Understanding the role of Acute Stress Disorder in trauma · Stress Disorder in trauma Dr. Trina...
Transcript of Understanding the role of Acute Stress Disorder in trauma · Stress Disorder in trauma Dr. Trina...
Understanding the role of Acute Stress Disorder in trauma
Dr. Trina Hall
Police Psychologist
Dallas Police Department
Lessons Learned: Unfolding the story of PTSD
NAMI 2014 Fall Conference
Trauma and Stressor Related disorders
• Acute stress disorder
• Post traumatic stress disorder
Prevalence of Exposure to Traumatic Events
50%-90% of general population are exposed to
traumatic events during their lifetime.
75% of law enforcement personnel are exposed to traumatic events in their career.
Most do not develop ASD or PTSD
What is the normal response to a traumatic event?
• anxiety,
• feeling “revved up;”
• emotional instability
• fatigue
• irritability
• hyper-vigilance
• trouble sleeping
• exaggerated startle response
• change in appetite
• feeling overwhelmed
• impatience
• isolation from family and friends
• shock
• nightmares
• somatic complaints
Acute Stress Disorder
• Criterion A: Directly experiencing the traumatic event
• Criterion B: Presence of at least 9 (or more)of the following symptoms from any of the 5 categories of: Intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred.
Acute Stress Disorder
• Criterion C: Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure.
• Looks at emotional reactions to a distressing event other than looking primarily at fear.
Intrusion
• Recurrent, involuntary, and intrusive distressing memories of the traumatic event
• Recurrent, distressing dreams of the event
• Dissociative reactions (flashbacks) where individual feels or acts as if the event were recurring
• Intense psychological or physiological distress in response to internal/external cues that represent aspects of the event
Negative Mood
• Persistent inability to experience positive emotions
Disassociation
• A subjective sense of numbing, detachment, or absence of emotional responsiveness
• A reduction in awareness of his/her surrounding
Disassociation
• Derealization
• Depersonalization
• Dissociative amnesia
Avoidance • Avoids thoughts, feelings, or conversations associated
with the trauma
• Avoids activities, places, or people that arouse recollection of the trauma
• Inability to recall an important aspect of the trauma
• Feelings of detachment or estrangement from others
Arousal
• Difficulty falling asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilience
• Exaggerated startle response
Prevalence Rates for ASD
• Identified in less than 20% of cases following traumatic events that do not involve interpersonal assault
• Higher rates (20%-50%) are reported following interpersonal traumatic events, including assault, rape, and witnessing/involved a shooting
Prevalence Rates for ASD
• More prevalent in females than males
• Risk factors include: prior mental disorder, high levels of negative affectivity (neuroticism), greater perceived severity to traumatic experience, and avoidant coping styles.
Initial Assessment
Factors affecting risk of onset of traumatic-associated illness
• Proximity to traumatic event
• Similarity to victim (actual versus vicarious experience)
• How helpless did the individual feel
• Extent of social support will greatly influence prognosis
• Exposure to stressors in past 6 months
• History and family history of mental illness
Difference between Acute Stress Disorder and PTSD
• ASD is more immediate, short term response to trauma.
• ASD is more associated with dissociative symptoms such as:
– Extreme emotional disconnection
– Difficulty experiencing pleasure
– Temporary or Dissociative Amnesia
Difference between Acute Stress
Disorder and similar disorders
Traumatic Grief
• Sudden unanticipated loss
• Distressing thoughts often related to longing
• Duration is a minimum of 2 months
Difference between Acute Stress Disorder and similar disorders
Adjustment Disorder
• Identifiable stressor within 3 months
• Depression, anxiety, and/or conduct are primary emotional and behavioral characteristics
Treatment of Acute Stress Disorder
• Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.
• Alternative treatment options include:
– Yoga
– Meditation
Questions
References
• Kessler, R.C., Sonnega, A., Bromet, E. Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
• Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.
• Kulka, R.A., Schlenger, W.E., Fairbank, J.A. Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1990). Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study, New York: Brunner/Mazel.
• Tanielian, T. & Jaycox, L. (Eds.)(2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.
• www.counseling.org • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th
ed., text revision). Washington, DC: • Benner, A. (2000). Cop Docs. Psychology Today Nov/Dec2000, Vol. 33 Issue 6, p36, 4p, 1c • Beutler, L. E., Nussbaum, P., & Meredith, K. (1988). Changing personality patterns of police officers.
Professional Psychology: Research and Practice. Vol. 19 (5), 503-507. • Bisson, J. I., McFarlane, A. C., & Rose, S. (2000). Psychological debriefing. In E. F. Foa, T. M. Keane, &
M. J. Friedman (Eds.) Effective treatments for PTSD (pp. 39-59, 317-319). New York: Guilford. • Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I.
Kurke, & E. M. Scrivner (Eds.), Police psychology into the 21st century (pp. 169-188). Hillsdale, NJ: Erlbaum.