Case Scenario: Woman Is Admitted To The Adult Inpatient Bed

Case Scenarioa Woman Is Admitted To The Adult Inpatient Behavioral He

Case Scenario: A woman is admitted to the adult inpatient behavioral health unit after experiencing flashbacks to her rape that occurred when she was a 12-year-old girl while at her babysitter’s. She was raped by the babysitter’s 15-year-old son and three of his friends. Upon admission, the client is quiet, curled on her side in the fetal position on the bed, and rejecting of others who enter her room, shrinking to the far side of the bed whenever any person opens her door. Her sister, who accompanied her to the hospital, tells you that the client has been like this since a news story appeared last week about a young girl being abducted from a mall and beaten and raped by several teenage boys. The client has not eaten, slept, or gone to work since hearing the news account.

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The case of this woman depicts a complex presentation of trauma-related symptoms that align closely with post-traumatic stress disorder (PTSD). PTSD is a mental health condition that can develop after exposure to a traumatic event involving actual or threatened death, serious injury, or sexual violence. The symptoms observed in this client—such as emotional numbing, hyperarousal, avoidance behaviors, and intrusive flashbacks—are characteristic of PTSD and are consistent with her history of childhood sexual abuse and recent stress due to media reports on violence against children.

Her behavioral and psychological responses are indicative of her trauma reactivation. The fetal position, withdrawal from others, and refusal to communicate suggest emotional numbing and dissociation, common in PTSD. The triggering news story about a young girl being abducted and assaulted appears to have exacerbated her symptoms, implying a heightened state of arousal and re-experiencing of her past trauma. Her refusal to eat or sleep, and her withdrawal from social and occupational roles, reflect significant impairment and distress associated with her condition.

1. Trauma/Stress-Related Disorder

This patient is experiencing symptoms consistent with PTSD, a prevalent trauma and stressor-related disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PTSD manifests with intrusion symptoms (e.g., flashbacks, intrusive thoughts), avoidance of trauma-related stimuli, negative alterations in cognition and mood, and marked alterations in arousal and reactivity (American Psychiatric Association, 2013). Her flashbacks, emotional numbing, withdrawal, and hyperarousal align with these symptoms, confirming PTSD as the primary diagnosis. Additionally, her history of childhood sexual abuse places her at higher risk for developing PTSD following re-traumatization or stressors reminiscent of her past trauma (Brewin et al., 2010).

2. Risk Factors Exhibited

This woman exhibits several risk factors that contribute to the severity and persistence of PTSD symptoms. Firstly, her history of childhood sexual abuse signifies a significant early trauma, which increases vulnerability to future trauma responses. Childhood trauma can alter brain development, particularly in areas regulating stress and emotional responses, predisposing individuals to PTSD (Teicher et al., 2016). Secondly, her recent re-traumatization triggered by media reports about child abduction and assault acts as a potent reminder of her past experiences, intensifying her stress response.

Additional risk factors include her social withdrawal and refusal to eat or sleep, which could lead to physical health deterioration, complicating her mental health treatment. Her response to the news suggests high levels of hyperarousal and hypervigilance, common in PTSD, which can increase the risk of suicidal ideation or self-harm if her symptoms persist without intervention (Bryant, 2019).

3. Viable Treatment Interventions

Effective treatment approaches for her condition involve trauma-informed care tailored to her specific needs. Two evidence-based interventions include:

1. Cognitive-Behavioral Therapy (CBT) with Trauma Focus: Trauma-focused CBT is considered the gold standard for PTSD treatment. It involves psychoeducation, cognitive restructuring, exposure techniques, and skill development to help the client process traumatic memories and modify maladaptive thoughts related to her trauma (Foa et al., 2018). Gradual exposure to trauma memories in a safe environment reduces avoidance behaviors and decreases PTSD symptoms.
2. Eye Movement Desensitization and Reprocessing (EMDR): EMDR is another empirically validated modality effective in treating trauma-related disorders. It involves bilateral stimulation—such as guided eye movements—while the client recalls traumatic events, facilitating neural processing and integration of traumatic memories (Shapiro, 2018). EMDR can help diminish the intensity of flashbacks and emotional distress, leading to symptom reduction.

Additional supportive strategies could include crisis stabilization, medication management (e.g., SSRIs for symptom relief), and psychoeducation to foster understanding and coping skills. Initiating pharmacotherapy may alleviate hyperarousal and emotional numbness, improving the client’s engagement with psychotherapy (Stein et al., 2019). A multidisciplinary approach that combines psychotherapy, medication, and social support systems offers the best prognosis for recovery and symptom management.

Conclusion

This case underscores the complex interplay between childhood trauma and the effects of re-traumatization, highlighting the importance of trauma-informed mental health care. Recognizing PTSD symptoms allows clinicians to tailor interventions such as trauma-focused CBT and EMDR, which are supported by substantial research evidence, to aid in the client’s recovery process. Early intervention, combined with a compassionate understanding of her trauma history, is vital to facilitate healing and restore her well-being.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Brewin, C. R., et al. (2010). Understanding trauma and post-traumatic stress disorder: New research, new therapies. Wiley-Blackwell.
• Bryant, R. A. (2019). Post-traumatic stress disorder: A state-of-the-art review of evidence and treatment. Aust N Z J Psychiatry, 53(2), 110-118.
• Foa, E. B., et al. (2018). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. The Journal of Clinical Psychiatry, 79(1).
• Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.
• Stein, D. J., et al. (2019). Pharmacotherapy of PTSD. The Psychiatric Clinics of North America, 42(3), 377–391.
• Teicher, M. H., et al. (2016). The effects of childhood maltreatment on brain structure, function, and connectivity. Nature Reviews Neuroscience, 17(10), 644–655.