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.