Somatic Symptom Disorders/Trauma and Stressor Related Disorders PDF

SOMATIC SYMPTOM DISORDERS/ TRAUMA AND STRESSOR RELATED DISORDERS ANNIE SMITH, RN-BC, MSN 01/29/2025 1 OBJECTIVES  1.Describe various types of trauma and stressor-related disorders and identify symptomatology associated with each; use in the information is client assessm...

SOMATIC SYMPTOM DISORDERS/ TRAUMA AND STRESSOR RELATED DISORDERS ANNIE SMITH, RN-BC, MSN 01/29/2025 1 OBJECTIVES  1.Describe various types of trauma and stressor-related disorders and identify symptomatology associated with each; use in the information is client assessment.  2.Describe appropriate nursing interventions and treatments for behaviors associated with trauma and stressor-related disorders.  3.Describe various types of somatic symptom and dissociative disorders and identify symptomatology associated with each; use this information in patient assessment.  4.Describe appropriate nursing interventions and treatments for behaviors associated with somatic symptom and dissociative disorders. 01/29/2025 2 TRAUMA AND STRESSOR RELATED DISORDERS  Post-trauma response was historically known by different names.  Renewed interest began in the 1970’s, in response to problems encountered by Vietnam veterans.  Diagnosis of post-traumatic stress disorder (P T S D) first appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (D S M-3, 1980). 01/29/2025 3 HISTORICAL AND EPIDEMIOLOGICAL DATA  More than half of all individuals will experience a traumatic event in their lifetime, but less than 10% will develop P T S D.  The traumatic event is described as one that is “outside the range of usual human experience.” 01/29/2025 4 WHO EXPERIENCES TRAUMA?  Trauma has social context  Systems of oppression influence peoples’ experiences of harm  Movement toward consideration of traumatic events in the context of larger systems vs. as individual tragedies (Treleaven, 2018) 02/12/2025 5 GENDER  Cis-gender women in the United States are significantly more likely to be stalked by an intimate partner or experience sexual assault. The risk is even further elevated for women with low socioeconomic status and women of color.  Transgender individuals are at least 10 times more likely to experience sexual violence than cis-gender males. 02/12/2025 6 RACE  Native Americans are at least twice as likely as any other group to experience rape or sexual assault.  Black and Hispanic people have higher rates of trauma exposure than Caucasians.  Racial disparities are noted in natural disasters with Black individuals experiencing higher rates of death in the wake of hurricanes in particular 02/12/2025 7 DISABILITY  Individuals born with a disability are significantly more likely to experience sexual violence, with a large portion of the differently-abled population experiencing more than ten incidents of sexual abuse in a lifetime. 02/12/2025 8 PTSD When was PTSD added to the DSM? 02/12/2025 9 TRAUMA-RELATED DISORDERS  PTSD  A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man- made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes  Characteristic symptoms include  Reexperiencing the traumatic event  A sustained high level of anxiety or arousal  A general numbing of responsiveness  Intrusive recollections or nightmares P T S D Amnesia to certain aspects of the trauma  Depression; survivor’s guilt  Substance abuse  Anger and aggression  Relationship problems   Symptoms may begin within the PTSD first 3 months after the trauma, or there may be a delay of several months or even years. 01/29/2025 12 ACUTE STRESS DISORDER (A S D)  Similar to P T S D in terms of precipitating traumatic events and symptomatology  Symptoms are time limited: up to 1 month following the trauma.  If the symptoms last longer than 1 month, the diagnosis is P T S D. 01/29/2025 13  INTERVENTION STAGES  Stage 1: Provide safety and stabilization  Stage 2: Reduce arousal and regulate emotion through symptom reduction  Stage 3: Catch up on developmental and social skills; develop a value system 01/29/2025 14 1. Two months ago, Ms. T was sexually assaulted while jogging in an isolated park. She is hospitalized for suicidal ideation at this time. She awakens in the middle of the night screaming about having nightmares of the incident. Which of the following is the most appropriate initial nursing intervention? A. Call the doctor to report the incident. B. Stay with Ms. T until the anxiety has subsided. C. Administer p r n alprazolam D. Allow her some privacy to work through the emotions. Correct Answer: B It is important to not leave a client who is experiencing flashbacks or nightmares alone. Clients often feel they are “going crazy” when this happens, and the presence of a trusted individual calms fears and reassures the client of her safety.  INTERVENTIONS FOR CHILD WITH PTSD  Establish trust and safety  Use developmentally appropriate language  Teach relaxation techniques  Use art and play to promote expression of feelings 01/29/2025 17 INTERVENTIONS FOR CHILD WITH PTSD  Involve caretakers in 1:1s, unless they are the cause of trauma  Educate child and caretakers about grief process  Assist caretakers in resolving personal distress  Coordinate with social work for protections 01/29/2025 18  CASE STUDY Max, age 6, has been traumatized by a history of violence from an alcoholic father. A neighbor calls the police one night, and the father is taken in for questioning and agrees to enroll in rehab. Max is taken to the hospital for assessment of his arm, which is covered with bruises. His mother is distraught and says she wants help for the whole family, including her husband. The nurse prepares to assess Max’s mental health. 01/29/2025 19 CASE STUDY: DISCUSSION The nurse prepares to assess Max’s mental health. Identify some broad areas of mental health assessment for this child. 01/29/2025 20 AUDIENCE RESPONSE QUESTIONS Before going home from the hospital, Max and his family begin intervention therapy. Which is probably the least useful strategy at this time? A. Establish trust and safety in the therapeutic relationship. B. Use art to help Max express his feelings. C. Bring Max’s father into 1:1 play therapy sessions. D. Teach Max and his parents about grief. 01/29/2025 21 AUDIENCE RESPONSE QUESTION Which of the following should be established first in working with a child with PTSD? A. Provide safety and stabilization B. Reduce symptoms C. Develop a value system D. Provide support for catching up on developmental and social skills 01/29/2025 22   Somatic symptom disorders are characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology or a known pathophysiological mechanism to account for them. INTRODUCTION  Dissociative disorders are defined by a disruption in the usually integrated functions of consciousness, memory, and identity.   Somatic symptom disorders:  Affect women and men equally  Conversion disorders are more EPIDEMIOLOGICA commonly found in L STATISTICS  Women than in men  Less educated persons  Rural areas EPIDEMIOLOGICAL STATISTICS  Dissociative disorders (D I D’s) are statistically quite rare.  D I D is more prevalent in women than in men.  Brief episodes of depersonalization symptoms appear to be common in young adults, particularly in times of severe stress. 01/29/2025 25   Somatic symptom disorder  A syndrome of multiple somatic symptoms that cannot be explained medically and is associated with psychosocial distress and long-term seeking of assistance from healthcare TYPES OF professionals  The disorder is chronic, and anxiety, SOMATIC depression, and suicidal ideation are frequently manifested. SYMPTOM  Drug abuse and dependence are DISORDERS common complications of somatic symptom disorder.  Personality characteristics: Heightened emotionality, strong dependency needs, and a preoccupation with symptoms and oneself   Illness anxiety disorder  Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease TYPES OF  The behavioral response to even SOMATIC the slightest changes in feeling or SYMPTOM sensation is unrealistic and DISORDERS exaggerated.  Anxiety and depression are common, and obsessive- compulsive traits frequently accompany the disorder. TYPES OF SOMATIC SYMPTOM DISORDERS  Conversion disorder  A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism.  Some instances of conversion disorder may be precipitated by psychological stress.  Common symptoms—paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy  “La belle indifférence” versus distress   Factitious disorder  Conscious, intentional feigning of physical and/or psychological symptoms  Individual pretends to be ill to receive emotional care and TYPES OF support commonly associated SOMATIC with the role of “patient.” SYMPTOM  The disorder may also be DISORDERS identified as Munchausen syndrome.  The disorder may be imposed on another person under the care of the perpetrator (formerly called Factitious Disorder by Proxy).   Types of dissociative disorders  Dissociative amnesia  Defined as an inability to recall important personal information DISSOCIATIV that is too extensive to be E explained by ordinary forgetfulness, and which is not DISORDERS due to the direct effects of substance use or a neurological or other medical condition  Onset usually follows severe psychosocial stress.  Types of disturbance in recall  Localized amnesia  The inability to recall all incidents associated with the traumatic event for a specific period following the event  Selective amnesia DISSOCIATI  The inability to recall only certain incidents VE AMNESIA associated with a traumatic event for a specific period following the event  Generalized amnesia  The inability to recall anything that has happened during the individual’s entire lifetime, including personal identity DISSOCIATIVE IDENTITY DISORDER  Dissociative identity disorder  Characterized by the existence of two or more personalities within a single individual  Transition from one personality to another usually sudden, often dramatic, and usually precipitated by stress  Posttraumatic model occurs due to past traumatic events  Sociocognitive model learned cultural behavior DEPERSONALIZATION-DEREALIZATION DISORDER  Characterized by a temporary change in the quality of self- awareness, which often takes the form of:  Feelings of unreality  Changes in body image  Feelings of detachment from the environment  A sense of observing oneself from outside the body 01/29/2025 33 DEPERSONALIZATION-DEREALIZATION DISORDER Derealization is Depersonalizatio described as an n is defined as a alteration in the disturbance in perception of the the perception of external oneself. environment.   Symptoms of this disorder are often accompanied by:  Anxiety and depression DEPERSONALIZATION- DEREALIZATION  Fear of going insane DISORDER  Obsessive thoughts  Somatic complaints  Disturbance in the subjective sense of time   Psychological trauma  A growing body of evidence points to the etiology of D I D as a set of traumatic experiences that overwhelm the individual’s PREDISPOSING capacity to cope by any means other than dissociation. FACTORS TO  These experiences usually take DISSOCIATIVE the form of severe physical, DISORDERS sexual, or psychological abuse by a significant other in the child’s life.  D I D is thought to serve as a survival strategy for the child in this traumatic environment.