reaction to trauma: myths and realities professor david a alexander ma(hons), c.psychol, phd, fbps,...

REACTION TO REACTION TO TRAUMA: MYTHS TRAUMA: MYTHS AND REALITIESAND REALITIESProfessor David A Alexander

MA(Hons), C.Psychol, PhD, FBPS, FRSM, (Hon) FRCPsych

Aberdeen Centre for Trauma Research

“Oh, give me a home, where the buffalo roam...”

“Bummer of a birthmark, Hal."

Post-traumatic Stress Disorder (PTSD)

Primary features are:• experience of an abnormally stressful event

• persistent re-experiencing of that event

• persistent avoidance of reminders

• persistent hyperarousal (hypervigilance)

NB: Symptoms must have lasted for 1 month

• 10% of all deaths in UK

• leading cause of death in young people

• for every death two permanently disabled

• high economic cost

‘The trauma epidemic’

How common are post-traumatic conditions?

Best estimates (Alexander, 1997)

• Burn injuries - 45%

• RTAs - 18%

• Industrial accidents - 18%

• Major disasters - 50%

• Rape - 50%

HOW DO PEOPLE REACT HOW DO PEOPLE REACT AFTER TRAUMA?AFTER TRAUMA?

Individual reactions

Emotional Cognitive

SocialPhysical

Individual reactions

Emotional

NumbnessFearDepressionGuiltAngerHelpless

Individual reactions

Cognitive

False beliefsLoss of faithMemory/

concentrationFlashbacks

Individual reactions

SocialAvoidanceIrritabilityWithdrawal

Individual reactions

Physical

HyperarousalSleep problems

At risk factors include...Trauma

• sudden, unexpected

• man made

• (perceived) threat to life

• extended exposure

• multiple deaths/mutilations

Survivor

• previous trauma

• psychiatric history

• severity (meaning) of injury

• lack of support

• other stresses

HAVE YOU SOMEONE TO HAVE YOU SOMEONE TO GO HOME TO...?GO HOME TO...?

• eviction

• leukaemic daughter

• redundancy

• physical ill health

• pending divorce

Yes, but...

A team of trained counsellors is standing

by…

““WATCHFUL WAITING”WATCHFUL WAITING”

Phases of Response to Major Trauma

Warning

Impact

“Honeymoon”

Level of

Adju

stm

ent

Time Weeks Months

Previous Level of Adjustment

(Raphael [1986] “When disaster strikes”)

Disillusionment Enhanced Community and Individual Adjustment

“Second Disaster”