Chapter 16 Trauma Stressorrelated and Dissociative Disorders Copyright

Trauma-Related Disorders in Children Clinical Picture Posttraumatic stress disorder in preschool children Ø Reactive

Trauma-related Disorders in Children (Cont. ) Epidemiology Comorbidity Biological factors Genetic Ø Neurobiological Ø

Trauma-related Disorders in Children (Cont. ) Psychological factors Ø Attachment theory Environmental factors Cultural

Application of the Nursing Process Assessment Ø Developmental assessment Nursing diagnoses Outcomes identification Implementation

Case Study A child has been traumatized by a history of violence. The nurse

Application of the Nursing Process (Cont. ) Interventions Advanced practice interventions Psychopharmacology Evaluation Copyright

Case Study (Cont. ) What are some interventions the nurse could use with this

Trauma-Related Disorders in Adults Posttraumatic stress disorder (PTSD) Re-experiencing of the trauma Ø Avoidance

Trauma-Related Disorders in Adults (Cont. ) Adjustment disorder Precipitated by stressful event Ø Debilitating

Trauma-Related Disorders in Adults (Cont. ) Epidemiology Comorbidity Psychological factors Ø Polyvagal theory Copyright

Dissociative Disorders Occur after significant adverse experiences/traumas Individuals respond to stress with severe interruption

Dissociative Disorders (Cont. ) Depersonalization/derealization disorder Dissociative amnesia Dissociative identity disorder Copyright © 2014,

Dissociative Disorders (Cont. ) Epidemiology Comorbidity Etiology Biological factors Genetic Ø Neurobiological Ø Copyright

Dissociative Disorders (Cont. ) Psychological factors Environmental factors Cultural considerations Copyright © 2014, 2010,

Depersonalization/Derealization Disorder Depersonalization—focus on self Derealization—focus on outside world Copyright © 2014, 2010, 2006

Dissociative Amnesia Inability to recall important personal information Often of traumatic or stressful nature

Dissociative Identity Disorder Presence of two or more distinct personality states Each alternate personality

Dissociative Disorders Assessment History Moods Impact on patient and family Suicide risk Self-assessment Copyright

Dissociative Disorders Implementation Interventions Psychoeducation Ø Pharmacological interventions Ø Advanced practice interventions Ø Somatic

Audience Response Questions 1. A nurse assesses a patient diagnosed with dissociative identity disorder.

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Trauma-Related Disorders in Children Clinical Picture Posttraumatic stress disorder in preschool children Ø Reactive attachment disorder Ø Disinhibited social engagement disorder Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

Trauma-related Disorders in Children (Cont. ) Psychological factors Ø Attachment theory Environmental factors Cultural considerations Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4

Application of the Nursing Process Assessment Ø Developmental assessment Nursing diagnoses Outcomes identification Implementation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5

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? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6

Trauma-Related Disorders in Adults Posttraumatic stress disorder (PTSD) Re-experiencing of the trauma Ø Avoidance of stimuli associated with trauma Ø Persistent symptoms of increased arousal Ø Alterations in mood Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9

Trauma-Related Disorders in Adults (Cont. ) Adjustment disorder Precipitated by stressful event Ø Debilitating cognitive, emotional, and behavioral symptoms that negatively impact normal functioning Ø Responses to stressful event may include combinations of depression, anxiety, and conduct disturbances Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10

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. 12

Dissociative Amnesia Inability to recall important personal information Often of traumatic or stressful nature Ø Dissociative fugue Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17

Dissociative Identity Disorder Presence of two or more distinct personality states Each alternate personality (alter) has own pattern of Perceiving Ø Relating to and Ø Thinking about the self and environment Ø Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18

Dissociative Disorders Implementation Interventions Psychoeducation Ø Pharmacological interventions Ø Advanced practice interventions Ø Somatic therapy Evaluation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 20

Audience Response Questions 1. A nurse assesses a patient diagnosed with dissociative identity disorder. Which finding would likely be part of the patient’s history? A. Travel to a foreign country B. Physical or sexual abuse C. Thyroid dysfunction D. Eating disorder Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 21