Chapter 10: Trauma & Stress-Related Disorders & Dissociative Disorders

Trauma & Stress-Related Disorders & Dissociative Disorders begins by differentiating between beneficial eustress and harmful distress, detailing the biological mechanisms of the stress response, including the "fight-or-flight" activation of the sympathetic nervous system and the "freeze" response, as well as the neuroendocrine role of the hypothalamus-pituitary-adrenal (HPA) axis and cortisol release. The content deeply explores Posttraumatic Stress Disorder (PTSD), defining its diagnostic criteria such as intrusive re-experiencing (flashbacks), persistent avoidance, negative alterations in cognition or mood, and hyperarousal. It distinguishes PTSD from Acute Stress Disorder based on symptom duration and highlights the high prevalence of comorbidities like Major Depressive Disorder, substance use disorders, and Traumatic Brain Injury (TBI), particularly within military and veteran populations. Significant attention is given to the concept of compassion fatigue or secondary traumatic stress, a risk for healthcare professionals exposed to the trauma of others, emphasizing the necessity of self-care and trauma-informed care practices. Evidence-based treatments for trauma are reviewed, including psychopharmacology (SSRIs like sertraline and paroxetine, and alpha-blockers like prazosin for nightmares) and psychotherapies such as Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and Eye Movement Desensitization and Reprocessing (EMDR). The chapter then transitions to Dissociative Disorders, which involve disruptions in consciousness, memory, identity, and perception, often stemming from severe childhood abuse. It categorizes and explains specific conditions including Depersonalization/Derealization Disorder, Dissociative Amnesia (including fugue states), and Dissociative Identity Disorder (DID), formerly known as multiple personality disorder. The text concludes by outlining the nursing process for these conditions, prioritizing safety interventions for suicide risk, the establishment of a therapeutic relationship, and the use of grounding techniques to manage dissociation and anxiety.