Trauma and abuse-related disorders Notes

NOTES NOTES TRAUMA– & ABUSE–RELATED DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES ▪ Mental disorders caused by/associated with past traumatic/stressful event ▪ Abuse: intentional mistreatment of others; may be directed at anyone; often features children or the elderly ▫ Increases risk of the target developing a mental disorder; generally results in depression or aggressiveness; may incite posttraumatic stress disorder ▪ Psychological symptoms → behavioral changes ▪ Individuals might self-medicate with substance use SIGNS & SYMPTOMS DIAGNOSIS ▪ See individual disorders TREATMENT MEDICATIONS ▪ See individual disorders PSYCHOTHERAPY ▪ Abuse-related: cognitive behavioral therapy OTHER INTERVENTIONS ▪ Manage substance use ▪ Anxiety/fear associated with traumatic/ stressful stimuli ▪ Reduced pleasure, self-acceptance; depression; anger, aggressiveness; dissociation (detachment from present in cognitive/sensory capacity); etc. PHYSICAL & SEXUAL ABUSE osms.it/physical_and_sexual_abuse PATHOLOGY & CAUSES ▪ Intentional injuring of others, which may include hitting, burning, or even poisoning ▪ Sexual abuse: forced or otherwise inappropriate (e.g. in age difference) sexual behavior with others COMPLICATIONS ▪ Increases risk of the target developing a mental disorder; generally results in depression or aggressiveness; may incite posttraumatic stress disorder ▪ Severe abuse may cause prolonged or irreversible damage to the body OSMOSIS.ORG 759

TREATMENT SIGNS & SYMPTOMS ▪ Bruising, cuts, sores, burns or rashes; fractured or broken bones; damage to internal organs; failure to thrive ▪ Anxiety related to the abuse ▪ Dissociative reactions ▪ Depression ▪ Aggressiveness ▪ PTSD ▪ Sexual abuse ▫ Fear of or anxiety towards sexual activity ▫ Increased risk of suicide ▫ If appropriate, physical symptoms (e.g. physical trauma, STIs, UTIs) MEDICATIONS ▪ Sexual abuse: may require emergency contraceptives or STD prophylactics PSYCHOTHERAPY ▪ Focus on screening and prevention; may include symptomatic treatment or psychotherapy (esp. cognitive behavioral therapy) OTHER INTERVENTIONS ▪ Medical intervention, as needed ▪ Referral to protective services for legal/ social support DIAGNOSIS OTHER DIAGNOSTICS ▪ Based on individual history and presence of above symptoms POSTTRAUMATIC STRESS DISORDER (PTSD) osms.it/PTSD 760 OSMOSIS.ORG PATHOLOGY & CAUSES SIGNS & SYMPTOMS ▪ Memory of past traumatic event → recurrent mental, physical stress ▫ E.g. car crashes; sexual abuse; military service; natural disasters ▪ Psychological symptoms → behavioral changes ▪ Individuals might self-medicate with substance use ▪ Neurological factors ▫ Dysfunctions in hypothalamic-pituitaryadrenal axis/endogenous opioid system; deficits in arousal, sleep regulation; family history ▪ Psychological ▫ Nightmares, flashbacks, intrusive thoughts ▪ Behavioral ▫ Avoidance of situations/environments, hypervigilance, hyperarousal → trouble sleeping, general irritability, emotional outbursts ▪ Children less likely to show distress; often use play to express memories

Chapter 105 Trauma- and Abuse-Related Disorders DIAGNOSIS OTHER DIAGNOSTICS ▪ Exposure to traumatic event ▪ Intrusive symptoms ▫ Recurrent, distressful memories, dreams ▫ Dissociative reactions ▫ Distress/physiological reactions in response to stimuli ▪ Avoidance of associated stimuli, psychological (e.g. memories)/tangible (e.g. places) ▪ Negative changes in thoughts, feelings ▪ Increased sensitivity to event, associated stimuli ▪ Disturbance lasts > one month → distress in other areas of life ▪ Disturbance cannot be better explained by another condition/substance TREATMENT MEDICATIONS ▪ Antidepressants, esp. selective serotonin reuptake inhibitors (SSRIs); anti-anxiety; sleep aids PSYCHOTHERAPY ▪ Exposure, group therapy OTHER INTERVENTIONS ▪ Manage substance use SOMATIC SYMPTOM DISORDER osms.it/somatic-symptom-disorder PATHOLOGY & CAUSES ▪ Extended periods of unexplainable physical symptoms ▪ Individuals not faking symptoms (unlike factitious disorder) ▪ Thinking about physical symptoms → cognitive symptoms (e.g. stress/anxiety) ▪ Cause unknown; affected individuals sensitive to physical changes → everyday experiences misinterpreted ▪ High comorbidity with depressive, anxiety disorders SIGNS & SYMPTOMS ▪ Somatic symptoms (e.g. pain, sexual, gastrointestinal problems); change over time ▪ Cognitive symptoms (e.g. worry, anxiety) DIAGNOSIS OTHER DIAGNOSTICS ▪ ≥ one somatic symptoms → distress in other areas of life, last > six months ▪ Changes in behavior/thinking, related to somatic symptoms ▫ Excessive thought about severity of symptoms ▫ Anxiety about symptoms/health ▫ Devotion of time/energy to symptoms/ health ▪ Severity determined by changes in behavior/thinking ▫ Mild = one change ▫ Moderate = ≥ two changes ▫ Severe = ≥ two changes + multiple physical symptoms/one severe symptom TREATMENT PSYCHOTHERAPY ▪ Improve cognitive symptoms (e.g. cognitive-behavioral/group therapy) OSMOSIS.ORG 761