Chapter 16: Trauma, Stressor & Dissociative Disorders

Moving into Posttraumatic Stress Disorder (PTSD), the material details its manifestation in children and adolescents—who often exhibit reduced play, self-blame, and hypervigilance—and in adults, where the presentation includes persistent re-experiencing (flashbacks), avoidance of stimuli, and alterations in mood. Central to understanding these disorders is the neurobiological component, covering the critical function of the limbic system, prefrontal cortex, and the dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis, which influences stress hormone levels. The Polyvagal Theory is introduced to explain the spectrum of autonomic nervous system responses, ranging from hyperarousal to the hypoaroused state known as dissociation. Nursing care for trauma follows a three-stage model, emphasizing safety and stabilization first, followed by emotion regulation aimed at maintaining the patient within the "window of tolerance," and finally, focusing on developmental skills catch-up. Evidence-based treatment modalities highlighted include Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), often paired with pharmacotherapy for managing comorbid symptoms. Additionally, the chapter defines Acute Stress Disorder (ASD), a short-term response occurring within one month of the trauma, and Adjustment Disorder, a milder response to general life stressors. The conclusion of the chapter focuses on Dissociative Disorders, which represent a breakdown in the normal integration of consciousness, memory, and identity, driven by overwhelming trauma. These include Dissociative Amnesia, Depersonalization/Derealization Disorder (feeling detached from self or surroundings), and Dissociative Identity Disorder (DID), characterized by multiple distinct personality states (alters). The overall goal for DID treatment is long-term integration, supported by safety-focused nursing interventions and the use of grounding techniques.