Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normalreaction to an abnormalsituation. •Any human being has the potential to develop PTSD •Cause external –Psychiatric Injury not Mental Illness •Not resulting from the individual’s personality –Victim is not inherently weak or inferior

1. Trauma and
Post Traumatic Stress
Janet Louise Parker,
B.S., M.S., D.V.M.
“People are like stained glass windows. They sparkle and shine when the
sun is out; but when the darkness sets in, their true beauty is revealed
only if there is a light within.” Elizabeth Kübler-Ross

2. Positive Stress (or eustress)
• Competent management
• Mature leadership
• Everyone is valued and supported.
enhances well-being
• Enhances performance and fuel
achievement.

3. Negative Stress (or distress)
• Threat
• Coercion
• Fear
• Dysfunctional and inefficient
management
• Diminishes quality of life
• Injury to health

4. Post Traumatic Stress
Post Traumatic Stress Disorder
(PTSD) is a natural emotional
reaction to a deeply shocking
and disturbing experience. It is a
normal reaction to an abnormal
situation.

5. Who Gets PTSD
• Crime Victims
• Persons experiencing death of family
member, friend, co-worker
• Returning Veterans
• Cancer Survivors & their family
• Domestic Violence Victims
• Sexual Assault Victims
• Targets of Workplace Bullying

6. Origin is External not Internal
• Any human being has the potential to
develop PTSD
• Cause external – Psychiatric Injury
not Mental Illness
• Not resulting from the individual’s
personality – Victim is not inherently
weak or inferior
DSM-IV-TR (APA, 2000)

7. Impact of Trauma
• Difficulty trusting others and forming close
relationships (may appear withdrawn,
uncooperative, defensive or aggressive).
• Fear or concern about safety.
• Difficulty managing and expressing feelings.
• Lack of belief in self-worth and capabilities.

8. Hyper-arousal
• Hypervigilance • Sleep disturbance
• Irritability • Dissociation
• Depression • Problems of
• Proneness concentration
to anger • Vulnerability to
• Exaggerated startle medical illness
response

9. Traumatic Memory
• Intrusive • Reenactment
recollections play
• Nightmares • Perceptual
illusions
• Emotional
(somatic) • Dissociation,
memories, memory retrieval
actingout/
reliving trauma.

10. Denial
• Avoidance • Substance abuse,
• Emotional • Social/geographical
numbing, isolation
• Amnesia, • Desexualization,
• Loss of active estrangement and
social detachment
interpersonal • Obsessive-
engagement, compulsive
• Attention diversion
as defense

11. Self-concept, Ego states
• Demoralization, • Prone to
ego fragmentation dissociation,
hopelessness and
• Identity diffusion helplessness
• Vulnerability • Shame, guilt
• Loss of spirit and • Misanthropic
vitality, dysphoria, beliefs
• Faulty cognitions

12. Interpersonal relations:
• Alienation • Issues of loss,
abandonment
• Mistrust
• Impulsiveness
• Detachment
• Self-destructive
• “Boundary” relationships
problems with
others

13. Patterns of anticipation
• Individuals suffering from PTSD live
daily life as if the traumatic
experience is recent, even though it
may have happened years earlier.
• Triggers will cause the event to be
re-experienced.
• “Isolation and paralysis of the
mind”(Holter, 2005, abstract).

14. NCPTSD, July 4, 2007
• 32 % War experiences
• 48 % Abuse (spousal, childhood,
sexual, bullying)
• 19 % Crime
• 18 % Accidents
• 8 % Acts of terrorism
• 5 % Natural disasters

15. Response to Chronic Stress
• Breakdown of immune
system
• Increased heart rate and
blood pressure
• Increased cortisol level
• Shrinking of the hippocampus
(affecting learning and memory)
• Enlargement of the amygdala
(affecting emotional behaviors)

16. Dissociation
• PTSD is “soul murder”
• Disconnection between the traumatic
events and the meaning associated
with those events
• Interferes with ability to verbalize the
events and their meaning

17. 3 Levels of Victimization
1. Loss of feelings of safety, loss of
perception of an orderly world, and
loss of a positive sense of self.
2. People do not believe, and deny the
severity of the trauma thus blaming
and stigmatizing the victim. (Ridicule
and Punishment)
3. Perceiving oneself as a victim with
no personal power

18. Daubert Standard
• Standard for admitting expert
testimony
• Scientific basis for professional
opinions
Federal Rule of Evidence 702 when evaluating claims of
psychological injuries as authorized by the Civil Rights Act
of 1991

19. Trauma-Informed Services
Trauma-informed Traditional Approaches
• Problems/Symptoms are
• Problems/Symptoms are
inter-related responses to
discrete and separate.
or coping mechanisms to
deal with trauma. • People providing services
are the experts. Trauma
• Providing choice,
Survivors broken, &
autonomy and control is
vulnerable.
central to healing.
• Primary goals are defined
• Primary goals are defined
by service providers and
by trauma survivors and
focus on symptom
focus on recovery, self-
reduction.
efficacy, and healing.
• Reactive – services and
• Proactive – preventing
symptoms are crisis driven
further crisis & avoiding
and focused on minimizing
retraumatization.
liability.

20. Understanding Trauma
• Anxiety causes traumatized individuals to have
difficulty in processing information.
• Understanding trauma response and its triggers.
• Recognizing behaviors as adaptations.
• Identifying and reducing triggers to avoid re-
traumatization.

21. Poor Support – Intensifies
Damage
When an individual
suffering from
PTSD is unable to
resolve issues
related to the
trauma he/she is
unable to establish
a new baseline of
biopsychosocial
functioning.

22. Secondary Re-Traumatization
• The loss of human potential is
incalculable.
• Society has a tendency to blame the victim
for not being able to simply “get over it”
and this cultural lack of support can be
classified as secondary wounding and
promotes a victim mentality, thus keeping
the problem going.
“Human beings, like plants grow in the soil of acceptance,
not in the atmosphere of rejection.” John Powell, S.J.

23. Re-Experiencing Trauma
• Re-experiencing original trauma (symbolically
or actually).
• Trauma Survivor responds as if there is danger
even if it is not actual danger.
• Triggers may be subtle and difficult to identify.
“One of the most courageous things you can do is identify yourself,
know who you are, what you believe in, and where you want to go.”
Sheila Murray Bethel

24. Trauma Victims Disposable?
• Our society views many objects as
disposable and when an object is
tarnished or dented the tendency is
to deem its value gone, throw it away,
and rush to the stores to replace it.
• Humans are not objects, and the
growth potential available though the
healing process is infinite.

25. From Vulnerability to Strength
Celebration – Self Actualization
Overcoming Vulnerability – Recognition
Compensation – Self Esteem Needs
Sharing with Others (Sense of
Belonging)
Exploring Protection Needs
Identifying Safety Needs
Denial of Vulnerability
Elimination of Danger
Vulnerable

26. Promoting Safety
• Because PTSD is “soul murder” and splinters
the sense of self, and creates acute mistrust in
the individual’s environment .
• Provide a safe physical environment.
• Provide emotional safety: tolerance for wide
range of emotions.
• A Sense of Safety is Critical to relationship
building.

27. Build Trust – Long Term
Process
• PTSD changes the diagnosed
individual’s life and greatly impacts
the lives of those with whom they are
close and regularly interact.
• Trusting relationships are
essential to combat the
dehumanizing effect of trauma.

28. Supporting Control,
Choice & Autonomy
• Trauma survivors feel powerless.
• Equalize power imbalances.
• Recovery requires a sense of power and control.
• Relationships should be respectful and support
mastery.
• Trauma Survivors should be encouraged to make
choices.

29. Communicating Openly
“If I can listen to what he tells me, if I can understand how it seems
to him, if I can sense the emotional flavor which it has for him, then
I will be releasing potent forces of change within him.”
Carl Rogers
• Respect Trauma Survivor’s right to open
expression.
• Discourage withholding information or keeping
secrets.

30. Integrating Care
• Because of the dehumanizing nature of trauma it
is important that care approaches deal with the
client holistically as opposed to treatments
designed solely to reduce symptoms.
• Trauma Survivor’s symptoms and behaviors are
adaptations to trauma.
• Services should address all of the survivor’s
needs rather than just symptoms.

31. Fostering Healing
• Humans are not objects, and the growth
potential available though the healing
process is infinite.
• Instilling hope.
• Strengths-based approach.
• Future orientation.
• Cultural Competence

32. Inward Reflection
• Trauma causes individuals
to look spiritually inward.
• The “healed self that was once
traumatized can project itself into the
future with joy, serenity, and a
measure of wisdom.” Walsh (1985)

33. UPSIDE to Trauma?
According to Wilson et al., 2001
Individuals, once healed, are
“potential guides, healers, teachers,
and may be subjects of scientific
inquiry concerning resiliency,
salutogenesis, and self-efficacy”

34. Inspirations
“Great minds have purposes, others have wishes. Little minds are
tamed and subdued by misfortune, but great minds rise above them.”
Washington Irving
“Sometimes I think that the main obstacle to empathy is our
persistent belief that everybody is exactly like us.” John Powell, S.J.
“The deepest craving of human nature is the need to feel
appreciated.” William James
“Great Things are not done on impulse but by a series of small things
brought together.” Vincent van Gogh