Immigration

&
PTSD
Tammy Shaffer Ed.D., LPCC, LPC, NCC, ACS,
KCA Conference
October 26, 2007
 Interest in
Trauma Research
U.S. Census Bureau, 2000.
 One in four low-income
children lives in an immigrant
family (Urban Institute 2001).
 Three in five low-income non-
citizens are uninsured (Brown
et al. 1999).
 One in five K-12 school
children is an immigrant or
has an immigrant parent
(Hernandez et al. 1998).
Hippocrates – 400’s BC
 A crisis is a sudden
state that gravely
endangers life.
Sigmund Freud
1920

Trauma occurs when the ego is

overwhelmed “as a consequence
of an extensive breach being
made in the protective shield
against stimuli.”
History of Posttraumatic
Stress Disorder

 Civil war
 Nostalgia
 World war I
 Shell shock
 World war II
 Battle fatigue
 Vietnam
 Thousand mile
stare

PTSD – DSM-III (1980)

Accident vs. Disaster

 “…in a disaster, the social

structure and processes are
affected sufficiently to threaten
the existence and functioning of
the community.
 Theresource needs are greater
than the resources available.”

Eranen & Liebkind, cited in Ursano, Fullerton, & Norwoo

 High Risk Groups

 Rescue workers and heroes

 Injured

 Children
 Initial Intervention

 Safety
 Respite
 Physiological recovery
 Easing symptoms
 Food and water
 Outreach programs

Ursano et al., 1998.

 Later Interventions

 Differential diagnosis
 Debriefing
 Psychotherapy

 Individual, Family, or Group

 Treatmentfor disorders
 Media-based recovery education

(Ursano et al., 1995)

Disaster Exposure

 Lifetime U.S. Prevalence

39.1% 1
 Survivor PTSD 3% - 58%1
 Risk of developing PTSD in
course of emergency
worker career = 16%2
1
DSM IV, 1994
2
Everly & Mitchell, 1993
Determinants of
Trauma Severity

 Type of disaster
 Degree of sustained injury
 Amount of damage
 Degree of life threatened
 Duration of community disruption
 Attribution of meaning
Psychiatric Responses to
Disaster
Organic mental Posttraumatic
disorders stress disorder
Acute stress Major depression
disorder
Adjustment Generalized
disorder anxiety disorder
Alcohol abuse Drug abuse
 PTSD Time Frame
Specify if:
• Acute: if duration of symptoms is less than 3
months

• Chronic: if duration of symptoms is 3 months or

more

Specify if:
• With Delayed Onset: if onset of symptoms is at
least 6 months after the stressor
 Symptoms of PTSD
 Repeated dreams or
recurrent flashbacks
 Traumatic dreams
 Sleeping problems
 Psychological numbing
 Intense distress if exposed
to anything resembling the
event
 Anger outbursts
 Hypervigalence
 Symptoms of PTSD (cont’d)
 A preoccupation with possible unknown threats
 Chronic physical symptoms
 Pain
 Headache
 irritable bowel

 Efforts to avoid people or activities that may

arouse recollection of the trauma
 Feelings of guilt

 No sense of a future
 Common Feelings &
Behaviors of Children
 Fears and anxieties
 Sleep disturbances

 School avoidance

 Somatic complaints

 Feelings of loss

 Regression

 Restricted range of affect

DSM -IV-TR, 2000
Stressor
 An agent,
 condition,
 or other stimulus
 that causes stress
to
 an organism.

American Heritage Dictionary

Distress

Seyle
Eustress

Seyle
PTSD and
Refugees/Immigrants
 Many refugees/immigrants have
experienced …
 Traumatic events in their country of
origin
• Humiliation, torture, starvation, illness
 Exodus of their country
 Refugee camps

(Taylor, 2006)
Narrative Exposure Therapy
(NET) with Refugees
 4 sessions (90 minute sessions)
 Psychoeducation—problem-solving
about current concerns
 Recording client’s biography of
traumatic events
 Discussion of traumatic events—client
asked to relive distressing emotions
 Client given a copy of the biography
and discussion

(Taylor, 2006)
80

70

60

50

40
% with PTSD after 4
sessions
30

20

10

0
NET Couns. Psycho-
ed

(Taylor, 2006)
Benefits of NET with
Refugees/Immigrants
 Willing to enter treatment
 Fewer drop-outs

 Efficacy with traumatized children

(Taylor, 2006)
 Implications for School
Counselors
 Classroom behavior
 Repetitive play reenacting event/theme
 Disorganized or agitated behavior
 Academic Performance
 Increased need for counseling services
 Family and school integration
 Awareness of psychopharmacology
 Educate faculty
 Flexibility
 Easing transitions
Resources

 Professional Organizations
 Colleagues

 Libraries

 Internet

Yourself
What Did I Learn?
Questions