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Lecture 4 PTSD and Crisis Stress (Loss, grief & bereavement (Types of…
Lecture 4
PTSD and Crisis Stress
PTSD
Criteria
1) Stressor
2) Intrusion symptoms
3) Avoidance
4) Negative alternations in cognition & mood
5) Alternations in arousal and reactivity
6) Duration, persistence of symptoms
7) Functional significance
8) Exclusion
**SIA NAD FE
List of PTSD
Acute stress disorder
(< 1 month)
Acute PTSD
(1 - 3 months)
Chronic PTSD
(> 3 months)
Delayed expression PTSD
(diagnosed after > 6 months from crisis)
Dissociative symptoms
depersonalisation
derealisation
History of PTSD
1) Nostalgia
2) Soldier's heart
3) Red badge of courage
4) Shell shock **
5) War neurosis
5) Combat exhaustion
6) Combat fatigue
7) Combat stress reaction
8) PTSD (1980)
Principles of shell shock
Proximity
Immediacy
Expectancy
Simplicity
**PIES
Loss, grief & bereavement
Bereavement - grief - mourning
Types of grief
Normal loss:
death of a loved one in circumstance that allows preparation and expectations of death
returns to full functionality
Traumatic loss:
death of a loved one in circumstance that is sudden and unexpected, often in horrific/violent situation
intensify traumatic experience
Traumatic bereavement:
death of a loved one in circumstance that is complicated
ie. absence of body
results in chronic grief, unremitting bereavement
Losses
Physical
ie. house, personal valuables
Symbolic
ie. hope, fame, identity
Factors affecting grief
Biological:
age
mental retardation
mental illness
Psychological:
personality
ambivalent relationship
loss without sense of reality/finality
Social:
social role and stereotypes
taboo against expression of emotions
role of the strong one
Grief stages & reactions
Grief reactions
Emotional:
depression
irritability or outbursts of anger
Physical (somatic):
sleep disturbances
loss of appetite
Psychological:
delusion
confusion
Behavioural:
poor performance in school/work
social withdrawal
expression of distress
Grief stages
Initial reaction:
shock, denial, numbness, isolation
Negative emotions:
anger, guilt, resentment, despair, agitation
Depression:
frequency and duration of depressed mood increases
reality becomes more permanent
Re-entry:
acceptance, adaption, resolution
Kublier Ross Model: 5 stages of grief
1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
Grief reaction during
sudden death
1) Increased need to understand
2) Immense shock
3) Agitation - fight/flight response
4) Without a sense of reality/finality
5) Delayed grief
6) A sense of helplessness
7) Unfinished business
8) Exacerbation of guilt feelings
9) Need to blame
Helping the bereaved:
encourage involvement in funeral rituals
show respect for spiritual, religious, cultural beliefs
normalise grief process without being insensitive
empathise without over-identifying
avoid catastrophising