Lecture 7b: Trauma and Self-Directed Violence

mental health notes 7ecture B2: /10M Trauma and Self-Directed Violence Trauma j PTSD DeLnition of Trauma gPA Apis Adverse xhildhood Ep(eriences )AxEsH Rerson has eSperienDedxuitnessed an e/ent uhere theg tho)-ht their yife uas -oin- to end or Dome Dyose Uastin- impaDt d)e to a fear response Potential xonseWuences of Traumatic Ep(osure Trauma-Related Disorders: E(idemioloQy Posttraumatic Stress Disorder )PTSDH zzW84Y of peopye ha/e eSperienDed at yeast one tra)matiD e/ent AeWeSperienDin- of the tra)ma zY de/eyop RL., E/oidanDe of stim)yi assoDiated uith tra)ma comen more than men CyashbaD(sI dreamsI paniD attaD(I etD: 6ag yead to s)bstanDe )se Rersistent sgmptoms of inDreased aro)say Qein- on ed-eI hi-hWayert Dissociative Disorders Eyterations on mood Dissociative Disorders Dissociative Identity Disorder )DIDH Ettempt to disDonneDt from reayitg RresenDe of 3; distinDt personayitg states1 disinW te-ration GDD)r after si-nikDant ad/erse eSperienDesxtra)mas ,iPerent identities deay uith /ario)s DonDerns vndi/id)ays respond to stress uith se/ere interr)pW tion of DonsDio)sness FaDh ayternate personayitg wayterH has oun pattern of+ 0nDonsDio)s defense meDhanism RerDei/in- and reyatin- RroteDts indi/id)ay a-ainst o/eruheymin- anSietg thro)-h emotionay separation Lhin(in- abo)t the seyf and en/ironment Suicide Psychosocial Factors of Suicide Self-Directed Violence: Suicide Suicide RisC Factors Sigmund Freud: E--ression t)rned inuard vntentionay aDt of endin- one2s yife bg ang means Aaron Beck: 'entray emotionay faDtor is hopeyessness Ninth yeadin- Da)se of death in the 0. Ai-id ayyWorWnothin- thin(in- li-her in Dhiydren and adoyesDents vnabiyitg to see ayternati/e options1 perfeDtionism 3nd yeadin- Da)se of death T4WM5 RsgDhiatriD disordersI E0,x.0, vmpaired B)d-ment 6aye -ender wT:zS femayeH 6ore yethay methods AeDent theories s)--est a Dombination of s)iDiday fanW tasies and si-nikDant yoss wdiathesisWstressH vnDreasin- a-e AaDe wuhitexnati/eHI reyi-ion questions for SI Protective Factors ?enetiD 'omponent Luin and adoption st)dies Rre-nanDg+ Aesponsibiyitg for another w; petH Ratterns of bipoyar disorder la/e go) been thin(inabo)t death or s)iDide wdireDtH reDentyg9 Uou .erotonin Ue/eys EDDess to heaythDare Rositi/e soDiay s)pport .atisfaDtion uith yife1 intaDt reayitg testin- RhgsiDay heayth1 DhroniD iyyness la/e go) e/er feyt that yife uas not uorth yi/in-9 .po)seI DhiydrenI a-in-I parentI etD: Aeyi-io)s beyiefs Uoss of Bob .)iDide ris( is hi-hest prioritg n)rsin- dS 2ioloQical Factors .ense of responsibiyitg to famiyg 6arria-eI profession wDareH Uou ye/eys of serotonin in Derebrospinay j)id of indiW /id)ays uho are s)iDiday Suicidal Ideation G/ert .tatements Vv uish v uere deadV la/e go) e/er uished go) uere deadxuent to syeep % ne/er uo(e )p9 FPeDti/e Dopin- and probyemWsoy/in- s(iyys Vv ha/e nothin- to yi/e forV VF/ergone uo)yd be better oPV carnin- .i-ns CreO)entyg mentionin- death Suicide Assessment Assess Tools: IS PATg &ARk lopeyessnessI uorthyessness Assess Tools: SAD PERSONS Ideation vsoyation or reD(yessness SeS+ 6aye S)bstanDe ab)se .)ddenyg bri-ht mood A-e+ 3zW55 or qz; gears P)rposeyessness+ rxt hopeyess ?i/in- auag possessions Depression An-er Pre/io)s attempt Trapped+ No uag o)t of sit)ation VF/ergthin- uiyy be ayri-ht soonV Ethanoy )se Hopeyessness Vv uon2t be a probyem for yon-V Rationay thin(in- yoss Withdrauin- SoDiay s)pports yaD(in-xreDent yoss AnSietg Or-ani7ed pyan ReD(yessness+ EDtin- uitho)t re-ard No spo)se Mood Dhan-es 'o/ert .tatementsxNonW&erbay ')es SiD(ness Aatin4W3+ 6onitor RisC Assessment MW5+ 'heD( on freO)entyg zWq+ 'onsider Dommitment to )nit "WT4+ Needs to be hospitayi7ed Plan: Lho)-ht o)t Intent: EDti/e tho)-ht Gtheruise passi/e Means: Uethayitg of pyan keds to Reduce RisC Uithi)m and Dyo7apine Interventions for Self-Directed Violence: Safety Plan Interventions Primary: EDti/ities pro/idin- s)pportI infoI and ed)Dation to pre/ent s)iDide Aed)Din- ris( faDtors and promotin- proteDW ti/e faDtors T+T pre/ention1 therape)tiD Domm)niDation CaDiyitate probyem soy/in-1 de/eyop a safetg pyan Secondary: LS of a s)iDiday Drisis Eddressin- shortWterm impaDt 'risis Do)nseyin-I medsI therapgI fx) DareI reW d)Din- yethay means Tertiary: vnter/entions uithin a DirDye of s)r/i/ors yeft bg indi/id)ays uho Dompyeted s)iDide to reW d)De the tra)matiD Uon-Wterm responsesxpyans of s)iDide afterW ePeDts ,eyiberatexdireDt attempts to Da)se inB)rg uxo intent to die TMW3MY of adoyesDents uoryduide ha/e en-a-ed in N..v Rea(s in the yate teens1 tgpiDayyg deDyines after a-e 3z Rossibyg more Dommon in femayes N)rsin- 'are Es( abo)t in safetg assessment1 tho)-ht of harmin- seyf CreO)enDgI tri--ersI means Rerform phgsiDay assessment ws(inH vntent LgpiDayyg to ayye/iate emotionay pain .ometimes as seyfWp)nishment .ometimes attentionWsee(in- or manip)yati/e wa/oidin- a responsibiyitg or sit)ationH 6ethods 6ost freO)entyg bg D)ttin- or b)rnin.Drapin-I sDratDhin-I bitin-I hittin-I piD(in-I interferin- uith uo)nd heayin-1 hayf of peopye )se m)ytipye methods Nationay and .tate .er/iDes Needs to be part of an assessment that identikes ris( wbest uritten o)tH 6entay leayth EmeriDa of &E NonWemer-enDg carm Uine leyp pt to identifg tri--ers and sit)W ations that pose -reatest ris( Nationay .)iDide Rre/ention Uifeyine cor( uith pt to yist and praDtiDe Dopin- s(iyys ,etermine aDDess to -)nsI yethay medsI or other means for seyfWharm vn/oy/e famiyg membersxtr)sted indiW /id)ays uho Dan heyp -et pt thro)-h a Drisis vdentifg so)rDes of s)pport and proW /ide phone n)mbersI hotyinesI or teSt yines .afetg pyans ha/e been fo)nd to be more ePeDti/e than noWharm DonW traDts Non-Suicidal Self In ury )NSSIH Non-Suicidal Self-In ury )Self-garmH xrisis and Su((ort Resources NSSI Interventions Fstabyish therape)tiD ayW yianDe wsense of DareH ,e/eyopment of ayternaW ti/e Dopin- s(iyys .trate-ies to address nonWs)iDiday seyfWinB)rg Dan be Dhayyen-in-I some patients are amW bi/ayent abo)t reDei/inheyp Nationay EyyianDe on 6entay leayth &E wDayy or emaiyH 'risis 'ayy 'enter+ 8TTx8 .eyfWvnB)rg Co)ndation 35Wlo)r lotyine wDayy or teStH 'haryottes/iyye and 0&E .er/iDes Ae-ionay 'risis 'ayy 'enter Nationay o)th 'risis lotyine 'risis LeSt Uine+ Cor those are in Drisisxb)yyied and not DomW fortabyexabye to spea( on the phone &eterans 'risis Uine wDayy or teStH Lre/or wU?QL ;H Uifeyine wDayy or teStH1 Lrans Uifeyine Nationay ,omestiD &ioyenDe lotyine .eS)ay Essa)yt lotyine wDayy or teStH 0&E 'o)nseyin- and RsgDhoyo-iDay .er/iDes w'ER.H1 Uet2s Lay( dropWin Dons)ytsI Limeyg'are app