Chapter 23 - PTSD Flashcards
(135 cards)
1
Q
What is post-traumatic stress disorder (PTSD)?
A
A severe and long-lasting reaction to a traumatic event involving intense fear, horror, and feelings of hopelessness.
Definition according to the American Psychiatric Association, 2000.
2
Q
What are common types of traumatic events that can lead to PTSD?
A
War, sexual abuse, physical abuse, natural disasters (earthquakes, floods, tidal waves).
These events vary considerably in nature.
3
Q
What is the estimated prevalence of significant traumatic events experienced by children?
A
One in four children experiences a significant traumatic event before reaching adulthood.
Estimated by Costello et al., 2002.
4
Q
What percentage of children show symptoms of PTSD immediately after a traumatic event?
A
Many children show some symptoms of PTSD immediately after the event.
This is noted by Aaron, Zaglul and Emery, 1999.
5
Q
Is it normal for children to experience psychological distress after a trauma?
A
Yes, moderate psychological distress shortly after the trauma can be considered normal.
According to Cohen, D. et al., 2010.
6
Q
What percentage of PTSD sufferers continue to have symptoms one month after the traumatic event?
A
About 30 percent.
This statistic is supported by Kessler et al., 1995; Cohen, D. et al., 2010.
7
Q
How slow were mental health professionals to recognize PTSD in children and adolescents?
A
They were as slow to recognize PTSD as they were with anxiety disorders.
Historical context provided by awareness from authors, journalists, and photojournalists.
8
Q
What does the chapter cover regarding the recognition of PTSD?
A
It discusses the slow process leading to the recognition of PTSD as a serious problem for children and adolescents.
This includes information on diagnostic criteria and prevalence.
9
Q
What factors differentiate children and youth likely to develop PTSD?
A
Factors that have been found to differentiate those most and least likely to develop PTSD after a traumatic incident.
Details are covered in the prevalence section of the chapter.
10
Q
What primary focus does the section on causes and correlates have?
A
Biological processes influencing individual reactions to traumatic events.
This section is dedicated to understanding these biological influences.
11
Q
What does the chapter conclude with?
A
A section on treatment for PTSD.
Treatment approaches are discussed in the final section.
12
Q
Who is Lenore Terr?
A
A psychoanalyst known for her work on children’s reactions to trauma.
13
Q
What incident did Lenore Terr base her influential writings on?
A
The kidnapping of twenty-three children in Chowchilla, California on July 15, 1976.
14
Q
What age range did the kidnapped children in Chowchilla fall under?
A
5 to 14 years of age.
15
Q
How long were the children held captive during the Chowchilla incident?
A
27 hours.
16
Q
What was the prediction of the local mental health physician regarding the emotional effects on the kidnapped children?
A
Only one child would be emotionally affected in the long term.
17
Q
What were some maladaptive reactions exhibited by the children after the kidnapping?
A
- Anger and obstinacy in Sheila
- Fear of strange vehicles in Bob
- Fighting among siblings
- Anxiety related to moving vehicles in Alison
- Fear of fear in several children
18
Q
What recurring theme appeared in the children’s dreams after the kidnapping?
A
Dreams of other kidnapping incidents with dire outcomes.
19
Q
What is the title of Lenore Terr’s influential publication on child-battering?
A
The Battered Child Rebrutalized.
20
Q
What did Terr’s publication highlight regarding child-battering?
A
The traumatic effects of battering and the adversarial legal process.
21
Q
What was reported by the Children’s Bureau of the United States government in 2009 regarding child abuse?
A
1,770 children died due to physical and psychological abuse and neglect.
22
Q
What percentage of child abuse incidents in 2009 were committed by parents?
A
81 percent.
23
Q
What is the estimated percentage of child abuse cases reported to authorities?
A
1-5 percent.
24
Q
According to retrospective interviews, what proportion of adolescents and young adults reported experiencing abuse as children?
A
About one in four.
25
Fill in the blank: Lenore Terr urged greater attention to _______ of children.
[traumata]
26
True or False: The statistics regarding child abuse indicate that a majority of cases are substantiated.
False.
27
What alarming statistic is noted about children suffering from abuse?
Approximately two million confirmed child victims each year.
28
What did Lenore Terr emphasize about the study of trauma among psychoanalysts?
They had moved away from the study of trauma despite its importance.
29
What significant legislative change occurred due to awareness of child abuse?
Legislation requiring professionals to report suspected child abuse.
30
What did many children express fear of after the kidnapping incident?
The fear of being kidnapped again.
31
What types of natural disasters have dominated headlines in recent years?
Tsunamis and earthquakes
## Footnote
Examples include a tsunami in Sri Lanka and an earthquake in Haiti.
32
What psychological toll do war and becoming a refugee have on children?
They exact a toll on millions of children, some of whom are already vulnerable due to psychological problems.
33
What significant recognition regarding PTSD was made in DSM-III?
The recognition of PTSD is often attributed to public awareness of the psychological needs of returning Vietnam War veterans.
34
What event sensitized the American public to the plight of children in war?
Revealing photographic details of the suffering of children in the Vietnam War.
35
What incidents shocked the public after the Vietnam War regarding children's suffering?
The mass shooting of schoolchildren in Columbine, Colorado, and the attacks on the World Trade Center towers.
36
What happens in countries with well-developed mental health services during disasters?
Professionals participate in rescue teams and researchers study the effects on children.
37
What takes precedence in places with limited mental health services during disasters?
Physical survival needs.
38
What did Strauss and her colleagues find in their long-term follow-up study of war-related trauma survivors from WWII?
Many still experienced psychological effects, especially depression, into old age.
39
What is a common societal concern regarding the diagnosis of abused children?
It is not without its critics.
40
What does Best (1997) chronicle in his review regarding victimization awareness?
Criticism of the societal ramifications and the growing awareness of victimization.
41
What types of abuses do critics condemn in relation to combating abuse?
Alarmist inflation of numbers, unjustified use of the 'abuse excuse', and emergence of a 'victim industry'.
42
What does the term 'victim industry' refer to?
An industry benefiting from exaggerating victim numbers and using unproven treatment techniques.
43
What problem does Best highlight regarding PTSD identification?
Ignoring broader social forces that cause PTSD due to medicalizing individual cases.
44
What is recognized for the first time in the 1987 revision of the DSM-III-R regarding children's reactions to trauma?
Children’s reactions to traumatic experiences might be different from those of adults
## Footnote
Children may react with fear, horror, agitated behavior, or defiance.
45
How might children express their traumatic experiences?
Through nightmares and dramatic play
## Footnote
They may also develop unexplained physical symptoms like stomach aches or headaches.
46
What does the diagnostic category of post-traumatic stress disorder (PTSD) pertain to?
A wide range of trauma, some unpredictable, some involving familiar people, and some linked to political events
## Footnote
This includes the understanding that prevalence data may not apply to all causes of PTSD.
47
What is unique about PTSD among DSM diagnoses?
It is based on an identifiable cause, the precipitating trauma
## Footnote
This is considered logical but raises concerns about the diagnostic procedures.
48
How do children display PTSD differently from adults?
Children may relive traumatic experiences through repetitive play and/or somatic symptoms
## Footnote
They may also encode traumatic events less completely than older children and adults.
49
What are some developmental factors affecting children's encoding of traumatic events?
Young children encode less completely and slowly, and they often lack background knowledge
## Footnote
This can lead to strong emotional responses and misinterpretations.
50
What impact does PTSD have on children's lives?
It affects sleep patterns, school functioning, and family lives
## Footnote
Comorbid major depressive disorder is often diagnosed alongside PTSD.
51
What comorbid conditions are frequently found with PTSD in children?
* Major depressive disorder
* Attention deficit/hyperactivity disorder
* Oppositional defiant disorder
* Other anxiety disorders
## Footnote
Victims with comorbid conditions may be more difficult to treat.
52
In DSM-5, what chapter does PTSD belong to?
Trauma and Stress-Related Disorders
## Footnote
This chapter also includes reactive attachment disorder and disinhibited social engagement disorder.
53
What is a key change regarding PTSD in DSM-5 compared to DSM-IV?
PTSD is no longer considered an anxiety disorder
## Footnote
This change emphasizes the traumatic origin of the syndrome.
54
What must occur for the diagnosis of PTSD in individuals older than 6 years?
Exposure to a potentially traumatic experience and intrusion of the event into current experience
## Footnote
This may include distressing memories, flashbacks, and avoidance of stimuli associated with the trauma.
55
What is a new criterion for children under 6 years in DSM-5?
Increased emphasis on flashbacks and intrusions into dramatic play
## Footnote
The criteria are similar to those for adults.
56
What concern does pediatrician Harriet L. MacMillan raise about the DSM-5 criteria for PTSD?
The expansion of criteria may result in overdiagnosis and treatment of children who might recover without special intervention
## Footnote
This raises questions about the definition of PTSD as a single disorder.
57
How does the ICD-10 diagnosis of PTSD compare to DSM-5?
It is conceptually similar but with considerable differences in diagnostic criteria
## Footnote
Future revisions of ICD may align more closely with DSM-5.
58
What do proposals for ICD-11 advocate regarding PTSD criteria?
More specific criteria directing professionals to the central features of PTSD
## Footnote
This is supported by comments from experts in the field.
59
What percentage of children exposed to natural disasters develop diagnosable PTSD?
Fewer than 5 percent.
60
What was the percentage of children suffering from post-traumatic symptoms 8 months after Hurricane Ike?
13 percent.
61
What percentage of children suffered post-traumatic symptoms 15 months after Hurricane Ike?
7 percent.
62
Children with both PTSD and _______ are less likely to recover over time.
depression.
63
What is the estimated likelihood of children developing PTSD after experiencing war?
As many as a third.
64
What is the typical PTSD diagnosis rate among children who have experienced violent crime?
About a third.
65
PTSD is believed to affect all children exposed to the _______ or _______ of their mothers.
sexual assault; murder.
66
What percentage of child victims of sexual abuse are estimated to develop PTSD?
50 to 90 percent.
67
The risk of developing PTSD increases dramatically with exposure to _______.
multiple traumatic events.
68
Reported incidence rates of PTSD in the general population range from _______ percent in Germany to _______ percent in the US.
1.6; 5 to 9.2.
69
What factors may influence the differences in reported incidence rates of PTSD?
* Diagnostic practice
* Self-report bias
70
Many reports indicate that the effects of trauma often last for _______.
many years.
71
Research on PTSD risk factors has included characteristics of the ______, ______, and ______.
* Individual child
* Family network
* Surrounding culture
72
Which gender is diagnosed with PTSD more often?
Girls.
73
Boys are more likely to react _______ than girls when experiencing trauma.
behaviorally.
74
A parental history of mental illness can ______ the risk of PTSD in children.
double.
75
What are some family problems that leave children vulnerable to PTSD?
* Insecure child-parent attachment
* Conflict
* Lack of family cohesion
* Coercive child-rearing
* Divorce
* Family economic hardship
76
Extensive television viewing of disaster-related events can ______ the risk of PTSD for children.
increase.
77
What is a protective factor associated with resilience in children facing trauma?
Social support networks.
78
Older children who can understand their situation tend to ______ than less mature children.
fare better.
79
What is thought to work as a protective factor against suffering from trauma-related rethinking?
General intellectual capacity.
80
Certain specific thinking skills, such as _______ and ________, may operate in a protective manner.
* Abstract reasoning
* Memory
81
Creative thinking may be an asset to coping, as shown in studies of children experiencing _______.
political violence.
82
What roles can culture play in relation to mental health?
Culture may work as a risk factor, protective factor, or moderating factor.
83
How does living in a country at war affect mental health?
It is associated with increased risk.
84
What is positive cultural identification linked to?
Unified families, participation in religious activities, and social gatherings.
85
How can religious beliefs impact mental health?
They may lead to fatalism and pessimism or bring hope and faith in a better future.
86
What effect does poverty have on family life?
Poverty exerts an effect on family life and is linked to PTSD in children and adolescents.
87
What gender differences exist in PTSD diagnosis?
Girls and women are about twice as likely to be diagnosed with PTSD compared to boys and men.
88
Do boys and men report traumatic events more frequently than girls and women?
Yes, boys and men are significantly more likely to report a potentially traumatic event.
89
What types of trauma do girls and boys report differently?
Girls report more incidents of sexual assault; boys experience more accidents and physical assaults.
90
How do boys and girls typically display PTSD symptoms?
Boys often act out aggressively; girls tend to experience internalizing symptoms like anxiety and depression.
91
What is a requirement for PTSD diagnosis in the DSM system?
A traumatic event.
92
What does the developmental traumatology model suggest about maltreatment?
Maltreatment affects children's biological stress systems, developing brain, and cognitive functioning.
93
What happens to the secretion of cortisol in children with PTSD?
It becomes dysregulated, showing either higher or lower levels of cortisol.
94
Which brain area is associated with attention and memory that may be affected by PTSD?
The hippocampus.
95
What are some areas of the brain that may be affected by PTSD?
Corpus callosum, prefrontal cortex, and cerebral lobes.
96
What biological alterations immediately after a traumatic event may relate to PTSD severity?
Immediate reduction in cortisol level.
97
What is needed to clarify the issues related to the biology of PTSD?
Much more research.
98
What is the likelihood that children and adolescents with PTSD are seen by mental health professionals?
Only a small proportion are seen.
99
Why is it unfortunate that many children and adolescents with PTSD do not receive treatment?
Because treatment can be quite helpful.
100
Name three diverse treatment strategies attempted by psychotherapists for PTSD.
* CBT
* Art therapy
* Hypnotherapy
101
What is the purpose of exposure treatment in PTSD therapy?
To gradually lead to the ability to remember and discuss serious traumatic experiences.
102
What formats have been implemented for PTSD treatment?
* Group treatment
* Individual treatment
103
According to Trowell et al. (2002), which format of psychotherapy is superior for treating PTSD?
Individual psychotherapy.
104
What is one method used in some successful therapies for PTSD?
Children maintain a journal of their thoughts and experiences.
105
Fill in the blank: The strategies attempted by psychotherapists for PTSD include _______.
[a variety of therapies such as CBT, art therapy, hypnotherapy, etc.]
106
True or False: Both group and individual treatment formats are used for PTSD.
True.
107
What does relaxation training aim to do in the context of PTSD therapy?
Help individuals manage stress and anxiety.
108
What is narrative retelling of trauma in PTSD treatment?
A method where individuals recount their traumatic experiences.
109
What is the role of psychoeducation in PTSD treatment?
To educate individuals about the nature of PTSD.
110
What is the significance of training in the interruption of dysfunctional thoughts?
To help individuals manage negative thinking patterns.
111
In PTSD treatment, what is the goal of social skills training?
To improve interpersonal interactions and relationships.
112
What types of psychotherapy are more effective for children and adolescents with PTSD?
Interventions that focus specifically on the traumatic event are more effective than indirect approaches.
## Footnote
Examples of indirect approaches include relationship-based child-centered psychotherapy.
113
Which therapy has been found more effective for PTSD compared to other approaches?
Cognitive behavior therapy, specifically adapted for PTSD.
## Footnote
This finding is supported by Cohen, Mannarino and Deblinger (2006) and Saunders, Berliner and Hanson (2004).
114
What did a meta-analysis of twenty-eight studies on sexual abuse reveal about psychotherapy effectiveness?
Effectiveness depended on the specific outcome and manifestation of PTSD being considered.
## Footnote
Conducted by Hetzel-Riggin, Brausch and Montgomery (2007).
115
Which type of cognitive behavior therapy was most effective for relieving psychological distress?
Group cognitive behavior therapy.
## Footnote
However, it was not necessarily effective for enhancing self-concept.
116
What conclusion can be drawn about cognitive behavior therapy based on several reviews?
It is an established, effective intervention for PTSD.
## Footnote
Supported by various reviews including Saunders et al. (2004).
117
What did Harvey and Taylor's meta-analysis reveal about psychotherapy for sexual abuse victims?
Typical global treatment effects were in excess of one standard deviation, with significant effect sizes for some specific outcomes.
## Footnote
This analysis included thirty-nine separate studies.
118
What is the effect of parent involvement in treatment for children and adolescents with PTSD?
It tends to enhance the effectiveness of the treatment.
## Footnote
Parent involvement can include helping with parenting skills and dealing with children's emotions.
119
What types of interventions have been used successfully with parents of children with PTSD?
A wide range of interventions, including parenting skills, emotional support, and conflict resolution.
## Footnote
Therapists may also address personal problems of the parents, such as depression.
120
What is the value of conjoint sessions in therapy?
They involve the therapist working with both the parent and child during the same session.
## Footnote
This approach is emphasized by some therapists as beneficial.
121
True or False: More research is needed to identify optimal therapeutic approaches for specific objectives in PTSD treatment.
True.
## Footnote
While some conclusions can be made, further research is necessary.
122
What disorder is characterized by a severe and long-lasting reaction to a traumatic event involving fear, horror, and feelings of hopelessness?
Post-traumatic stress disorder (PTSD)
## Footnote
PTSD can occur among children and adolescents, although it is often concealed by adults.
123
What type of events can lead to PTSD in children?
PTSD may occur following:
* Natural disasters (e.g., tsunamis, earthquakes)
* Experiences during war (e.g., becoming a refugee)
* Mass shooting incidents at school
## Footnote
Children who have suffered one form of abuse are also likely to experience other forms.
124
True or False: Most children who have lived through traumatic experiences develop PTSD.
False
## Footnote
Importantly, most children who have lived through traumatic experiences do not develop PTSD.
125
What is a significant concern critics have about the diagnosis of PTSD in children?
Critics believe the DSM-5 criteria are too broad and may apply to more than a single disorder
## Footnote
This may result in the diagnosis of children with symptoms not severe enough to need extended professional help.
126
Which DSM edition first differentiated the diagnosis of PTSD in children from that of adults?
DSM-III-R
## Footnote
Children may demonstrate agitated, disorganized, or defiant behavior in addition to fear and horror.
127
What are common comorbid disorders diagnosed alongside PTSD in children?
Common comorbid disorders include:
* Major depressive disorder
* Attention deficit/hyperactivity disorder
* Oppositional defiant disorder
* Other anxiety disorders
## Footnote
Patients with comorbid disorders are often more difficult to treat.
128
What factors increase the risk of a child developing PTSD?
Risk factors include:
* Exposure to sexual assault or murder of mothers
* Suffering sexual abuse
* Experience of violent crime or war
* Parental history of mental illness
* Troubled family background prior to the event
* Insecure child-parent attachment
* Economic hardship
## Footnote
Risk is lower when a child has experienced a natural disaster.
129
What are some protective factors that can help mitigate the risk of PTSD in children?
Protective factors include:
* Social support networks
* Age (older children)
* General intellectual capacity
* Creative thinking
## Footnote
Supportive siblings and friends can also be beneficial.
130
What symptom differences may exist between boys and girls with PTSD?
Boys may:
* Act out aggressively
* Report more accidents and physical assaults
Girls may:
* Experience internalizing symptoms such as anxiety and depression
* Report more incidents of sexual assault
## Footnote
Males are more likely to report a potentially traumatic event.
131
What is the developmental traumatology model?
It refers to the idea that maltreatment leads to PTSD by affecting children’s biological stress systems and brain development
## Footnote
Excessive or prolonged arousal in the sympathetic nervous system dysregulates natural cortisol levels.
132
What treatment options are available for children with PTSD?
Treatment options include:
* Cognitive-behavioral therapy (CBT)
* Art therapy
* Hypnotherapy
* Social skills training
* Graduated exposure
## Footnote
Interventions focusing specifically on the traumatic event are more effective than indirect approaches.
133
True or False: Psychotropic medication is commonly used for children with PTSD.
True
## Footnote
However, strong effects for placebo tablets have been observed, and clinicians must consider side effects.
134
What controversial interventions exist for children with PTSD?
Interventions without scientific support include:
* Restricting access to food and water
## Footnote
Controversies also surround the accuracy of information elicited during therapy in the form of repressed memories.
135
What significant change regarding PTSD diagnosis was introduced in DSM-5?
Separate diagnostic criteria for children younger than 6 years
## Footnote
The criteria are not very different from those for older children and adults.
