Transcript Trauma and Stressor Related Disorders Presentation

Trauma- and StressorRelated Disorders
University of Manoa
Anna Weihl, Christine Keanu, Genevieve Parks, Patricia Kaleiwahea
Trauma- and Stressor- Related Disorders
This chapter includes disorders in which exposure to a traumatic or
stressful event is listed explicitly as a diagnostic criterion.
These include:
•Adjustment Disorders
•Reactive Attachment Disorder
•Disinhibited Social Engagement Disorder
•Other specified Trauma- and Stressor-Related Disorder
•Unspecified Trauma- and Stressor-Related Disorder
Posttraumatic Stress Disorder
Acute Stress Disorder
= we will mainly be talking about these two disorders tonight
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
• Adjustment Disorders
• Diagnostic Criteria
A. The development of emotional or behavioral symptoms in response to an identifiable
stressor(s) occurring within 3 months of the onset of the stressor(s)
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of
the following:
• 1. Marked distress that is out of proportion to the severity or intensity of the stressor, taking
into account the external context and the cultural factors that might influence symptom
severity and presentation.
• 2. Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder
and is not merely and exacerbation of a preexisting mental disorder
D. The symptoms do not represent normal bereavement
E. Once the stressor or its consequences have terminated, the symptoms do not persist for
more than an additional 6 months
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
• Diagnostic Features
• Prevalence
• Development and Course
• Risk and Prognostic Factors
• Culture-Related Diagnostic Issues
• Functional Consequences of Adjustment Disorders
• Differential Diagnosis
• Comorbidity
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
Other specified Trauma- and Stressor-Related Disorder (page 289)
•Symptoms are characteristic of a trauma- and stressor-related
disorder, but do not meet the full criteria for any of the trauma- and
stressor-related disorders diagnostic class.
•This diagnose used in situations in which the clinician chooses to
record “other specified trauma- and stressor-related disorder” followed
by specific reason. (e.g., persistent complex bereavement disorder.)
Unspecified Trauma- and Stressor-Related Disorder (page 290)
•Same as above except clinician chooses not to specify the reason the
criteria are not met due to insufficient information to make specific
diagnose. (e.g., in emergency room settings.)
Anna
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
Reactive Attachment Disorder (page 265)
Reactive Attachment Disorder (RAD) 313.89
• Characterized by a pattern of markedly disturbed and developmentally inappropriate attachment
behaviors, in which a child rarely or minimally turns preferentially to an attachment figure for
comfort, support, protection, and nurturance.
• The essential feature is absent or grossly underdeveloped attachment between child and putative
caregiving adults.
• Children with RAD are believed to have the capacity to form selective attachments. However,
because of limited opportunities during early development, they fail to show the behavioral
manifestations of selective attachments (i.e. when distressed they show no consistent effort to
obtain comfort, support, nurturance, or protection from caregivers and they do not respond more
than minimally to comforting efforts of caregivers).
• RAD is associated with the absence of expected comfort seeking and response to comforting
behaviors.
• Child with RAD emotion regulation capacity is compromised, and they display episodes of negative
emotions of fear, sadness, or irritability that are not readily explained.
• A diagnosis of RAD should not be made in children who are developmentally unable to form
selective attachments. Thus the child must have a developmental age of at least 9 months.
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
Reactive Attachment Disorder Continued(page 265)
• The prevalence of RAD is unknown but relatively rarely seen in clinical settings. RAD is often found in young
children exposed to severe neglect before being placed in foster care. However, even in this population the
disorder is uncommon and occurs in less than 10% of those children.
• There is no standard treatment for RAD, however it often includes: Individual counseling, education of parents
and caregivers about the condition, parenting skills classes, family therapy, medication for other conditions
that may be present (such as depression, anxiety, etc.), special education services, and residential or inpatient
treatment for children with more-serious problems or who put themselves or others at risk of harm.
• There are some controversial treatment practices that should be noted as they can be psychologically and
physically damaging and have led to accidental deaths. These practices include: re-parenting/rebirthing/holding therapy, tightly wrapping, binding or holding children, withholding food or water, forcing child
to eat or drink, and yelling, tickling or pulling limbs, triggering anger that finally leads to submission.
• Here’s a video clip on holding therapy: http://www.youtube.com/watch?v=OdWhcyz6KbY
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
• Disinhibited Social Engagement Disorder
• Diagnostic Criteria
• A. A pattern of behavior in which a child actively approaches and interacts with
unfamiliar adults and exhibits at least two of the following:
• 1. Reduced or absent reticence in approaching and interacting with unfamiliar adults
• 2. Overly familiar verbal or physical behavior
• 3. Diminished or absent checking back with adult caregiver after venturing away, even in
unfamiliar settings
• 4. Willingness to go off with an unfamiliar adult with minimal or no hesitation
• B. The behaviors in Criterion A are not limited to impulsivity (as in attentiondeficit/hyperactivity disorder) but include socially disinhibited behavior
• C. The child has experienced a pattern of extremes of insufficient care as evidenced by
at least one of the following:
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
• 1. Social neglect or deprivation in the form of persistent lack of having basic
emotional needs for comfort, stimulation, and affection met by caregiving adults
• 2. Repeated changes of primary caregivers that limit opportunities to form stable
attachments
• 3. Rearing in unusual settings that severely limit opportunities to form selective
attachments
• D. The care in Criterion C is presumed to be responsible for the disturbed behavior in
Criterion A
• E. The child has a developmental age of at least 9 months
• Specify
• Persistent- the disorder has been present for more than 12 months
• Current severity – Disinhibited social engagement disorder is specified as severe when the
child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high
levels
Overview of the Diagnostic Category of
Trauma- and Stressor-Related Disorders
• Diagnostic Features
• Associated Features Supporting Diagnosis
• Prevalence
• Development and Course
• Risk and Prognostic Factors
• Functional
• Differential Diagnosis
• Comorbidity
Descriptions for Acute Stress Disorder
Diagnostic Criteria:
A.) Client must have been exposed to actual threatened death, serious injury, or
sexual violation in one (or more) of the following ways:
1.) directly experiencing the traumatic event(s)
2.) witnessing, in person, the event(s) as it occurred to others
3.) learning that the event(s) occurred to a close family member or close friend.
4.) experiencing repeated or extreme exposure to aversive details of the
traumatic event(s).
B.) Also, there must be the presence of nine (or more) of the following symptoms
from any of the five categories of intrusion, negative mood, dissociation,
avoidance, and arousal, beginning or worsening after the traumatic event(s)
occurred. (there are 14 symptoms listed in the nine categories)
Specifiers: None listed
Coding and recording procedures: None listed
Descriptions for Acute Stress Disorder, continued….
Diagnostic Features:
•development of characteristic symptoms lasting from 3 days to 1 month
following exposure to one or more traumatic events, (traumatic event examples
are listed, some stressful events do not possess the severe and traumatic
components, but may lead to “adjustment disorder” diagnose instead),
•typically involves an anxiety response that includes some re-experiencing or
reactivity of traumatic event (e.g., strong emotional, physiological, anger, or
aggressive responses at traumatic reminder).
•Witnessing or learning of traumatic events are limited to close relatives or close
friends, which must have been violent or accidental (listed is some examples of
witnessed/learning events)
•Traumatic event being re-experienced, intrusive memories (various ways listed)
•Distressing dreams
•Flashbacks
•Psychological distress or physiological reactivity
Descriptions for Acute Stress Disorder, continued….
Diagnostic Features continued…
•Depersonalization, de-realization (detached sense of oneself, in a daze)
•Avoidance of trauma stimuli (refuse to discuss trauma, excessive alcohol use at
mention of trauma, avoiding interacting if reminds of trauma)
•Sleep onset and maintenance (nightmares)
•Quick temper with little provocation, irritability
•Concentration difficulties, memory difficulties, staying focused difficulties
•Jumpiness, heightened startle response
•Panic attacks, chaotic or impulsive behavior (children may display separation
anxiety)
Associated Features Supporting Diagnosis:
•Catastrophic or extremely negative thoughts about heir role in traumatic event,
or to the event itself or future likelihood of harm
•Acute grief reactions or post-concussive symptoms
Descriptions for Acute Stress Disorder, continued….
Prevalence:
•Varies according to the nature of the event and the context in which it is
assessed.
Development and course:
•Cannot be diagnosed until 3 days after a traumatic event
•May or may not progress to PTSD after 1 month (half who develop PTSD initially
presented Acute Stress Disorder)
•Symptoms can worsen during the initial month
•Re-experiencing can vary across development, (children can report differently
than adults)
Functional Consequences:
•Impaired functioning in social, interpersonal or occupational, also sleep, energy
levels and capacity to attend to tasks.
•Avoidance, withdraw, and nonattendance.
Descriptions for Acute Stress Disorder, continued….
Risk and Prognostic Factors:
Temperamental- having prior mental health, higher levels of negativity affectivity,
greater perceived severity of traumatic event(s), avoidance coping style, and/or
having catastrophic appraisals of the traumatic event are strong predictors of acute
stress disorder.
Environmental- if been exposed to traumatic event(s), and/or has an history of
prior trauma(s), greater chances of developing acute stress disorder.
Genetic and Physiological- Females are at greater risk, and/or elevated reactivity
before trauma(s) is another predictor of an increased risk of developing acute
stress disorder after a trauma.
Culture-Related Diagnostic Issues:
Varies cross-culturally, particularly with respect to dissociative symptoms,
nightmares, avoidance, and somatic symptoms.
Gender-Related Diagnostic Issues:
More prevalent in females than males, maybe due to sex-linked neurobiological
differences in stress response, or the likelihood of possibility of exposure to high
conditional risk trauma(s) (e.g., rape, other interpersonal violence)
Differential Diagnosis:
Adjustment disorders: diagnose given when criteria doesn’t meet acute stress
disorder’s Diagnostic Criteria A.)
Panic disorder: although common in acute disorder, panic disorder is diagnosed
only if panic attacks are unexpected, there is anxiety about future attacks, or there
are maladaptive changes in behavior associated with fear of dire consequences of
the attacks.
Dissociative disorder: in absence of characteristics of acute stress disorder, severe
dissociative responses can be diagnosed as de-realization/depersonalization
disorder, or if severe amnesia, dissociative amnesia may be indicated.
Posttraumatic stress disorder: if symptoms persist more than 1 month and meet
criteria for PTSD, (acute stress must occur 1 month after trauma, and resolve within that 1 month period), criteria is then changed from acute stress to PTSD.
Differential Diagnosis continued….
Obsessive-compulsive disorder: recurrent intrusive thoughts, but not related to an
experienced traumatic event, compulsions are usually present, and other
symptoms of acute stress disorder are typically present.
Psychotic disorder: flashbacks must be distinguished from illusions, hallucinations,
or other perceptual disturbances, which may occur in schizophrenia, other
psychotic disorders, depressive or bipolar disorder w/ psychotic features, a
delirium, substance/medication-induced disorders, and psychotic disorders due to
another medical condition. Flash are distinguished by being directly related to
traumatic experience and by occurring in the absence of other psychotic or
substance-induced features.
Traumatic brain injury (TBI): symptoms for a brain injury from traumatic event(s),
and symptoms previously termed post-concussive can overlap with symptoms of
acute stress disorder, however re-experiencing and avoidance are characteristics of
acute stress disorder where as persistent disorientation and confusion are more
specific to TBI. Also, symptoms of acute stress disorder persist for up to only 1
month following trauma exposure.
Acute Stress Disorder/YouTube Video
http://www.youtube.com/watch?v=Al1A0t1vWzk
(1 minute, 55 seconds)
EBP for Acute Stress Disorder??
Psychotherapeutic Interventions:
Cognitive behavior therapy
•Patient utilization of existing
support network
•Psychological debriefing
•Single-session therapy
Eye movement desensitization and
reprocessing (EMDR)
•Reactive eye dilation desensitization
and reprocessing (REDDR)
•Hypnotherapy
•Desensitization
•Relaxation exercises
•Internet based therapies
•Stress inoculation
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Imagery rehearsal
Prolonged exposure techniques
Case management
Group therapies including presentcentered and trauma-focused group
therapies
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Optimism training
Goal setting and achievement
Biofeedback
Multiple channel exposure therapy
Assertiveness training
Outward Bound group recreational
therapies
http://www.nrepp.samhsa.gov/
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) is said to be an effective
psychotherapeutic approach for treatment of traumatic memories.
It is an “empirically supported integrative psychotherapeutic approach for
treatment of Post-Traumatic Stress Disorder (PTSD)” (Van der Hart, Nijenhuis,
Solomon, 2010). It is not only used to treat Post-Traumatic Stress Disorder but any
other disturbing event that the individual finds him-self unable to move through in
a healthy way.
“EMDR involves a neurobiological process that helps the individual reprocess a
traumatic or disturbing event into an experience that can be remembered without
pain” (Shapiro, Forrest, 2004).
One of the goals and objectives in treatment is to use EMDR to resolve disturbing
events (trauma), the identification and utilization of resources, and for future
scripting.
Basically, by processing negative cognitions through EMDR, an increased ability to
self-regulate emotional responses is seen.
http://www.youtube.com/watch?v=KpRQvcW2kUM
4 Literature Reviews on the EBP EMDR for ASD
1.) Kutz, et. al, 2008, found that “a single session of modified and abridged
protocol of EMDR was found to provide complete relief for 50% and substantial
relief for another 27% of acutely stressed patients, most of whom had been
exposed to an isolated traumatic event. While the standard EMDR protocol is
geared as a comprehensive approach for chronic patients with multiple
accumulating issues, this single-session abridged protocol was effective for focused
symptom relief in the early phases.
2.) The American Journal of Psychiatry, et. al, 2004, compared EMDR with no
treatment, cognitive behavior therapy, exposure approaches (not involving in vivo
exposure), variants of EMDR (e.g., dismantling studies), and “nonspecific”
treatments. EMDR was more effective than no treatment and comparable to other
active treatments.
4 Literature Reviews on the EBP EMDR for ASD
continued…
3.) An article in the Wiley Inter Science Journal, 2009, found that “symptom
reduction has been shown to be comparable over treatment with EMDR …and the
6-month follow-up, EMDR had the superior outcome. In studies that had diagnosis
as an outcome measure, between 77% and 90% of EMDR patients no longer met
diagnostic criteria for PTSD at the end of treatment.
4.) “Researchers found that only trauma-focused CBT and EMDR produced
significant clinical improvements, and no major differences were found between
the two in head-to-head comparison studies” (Kennedy, et. al., 2007).
Posttraumatic Stress Disorder YouTube Video
http://www.bing.com/videos/search?q=George+Carlin+Ptsd&Form=VQ
FRVP#view=detail&mid=9B6B008519D3B722036E9B6B008519D3B72
2036E
PTSD ETIOLOGY/CRITERIA
PTSD is an anxiety disorder that develops in response to
A.Exposure to actual or threatened death, serious injury, or sexual violence by directly
experiencing, witnessing the event, learning that the traumatic event happened to a close
family member or friend, and experiencing repeated exposure
THOSE AT-RISK INCLUDE:
•People who have been in a natural disaster, such as a tidal wave, earthquake,
tornado or tsunami.
•Anyone who have been raped or physically or sexually abused.
•Anyone who have witnessed or been a part of a life-threatening event.
•Anyone with military combat experience or even civilians who have been injured
in war.
PTSD ETIOLOGY/CRITERIA
B. Presence of one (or more) of the following symptoms associated with the
traumatic events, beginning after the traumatic event(s) occurred:
• Re-experiencing the event involuntarily through distressing
memories(flashbacks)
• Re-experiencing nightmares or distressing dreams in which it is related to
traumatic event.
• Dissociative reactions(flashbacks) where individual feels or acts as if the
traumatic event was recurring.
• Intense or prolonged psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the traumatic
event(s)
• Marked physiological reactions such as Numbness, Insomnia, Lack of
concentration.
PTSD ETIOLOGY/CRITERIA
C. Persistent avoidance of stimuli associated with the traumatic event(s)
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•
Avoiding people, places, conversations, etc. that arouse distressing memories of
traumatic event.
Avoiding distressing memories, thoughts, or feelings about or associated with the
traumatic event.
D. Negative alterations in cognitions and mood associated with the traumatic
event(s), beginning or worsening after the traumatic event(s) occurred.
E. Marked alterations in arousal and reactivity associated with the traumatic
event.
F. Duration of the disturbance is more than 1 month.
G. Disturbance causes clinically significant distress or impairment in
relationships with parents, siblings, peers, or other caregivers.
H. Disturbance is not attributable to the physiological effects of a
substance(medication or alcohol) or another medical condition.
Prevalence
• Projected lifetime risk of PTSD rates higher among veterans as well
as police, firefighters, emergency medical personnel (jobs high risk)
• Projected lifetime risk for PTSD at age 75 years is 8.7%(U.S.)
• Twelve-month prevalence among U.S. adults is 3.5%
• Europe and most Asian, African, and Latin American countries have
lower estimates of .5%-1.0%
• Highest rates are found among survivors of rape, military combat,
and ethnically or politically motivated internment and genocide.
Development and course
• Any age (beginning after the 1st year of life)
• Symptoms begin approximately 3 months after traumatic event
• Abundant evidence for what DSM-IV called “delayed onset” now called
“delayed expression” which is a delay in meeting full criteria
• ½ of adults will experience complete recovery within 3 months
• Symptoms for some lasts more than 12 month and for others more than
50 years
Functional Consequences
PTSD ASSOCIATED WITH:
•High levels of social, occupational, and physical disability
•Considerable economic costs
•Impaired functioning across social, interpersonal, developmental,
educational, physical health, and occupational domains
•Poor social and family relationships, work absences, lower income, lower
educational and occupational success.
•High levels of medical utilization
Evidence Based Practices: Pharmacotherapy
Post-Traumatic Stress Disorder in Women
•SSRI’s (Selective serotonin reuptake inhibitor)remain a first-line
pharmacotherapy for PTSD, although mood stabilizers, newer
antidepressants, atypical antipsychotics and adrenergic agents have some
evidence for efficacy. SSRI’s were the first class of psychotropic drugs
discovered and are the most widely prescribed antidepressants in many
countries.
•CBT, although randomized, comparative studies do not provide evidence
for superiority of one intervention over another
•Exposure therapy and cognitive processing have been demonstrated to
work well in women with PTSD following adult victimization or childhood
abuse.
Evidence Based Practices: Pharmacotherapy
CURRENT STATUS OF PHARMACOTHERAPY FOR PTSD:
AN EFFECT SIZE ANALYSIS OF CONTROLLED STUDIES
• Findings suggested that serotonergic antidepressants for the treatment
of PTSD are effective and of a relative advantage
• Effective medications for conditions characterized by pervasive anxiety,
intrusive thoughts, and avoidance (PTSD) may have strong but extreme
selectivity for blocking reuptake of serotonin over norepinephrine.
• Serotonergic agents for treatment of PTSD is encouraged
Evidence Based Practices: CBT EMDR
A Community-Based study of EMDR and Prolonged Exposure
•Pilot study which compared prolonged exposure and EMDR
•22 patients from a university based clinic serving rape and crime victims
•Results showed that both approaches produced significant reduction in
PTSD and depression symptoms
•Success was faster with EMDR with 7 of 10 of the participants having 70%
reduction in PTSD symptoms as compared to PE which was 2 of 10
•EMDR better tolerated by participants thus having lower drop out rate
•However patients who remained in PE had reduction of PTSD scores as
well
•Results of this study suggest that both PE and EMDR equally effective in
reducing symptoms of PTSD and depression
Evidence Based Practices: CBT Prolonged Exposure
Treatment choice for PTSD
•Study on 273 women with varying degrees of trauma history and
subsequent PTSD symptoms.
•All participants were given the same sexual assault scenario and three
treatment options to choose from which included: Sertraline(SER),
prolonged exposure(PE), or no treatment. Question “if this happened to
you, what would you do”
•Treatment choice, reaction to treatment options, and treatment
credibility were examined.
•Women were more likely to choose PE for treatment of chronic PTSD.
Description for Culture: Women
Overview: Forging Research Priorities for Women’s Mental Health
By Nancy Felipe Russo
Prevalence Rates
- Frequencies and patterns of mental disorder are vastly different for women and
men.
- The NIMH Epidemiological Catchment Area Program found that there are
substantial gender differences in prevalence rates of lifetime diagnoses: (a)
women clearly predominate in diagnoses of major depressive episodes,
agoraphobia, and simple phobia, whereas men predominate in antisocial
personality disorder and alcohol abuse/dependence; (b) women are more likely
than men to have received a diagnosis of dysthymia, obsessive-compulsive,
schizophrenia, somatization disorder, and panic disorder; and (c) no gender
differences in manic episode or cognitive impairment.
Description for Culture: Women
Utilization Rates
- There are marked differences between men and women in the utilization of
mental health services, differences that vary with type of facility.
- For inpatient facilities, women make up a greater proportion of admissions than
men in nonfederal general hospitals and private mental hospitals men
predominate in admission to state and county mental hospitals and Veterans
Administration hospitals.
- For outpatient facilities, female clients predominate.
Diagnosis Related to Gender, Marital Status and Ethnicity
- There are gender differences in diagnosis that vary by marital status and
race/ethnicity and that cannot be explained by biomedical models.
- The relationships among gender, marital status, and psychological disorder
depends on the psychological disorder and vary with ethnicity.
Description for Culture: Women
Overview: Forging Research Priorities for Women’s Mental Health
By Nancy Felipe Russo
Diagnosis and Service Delivery
- Patterns of mental disorder vary markedly for men and women whether data
from community surveys or from patient populations are used.
- According to community surveys, women predominantly are diagnosed with the
more severe forms of psychiatric disorders but according to service delivery
research, men predominate in the more intensive community treatment settings
(residential and partial care vs. outpatient). The question remains does this
represent a desirable outcome of treating females in less restrictive settings or
does it show that females are underserved.
Description for Culture: Women
Overview: Forging Research Priorities for Women’s Mental Health
By Nancy Felipe Russo
Multiple Roles and Women’s Mental Health
- Women typically have multiple roles that they are fulfilling (mother, wife,
employee, etc.) and this can affect their mental health.
- Parenting is one caretaking role that affects women more than men. According
to McBride (1988), parenthood, particularly when children are young, increases
the symptoms of psychological distress for women whether or not they work
outside the home and the symptoms appear to increase with the number of
children living in the home.
Description for Culture: Women
Prevalence of Civilian Trauma and Posttramatic Stress Disorder in a Representative National
Sample of Women
By Resnick, H.S., et al.
-The study assessed prevalence of crime and noncrime civilian traumatic events, lifetime
posttraumatic stress disorder (PTSD), and PTSD in the last six months amongst a sample of 4,008
U.S. adult women.
- The study found that lifetime exposure to any type of traumatic event was 69%, whereas
exposure to crimes that included sexual or aggravated assault or homicide of a close relative or
friend occurred among 36%.
- The overall prevalence of PTSD was 12.3% lifetime and 4.6% within the past 6 months.
- The rate of PTSD was significantly higher among crime versus noncrime victims (25.8% vs.
9.4%).
- History of incidents that included direct threat to life or receipt of injury was a risk factor for
PTSD in women.
Description for Culture: Women
Trauma Exposure and Posttraumatic Symptoms in Hawaii: Gender, Ethnicity, and Social Context
By Klest, B., Freyd, J.J., & Foynes, M.M.
-This was a longitudinal cohort study of 833 members of an ethnically diverse group in Hawaii,
who were surveyed about their personal exposure to several types of traumatic events,
socioeconomic resources and mental health symptoms.
- Findings were that men and women are exposed to similar rates of trauma overall. However,
women report more exposure to traumas high in betrayal and men report exposure to more
traumas lower in betrayal.
- Trauma exposure was predictive of mental health symptoms. Neglect, household dysfunction,
and high betrayal traumas predicted symptoms of depression, anxiety, PTSD, dissociation, and
sleep disturbance. Lower in betrayal traumas predicted PTSD and dissociation symptoms.
- Results suggest that more inclusive definitions of trauma are important for gender equity.
Description for Culture: Women
“Although women are exposed to proportionately fewer traumatic events in their lifetime than
men, they have a higher lifetime risk of PTSD” (Seedat, Stein, and Carey, 2005)
Studies show risk factors for PTSD in women include
- higher incidents of sexual assault and intimate partner violence.
- peritraumatic dissociation (dissociation that occurs at the time of a trauma) is a strong
predictor of PTSD
- pregnancy, traumatic childbirth, pregnancy loss
- neurobiological dysregulation resulting from sensitization to stress hormones
(epinephrine and cortisol)
- concurrent PTSD and increased alcohol use is seen significantly more in women
Description for Culture: Women
•Resilience and Recovery
•Resilience – reflects the ability to maintain stable equilibrium
•Recovery – connotes a trajectory in which normal functioning temporarily
gives way to symptoms of depression, PTSD, or other
•Creating a therapeutic alliance – building trust
•Client-centered
•Validation
•Non-threatening
•Holistic - looking at various aspects of a woman’s life and environment
(Seedat, et.al., 2005; Olff, Draijer, Langeland, Gersons, 2007; Grieger, Fullerton, & Ursano, 2003)
References
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References (continued)
Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of
women. Journal of consulting and clinical psychology, 61(6), 984.
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