victims trauma ptsd dicky pelupessy
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 (DSMIV-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
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 (DSMIV-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