Posttraumatic stress disorder (PTSD) Basically anxiety disorder Basically anxiety disorder Can happen after experiencing a situation, which constitute heavy stress and emotional load, surpass usual human experience and would be traumatizing for most of the people Can happen after experiencing a situation, which constitute heavy stress and emotional load, surpass usual human experience and would be traumatizing for most of the people Main symptoms are posttraumatic flashbacks, avoidant behaviour and non-specific symptoms like sleep and mood disorders Main symptoms are posttraumatic flashbacks, avoidant behaviour and non-specific symptoms like sleep and mood disorders

Trauma – definition Trauma happens in case of existence of a such external stimulus, which evokes extreme horror and shock, entails immediate experiencing of life imperilment or body and/or psychic integrity, brings feeling of helplessness, impossibility to escape, inconceivability. Trauma happens in case of existence of a such external stimulus, which evokes extreme horror and shock, entails immediate experiencing of life imperilment or body and/or psychic integrity, brings feeling of helplessness, impossibility to escape, inconceivability. Reaction of the organism is more important than the stimulus which causes trauma (it depends on our interpretation, if we perceive some stimulus as traumatogenic and the other not). Reaction of the organism is more important than the stimulus which causes trauma (it depends on our interpretation, if we perceive some stimulus as traumatogenic and the other not). Developmental trauma in comparison to a shock trauma happens in a long time span, often in a period of preverbal development. Usually, most patients are not aware of it. Developmental trauma in comparison to a shock trauma happens in a long time span, often in a period of preverbal development. Usually, most patients are not aware of it. There is a difference between cause and trigger of trauma There is a difference between cause and trigger of trauma

Factors influencing trauma The situations itself, its lenght, intensity, frequency The situations itself, its lenght, intensity, frequency The individual – age, somatic and psychic health, tolerance to stress The individual – age, somatic and psychic health, tolerance to stress Life context in the situations of trauma Life context in the situations of trauma Life experiencies (failures, achievements) Life experiencies (failures, achievements) Learned capabilities to cope with traumatogenic situations Learned capabilities to cope with traumatogenic situations Self-confidence and availibility of resources of support (external resources -personality, internal resources, social network) Self-confidence and availibility of resources of support (external resources -personality, internal resources, social network) Faith, values Faith, values

Traumatogenic factors I Natural catastrophe Natural catastrophe Loss of close person Loss of close person Infidelity, divorce, loss of child Infidelity, divorce, loss of child Accidents, injuries Accidents, injuries Physical and psychical bullying Physical and psychical bullying Neglect (childrens, older persons) Neglect (childrens, older persons) Assault, kidnap, blackmail (or just perceiving these acts) Assault, kidnap, blackmail (or just perceiving these acts) Unintentional killing Unintentional killing Iatrogenic traumatisation due to way of giving informations to patient Iatrogenic traumatisation due to way of giving informations to patient

Traumatogenic factors II Intrauterine trauma, child birth trauma Intrauterine trauma, child birth trauma Disease, high temperature (febrile smasms), random intoxications, loss of orientation, apneusis) Disease, high temperature (febrile smasms), random intoxications, loss of orientation, apneusis) Abortion, interruption Abortion, interruption Some medical, chirurgic, stomatologic operations (tonsilectomia) Some medical, chirurgic, stomatologic operations (tonsilectomia) Anaesthesia, narcosis Anaesthesia, narcosis Loss of intimacy, dehumanization (doctor´s round) Loss of intimacy, dehumanization (doctor´s round) Long-term fixation of limbs, immobility Long-term fixation of limbs, immobility Dying, or experience of dying Dying, or experience of dying

Symptoms of trauma Excessive irritability (also light, sound,pain), alertnes, hyperactivity Excessive irritability (also light, sound,pain), alertnes, hyperactivity Withrawal, dissociation, feeling helpless Withrawal, dissociation, feeling helpless flashbacks flashbacks Sleep disorders, fear of darkness, nightmares Sleep disorders, fear of darkness, nightmares Swings of mood and energy, excessive emotional reactions or no reactions Swings of mood and energy, excessive emotional reactions or no reactions Panic, anxiety, phobia Panic, anxiety, phobia

Symptoms of trauma II Psychical emptiness, derealisation avoidance behaviour Psychical emptiness, derealisation avoidance behaviour fascination with dangerous situations fascination with dangerous situations frewuent crying frewuent crying excessive or diminished sexuality excessive or diminished sexuality Amnesia, memory disorders Amnesia, memory disorders Loss of ability tu love, care of others, make friends Loss of ability tu love, care of others, make friends fear of intimacy fear of intimacy fear of going insane fear of going insane

Symptoms of trauma III Excessive or no shyness Excessive or no shyness Inability to keep a promise Inability to keep a promise Chronic fatigue or lack of energy Chronic fatigue or lack of energy Feelings of isolation, derealisation Feelings of isolation, derealisation Jubilee syndrom Jubilee syndrom

Characteristics of burns – patients with experience of psycho-trauma or high stress in their history Anxieties, mood swings, tension, low ability or inability to relax, abnormal emotional reactions regarding timing and intensity. Anxieties, mood swings, tension, low ability or inability to relax, abnormal emotional reactions regarding timing and intensity. Regressive behaviour, alexithymia, psychosomatic problems. Regressive behaviour, alexithymia, psychosomatic problems. Too high or too low abashmend. Too high or too low abashmend. Unability to plan and to orient oneself on future. Unability to plan and to orient oneself on future. Abnormal sensitivity to pain (too high or too low pain threshold). Abnormal sensitivity to pain (too high or too low pain threshold). Abnormal or weak reaction to psychiatric medication. Abnormal or weak reaction to psychiatric medication. Resistance to psychological treatment (banal informations, avoidance). Resistance to psychological treatment (banal informations, avoidance). Little or no ability to follow voluntarily procedures prescribed by specialists. Little or no ability to follow voluntarily procedures prescribed by specialists. Hazardous behaviour, frequent injuries, accidents or selfinfliction, signs of deprivation, dependency behaviour in the patients´ history. Hazardous behaviour, frequent injuries, accidents or selfinfliction, signs of deprivation, dependency behaviour in the patients´ history. Dysfunctional family (often masked by family members). Dysfunctional family (often masked by family members).

Research on trauma Delinquency. According to the research, children which experienced developmental trauma, have disorders of attention, of recognition of social danger, disorders of perceiving of space (depth, lenght), of gross and fine motoric activity. Consequently, they suffer from injuries more often than other children. For example, almost 20 % of youth in South America´s favelas die because of hazardeous games, such as ridding on the roof of the train in front of tunnels. These children are often traumatized by their deficient social enviroment. Delinquency. According to the research, children which experienced developmental trauma, have disorders of attention, of recognition of social danger, disorders of perceiving of space (depth, lenght), of gross and fine motoric activity. Consequently, they suffer from injuries more often than other children. For example, almost 20 % of youth in South America´s favelas die because of hazardeous games, such as ridding on the roof of the train in front of tunnels. These children are often traumatized by their deficient social enviroment. Alcoholism. As far as 90 % of women – alcoholics, are in fact PTSD, similarly many drug users. Alcoholism. As far as 90 % of women – alcoholics, are in fact PTSD, similarly many drug users. Also border-line, dissociative (multiple), narcistic personality disorder, bipolar behaviour (in fact alternating of alfa-activation and beta- avoidance stress reaction) can be the consequences of trauma. Also border-line, dissociative (multiple), narcistic personality disorder, bipolar behaviour (in fact alternating of alfa-activation and beta- avoidance stress reaction) can be the consequences of trauma. Disorders of body sensitivity, automutilations, also prostitution Disorders of body sensitivity, automutilations, also prostitution Pseudo-inflammations of tendons (carpal tunnel, tennis elbow, tendon of Achilles) Pseudo-inflammations of tendons (carpal tunnel, tennis elbow, tendon of Achilles) Multiple sclerosis Multiple sclerosis Algic syndrom, somatizations in various muscles Algic syndrom, somatizations in various muscles Chronic fatigue syndrom Chronic fatigue syndrom Polyartritis, thyroid gland, kidneys etc…. Polyartritis, thyroid gland, kidneys etc….

Ethical problems Many patient´s can be traumatized by their injury, illness or due to other life experiences preceding medical treatment. This is not often recognized and properly treated with respect. Many patient´s can be traumatized by their injury, illness or due to other life experiences preceding medical treatment. This is not often recognized and properly treated with respect. Many patient´s can be traumatized or retraumatized in the context of medical treatment and because of the variability of trauma symptoms, this is often even not recognized by the medical staff or even by the patient himself. Many patient´s can be traumatized or retraumatized in the context of medical treatment and because of the variability of trauma symptoms, this is often even not recognized by the medical staff or even by the patient himself.