Recent Burn Injuries
Survivors and Families
Christopher James
MFTI, PsyD Student
World Burn Congress
10/23/2015
Before We Get Started…
Three things to keep in mind 1.Normalizing not Stigmatizing
2.NO direct causation
3.Symptoms not disorders
Background
Roughly 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 Prevalence
According 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 Common
PTSD, 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 Factors
Size 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 Demystified
Based 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 Disorder
Need 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 day
Loss of pleasure
Loss or gain of body weight
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Diminished ability to concentrate, or indecisive Recurrent thoughts of death, or
suicide (attempts or plan)
Mental Health Diagnoses
Generalized Anxiety Disorder
Excessive 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 not
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance
Mental Health Diagnoses
Panic Disorder
Recurrent panic attacks with four or more of the following symptoms
Palpitations, Sweating, Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking, Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, light-headed, or faint, Chills or heat sensations, Paresthesias ,
Derealization
Fear 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 DISORDER
Exposure to actual or threatened death, injury, or sexual violence
Directly experiencing the traumatic events
Witnessing, in person, the event(s) as it occurred to others
Learning 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 event
Negative beliefs about oneself (“I am bad” or “no one can be trusted”)
Distortions in thinking that lead to self-blame or blaming of others
Persistent negative emotional state (fear, anger, guilt, shame)
Disinterest in participation in activities previously enjoyed
Feelings of detachment or estrangement from others
Difficulty experiencing positive emotions
Mental Health Diagnoses
PTSD (con’t.)
HYPERAROUSAL, need two or more
Irritability or angry outbursts
Reckless or self-destructive behavior
Hypervigilance
Exaggerated startle response
Problems concentrating
Sleep disturbance
Physical Challenges
Constant Surgeries/procedures
Itching
Pain Management
Medication Management
Immobility
What else? You name it…
Other Challenges
Occupational/educational – Difficulty taking risks and challenging oneself.
Extraordinary burden of monetary setbacks due to hospital bills
Difficulties finding employment
Familial Challenges
Setting appropriate boundaries
How do you communicate with loved ones?
Regression?
Romantic/Intimacy
Self-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 Growth
Similar 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 life
Warmer to others
More intimate in relation with others
Greater sense of personal strength
Recognition of new possibilities
Spiritual development
Post Traumatic Growth
Active 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
References
American 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
References
McKibben, 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.