Responses to traumatic stress

Question 1

Individual exposed traumatic events?

Answer 1

Intentional
- assault
- robbery
- rape

Unintentional
- motor vehicle accident
- industrial accident

Question 2

Community/population exposed traumatic events?

Answer 2

Human made
- Industrial disaster
- Transportation disaster

Natural
- Earthquake
- Floods
- hurricane

Question 3

Further examples of traumatic events?

Answer 3

Transportation disasters
Terrorism
Assault
Road traffic incidents
Fires
Industrial Injury
Adverse Childhood Experiences (ACEs)
Critical illness

Question 4

What is type 1 trauma?

Answer 4

Single incident trauma - sudden, unexpected.

Question 5

What is type 2 trauma?

Answer 5

Repetitive trauma
- ongoing abuse, hostage taking

Adverse Childhood Experiences (ACEs)
- betrayal of trust in primary caregiving relationship
- developmental trauma - issues about attachment /attunement
- x3 risk for PTSD (complex PTSD) compared with Type 1
- may affect as many as 1 in 10 to 1 in 7 children

Question 6

50% of patients with bipolar disorder have a history of childhood deprivation or abuse. true/false?

Answer 6

True

Question 7

Is anxiety a sign of weakness?

Answer 7

No

A genetically ingrained function of the nervous system

NOT a sign of weakness

It has adaptive evolutionary significance
promotes survival

Question 8

Fight, flight, freeze, hide, seek, avoid, attach, submit, despair & uncontrolled activation states all originate from where?

Answer 8

All originate in PAG or Ventral Tegmental Area

Question 9

What is the ventral tegmental area?

Answer 9

known for regulating reward consumption, learning, memory, and addiction behaviors through mediating dopamine (DA) release in downstream regions.

Question 10

Brain activity when under threat?

Answer 10

Activity shifts from cortex (PFC) to brainstem - SC (superior colliculus) & PAG (Periaqueductal gray)

Question 11

What can cause deactivation of Broca’s area?

Answer 11

Deactivation of Broca’s area when individual’s access personal traumatic memories

Question 12

Patient-related risk factors?

Answer 12

severe acute stress reaction
low serum cortisol increase acutely
family or personal history of mental disorder
serious physical injury (patient’s perception)
loss of normal daily function (such as employment)
extremes of age (varies by trauma)
transgenerational effects
past experience of trauma
especially childhood/developmental trauma

Question 13

Environmental risk factors?

Answer 13

lack of a support network (or inability to utilise it)
ongoing life stresses
reactions of others
lack of economic resources
disadvantage (whether social, educational or economic)
displacement

Question 14

Trauma / disasters are truly exceptional events. True/false?

Answer 14

False

They are a normal part of daily life & in some areas or for some people - a repetitive experience

Question 15

Trauma is equal opportunity, without respect for social class or economic status. True/false?

Answer 15

False

Poor & marginalised are much more likely to be victims (& die)
Also, less likely to present for treatment

Question 16

Panic is a common response to a traumatic event (including disasters). True/false?

Answer 16

False

Most people behave rationally - panic is rare
e.g., empirical evidence from London bombings, Kings Cross Fire & Piper Alpha Oil Platform Disaster