REME ROSE J. FELIZARDO
NCM 117
BSN 3-3
PSYCHIATRIC DISORDERS
4F of TRAUMA RESPONSE
FIGHT FLIGHT FAWN FREEZE
(FIST UP) (FEET MOVING) (FRIENDLY FAKE) (FROZEN STILL)
Response Response Response Response
Confronting the threat with Escaping/ Avoiding the Appeasing/ Pleasing the Immobile/ numb in the
aggression/ assertiveness threat threat face of threat
Behavior Behavior Behavior Behavior
Remember: Furious and Remember: Fast and Remember: Friendly & Remember: Frozen &
Forceful Fidgety Fake Foggy
• Anger • Anxiety, Panic • People- pleasing • Dissociation
• Irritability • Restlessness/ • Fear of saying • Feeling stuck/
• Controlling excessive “NO” Numb
behavior movement • Over- apologizing • Detachment
• Defensiveness • Avoidance • Prioritize others • Difficulty
• Overworking, over oneself speaking, moving
Perfectionism and making
choices
Often link to: Often link to: Often link to: Often link to:
• Borderline • Generalized • CPTSD • Dissociative
Personality Anxiety disorder • Co-dependency disorder
disorder (BPD) (GAD) • BPD • Depression
• Intermittent • Panic disorder • PTSD
Explosive
• OCD
disorder (IED)
• PTSD
POSTTRAUMATIC STRESS THINK: TRAUMA
DISORDER (PTSD) T- Terror & Triggers: flashbacks, nightmares,
➢ a disturbing pattern of behavior by intense distress when triggered
someone who has experienced, R- Re- experiencing: intrusive thoughts, reliving the
witnessed, or been confronted with a trauma
traumatic event such as a natural disaster, A- Avoidance: staying away from triggers/ stimuli
combat, or an assault. (people, situations, memories)
➢ symptoms occur 3 months or more after U- Unable to relax: hypervigilance, irritability, angry
the trauma (what distinguish it from outburst, insomnia
acute stress d/o where symptoms last 3d- M- Mood changes: depression, guilt, emotional
1 month) numbness, detachment, isolation
➢ PTSD is chronic in nature, although A- Arousal increase: anxiety, difficulty focusing,
symptoms can fluctuate in intensity and reckless behavior
severity, becoming worse during stressful
periods. ❖ CAUSES
➢ PTSD & ASD had been classified as THINK: TRAUMA
anxiety d/o before, but now is a category T- Threat to life: near- death experiences, violence,
on their own abuse
➢ many clients with PTSD develop other R- Repeated exposure: ongoing abuse, wars,
psychiatric disorders, such as depression, domestic violence
anxiety disorders, or alcohol and drug A-Abuse: sexual, emotional, physical abuse,
abuse common cause for children is child abuse
❖ SIGNS & SYMPTOMS U- Unexpected loss: sudden death of a loved one,
(+) = flashbacks, Hyperarousal, Intrusive thoughts miscarriage
M- Major disasters: natural disasters, wars,
(-) = Emotional numbness, social withdrawal, avoidant
,REME ROSE J. FELIZARDO
NCM 117
BSN 3-3
❖ TREATMENT Examples of theracomm:
-outpatient therapy -remind the client that they are in the present, are an
- Inpatient treatment is not indicated for clients with adult, and are safe and validate feelings
PTSD; however, in times of severe crisis, short Grounding techniques:
inpatient stays may be necessary “What are you feeling?”
“Are you hearing something?”
THINK: CALM “What are you touching?”
C- Counselling and CBT: “Can you see me and the room we’re in?”
• Trauma- focused CBT- used Encourage expression of feelings:
successfully with rape survivors & “I know this is frightening, but you are safe now.”
combat veterans “It’s okay to take your time. You don’t have to talk
• Exposure therapy- to combat the about anything until you are ready.”
Validation of feelings:
avoidance behavior; help the client face
“What happened to you is not your fault.”
troubling thoughts and feelings and
“Your feelings are completely valid, and I respect
regain a measure of control over their
what you’re going through”
thoughts and feelings. Build a sense of control:
• EMDR (Eye Movement “Would you like to take a break or keep going? You
Desensitization and Reprocessing) are in control of this conversation”
• Adaptive disclosure- a specialized CBT
approach developed by the military to ❖ RELATED DISORDER
offer an intense, specific, short-term 1. Adjustment D/o
therapy for active-duty military o a reaction to a stressful event that causes
personnel with PTSD problems for the individual.
A- Antidepressants & Anxiolytics medication: o symptoms develop within a month,
• SSRIs & SNRIs - fluoxetine, paroxetine, lasting no more than 6 months
sertraline, & venlafaxine o commonly cause by financial and work-
• Prazosin (for nightmare) related stressors
• Benzodiazepine – lack of evidence but is o characterized by reexperiencing,
use as well avoidance, and hyperarousal that occur
L- Lifestyle changes & support: from 3 days to 4 weeks following a
• Exercise, meds, grounding techniques trauma
• Social supports- family, friends, support o Cognitive–behavioral therapy (CBT)
groups involving exposure and anxiety
M- Mood Regulation: management help this from progressing
• Relaxation techniques into PTSD
• Deep breathing exercises
• Journaling, art therapy, self- care 2. Reactive attachment disorder (RAD) &
Disinhibited social engagement disorder
❖ NURSING RESPONSIBILITIES (DSED)
THINK: SAFETY o occur before 5 years of age in response to
the trauma of child abuse or neglect
S- Support and listen actively
o child with RAD exhibits minimal social
A- Assess for triggers and symptoms
and emotional responses to others; lacks
F- Facilitate sense of control
a positive effect; and may be sad,
E- Encourage grounding Technique
irritable, or afraid for no apparent reason
T- Teach coping mechanisms
o child with DSED exhibits unselective
Y- Yield to professional support: encourage therapy,
socialization, allowing or tolerating
refer to psychiatrist if needed
social interaction with caregivers and
strangers alike. They lack the hesitation
in approaching or talking to strangers.
, REME ROSE J. FELIZARDO
NCM 117
BSN 3-3
DISSOCIATIVE
DISORDER
➢ a subconscious defense mechanism that THINK: DISSOCIATE
helps a person protect their emotional D- Detachment: feeling disconnected from self/
self from recognizing the full effects of world
some horrific or traumatic event by I- Identity- confusion: struggles with sense of self,
allowing the mind to forget or remove identity changes
itself from the painful situation or S- Sudden memory loss: amnesia
memory S- Sense of unreality: Depersonalization/
➢ have the essential feature of a disruption Derealization
in the usually integrated functions of O- Out of body experiences: feeling like an observer
consciousness, memory, identity, or of oneself
environmental perception interfering C- Compartmentalized emotion: feeling
with a person’s relationship and ADL emotionally numb and detached
➢ relatively rare I- Inability to recall trauma
➢ REPRESSED MEMORY THEORY- A- Altered perception of time: feeling like time is
memories buried deeply in the too fast/ slow
subconscious mind due to painful T- Trance-like state: spacing out, losing track of time
experiences E- Emotional distress: anxiety, depression
➢ FALSE MEMORY SYNDROME- a
condition where someone strongly ❖ CAUSES
believe in false/ distorted memories even THINK: TRAUMA
if they did not happen T- Trauma: severe emotional, physical, sexual abuse
especially in childhood
TYPES OF DISSOCATION R- Repeated stress: ongoing abuse, domestic
violence, chronic fear
Dissociative Amnesia Dissociative Identity A-Avoidance coping: defence mechanism to escape
• inability to remembers Disorder unbearable emotions
important personal • formerly known as U- Unresolved grief/ loss: sudden death of a loved
experiences multiple personality one, abandonment issues
• fugue experience is where disorder M- Mind Fragmentation: splitting of identity or
the client suddenly moves • The client displays two memory to protect from overwhelming pain
to a new geographic or more distinct A- Altered Consciousness: using dissociation to
location with no memory identities or personality escape reality, often linked to PTSD
of past events and often states that recurrently
the assumption of a new take control of their ❖ TREATMENT
identity behavior THINK: STABLE
Depersonalization disorder Derealization disorder S- Safet and support:
• persistent or recurrent • sensation of being in a
• nurse can help the client learn to go to a
feeling of being detached dream-like state in safe place during destructive thoughts
from their mental which the environment
and impulses so that they can calm down
processes or body seems foggy or unreal and wait until they pass
• a feeling of detachment • detachment from the T- Therapy:
from own self world
• CBT
• Dialectical Behavior Therapy- for
❖ SIGNS & SYMPTOMS
emotional regulation
• EMDR- helps process trauma
(+) = Depersonalization, Derealization, Fragmented A- Avoid triggers and encourage grounding
reality, intrusive memories/ flashbacks technique:
(-)= Amnesia (Dissociative amnesia), Emotional • Breathing techniques
numbness, Loss of voluntary control, Loss of identity • Reduce exposure to stressors
NCM 117
BSN 3-3
PSYCHIATRIC DISORDERS
4F of TRAUMA RESPONSE
FIGHT FLIGHT FAWN FREEZE
(FIST UP) (FEET MOVING) (FRIENDLY FAKE) (FROZEN STILL)
Response Response Response Response
Confronting the threat with Escaping/ Avoiding the Appeasing/ Pleasing the Immobile/ numb in the
aggression/ assertiveness threat threat face of threat
Behavior Behavior Behavior Behavior
Remember: Furious and Remember: Fast and Remember: Friendly & Remember: Frozen &
Forceful Fidgety Fake Foggy
• Anger • Anxiety, Panic • People- pleasing • Dissociation
• Irritability • Restlessness/ • Fear of saying • Feeling stuck/
• Controlling excessive “NO” Numb
behavior movement • Over- apologizing • Detachment
• Defensiveness • Avoidance • Prioritize others • Difficulty
• Overworking, over oneself speaking, moving
Perfectionism and making
choices
Often link to: Often link to: Often link to: Often link to:
• Borderline • Generalized • CPTSD • Dissociative
Personality Anxiety disorder • Co-dependency disorder
disorder (BPD) (GAD) • BPD • Depression
• Intermittent • Panic disorder • PTSD
Explosive
• OCD
disorder (IED)
• PTSD
POSTTRAUMATIC STRESS THINK: TRAUMA
DISORDER (PTSD) T- Terror & Triggers: flashbacks, nightmares,
➢ a disturbing pattern of behavior by intense distress when triggered
someone who has experienced, R- Re- experiencing: intrusive thoughts, reliving the
witnessed, or been confronted with a trauma
traumatic event such as a natural disaster, A- Avoidance: staying away from triggers/ stimuli
combat, or an assault. (people, situations, memories)
➢ symptoms occur 3 months or more after U- Unable to relax: hypervigilance, irritability, angry
the trauma (what distinguish it from outburst, insomnia
acute stress d/o where symptoms last 3d- M- Mood changes: depression, guilt, emotional
1 month) numbness, detachment, isolation
➢ PTSD is chronic in nature, although A- Arousal increase: anxiety, difficulty focusing,
symptoms can fluctuate in intensity and reckless behavior
severity, becoming worse during stressful
periods. ❖ CAUSES
➢ PTSD & ASD had been classified as THINK: TRAUMA
anxiety d/o before, but now is a category T- Threat to life: near- death experiences, violence,
on their own abuse
➢ many clients with PTSD develop other R- Repeated exposure: ongoing abuse, wars,
psychiatric disorders, such as depression, domestic violence
anxiety disorders, or alcohol and drug A-Abuse: sexual, emotional, physical abuse,
abuse common cause for children is child abuse
❖ SIGNS & SYMPTOMS U- Unexpected loss: sudden death of a loved one,
(+) = flashbacks, Hyperarousal, Intrusive thoughts miscarriage
M- Major disasters: natural disasters, wars,
(-) = Emotional numbness, social withdrawal, avoidant
,REME ROSE J. FELIZARDO
NCM 117
BSN 3-3
❖ TREATMENT Examples of theracomm:
-outpatient therapy -remind the client that they are in the present, are an
- Inpatient treatment is not indicated for clients with adult, and are safe and validate feelings
PTSD; however, in times of severe crisis, short Grounding techniques:
inpatient stays may be necessary “What are you feeling?”
“Are you hearing something?”
THINK: CALM “What are you touching?”
C- Counselling and CBT: “Can you see me and the room we’re in?”
• Trauma- focused CBT- used Encourage expression of feelings:
successfully with rape survivors & “I know this is frightening, but you are safe now.”
combat veterans “It’s okay to take your time. You don’t have to talk
• Exposure therapy- to combat the about anything until you are ready.”
Validation of feelings:
avoidance behavior; help the client face
“What happened to you is not your fault.”
troubling thoughts and feelings and
“Your feelings are completely valid, and I respect
regain a measure of control over their
what you’re going through”
thoughts and feelings. Build a sense of control:
• EMDR (Eye Movement “Would you like to take a break or keep going? You
Desensitization and Reprocessing) are in control of this conversation”
• Adaptive disclosure- a specialized CBT
approach developed by the military to ❖ RELATED DISORDER
offer an intense, specific, short-term 1. Adjustment D/o
therapy for active-duty military o a reaction to a stressful event that causes
personnel with PTSD problems for the individual.
A- Antidepressants & Anxiolytics medication: o symptoms develop within a month,
• SSRIs & SNRIs - fluoxetine, paroxetine, lasting no more than 6 months
sertraline, & venlafaxine o commonly cause by financial and work-
• Prazosin (for nightmare) related stressors
• Benzodiazepine – lack of evidence but is o characterized by reexperiencing,
use as well avoidance, and hyperarousal that occur
L- Lifestyle changes & support: from 3 days to 4 weeks following a
• Exercise, meds, grounding techniques trauma
• Social supports- family, friends, support o Cognitive–behavioral therapy (CBT)
groups involving exposure and anxiety
M- Mood Regulation: management help this from progressing
• Relaxation techniques into PTSD
• Deep breathing exercises
• Journaling, art therapy, self- care 2. Reactive attachment disorder (RAD) &
Disinhibited social engagement disorder
❖ NURSING RESPONSIBILITIES (DSED)
THINK: SAFETY o occur before 5 years of age in response to
the trauma of child abuse or neglect
S- Support and listen actively
o child with RAD exhibits minimal social
A- Assess for triggers and symptoms
and emotional responses to others; lacks
F- Facilitate sense of control
a positive effect; and may be sad,
E- Encourage grounding Technique
irritable, or afraid for no apparent reason
T- Teach coping mechanisms
o child with DSED exhibits unselective
Y- Yield to professional support: encourage therapy,
socialization, allowing or tolerating
refer to psychiatrist if needed
social interaction with caregivers and
strangers alike. They lack the hesitation
in approaching or talking to strangers.
, REME ROSE J. FELIZARDO
NCM 117
BSN 3-3
DISSOCIATIVE
DISORDER
➢ a subconscious defense mechanism that THINK: DISSOCIATE
helps a person protect their emotional D- Detachment: feeling disconnected from self/
self from recognizing the full effects of world
some horrific or traumatic event by I- Identity- confusion: struggles with sense of self,
allowing the mind to forget or remove identity changes
itself from the painful situation or S- Sudden memory loss: amnesia
memory S- Sense of unreality: Depersonalization/
➢ have the essential feature of a disruption Derealization
in the usually integrated functions of O- Out of body experiences: feeling like an observer
consciousness, memory, identity, or of oneself
environmental perception interfering C- Compartmentalized emotion: feeling
with a person’s relationship and ADL emotionally numb and detached
➢ relatively rare I- Inability to recall trauma
➢ REPRESSED MEMORY THEORY- A- Altered perception of time: feeling like time is
memories buried deeply in the too fast/ slow
subconscious mind due to painful T- Trance-like state: spacing out, losing track of time
experiences E- Emotional distress: anxiety, depression
➢ FALSE MEMORY SYNDROME- a
condition where someone strongly ❖ CAUSES
believe in false/ distorted memories even THINK: TRAUMA
if they did not happen T- Trauma: severe emotional, physical, sexual abuse
especially in childhood
TYPES OF DISSOCATION R- Repeated stress: ongoing abuse, domestic
violence, chronic fear
Dissociative Amnesia Dissociative Identity A-Avoidance coping: defence mechanism to escape
• inability to remembers Disorder unbearable emotions
important personal • formerly known as U- Unresolved grief/ loss: sudden death of a loved
experiences multiple personality one, abandonment issues
• fugue experience is where disorder M- Mind Fragmentation: splitting of identity or
the client suddenly moves • The client displays two memory to protect from overwhelming pain
to a new geographic or more distinct A- Altered Consciousness: using dissociation to
location with no memory identities or personality escape reality, often linked to PTSD
of past events and often states that recurrently
the assumption of a new take control of their ❖ TREATMENT
identity behavior THINK: STABLE
Depersonalization disorder Derealization disorder S- Safet and support:
• persistent or recurrent • sensation of being in a
• nurse can help the client learn to go to a
feeling of being detached dream-like state in safe place during destructive thoughts
from their mental which the environment
and impulses so that they can calm down
processes or body seems foggy or unreal and wait until they pass
• a feeling of detachment • detachment from the T- Therapy:
from own self world
• CBT
• Dialectical Behavior Therapy- for
❖ SIGNS & SYMPTOMS
emotional regulation
• EMDR- helps process trauma
(+) = Depersonalization, Derealization, Fragmented A- Avoid triggers and encourage grounding
reality, intrusive memories/ flashbacks technique:
(-)= Amnesia (Dissociative amnesia), Emotional • Breathing techniques
numbness, Loss of voluntary control, Loss of identity • Reduce exposure to stressors
