Related factors (Etiology)
· Overwhelming anxiety secondary to:
o War experiences/military combat
o Natural disaster (earthquake, hurricane, tornado, flood)
o Personal assault (rape, incest, molestation, beatings, abuse)
o Kidnap of self or significant others
o Catastrophic illness or accident
o Prisoner of war death camp hostage experiences
o Learning of a loved one’s serious accident, injury, or maiming
o Destruction of home or valued resources
o Witnessing a serious accident or act(s) of violence (car crash, building collapse, mother being beaten, killing of family member)
o Viewing a scene in which there are dead and/or maimed bodies (aftermath of war, plane or train crash, earthquake)
o Threat to physical and emotional integrity (all of the above)
Defining Characteristics
· Client relates frequent intrusive recollection of past traumatic experience.
· States that recollections are accompanied by feelings of dread, terror, helplessness, powerlessness, cardiac palpitations, shortness of breath, and other symptoms of emotional physical reactivity.
o “I feel out of control and terrified when I recall the event”
o “I get out of breath and my heart beats faster and faster”
o “I have a sense of doom, as if something terrible is going to happen”
· Describes recurrent dreams or nightmares in which vivid details of traumatic event are relived or reenacted.
o “I had another horrible nightmare last night and went through the same trauma and anxiety all over again”
· Express feelings of “numbness” detachment, or loss of interest toward people and the environment (generally occurs immediately after the traumatic event)
· Demonstrates avoidance or lack of responsiveness toward stimuli associated with the traumatic event (in rare instances, may experience psychogenic amnesia)
o A war veteran avoids hospitals, injured persons, bandages, and blood.
o An accident victim demonstrates a flat affect while listening to a news report describing a traumatic event.
· Demonstrates symptom of psychogenic reactivity (anxiety symptom) when exposed to events that resemble or symbolize the original trauma.
o A young woman develops fear, dread, or terror when she attempt sexual intimacy with her partner because it reminds her of when she was raped.
o A prison camp victim experiences sympathetic nervous system stimulation (rapid heart rate, shortness of breath, nausea, diarrhea) while sitting in a cell-sized room.
o A war veteran who fought in a hot, humid climate experiences dread or terror when exposed to similar weather many years later.
· Demonstrates symptom of increased arousal (inability to fall asleep or remain asleep, hypervigilance, exaggregated startle response).
· Manifest unpredictable episodes of explosive anger or aggression.
· Verbalize inability to concentrate or complete task.
o “I’m too distracted to make my bed or go to an activity”
o “I can’t concentrate on my craft”
o “I can barely shower and groom myself”
· Relates inability to express angry feelings.
o “I feel as if I might explode, but I can’t let it out”
o “I can’t begin to express my anger”
· Expresses thoughts of self-blame and guilt regarding a traumatic event.
o “If only I had locked the door, it wouldn’t have happened”
o “If I had been there on time, it wouldn’t have occurred”
· Verbalizes anger at others for perceived role in traumatic event.
o “If they had helped more, he wouldn’t have lived”
o “If they have called for help right away, I wouldn’t be so badly injured”
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