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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterward. The severity of these symptoms depends on the person, the type of trauma involved, and the emotional support they receive from others. Reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them.
After a traumatic experience, a person may re-experience the trauma mentally and physically, hence trauma reminders, also called triggers, can be uncomfortable and even painful. It can damage people’s sense of safety, self, self-efficacy, as well as the ability to regulate emotions and navigate relationships. They may turn to psychoactive substances including alcohol to try to escape or dampen the feelings. These triggers cause flashbacks, which are dissociative experiences where the person feels as though the events is reoccurring. They can range from distracting to complete dissociation or loss of awareness of the current context. Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience.
Triggers and cues act as reminders of the trauma, and can cause anxiety and other associated emotions. Often the person can be completely unaware of what these triggers are. In many cases this may lead a person suffering from traumatic disorders to engage in disruptive or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Panic attacks are an example of a psychosomatic response to such emotional triggers.
Consequently, intense feelings of anger may frequently surface, sometimes in inappropriate or unexpected situations, as danger may always seem to be present, as much as it is actually present and experienced from past events. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. Trauma doesn't only cause changes in one's daily functions but could also lead to morphological changes. Such epigenetic changes can be passed on to the next generations, thus making genetics as one of the components of the causes of psychological trauma. However, some people are born with or later develop protective factors such as genetics and sex that help lower their risk of psychological trauma.
The person may not remember what actually happened, while emotions experienced during the trauma may be re-experienced without the person understanding why (see Repressed memory). This can lead to the traumatic events being constantly experienced as if they were happening in the present, preventing the subject from gaining perspective on the experience. This can produce a pattern of prolonged periods of acute arousal punctuated by periods of physical and mental exhaustion. This can lead to mental health disorders like acute stress and anxiety disorder, traumatic grief, undifferentiated somatoform disorder, conversion disorders, brief psychotic disorder, borderline personality disorder, adjustment disorder...etc.
In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult or impossible. Emotional detachment, as well as dissociation or "numbing out", can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied, distant, or cold. Dissociation includes depersonalisation disorder, dissociative amnesia, dissociative fugue, dissociative identity disorder, etc. Exposure to and re-experiencing trauma can cause neurophysiological changes like slowed myelination, abnormalities in synaptic pruning, shrinking of the hippocampus, cognitive and affective impairment. This is significant in brain scan studies done regarding higher order function assessment with children and youth who were in vulnerable environments.
Some traumatized people may feel permanently damaged when trauma symptoms do not go away and they do not believe their situation will improve. This can lead to feelings of despair, transient paranoid ideation, loss of self-esteem, profound emptiness, suicidality, and frequently depression. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question. Often despite their best efforts, traumatized parents may have difficulty assisting their child with emotion regulation, attribution of meaning, and containment of post-traumatic fear in the wake of the child's traumatization, leading to adverse consequences for the child. In such instances, it is in the interest of the parent(s) and child for the parent(s) to seek consultation as well as to have their child receive appropriate mental health services.
Psychological trauma is a type of damage to the mind that occurs as a result of a severely distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope, or integrate the emotions involved with that experience. A traumatic event involves one's experience, or repeating events of being overwhelmed that can be precipitated in weeks, years, or even decades as the person struggles to cope with the immediate circumstances, eventually leading to serious, long-term negative consequences.
However, trauma differs between individuals, according to their subjective experiences. People will react to similar events differently. In other words, not all people who experience a potentially traumatic event will actually become psychologically traumatized. However, it is possible to develop posttraumatic stress disorder (PTSD) after being exposed to a potentially traumatic event.
This discrepancy in risk rate can be attributed to protective factors some individuals may have that enable them to cope with trauma; they are related to temperamental and environmental factors. Some examples are mild exposure to stress early in life, resilience characteristics, and active seeking of help.
Symptoms of PTSD generally begin within the first 3 months after the inciting traumatic event, but may not begin until years later. In the typical case, the individual with PTSD persistently avoids trauma-related thoughts and emotions, and discussion of the traumatic event, and may even have amnesia of the event. However, the event is commonly relived by the individual through intrusive, recurrent recollections, flashbacks, and nightmares. While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder).
Posttraumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk for suicide and intentional self-harm.
Most people who have experienced a traumatic event will not develop PTSD. People who experience interpersonal trauma (for example rape or child abuse) are more likely to develop PTSD, as compared to people who experience non-assault based trauma such as accidents and natural disasters. About half of people develop PTSD following rape. Children are less likely than adults to develop PTSD after trauma, especially if they are under ten years of age. Diagnosis is based on the presence of specific symptoms following a traumatic event.
Prevention may be possible when therapy is targeted at those with early symptoms but is not effective when carried out among all people following trauma. The main treatments for people with PTSD are counselling and medication. A number of different types of therapy may be useful. This may occur one-on-one or in a group. Antidepressants of the selective serotonin reuptake inhibitor type are the first-line medications for PTSD and result in benefit in about half of people. These benefits are less than those seen with therapy. It is unclear if using medications and therapy together has greater benefit. Other medications do not have enough evidence to support their use and in the case of benzodiazepines may worsen outcomes.
In the United States about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life. In much of the rest of the world, rates during a given year are between 0.5% and 1%. Higher rates may occur in regions of armed conflict. It is more common in women than men. Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks. During the World Wars study increased and it was known under various terms including "shell shock" and "combat neurosis". The term "posttraumatic stress disorder" came into use in the 1970s in large part due to the diagnoses of U.S. military veterans of the Vietnam War. It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-III).
The diagnosis of PTSD was originally developed for adults who had suffered from a single event trauma, such as rape, or a traumatic experience during a war. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, and a disruption in attachment to their primary caregiver. In many cases, it is the child's caregiver who caused the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child’s development.
The term developmental trauma disorder (DTD) has also been suggested. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be characterized by subjective events like betrayal, defeat or shame.
Repeated traumatization during childhood leads to symptoms that differ from those described for PTSD. Cook and others describe symptoms and behavioural characteristics in seven domains:
- "Attachment" – "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others' emotional states"
- "Biology" – "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
- "Affect or emotional regulation" – "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
- "Dissociation" – "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
- "Behavioural control" – "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
- "Cognition" – "difficulty regulating attention, problems with a variety of 'executive functions' such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with 'cause-effect' thinking, and language developmental problems such as a gap between receptive and expressive communication abilities."
- "Self-concept" – "fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".
Early childhood trauma refers to psychological trauma experienced in early childhood, in a critical developmental period in a child’s life spanning from conception to the age of five. Trauma experienced in early childhood can manifest across the lifespan and is believed to be associated with a variety of health problems in later life.
Development of psychological resilience is believed to significantly reduce the effects of a childhood trauma on a child’s development.
Adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization as children as well as prolonged trauma as adults. This early injury interrupts the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or older siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon.
This can become a pervasive way of relating to others in adult life described as insecure attachment. The diagnosis of dissociative disorder and PTSD in the current DSM-5 (2013) do not include insecure attachment as a symptom. Individuals with Complex PTSD also demonstrate lasting personality disturbances with a significant risk of revictimization.
Six clusters of symptoms have been suggested for diagnosis of C-PTSD:
- alterations in regulation of affect and impulses;
- alterations in attention or consciousness;
- alterations in self-perception;
- alterations in relations with others;
- somatization;
- alterations in systems of meaning.
Experiences in these areas may include:
- Difficulties regulating emotions, including symptoms such as persistent dysphoria, chronic suicidal preoccupation, self injury, explosive or extremely inhibited anger (may alternate), or compulsive or extremely inhibited sexuality (may alternate).
- Variations in consciousness, including forgetting traumatic events (i.e., psychogenic amnesia), reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation), or having episodes of dissociation.
- Changes in self-perception, such as a chronic and pervasive sense of helplessness, paralysis of initiative, shame, guilt, self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings.
- Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge, idealization or paradoxical gratitude, seeking approval from the perpetrator, a sense of a special relationship with the perpetrator or acceptance of the perpetrator's belief system or rationalizations.
- Alterations in relations with others, including isolation and withdrawal, persistent distrust, anger and hostility, a repeated search for a rescuer, disruption in intimate relationships and repeated failures of self-protection.
- Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.
- Disconnection from surroundings accompanied by feelings of terror and confusion.
Symptoms show considerable variation but usually include:
An initial state of "DAZE" with some constriction of the field of consciousness and narrowing of attention, inability to comprehend stimuli, disorientation. Followed either by further withdrawal from the surrounding situation to the extent of a dissociative stupor or by agitating and over activity.
The signs are: Tachycardia (increased heart rate), Sweating, Hyperventilation (increased breathing).
The symptoms usually appear within minutes of the impact of the stressful stimulus and disappear within 2–3 days.
Traumatic brain injury (TBI) is an exchangeable word used for the word concussion. This term refers to a mild brain injury. This injury is a result due to a blow to the head that could make the person’s physical, cognitive, and emotional behaviors irregular. Symptoms may include clumsiness, fatigue, confusion, nausea, blurry vision, headaches, and others. Mild concussions are associated with sequelae. Severity is measured using various concussion grading systems.
A slightly greater injury is associated with both anterograde and retrograde amnesia (inability to remember events before or after the injury). The amount of time that the amnesia is present correlates with the severity of the injury. In all cases the patients develop postconcussion syndrome, which includes memory problems, dizziness, tiredness, sickness and depression. Cerebral concussion is the most common head injury seen in children.
Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull. Head injuries can be closed or open. A closed (non-missile) head injury is where the dura mater remains intact. The skull can be fractured, but not necessarily. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small, specific area. A head injury may cause skull fracture, which may or may not be associated with injury to the brain. Some patients may have linear or depressed skull fractures.If intracranial hemorrhage occurs, a hematoma within the skull can put pressure on the brain. Types of intracranial hemorrhage include subdural, subarachnoid, extradural, and intraparenchymal hematoma. Craniotomy surgeries are used in these cases to lessen the pressure by draining off blood.
Brain injury can occur at the site of impact, but can also be at the opposite side of the skull due to a "contrecoup" effect (the impact to the head can cause the brain to move within the skull, causing the brain to impact the interior of the skull opposite the head-impact). If the impact causes the head to move, the injury may be worsened, because the brain may ricochet inside the skull causing additional impacts, or the brain may stay relatively still (due to inertia) but be hit by the moving skull (both are contrecoup injuries).
Specific problems after head injury can include
A gunshot wound (GSW) is a form of physical trauma sustained from the discharge of arms or munitions. The most common forms of ballistic trauma stem from firearms used in armed conflicts, civilian sporting, recreational pursuits and criminal activity. Ballistic trauma can be fatal or cause long-term consequences.
Emotional detachment, in psychology, can mean two different things.
Emotional detachment can be a positive behavior which allows a person to react calmly to highly emotional circumstances/ individuals. Emotional detachment in this sense is a decision to avoid engaging emotional connections, rather than an inability or difficulty in doing so, typically for personal, social, or other reasons. In this sense it can allow people to maintain boundaries, psychic integrity and avoid undesired impact by or upon others, related to emotional demands. As such it is a deliberate mental attitude which avoids engaging the emotions of others.
This detachment does not necessarily mean avoiding empathy; rather it allows the person space needed to rationally choose whether or not to be overwhelmed or manipulated by such feelings. Examples where this is used in a positive sense might include emotional boundary management, where a person avoids emotional levels of engagement related to people who are in some way emotionally overly demanding, such as difficult co-workers or relatives, or is adopted to aid the person in helping others such as a person who trains himself to ignore the "pleading" food requests of a dieting spouse, or indifference by parents towards a child's begging.
Emotional detachment can also be used to describe what is often considered "emotional numbing", "emotional blunting", i.e., dissociation, depersonalization or in its chronic form depersonalization disorder. This type of emotional numbing or blunting is a disconnection from emotion, it is frequently used as a coping/ survival skill during traumatic childhood events such as abuse or severe neglect. Over time and with much use, this can become second nature when dealing with day to day stressors.
Emotional detachment often arises from psychological trauma and is a component in many anxiety and stress disorders. The person, while physically present, moves elsewhere in the mind, and in a sense is "not entirely present", making them sometimes appear preoccupied.
Thus, such detachment is often not as outwardly obvious as other psychiatric symptoms; people with this problem often have emotional systems that are in overdrive. They may have a hard time being a loving family member. They may avoid activities, places, and people associated with any traumatic events they have experienced. The dissociation can also lead to lack of attention and, hence, to memory problems and in extreme cases, amnesia.
A fictional description of the experience of emotional detachment experienced with dissociation and depersonalization was given by Virginia Woolf in "Mrs Dalloway". In that novel the multifaceted sufferings of a war veteran, Septimus Warren Smith, with post-traumatic stress disorder (as this condition was later named) including dissociation, are elaborated in detail. One clinician has called some passages from the novel "classic" portrayals of the symptoms.
There may be more than one reason to account for emotional detachment.
It is known that SSRI (selective serotonin reuptake inhibitor) antidepressants, after taken for a while or taken one after another (if the doctor is trying to see what works), can cause what is called "emotional blunting". In this instance, the individual in question is often unable to cry, even if he or she wants to.
In other cases, the person may seem fully present but operate merely intellectually when emotional connection would be appropriate. This may present an extreme difficulty in giving or receiving empathy and can be related to the spectrum of narcissistic personality disorder.
Emotional detachment also allows acts of extreme cruelty, such as torture and abuse, supported by the decision to not connect empathically with the person concerned. Social ostracism, such as shunning and parental alienation, are other examples where decisions to shut out a person creates a psychological trauma for the shunned party.
Considering these different definitions, the decision as to whether emotional detachment in any given set of circumstances is considered to be a positive or negative mental attitude is a subjective one, and therefore a decision on which different people may not agree.
Injury is damage to the body caused by external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or death.
In 2013, 4.8 million people died from injuries, up from 4.3 million in 1990. More than 30% of these deaths were transport-related injuries. In 2013, 367,000 children under the age of five died from injuries, down from 766,000 in 1990. Injuries are the cause of 9% of all deaths, and are the sixth-leading cause of death in the world.
The World Health Organization (WHO) developed the International Classification of External Causes of Injury (ICECI). Under this system, injuries are classified by
- mechanism of injury;
- objects/substances producing injury;
- place of occurrence;
- activity when injured;
- the role of human intent;
and additional modules. These codes allow the identification of distributions of injuries in specific populations and case identification for more detailed research on causes and preventive efforts.
The United States Bureau of Labor Statistics developed the Occupational Injury and Illness Classification System (OIICS). Under this system injuries are classified by
- nature,
- part of body affected,
- source and secondary source, and
- event or exposure.
The OIICS was first published in 1992 and has been updated several times since.
The Orchard Sports Injury Classification System (OSICS) is used to classify injuries to enable research into specific sports injuries.
Trauma affects all children differently (see Stress in early childhood). Some children who experience trauma develop significant and long-lasting problems, while others may have minimal symptoms and recover more quickly. Studies have found that despite the broad impacts of trauma, children can and do recover, and that trauma-informed care and interventions produce better outcomes than “treatment as usual”. Trauma-informed care is defined as offering services or support in a way that addresses the special needs of people who have experienced trauma.
Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation, as a defence mechanism, pathologically and involuntarily. Dissociative disorders are sometimes triggered by psychological trauma, but may be preceded only by stress, psychoactive substances, or no identifiable trigger at all.
The dissociative disorders listed in the American Psychiatric Association's DSM-5 are as follows:
- Dissociative identity disorder (formerly multiple personality disorder): the alternation of two or more distinct personality states with impaired recall among personality states. In extreme cases, the host personality is unaware of the other, alternating personalities; however, the alternate personalities can be aware of all the existing personalities. This category now includes the old derealization disorder category.
- Dissociative amnesia (formerly psychogenic amnesia): the temporary loss of recall memory, specifically episodic memory, due to a traumatic or stressful event. It is considered the most common dissociative disorder amongst those documented. This disorder can occur abruptly or gradually and may last minutes to years depending on the severity of the trauma and the patient.
- Dissociative fugue (formerly psychogenic fugue) is now subsumed under the dissociative amnesia category. It is described as reversible amnesia for personal identity, usually involving unplanned travel or wandering, sometimes accompanied by the establishment of a new identity. This state is typically associated with stressful life circumstances and can be short or lengthy.
- Depersonalization disorder: periods of detachment from self or surrounding which may be experienced as "unreal" (lacking in control of or "outside" self) while retaining awareness that this is only a feeling and not a reality.
- The old category of dissociative disorder not otherwise specified is now split into two: Other specified dissociative disorder, and unspecified dissociative disorder. These categories are used for forms of pathological dissociation that do not fully meet the criteria of the other specified dissociative disorders, or if the correct category has not been determined.
Both dissociative amnesia and dissociative fugue usually emerge in adulthood and rarely occur after the age of 50. The ICD-10 classifies conversion disorder as a dissociative disorder while the DSM-IV classifies it as a somatoform disorder.
Birth trauma (BT) refers to damage of the tissues and organs of a newly delivered child, often as a result of physical pressure or trauma during childbirth. The term also encompasses the long term consequences, often of a cognitive nature, of damage to the brain or cranium. Medical study of birth trauma dates to the 16th century, and the morphological consequences of mishandled delivery are described in Renaissance-era medical literature. Birth injury occupies a unique area of concern and study in the medical canon. In ICD-10 "birth trauma" occupied 49 individual codes (P10-Р15).
However, there are often clear distinctions to be made between brain damage caused by birth trauma and that induced by intrauterine asphyxia. It is also crucial to distinguish between "birth trauma" and "birth injury". Birth injuries encompass any systemic damages incurred during delivery (hypoxic, toxic, biochemical, infection factors, etc.), but "birth trauma" focuses largely on mechanical damage. Caput succedaneum, subcutaneous hemorrhages, small subperiostal hemorrhages, hemorrhages along the displacements of cranial bones, intradural bleedings, subcapsular haematomas of liver, are among the more commonly reported birth injuries. Birth trauma, on the other hand, encompasses the enduring side effects of physical birth injuries, including the ensuing compensatory and adaptive mechanisms and the development of pathological processes (pathogenesis) after the damage.
A sequela (, ; usually used in the plural, sequelae) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Typically, a sequela is a chronic condition that is a complication which follows a more acute condition. It is different from, but is a consequence of, the first condition. Timewise, a sequela contrasts with a late effect, where there is a period, sometimes as long as several decades, between the resolution of the initial condition and the appearance of the late effect.
In general, non-medical usage, the terms "sequela" and "sequelae" mean consequence and consequences.
Chronic kidney disease, for example, is sometimes a sequela of diabetes, "chronic constipation" or more accurately "obstipation" (that is, difficulty in passing stool) is a sequela to an intestinal obstruction, and neck pain is a common sequela of whiplash or other trauma to the cervical vertebrae. Post-traumatic stress disorder may be a psychological sequela of rape. Sequelae of traumatic brain injury include headache and dizziness, anxiety, apathy, depression, aggression, cognitive impairments, personality changes, mania, psychosis.
Some conditions may be diagnosed retrospectively from their sequelae. An example is pleurisy.
Other examples of sequelae include those following neurological injury; including aphasia, ataxia, hemi- and quadriplegia, and any number of other changes that may be caused by neurological trauma. Note that these pathologies can be related to both physical and chemical traumas, as both can cause lingering neuron damage.
The phrase "status post", abbreviated in writing as "s/p", is used to discuss sequelae with reference to their cause. Clinicians typically use the phrase to refer to acute traumatic conditions. For example: "the patient had neck pain "status post" a motor vehicle accident".
Rheumatic fever is a nonsuppurative sequela of a primary infection of group A "Streptococcus" bacteria. Glomerulonephritis can also be a sequela of "Streptococcus pyogenes".
Onset of symptoms may be after just a few minutes, but usually occurs after at least 20 minutes of free hanging. Typical symptoms are pallor, sweating, shortness of breath, blurred vision, dizziness, nausea, hypotension and numbness of the legs. Eventually it leads to fainting, which may result in death due to oxygen deprivation of the brain.
The most common cause is accidents in which the person remains motionless suspended in a harness for longer periods of time. Motionlessness may have several causes including fatigue, hypoglycemia, hypothermia or traumatic brain injury.
Dissociative identity disorder (multiple personality disorder)
Cause: People with dissociative identity disorder usually have close relatives who have also had similar experiences.
Treatment: Long-term psychotherapy that helps the patient merge his/her multiple personalities into one personality. “The trauma of the past has to be explored and resolved with proper emotional expression. Hospitalization may be required if behavior becomes bizarre or destructive”. Dissociative identity disorder has a tendency to recur over a period of several years, and may become less of a problem after mid-life.
Dissociative amnesia
Cause: A way to cope with trauma.
Treatment: Psychotherapy (e.g. talk therapy) counseling or psychosocial therapy which involves talking about your disorder and related issues with a mental health provider. Psychotherapy often involves hypnosis (help you remember and work through the trauma); creative art therapy (using creative process to help a person who cannot express his or her thoughts); cognitive therapy (talk therapy to identify unhealthy and negative beliefs/behaviors); and medications (antidepressants, anti-anxiety medications or tranquilizers). These medications help control the mental health symptoms associated with the disorders, but there are no medications that specifically treat dissociative disorders. However, the medication Pentothal can sometimes help to restore the memories. The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation.
Dissociative fugue
Cause: A stressful event that happens in adulthood.
Treatment: Hypnosis is often used to help patient recall true identity and remember events of the past. Psychotherapy is helpful for the person who has traumatic, past events to resolve. Once dissociative fugue is discovered and treated, many people recover quickly. The problem may never happen again.
Depersonalization disorder
Cause: Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to chronic physical, sexual or emotional abuse or, less frequently, a home environment that is otherwise frightening or highly unpredictable; however, this disorder can also acutely form due to severe traumas such as war or the death of a loved one.
Treatment: Same treatment as dissociative amnesia, and same drugs. An episode of depersonalization disorder can be as brief as a few seconds or continue for several years.
The degree of tissue disruption caused by a projectile is related to the size of the temporary versus permanent cavity it creates as it passes through tissue. The extent of cavitation, in turn, is related to the following characteristics of the projectile:
- Kinetic energy: KE = 1/2"mv" (where "m" is mass and "v" is velocity). This helps to explain why wounds produced by missiles of higher mass and/or higher velocity produce greater tissue disruption than missiles of lower mass and velocity.
- Impulse: IMP = "mv". The impulse is working in a couple with kinetic energy, featuring the same characteristics
- Yaw
- Deformation
- Fragmentation
The immediate damaging effect of a gunshot wound is typically severe bleeding, and with it the potential for hypovolemic shock, a condition characterized by inadequate delivery of oxygen to vital organs. In the case of traumatic hypovolemic shock, this failure of adequate oxygen delivery is due to blood loss, as blood is the means of delivering oxygen to the body's constituent parts. Devastating effects can result when a bullet strikes a vital organ such as the heart or lungs, or damages a component of the central nervous system such as the spine or brain.
Common causes of death following gunshot injury include exsanguination, hypoxia caused by pneumothorax, catastrophic injury to the heart and larger blood vessels, and damage to the brain or central nervous system. Additionally, gunshot wounds typically involve a large degree of nearby tissue disruption and destruction due to the physical effects of the projectile. Non-fatal gunshot wounds frequently have severe and long-lasting effects, typically some form of major disfigurement and/or permanent disability.
Gunshot injuries can vary widely from case to case since the location of the injury can be in any part of the body, with wide variations in entry point. Also, the path and possible fragmentation of the bullet within the body is unpredictable. The study of the dynamics of bullets in gunshot injuries is called terminal ballistics.
As a rule, all gunshot wounds are considered medical emergencies that require immediate treatment. Hospitals are generally required to report all gunshot wounds to police.
This proposed subtype is characterized by depression occurring as a consequence of psychic, somatic or external stressors. Praag theorizes that if the individual's stress threshold is insufficient or overly sensitive, a prolonged stress response via the HPA axis can trigger anxiety followed by significant lowering of mood, the mechanisms of which act to reenforce each other, keeping the sufferer in a perpetual state of stress arousal, coupled with dysphoria; and that this occurs as a result of the stress response inhibiting the normal expression of neurotransmitters associated with wellbeing and pleasure. He proposes that sufferers may experience panic attacks, depersonalization and other psychic and somatic symptoms common to both anxiety and depression disorders.
According to van Praag, in Anxiety/Aggression-Driven Depression "...dysregulation of anxiety and/or aggression are primordial and mood lowering is a derivative phenomenon."