Chapter 12: Trauma- and Stressor-Related Disorders

Outline
 Trauma and Stress
 Child Maltreatment
 Prevalence
o Types
o Victim and family characteristics
o Perpetrator characteristics
o Causes
o Treatment and prevention
 Post-traumatic Stress Disorder (PTSD)
o Core Features
o Associated symptoms
o Prevalence
o Treatment

Introduction
 Trauma- and stressor-related disorders is new category in DSM-5
 Includes:
o ___________________________________________
 Acute Stress Disorder
 Adjustment Disorder
o Reactive Attachment Disorder
o Disinhibited Social Engagement Disorder
Trauma and Stress
 Trauma and stressful experiences in childhood or adolescence may involve:
 ________________________________________________________________________
◦ e.g., major accidents, natural disasters, kidnapping, brutal physical assaults, war and
violence, child maltreatment

 Children exposed to chronic or severe stressors, have an elevated risk of PTSD

Child Maltreatment
 “___________________________________________ on the part of a parent or caretaker,
which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an
act or failure to act which presents an imminent risk of serious harm”
Child Welfare Information Gateway, 2011

Healthy Families
 Healthy parenting includes:
◦ _________________________________________________________________
◦ Adequate coping skills and ways to enhance development through stimulation and
attention
◦ Normal parent-child attachment and communication
◦ ___________________________________________
◦ Shared parenting responsibilities
◦ Provision of social and health services

Maltreatment Prevalence
 ~679,000 children were victims of abuse or neglect in 2013.
o ~1,520 deaths
 Worldwide estimates: 40 million children are victims by age 14
Types of Maltreatment
 Physical abuse (PA): acts of aggression that physically harm the child
o _________________________________________________
 Neglect: _______________________________________________________________ –
physical, educational, emotional
 Sexual abuse (SA): inappropriate sexual contact or exploitation
 Emotional abuse: bizarre punishments, verbal put-downs, exposure to potentially harmful
experiences, isolation
 Children often experience ____________________________________________

Rates of Maltreatment by Type

 _______________________________________________________________________
o 80% of substantiated cases in 2013 involved neglect.
o 18% physical abuse
o 9% sexual abuse
o 10% psychological maltreatment
 _________________________________________
o 71% of child maltreatment fatalities involved neglect exclusively or in combination with
another type of maltreatment.

Rates of Maltreatment by Type

 Physical and sexual abuse have __________________ since 1992
 Rates of neglect have ___________________________________
Victim Characteristics
 Age:
o PA & neglect more common in younger children (ages 0-5)
o _______________________________________________
 Gender:
o Equal rates for PA & neglect
o _______________________________________________________________

Victim Characteristics (cont’d)

 Race/ethnicity:
o __________________________ for African-American, American Indian, Alaska Native, &
multiple race
o Caucasian & Hispanic equal
o Lowest rates for Asians

Family Characteristics
 _________________________________________________ - increased risk for PA & neglect
 Poverty

Perpetrators of Maltreatment
 89% of victims maltreated by a parent
 Neglect: _______________________________________

Perpetrators of Maltreatment (cont’d)

 Sexual abuse
o ___________________________
o ________________________________________
 However, females are more likely to be abused by family (father or father-
figure) than are males
Causes of Maltreatment
Causes of Sexual Abuse
 Not well understood
 Some offenders have sexual arousal toward children (pedophilia)
 _______________________________________________
 Perpetrators more likely to have:
o ______________________
o Low self-esteem
o History of child sexual abuse

Causes of PA & Neglect

 ______________________________________________
 Negative attributions about child’s behavior
 Lack of positive parenting models
 __________________
 Poverty
 Poor coping skills

Causes of PA & Neglect

 Social isolation
 Substance use
 ______________________________

 Child characteristics:
o _____________________________________________________________________
Consequences of Maltreatment
 _____________________________________
 Impact depends on:
o _____________________________________
o Child characteristics
o Family characteristics
o __________________________________
 Positive self-esteem
 Support person

Consequences: Neurobiological Development

 Children and adults with a history of child abuse show long-term alterations in the
________________________________________ and __________________________
o These alternations have a significant effect on __________________________________
______________________________
 More reactive to stress
 Affected brain areas:
o Include the hippocampus, prefrontal cortex, and amygdala

Consequences of Maltreatment (cont’d)

 Poor emotion regulation (ability to modulate or control the intensity and expression of feelings
and impulses)
o __________________________________________________
 Difficulty in relationships due to:
o Negative representations of self & others
o Poor role models
o Lack of social sensitivity
 Relations with peers: rejected
o Neglect – ________________________________
o PA – aggressive
Consequences of Maltreatment (cont’d)
 Neglected children: _____________________________________________________________
 Sexually abused children: PTSD, regression, sexualized behaviors, sexual problems in adulthood,
risk of future victimization, eating disorders
 PA & neglect adult outcomes: criminal, antisocial, & violent behavior
 Cycle-of-violence hypothesis: _______________________________________________
_____________________________________
 30% of PA children

Prevention and Treatment

 Obstacles to intervention and prevention services for maltreating families
o ____________________________________________________________
o They are brought to the attention of professionals after norms or laws have been
violated
 fear of losing their children or being charged with a crime

Prevention & Treatment of Physical Abuse

 Involve ways to change ___________________________________________________________
_____________________
 Evidence-based treatments for disruptive child behavior are effective
◦ Parent-Child Interaction Therapy
◦ Modification of Multisystemic Therapy
◦ _______________________________________
 Group-based parent education program
https://www.youtube.com/watch?v=5KZRqMcrl_k&list=PLTQ3LIdfj72Ev4bfh7gkQ1ATc-48JwXb_
◦ Triple P Parenting Program
 Addresses many levels of need
 Population wide media campaign
 Group & individual services for families with greater need
http://www.triplep.net/glo-en/see-and-hear/watch-videos/triple-p-interventions-explained /
Prevention & Treatment of Neglect
 _____________________________________________________________________________
 _______________________
◦ 3 modules:
 Home safety
 Child health
 Parent-child interaction
◦ Method of delivery:
 Home-based
 Hands-on learning: modeling, practice with corrective feedback, role play

Prevention & Treatment of Neglect (cont’d)

 ___________________________
◦ Found to reduce future rates of child maltreatment
◦ Showing promise for prevention

Post-traumatic Stress Disorder

 PTSD: Persistent anxiety following an overwhelming traumatic event that occurs outside the
range of usual human experience
◦ Causes _________________________________________________
◦ Disturbance lasts for _________________________________

PTSD: Four Core Features

 _____________________________ of the event (memories, dreams, flashbacks)
 ________________________ of distressing memories, thoughts or feelings, and reminder of the
trauma
 _______________________________________________ associated with the traumatic event
(elevated fear, emotional numbing, self-blame, guilt)
 ____________________________________________________ (angry outbursts, self-
destructive behavior, sleep problems, hypervigilance)
PTSD (cont’d)
 Other associated symptoms
◦ ____________________________________________
◦ Difficulty with emotion regulation
 Can lead to behavioral problems

PTSD (cont’d)
 Prevalence: ~3-6% among adolescents
 ______________________________________________________________________________
◦ Most do not develop PTSD
 Depends on child characteristics (e.g., age, coping skills, other stressors) and
nature of the trauma
 May be delayed for months or years
 May persist for a lifetime without treatment
 __________________________________________

Treatment: Exposure-Based Therapy

 __________________________________________ has been shown to reduce acute stress
symptom
 Many of these interventions are brief, ranging from 1 to 10 sessions
◦ Are often delivered in groups to reach as many children as possible
 Psychological First Aid
◦ ____________________________________________________________
◦ Goal is to stabilize child and family, ensure safety, and connect with social supports
Exposure-Based Therapy (cont’d)
 In-depth psychological interventions are for children who are severely affected by a traumatic
event
◦ The child typically begins by ________________________________________________
_____________________________________________________________
 Types
◦ Grief and Trauma Intervention for Children
◦ Trauma-focused cognitive-behavioral therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

 For abused children with PTSD
 __________________________________________
 Teach coping skills (e.g., relaxation)
 Gradual ___________________ to painful memories
◦ ___________________________________________