Which of the following psychological symptoms would the nurse expect to find in a hospitalized client who is the only survivor of a train accident?
A. Denial
B. Indifference
C. Perfectionism
D. Trust
Correct Answer: A. Denial
Denial can act as a protective response. If a situation is just too much to handle, the person may respond by refusing to perceive it or by denying that it exists. Many people use denial in their everyday lives to avoid dealing with painful feelings or areas of their life they don’t wish to admit. This is a primitive and dangerous defense – no one disregards reality and gets away with it for long! It can operate by itself or, more commonly, in combination with other, more subtle mechanisms that support it.
Option B: The client tends to be overwhelmed and disorganized by the trauma, not indifferent to it. The symptoms of PTSD include persistently re-experiencing the traumatic event, intrusive thoughts, nightmares, flashbacks, dissociation(detachment from oneself or reality), and intense negative emotional (sadness, guilt) and physiological reaction on being exposed to the traumatic reminder. Furthermore, problems with sleep and concentration, irritability, increased reactivity, increased startle response, hypervigilance, avoidance of traumatic triggers also occur. There is a significant impairment in social, occupational, and other areas of functioning.
Option C: Perfectionism is more commonly seen in clients with eating disorders, not in clients with PTSD. Perfectionism–the tendency to hold unrealistically high standards–has been implicated in the development of and maintenance of eating disorders. Clinical perfectionism is a primary target of intervention in Cognitive Behavioral Therapy (CBT-E), the leading treatment for adults with eating disorders. Studies have shown that patients with anorexia nervosa and bulimia nervosa have higher levels of perfectionism than control subjects.
Option D: Clients who have had a severe trauma often experience an inability to trust others. The initial step in the diagnosis of posttraumatic stress disorder is to obtain a detailed history. It is challenging for the patient at times to describe the nature and severity of the traumatic event, and they may choose to avoid mentioning it. However, the presentation and the duration of the symptoms are useful in making an accurate diagnosis. The health care workers must inquire about any depressive or anxiety symptoms, suicidal ideation or previous attempts, substance abuse, access to firearms.