International review of psychiatry
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Burns are devastating injuries that disproportionately affect people in developing countries, including children. In addition to a high mortality rate, survivors are burdened with life-long physical and emotional scars. The etiology and nature of burn injuries varies significantly by country, and this chapter explores the predominant causes and patterns of burn injury in both the developing and industrialized worlds. ⋯ Children are particularly vulnerable to burn injuries, accounting for almost 50% of all burn patients in some studies. A majority of pediatric burns are scald injuries usually affecting very young children below the age of 5 years, and we discuss the behavioral patterns underlying this finding. Finally, the elderly form a rapidly increasing proportion of the population in many countries, and are often burdened with comorbidities that are likely to pose significant challenges in burn care.
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This paper reviews four major topics related to the long-term psychosocial rehabilitation for burn survivors; (1) Body image adjustment process; (2) Social functioning challenges; (3) Interventions designed to address psychosocial rehabilitation challenges; and (4) Current policy developments in the USA and the UK that focus on raising the rehabilitation standards for psychosocial care for burn survivors. While acknowledging the close relationship between body image distress and social functioning, these two areas are reviewed separately with the goal of addressing two specific questions. First, what does current empirical research and clinical experience teach us about each of these areas, and second, what are the most important gaps in current knowledge about body image and social functioning, respectively? The final section of the paper specifically addresses the question of what can be done, from a practical and a health policy perspective, to ensure that existing body image and social difficulties are appropriately addressed.
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Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.
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For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. ⋯ Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth (PTG). This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters PTG and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.