The document outlines a diagnostic protocol for treating trauma and stressor-related disorders through a recreational therapy program. It identifies posttraumatic stress disorder as a specific diagnosis, outlining its symptoms and problems. Related factors that can influence PTSD are divided into pretraumatic, peritraumatic, and posttraumatic categories. The protocol lists process criteria like breathing exercises and leisure education, as well as outcome criteria such as a reduction in traumatic episodes and increased coping skills.
The document outlines a diagnostic protocol for treating trauma and stressor-related disorders through a recreational therapy program. It identifies posttraumatic stress disorder as a specific diagnosis, outlining its symptoms and problems. Related factors that can influence PTSD are divided into pretraumatic, peritraumatic, and posttraumatic categories. The protocol lists process criteria like breathing exercises and leisure education, as well as outcome criteria such as a reduction in traumatic episodes and increased coping skills.
The document outlines a diagnostic protocol for treating trauma and stressor-related disorders through a recreational therapy program. It identifies posttraumatic stress disorder as a specific diagnosis, outlining its symptoms and problems. Related factors that can influence PTSD are divided into pretraumatic, peritraumatic, and posttraumatic categories. The protocol lists process criteria like breathing exercises and leisure education, as well as outcome criteria such as a reduction in traumatic episodes and increased coping skills.
Diagnostic Protocol Diagnostic Grouping - Trauma and stressor-related disorders: disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion (DSM-5, 265). o Reactive attachment disorder o Disinhibited social engagement disorder o Posttraumatic stress disorder (PTSD) o Acute stress disorder o Adjustment disorders Specific Diagnosis - Posttraumatic Stress Disorder: The essential feature of PTSD is the development of characteristic symptoms following exposure to one or more traumatic events (DSM-5, 274). o Emotional reactions to the traumatic event (fear, helplessness, horror) are no longer part of the criterion (DSM-5, 274). - Symptoms include one or more of the following the traumatic event(s) (DSM-5, 271): o Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. o Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). In children, there may be frightening dreams without recognizable content. o Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). In children, trauma-specific reenactment may occur in play. o Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). o Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). Identified Problems (DSM-5, 275-76) - Loss of language (in young children) - Auditory pseudo-hallucinations o Having the sensory experience of hearing one’s thought spoken in one or more different voices, as well as paranoid ideation - Difficulties regulating emotions - Difficulties maintaining stable interpersonal relationships - Dissociative symptoms - Quick tempered o May engage in aggressive verbal and/or physical behavior with little or no provocation - May engage in reckless or self-destructive behavior o Dangerous driving o Excessive alcohol or drug use o Self-injury o Suicidal behavior - Heightened sensitivity to potential threats o Especially those related to the traumatic event Related Factors or Etiologies (DSM-5, 277-78) Factors are generally divided into pretraumatic, peritraumatic, and posttraumatic factors. - Pretraumatic factors o Temperamental: Childhood emotional problems developed by age 6 (such as anxiety problems) and prior mental disorders (such as panic disorder, OCD, or depressive disorder). o Environmental: Lower socioeconomic status; lower education; exposure to prior trauma (especially during childhood); childhood adversity; minority racial/ethnic status; and a family psychiatric history. o Genetic and physiological: Female gender and younger age at the time of trauma exposure (for adults). Certain genotypes may either be protective or increase risk of PTSD after exposure to traumatic events. - Peritraumatic factors o Environmental: Severity (dose) of the trauma (meaning the greater magnitude of trauma, the greater likelihood of PTSD), perceived life threat, personal injury, interpersonal violence (particularly trauma perpetuated by a caregiver or involving a witnessed threat to a caregiver in children), and, for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy. o Dissociation that occurs during the trauma and persists afterward is a risk factor. - Posttraumatic factors o Temperamental: Negative appraisals, inappropriate coping strategies, and development of acute stress disorder. o Environmental: Subsequent exposure to repeated upsetting reminders, subsequent adverse life events, and financial or other trauma-related losses. Social support (including family stability, for children) is a protective factor that moderates outcome after trauma. Process Criteria - Breathing exercises - Leisure education - Coping skills strategies - Stress-management - Self-esteem building - Provide activities for physical, mental, and social stimulation - Structured environment for activities Outcome Criteria - Reduction of identified traumatic episodes - Clients will develop an understanding of stress and demonstrated stress management techniques - Increased self-esteem - Increased coping skills - Restored functionality prior to traumatic event - Increased social support and family stability J. Jeppson TRS, CTRS (student) 18 October 2016 Works Cited Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association, 265-290.