Post-Traumatic Stress Disorder
What is Post-Traumatic Stress Disorder (PTSD)?
- Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witness a traumatic event such as a natural disaster, a serious accident, a terrorist attack, war/combat, rape or other violent personal assault.
Symptoms:
- Re-experiencing (flashbacks, nightmares) the trauma psychologically
- Avoiding reminders of the trauma
- Emotional numbing
- Hyperarousal
- Is associated with both suicide attempts and suicidal ideation. The suicide risk is increased in people who have experienced trauma, with those who have PTSD being at greater risk of suicide compared to those who did not develop PTSD after the trauma.
- Possible alcohol and drug abuse
What causes PTSD and who is most likely to be diagnosed for it?
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Not caused by normal, everyday stress.
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The type of trauma experienced strongly affects the risk of developing PTSD.
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Based on the graph above of research from Australian adults with PTSD in 2011, combat/military service is a less common cause of PTSD than many people expect.
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Rates of PTSD vary according to the type and duration of military service, along with many other factors affecting all trauma survivors, including the number of previous types of trauma experienced (both civilian and military), physical injuries sustained, whether there was social support after the trauma.
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PTSD occurs at any age.
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According to the National Health Service, UK, PTSD affects around 5% of men and 10% of women at some point during their life. Up to one in three people who experience a traumatic event develop PTSD as a result.
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“The disturbance, regardless of its trigger, causes clinically significant distress or impairments in the individual’s social interactions, capacity to work, or other important areas of functioning.” (Friedman et. al.)
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About 8 out of every 100 Veterans have PTSD according to the U.S Department of Veterans Affairs
Very common mental health disorder, according Trauma Disorders.com, 8.7% of people are affected by PTSD during their lifetime.
Vocabulary:
Avoidance Symptoms
- Keeping away from cues, activities or situations that are reminders of a stressful event from the past. Avoiding trauma reminders is a required criteria for PTSD.
Anhedonia
- Lack of enjoyment from, engagement in, or energy for life’s experiences; deficits in the capacity to feel pleasure and take interest in things.
Combat Exhaustion
- Name used for the diagnosis of the same symptoms of PTSD before 1980. Same as battle neurosis, battle fatigue and shell shock.
Battle Fatigue
- Name used for the diagnosis of the same symptoms of PTSD before 1980. Same as battle neurosis, combat exhaustion and shell shock.
Battle Neurosis
- Name used for the diagnosis of the same symptoms of PTSD before 1980. Same as battle fatigue, combat exhaustion and shell shock.
Depersonalization
- Feeling as if you are unreal/not real, detached or observing yourself from outside yourself regarding your thoughts, feelings, sensations, body or actions. Examples include altered perceptions, a distorted sense of time, unreal or absent self and feeling emotionally or physically numb.
Derealization
- Experiencing your surroundings as unreality or feeling detached from them. Examples include people or objects seeming unreal, dreamlike, foggy, lifeless, or visually distorted.
Dissociative
- Is a mental process of disconnecting from one's thoughts, feelings, memories or sense of identity.
Dissociative Amnesia
- This is the most common Dissociative Disorder. It is not caused by head injuries or physical damage to the brain, it is amnesia which has a psychological cause.
DSM-5
- The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. This volume defines and classifies mental disorders in order to improve diagnoses, treatment, and research.
Emotional Numbing
- These symptoms reflect difficulties in experiencing positive emotions.
Hyperarousal
- Irritability, being jumpy, or constantly “on alert.”
Hypervigilance
- Constantly checking the environment for signs of danger or finding threat in things that would have appeared harmless beforehand. Hypervigilance is common in PTSD, paranoid personality disorder and children abused/neglected by parents.
Paranoid Ideation
- Means paranoid ideas, thoughts, and beliefs that you are being harassed or persecuted
Shell Shock
- Name used for the diagnosis of the same symptoms of PTSD before 1980. Same as battle neurosis, battle fatigue and combat exhaustion
Startle Response
- An involuntary and reflexive reaction to a sudden and unexpected event, such as a loud noise or sharp movement. A symptom of PTSD.
Suicidal Ideation
- Ideas or mental images of suicide.
Road to Recovery:
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Recovery rates vary: the DSM-5 says around 50% of adults diagnosed with PTSD may recover within three months, some for over a year. In some cases, PTSD has continued for over 50 years. (ex: vietnam war veterans and holocaust survivors)
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Factors known to hinder recover, or worsen symptoms after trauma
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Reminders of the original trauma
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Normal “life stressors” (ex: unemployment, illness, or bereavement)
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New traumatic experiences
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Worsening physical declining health or cognitive function
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Social isolation can also worsen symptoms
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Therapy:
Trauma-focused psychotherapy is the most effective type of talk therapy for PTSD. There are different kinds of trauma-focused psychotherapy, these three having the most research support:
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Cognitive Processing Therapy for PTSD
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Prolonged Exposure for PTSD
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Eye Movement Desensitization and
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Reprocessing (EMDR) for PTSD
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Medication:
- Although some medication is found to have good evidence that it works, medication is generally considered less effective than some Cognitive-Behavioral Therapies, both in United States and British treatment guidelines.
Different Types of PTSD:
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Chronic PTSD:
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Refers to PTSD which lasts three months or longer
Negative views linked to persistent, chronic PTSD include:-
Nowhere is safe
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I cannot rely on other people
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I can’t trust my own judgments
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I am going mad
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It was my fault
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Severe PTSD:
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​Factors during the time of trauma that lead to more severe PTSD
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Sense of hopelessness
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Emotional detachment
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Confusion
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DSM-5 Diagnosis Criteria:
Code 309.81
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
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Directly experiencing the traumatic event(s).
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Witnessing, in person, the events(s) as it occurred to others.
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Learning that the traumatic events(s) occurred to a close family member or close friend. In cases of actual or threatened by death of a family member or friend, the events(s) must have been violent or accidental.
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Experiencing repeated or extreme exposure to adversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s) occurred:
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Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). In children older than 6, there may be frightening dreams without recognizable content.
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Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s).
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Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the trauma event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). In children, trauma-specific reenactment may occur in play.
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Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
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Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following:
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Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
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Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s), as evidenced by two (or more) of the following:
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Inability to remember an important aspect of the traumatic events(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
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Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "no one can be trusted," "the world is completely dangerous," "my whole nervousness system is permanently ruined.").
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Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
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Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
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Markedly diminished interest or participation in significant activities.
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Feelings of detachment or estrangement from others.
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Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following:
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Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
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Reckless or self-destructive behavior
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Hypervigilance
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Exaggerated startle response
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Problems with concentration
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Sleep disturbances
F. Criteria B, C, D, and E last more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the effects of a substance (ex: medication, alcohol) or another medical condition.
A Brief History of PTSD Diagnosis:
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Ancient texts such as The Odyssey and The Iliad of Homer both describe soldiers traumatized by war. In Shakespeare’s King Henry IV, the character of Hotspur suffers from post-traumatic nightmares.
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Post-Traumatic Neurosis was the term used in britain for over two hundred years, and symptoms were described even earlier in literature and other forms of art.
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Irritable heart is used to describe PTSD in civil war soldiers.
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1882: a book about Concussion of the Spine is published by London surgeon John Eric Erichsen, which promotes recognition of PTSD, with the view that “nervous shock” is caused by physical injuries resulting from railway accidents.
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1885-1889: Traumatic Neurosis was used by Hermann Oppenheim, a german neurologist, to describe PTSD symptoms. Oppenheim claimed there was a physical “disturbance” in the cerebrum (within the brain). This began to use the word trauma in psychiatry, rather than solely in surgery.
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1911: Swiss psychiatrist Eduard Stierlin studies effects of natural disasters, a rail accident and a mining disaster, finding lasting PTSD symptoms, he states traumatic neurosis has no predisposition and the key causes are violent emotions and fright.
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1914-1918: combat stress is studied during WWI. Disorderly action of the heart and “neurasthenia” are among the terms used to describe PTSD symptoms.
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1915: Charles Myers uses the term “shell-shock” to describe PTSD in medical literature, later recognizing it in soldiers never directly in combat. The term was already in common use; high explosives used in WWI were believed to cause brain damage, resulting in symptoms like sleep problems and panic.
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1941: Kardiner states that battle neurosis, battle fatigue, combat exhaustion, and shell shock are the same : “the common acquired disorder consequent on war stress”, and suggest that traumatic neuroses in peacetime is the same condition.
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1974: The Vietnam war and the women’s movement lead to greater public interest and more research. Variants of PTSD described include Post-Vietnam syndrome, Abused Child Syndrome and Battered Women Syndrome.
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1980: DSM-III manual published, including Post-traumatic Stress Disorder as a separate diagnosis for the first time. Contains diagnostic criteria for the first time as well as examples of trauma list both civilian and military combat trauma.
PTSD Awareness:
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Those with PTSD may experience denial about the condition, in addition to amnesia, avoidance, minimization of the effects of the trauma and/or cognitive impairment.
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Many people diagnosed with PTSD do not get the help they need.
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June is PTSD Awareness Month
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PTSD awareness is represented by the color teal.
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