1. Trauma, Stressor-related, and Dissociative Disorders
Chapter 16
Trauma, Stressor-related, and Dissociative Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Trauma-Related Disorders in Children
Clinical Picture
Posttraumatic stress disorder in preschool children
Reactive attachment disorder
Disinhibited social engagement disorder
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Trauma-related Disorders in Children (Cont.)
Epidemiology
Comorbidity
Biological factors
Genetic
Neurobiological
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4. Trauma-related Disorders in Children (Cont.)
Psychological factors
Attachment theory
Environmental factors
Cultural considerations
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5. Application of the Nursing Process
Assessment
Developmental assessment
Nursing diagnoses
Outcomes identification
Implementation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Case Study
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?
Broad categories to assess include safety, general appearance, socialization, activity level, speech, coordination and motor function, affect, manner of relating, intellectual function, thought processes and content, and characteristics of play.
Symptoms such as uncontrollable rage, somatic symptoms, posttraumatic symptoms (e.g., nightmares, night terrors, disturbing hallucinations, intrusive traumatic thoughts and memories, re-experiencing or flashbacks, traumatic re-enactments, and self-injurious behaviors), as well as negative symptoms (e.g., numbing and avoidance). Somatic symptoms may manifest as headaches, stomach aches, or pain; memory problems include amnesia, forgetfulness, difficulty concentrating, and trance states.
Comorbid conditions should be assessed.
Developmental testing should be done.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Application of the Nursing Process (Cont.)
Interventions
Advanced practice interventions
Psychopharmacology
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Case Study (Cont.)
What are some interventions the nurse could use with this child who has been traumatized?
Teach deep breathing techniques.
Soothing strategies might also include warm baths, singing, redirecting, distraction, listening to music, guided imagery, and using a low, calming voice.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Trauma-Related Disorders in Adults
Posttraumatic stress disorder (PTSD)
Re-experiencing of the trauma
Avoidance of stimuli associated with trauma
Persistent symptoms of increased arousal
Alterations in mood
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Trauma-Related Disorders in Adults (Cont.)
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
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Trauma-Related Disorders in Adults (Cont.)
Epidemiology
Comorbidity
Psychological factors
Polyvagal theory
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Dissociative Disorders
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
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13. Dissociative Disorders (Cont.)
Depersonalization/derealization disorder
Dissociative amnesia
Dissociative identity disorder
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14. Dissociative Disorders (Cont.)
Epidemiology
Comorbidity
Etiology
Biological factors
Genetic
Neurobiological
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Dissociative Disorders (Cont.)
Psychological factors
Environmental factors
Cultural considerations
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Depersonalization/Derealization Disorder
Depersonalization—focus on self
Derealization—focus on outside world
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17. Dissociative Amnesia
Inability to recall important personal information
Often of traumatic or stressful nature
Dissociative fugue
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18. Dissociative Identity Disorder
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
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19. Dissociative Disorders Assessment
History
Moods
Impact on patient and family
Suicide risk
Self-assessment
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20. Dissociative Disorders Implementation
Interventions
Psychoeducation
Pharmacological interventions
Advanced practice interventions
Somatic therapy
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

21. Audience Response Questions
A nurse assesses a patient diagnosed with dissociative identity disorder. Which finding would likely be part of the patient’s history?
Travel to a foreign country
Physical or sexual abuse
Thyroid dysfunction
Eating disorder
ANS: B
Also, define dissociative fugue related to distracter A.
REF:
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