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Recent Burn Injuries Survivors and Families
Christopher JamesMFTI, PsyD StudentWorld Burn Congress10/23/2015
Before We Get Started…
Three things to keep in mind -
1.Normalizing not Stigmatizing
2.NO direct causation
3.Symptoms not disorders
BackgroundRoughly 6.5 million burn injuries a year (2002)
According to ABA, 450,000 receive hospitalization or some form of medical intervention, and 10% require hospitalization
With more advances in technology, serious burn injuries are being treated more effectively, thus there are higher rates of those who survive
Overall mortality rates have decreased to 5-6% in the western world
Mental Health PrevalenceAccording to a Dutch Study in 2011 (Van Loey) 39% of burn survivors had at least one psychiatric disorder in the 12 months after injury, opposed to only 14% of general trauma population (comorbid disorder common as well)
Most common (over 10%)Specific Phobia, Generalized anxiety, Major Depression
Less CommonPTSD, Hypochondriasis, Agoraphobia, Panic Disorder, Eating Disorders
Mental Health Prevalence
Prevalence Rates Continued -
PTSD – 15-45%Some studies show up to 1/3 of burn survivors
Acute Stress Disorder – 19-33%
Depression – 13%*
Substance Use Disorders – 27%*
Panic Disorder – 5.4%*
Psychotic Disorders – 7.6%*
*2010 Finnish Study
Predisposing FactorsSize and severity not a good predictor -
Those with facial and hand (visible scaring) have shown higher prevalence for symptoms
More prone to psychological stress if –Female gender, Early childhood trauma, Previous trauma, Prior mental
health issues, Genetic history of mental issues, Avoidant coping, Neuroticism, Low social support, Homelessness or familial disruptions
More Blame of others = more stress
Mental Health DemystifiedBased on DSM (Diagnostic and Statistical Manual)
Meant as a way to help mental health professionals communicate Simply lists of symptoms like a physical ailment that makes up a
(somewhat) complete picture of what a person may be going through Most important, ask yourself, what might some of my symptoms be?
How does the body and mind react? Difference between Sympathetic and Parasympathetic
Mental Health Diagnoses
Major Depression DisorderNeed five or more for 2-week period where at least one symptom is either depressed mood or loss of interest or pleasure (1 or 2)
Depressed mood most of the day nearly every dayLoss of pleasureLoss or gain of body weightInsomnia or hypersomniaPsychomotor agitation or retardationFatigue or loss of energyFeelings of worthlessness or inappropriate guiltDiminished ability to concentrate, or indecisive Recurrent thoughts of
death, or suicide (attempts or plan)
Mental Health DiagnosesGeneralized Anxiety DisorderExcessive anxiety for at least 6 months, about a number of activities
Difficult to control worry
Three or more of the following lasting more days than notRestlessness or feeling keyed up or on edgeBeing easily fatiguedDifficulty concentrating or mind going blankIrritabilityMuscle tensionSleep disturbance
Mental Health Diagnoses
Panic DisorderRecurrent panic attacks with four or more of the following symptoms
Palpitations, Sweating, Trembling or shakingSensations of shortness of breath or smotheringFeelings of choking, Chest pain or discomfortNausea or abdominal distressFeeling dizzy, light-headed, or faint, Chills or heat sensations,
Paresthesias , DerealizationFear of losing control or going crazy, Fear of dying
Mental Health Diagnoses
Panic Disorder (con’t.)At least one of the attacks has been followed by one month or more of one or both of the following -
Persistent concern or worry about additional panic attacks or their consequences
Maladaptive change in behavior (avoiding situations that might cause panic attacks
Mental Health Diagnoses
POST TRAUMATIC STRESS DISORDERExposure to actual or threatened death, injury, or sexual violence
Directly experiencing the traumatic eventsWitnessing, in person, the event(s) as it occurred to othersLearning about the event from a friend or family member (person must
have had life threatened)Experiencing repeated traumatic events (first responders, veterans)
Four distinctive characteristics for more than one month
Mental Health Diagnoses
PTSD (con’t.)One or more of the following INTRUSIVE symptoms
Distressing memories
Distressing dreams
Dissociative flashbacks (recurrence of event)
Distress at any cue or trigger that reminds you of event
Physiological reactions to anything that reminds you of event
Mental Health Diagnoses
PTSD (con’t.)
AVOIDANCE of stimuli (need one or both)
Avoiding thoughts or memories associated with the trauma
Avoiding people, places or things that may remind you of the event
Mental Health Diagnoses
PTSD (con’t.)Negative cognitions or Mood Alterations (need at least two of the following) -
Inability to remember important aspect of traumatic eventNegative beliefs about oneself (“I am bad” or “no one can be trusted”)Distortions in thinking that lead to self-blame or blaming of othersPersistent negative emotional state (fear, anger, guilt, shame)Disinterest in participation in activities previously enjoyedFeelings of detachment or estrangement from othersDifficulty experiencing positive emotions
Mental Health Diagnoses
PTSD (con’t.)HYPERAROUSAL, need two or more
Irritability or angry outburstsReckless or self-destructive behaviorHypervigilanceExaggerated startle responseProblems concentratingSleep disturbance
Physical ChallengesConstant Surgeries/procedures
Itching
Pain Management
Medication Management
Immobility
What else? You name it…
Other ChallengesOccupational/educational – Difficulty taking risks and challenging
oneself.Extraordinary burden of monetary setbacks due to hospital billsDifficulties finding employment
Familial ChallengesSetting appropriate boundariesHow do you communicate with loved ones?Regression?
Romantic/IntimacySelf-image/esteem
Small Group Discussion
What are your specific challenges as a burn survivor?
Break up into small groups.
Have each person share their burn story, and discuss certain challenges you’ve had as a burn survivor or supporter
Large Group Discussion
How do we cope with all these issues?
RE-authoring your narrative… HOW can you tell your story? When is the best time?
Resources – Mental health, other Burn Survivors (organizations)
Post Traumatic GrowthSimilar to optimism and resiliency
The idea is that someone who has experienced great struggle may have certain strengths in one of many different domains beyond non-challenged others:
Greater appreciation for lifeWarmer to othersMore intimate in relation with othersGreater sense of personal strengthRecognition of new possibilitiesSpiritual development
Post Traumatic GrowthActive coping style, social support, and female gender strongest
predictors of PTG for burn survivors
Subjective experience of event, such as perceived helplessness (control over event) rather than event itself, has more influence over PTG
Those with spiritual connection experienced greater PTG
We must ACCEPT injury, and strengthen narrative before we can begin to offer others hope
ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual
of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Askay, S.W., Magyar-Russell, G. (2009). Post-traumatic growth and spirituality in burn recovery. International Review of Psychiatry, 21 (6): 570-579.
Davydow, D.S., Katon, W.J., Zatzick, D.F., (2009). Psychiatric morbidity and functional impairments in survivors of burns, traumatic injuries, and ICU stays for other critical illnesses: A review of the literature. International Review of Psychiatry; 21 (6): 531-538.
Klinge K., Chamberlain D.J., Redden M. & King L. (2009) Psychological adjustments made by postburn injury patients: an integrative literature review. Journal of Advanced Nursing 65 (11), 2274-2292. doi: 10.1111/j.1365-2009.05138.x
ReferencesMcKibben, J.B.A., Bresnick, M.G., Wiechman Askay, S.A., Fauerbach, J.A.,
(2008). Acute Stress Disorder and Posttraumatic Stress Disorder: A Prospective Study of Prevalence, Course, and Predictors in a Sample With Major Burn Injuries. American Burn Association. 1559-047X/2008.
Palmu, R., Suominen, K., Vuola, J., Isometsa, E., (2010). Mental disorder after burn injury: A prospective study. Burns. 37, 601-609.
Ter Smitten, M.H., De Graaf, R. Van Loey, N.E., (2010). Prevalence and co-morbidity of psychiatric disorders 1-4 years after burn. Burns. 37, 753-761.
Van Loey, N.E.E., Van Son, M.J.M, Van Der Heijden, P.G.M., Ellis, I.M., (2008). PTSD in persons with attributed responsibility, negative and positive emotional states. Burns 34. 1082-1089.