Transcript Document

Immigration
&
PTSD
Tammy Shaffer Ed.D., LPCC, LPC, NCC, ACS,
KCA Conference
October 26, 2007
Interest in
Trauma Research
U.S. Census Bureau, 2000.
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One in four low-income
children lives in an immigrant
family (Urban Institute 2001).
Three in five low-income noncitizens are uninsured (Brown
et al. 1999).
One in five K-12 school
children is an immigrant or
has an immigrant parent
(Hernandez et al. 1998).
Hippocrates – 400’s BC

A crisis is a sudden
state that gravely
endangers life.
Sigmund Freud
1920
Trauma occurs when the ego is
overwhelmed “as a consequence
of an extensive breach being
made in the protective shield
against stimuli.”
History of Posttraumatic
Stress Disorder
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Civil war
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World war I
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Shell shock
World war II
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Nostalgia
Battle fatigue
Vietnam
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Thousand mile
stare
PTSD – DSM-III (1980)
Accident vs. Disaster
 “…in
a disaster, the social
structure and processes are
affected sufficiently to threaten
the existence and functioning of
the community.
 The
resource needs are greater
than the resources available.”
Eranen & Liebkind, cited in Ursano, Fullerton, & Norwood, 1995
High Risk Groups
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Rescue workers and heroes
Injured
Children
Initial Intervention
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Safety
Respite
Physiological recovery
Easing symptoms
Food and water
Outreach programs
Ursano et al., 1998.
Later Interventions
 Differential
diagnosis
 Debriefing
 Psychotherapy
 Individual,
 Treatment
Family, or Group
for disorders
 Media-based recovery education
(Ursano et al., 1995)
Disaster Exposure

Lifetime U.S. Prevalence
39.1% 1

Survivor PTSD 3% - 58%1

Risk of developing PTSD in
course of emergency
worker career = 16%2
1
2
DSM IV, 1994
Everly & Mitchell, 1993
Determinants of
Trauma Severity
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Type of disaster
Degree of sustained injury
Amount of damage
Degree of life threatened
Duration of community disruption
Attribution of meaning
Psychiatric Responses to
Disaster
Organic mental
disorders
Acute stress
disorder
Adjustment
disorder
Alcohol abuse
Posttraumatic
stress disorder
Major depression
Generalized
anxiety disorder
Drug abuse
PTSD Time Frame
Specify if:
• Acute: if duration of symptoms is less than 3
months
• Chronic: if duration of symptoms is 3 months or
more
Specify if:
• With Delayed Onset: if onset of symptoms is at
least 6 months after the stressor
Symptoms of PTSD
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Repeated dreams or
recurrent flashbacks
Traumatic dreams
Sleeping problems
Psychological numbing
Intense distress if exposed
to anything resembling the
event
Anger outbursts
Hypervigalence
Symptoms of PTSD (cont’d)
A preoccupation with possible unknown threats
 Chronic physical symptoms

Pain
 Headache
 irritable bowel

Efforts to avoid people or activities that may
arouse recollection of the trauma
 Feelings of guilt
 No sense of a future

Common Feelings &
Behaviors of Children
Fears and anxieties
 Sleep disturbances
 School avoidance
 Somatic complaints
 Feelings of loss
 Regression
 Restricted range of affect

DSM -IV-TR, 2000
Stressor
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An agent,
condition,
or other stimulus
that causes stress
to
an organism.
American Heritage Dictionary
Distress
Seyle
Eustress
Seyle
PTSD and
Refugees/Immigrants

Many refugees/immigrants have
experienced …

Traumatic events in their country of
origin
• Humiliation, torture, starvation, illness
Exodus of their country
 Refugee camps

(Taylor, 2006)
Narrative Exposure Therapy
(NET) with Refugees

4 sessions (90 minute sessions)
Psychoeducation—problem-solving
about current concerns
 Recording client’s biography of
traumatic events
 Discussion of traumatic events—client
asked to relive distressing emotions
 Client given a copy of the biography
and discussion

(Taylor, 2006)
80
70
60
50
40
% with PTSD after 4
sessions
30
20
10
0
NET
Couns. Psychoed
(Taylor, 2006)
Benefits of NET with
Refugees/Immigrants
Willing to enter treatment
 Fewer drop-outs
 Efficacy with traumatized children
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(Taylor, 2006)
Implications for School
Counselors
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Classroom behavior
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Repetitive play reenacting event/theme
Disorganized or agitated behavior
Academic Performance
Increased need for counseling services
Family and school integration
Awareness of psychopharmacology
Educate faculty
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Flexibility
Easing transitions
Resources
Professional Organizations
 Colleagues
 Libraries
 Internet

Yourself
What Did I Learn?
Questions