1. Victim, Trauma and PTSD Dicky Pelupessy
Faculty of Psychology, Universitas Indonesia
Crisis Center, Faculty of Psychology, Universitas Indonesia
The 11th ASEAN Course on Victimology and Victim Assistance
Faculty of Law, Universitas Indonesia
July 26, 2011

2. Outline of the presentation
Trauma
Traumatic event
Impact of traumatic events to victims
Post-Traumatic Stress Disorder (PTSD)
Treatment

3. Trauma
Meaning: wound
Physical and Psychological wound

4. Psychological Trauma
Human reactions to trauma-provoking events or traumatic events (Roberts, 2002).
Accidents
Childhood abuse
Combat
Criminal assault
Rape
Torture
Natural disasters
What else?...

5. Psychological Trauma Not reactions per se
Technically refers to the event (Yule, 1999; Briere & Scott, 2006)

6. Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) American Psychiatric Association [APA]
Trauma:
…direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). (p. 463)

7. By definition, limited to events that “threatened death or serious injury, or other threat to one’s physical integrity”
Roberts (2005); Briere & Scott (2002): include events that extremely upsetting and at least temporarily overwhelms the individual’s internal resources

8. Traumatic Event
An event that is traumatic. An event that creates psychological wound.
Single, multiple, or on-going event

9. Traumatic event Briere & Scott (2006)’s Major Types:
. Natural disasters
. Mass interpersonal violence
. Large-scale transportation accidents
. House or other domestic fires
. Motor vehicle accidents
. Rape and sexual assault

10. Traumatic event Briere & Scott (2006)’s Major Types (continued):
. Stranger physical assault
. Partner battery
. Torture
. War
. Child abuse
. Emergency worker to trauma

11. Roberts (2005)’s trauma-provoking events:
. Violent crimes
. Crisis-prone situations
. Natural disasters
. Accidents
. Transitional or developmental events

12. Victim’s reactions to traumatic events
Victims = directly and personally experiencing, witnessing, or learning from others (secondary trauma)
Typical reactions immediately after the event: shock & denial
Other common reactions: an unusual feeling of being easily startled, difficulty concentrating, outbursts of irritability, feelings of emotional numbness, recurrent anxiety over personal safety or the safety of loved ones, an inability to let go of distressing mental images or thoughts, anxiety about, and avoidance of, specific reminders of the event, feelings of helplessness, powerlessness, and lack of control, feelings of guilt, etc.
It is a normal response to abnormal event!

13. Victim’s reactions to traumatic events
Longer term reactions: flashbacks, physical symptoms, emotional problems (unpredictable emotions), and strained relationships.
Revictimization: those who have experienced childhood abuse are considerably more like to be victimized again as adults (Classen et al., 2002; Tjaden & Thoennes, 2000)

14. Victim’s reactions to traumatic events
Revictimization (continued)
(1) the effects of childhood trauma that have lasted into adulthood
(2) the effects of more recent sexual or physical assaults
(3) the additive effects of childhood trauma and adult assaults (for example, flashbacks to both childhood and adult victimization experiences)
(4) the exacerbating interaction of childhood trauma and adult assault, such as especially severe, regressed, dissociated, or self-destructive responses to the adult trauma

15. Victim’s reactions to traumatic events, if persist…
A disorder, Post-Traumatic Stress Disorder (PTSD)
Meeting DSM-IV Criteria for PTSD and the symptoms must last for more than a month and must significantly affect important areas of life (Yeager & Roberts, 2005)
Main class of symptoms:
Intrusive re-experiencing of the trauma
Avoidant behaviors
Increased psychological arousal (hyperarousal)

16. Prevalence of PTSD
Not all people exposed to a traumatic event go on to develop PTSD
Depends on:
Individual differences
The nature and severity of the traumatic event
e.g. over 50% - the sinking of the cruise ship Jupiter (Yule et al., 1995); 15 to 50% - combat (Foy, 1992);

17. Prevalence of PTSD After Disaster (World Health Organization, 2005)
Description
After Disaster: 12 month prevalance rates
Severe disorder (e.g., psychosis, severe depression, severely disabling form of anxiety disorder, etc)
3-4%
Mild or moderate mental disorder
(e.g., mild and moderate forms of depression and
anxiety disorders, including of PTSD)
20%
Moderate or severe psychological distress
that does not meet criteria for disorder, that resolves over time or mild distress that does not resolve over time
30-50%
Mild psychological distress
which resolves over time
20-40%

18. Treatment Psychological First Aid (PFA) Exposure Therapy
Psychodynamic Psychotherapy
Hypnosis and Guided Imagery
Psychological Debriefing or Critical Incident Stress Debriefing (CISD)
Eye Movement Desensitization and Reprocessing (EMDR)
Pharmacotherapy
Group Therapy
Marital and Family Therapy

19. Thank you