Download Victim, Trauma and PTSD

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
Outline of the
presentation
 Trauma
 Traumatic event
 Impact of traumatic events to victims
 Post-Traumatic Stress Disorder (PTSD)
 Treatment
Trauma
 Meaning: wound
 Physical and Psychological wound
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?...
Psychological Trauma
 Not reactions per se
 Technically refers to the event (Yule, 1999; Briere &
Scott, 2006)
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)
 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
Traumatic Event
 An event that is traumatic. An event that creates
psychological wound.
 Single, multiple, or on-going event
Traumatic event
 Briere & Scott (2006)’s Major Types:
1. Natural disasters
2. Mass interpersonal violence
3. Large-scale transportation accidents
4. House or other domestic fires
5. Motor vehicle accidents
6. Rape and sexual assault
Traumatic event
 Briere & Scott (2006)’s Major Types (continued):
7. Stranger physical assault
8. Partner battery
9. Torture
10. War
11. Child abuse
12. Emergency worker to trauma
 Roberts (2005)’s trauma-provoking events:
1. Violent crimes
2. Crisis-prone situations
3. Natural disasters
4. Accidents
5. Transitional or developmental events
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!
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)
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
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)
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);
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%
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
Thank you