Chapter 16

Trauma, Stressor-related, and

Dissociative Disorders

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Clinical Picture Posttraumatic stress disorder in preschool children Reactive attachment disorder Disinhibited social engagement disorder

Trauma-Related Disorders in Children

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Epidemiology Comorbidity Biological factors

Genetic Neurobiological

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Trauma-related Disorders in Children (Cont.)

Psychological factors Attachment theory

Environmental factors Cultural considerations

Trauma-related Disorders in Children (Cont.)

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Assessment Developmental assessment

Nursing diagnoses Outcomes identification Implementation

Application of the Nursing Process

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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?

Case Study

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Interventions Advanced practice interventions Psychopharmacology Evaluation

Application of the Nursing Process (Cont.)

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What are some interventions the nurse could use with this child who has been traumatized?

Case Study (Cont.)

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Posttraumatic stress disorder (PTSD) Re-experiencing of the trauma Avoidance of stimuli associated with trauma Persistent symptoms of increased arousal Alterations in mood

Trauma-Related Disordersin Adults

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Adjustment disorder Precipitated by stressful event Debilitating cognitive, emotional, and behavioral

symptoms that negatively impact normal functioning Responses to stressful event may include

combinations of depression, anxiety, and conduct disturbances

Trauma-Related Disordersin Adults (Cont.)

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Epidemiology Comorbidity Psychological factors

Polyvagal theory

Trauma-Related Disordersin Adults (Cont.)

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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

Dissociative Disorders

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Depersonalization/derealization disorder Dissociative amnesia Dissociative identity disorder

Dissociative Disorders (Cont.)

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Epidemiology Comorbidity Etiology Biological factors

Genetic Neurobiological

Dissociative Disorders (Cont.)

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Psychological factors Environmental factors Cultural considerations

Dissociative Disorders (Cont.)

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Depersonalization—focus on self Derealization—focus on outside world

Depersonalization/Derealization Disorder

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

Dissociative fugue

Dissociative Amnesia

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Presence of two or more distinct personality states

Each alternate personality (alter) has own pattern of Perceiving Relating to and Thinking about the self and environment

Dissociative Identity Disorder

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History Moods Impact on patient and family Suicide risk Self-assessment

Dissociative Disorders Assessment

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Interventions Psychoeducation Pharmacological interventions

Advanced practice interventions Somatic therapy

Evaluation

Dissociative DisordersImplementation

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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

Audience Response Questions

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