms of depression and anxiety disorders, including of PTSD) 20% Moderate or severe psychological distress that does not meet criteria for disorder, that resolves over time or mild distress that does not resolve over time 30-50% Mild psychological distress which resolves over time 20-40%

Treatment Psychological First Aid (PFA) Exposure Therapy Psychodynamic Psychotherapy Hypnosis and Guided Imagery Psychological Debriefing or Critical Incident Stress Debriefing (CISD) Eye Movement Desensitization and Reprocessing (EMDR) Pharmacotherapy Group Therapy Marital and Family Therapy

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