Victim, Trauma and PTSD

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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
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Outline of the presentation

• Trauma
• Traumatic event
• Impact of traumatic events to victims
• Post-Traumatic Stress Disorder (PTSD)
• Treatment

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Trauma

• Meaning wound
• Physical and Psychological wound

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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?...

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Psychological Trauma

• Not reactions per se
• Technically refers to the event (Yule, 1999
  Briere Scott, 2006)

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Diagnostic and Statistical Manual of Mental
Disorders, 4th edition, Text Revision (DSM-IV-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 ones 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 persons 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)

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• By definition, limited to events that threatened
  death or serious injury, or other threat to ones
  physical integrity
• Roberts (2005) Briere Scott (2002) include
  events that extremely upsetting and at least
  temporarily overwhelms the individuals internal
  resources

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Traumatic Event

• An event that is traumatic. An event that creates
  psychological wound.
• Single, multiple, or on-going event

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Traumatic event

• Briere Scott (2006)s Major Types
• . Natural disasters
• . Mass interpersonal violence
• . Large-scale transportation accidents
• . House or other domestic fires
• . Motor vehicle accidents
• . Rape and sexual assault

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Traumatic event

• Briere Scott (2006)s Major Types (continued)
• . Stranger physical assault
• . Partner battery
• . Torture
• . War
• . Child abuse
• . Emergency worker to trauma

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• Roberts (2005)s trauma-provoking events
• . Violent crimes
• . Crisis-prone situations
• . Natural disasters
• . Accidents
• . Transitional or developmental events

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Victims 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!

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Victims 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)

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Victims 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

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Victims 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)

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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)

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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
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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

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Thank you