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{July 25, 2007}   Posttraumatic Stress Disorder

Posttraumatic Stress Disorder

 

What is it? Do I have it?

Criteria:
A. The person has been exposed to a traumatic event in which both of the following were present:
1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2. the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2. recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).
4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
5. physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event that occur on awakening or when intoxicated).

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
1. efforts to avoid thoughts, feelings, or conversations associated with the trauma
2. efforts to avoid activities, places, or people that arouse recollections of the trauma
3. inability to recall an important aspect of the trauma
4. markedly diminished interest or participation in significant activities
5. feeling of detachment or estrangement from others
6. restricted range of affect (e.g., unable to have loving feelings)
7. sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
1. difficulty falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
*The previous information is located here.

Symptoms of PTSD are generally of three types:
Intrusive: Dissociative states, Flashbacks, Intrusive emotions and memories, Nightmares and night terrors

Avoidant: Avoiding emotions, Avoiding relationships, Avoiding responsibility for others, Avoiding situations that are reminiscent of the traumatic event

Hyperarousal: Exaggerated startle reaction, Explosive outbursts, Extreme vigilance, Irritability, Panic symptoms, Sleep disturbance

*Intrusive memories and emotions interfere with normal thought processes and social interaction.

*Flashbacks feature auditory and visual hallucinations. For example, the sounds and images of combat often comprise the content of flashbacks experienced by military veterans. Flashbacks can be triggered by ordinary stimuli such as a low-flying airplane or a loud noise, anything that brings to mind an aspect of the event. Nightmares and night terrors also feature aspects of the traumatic event.
*Dissociative symptoms include psychic numbing, depersonalization, and amnesia.
*People with PTSD commonly avoid stimuli and situations that remind them of the traumatic event because they trigger symptoms.
*People experiencing hyperarousal symptoms are always on the alert for danger or threat and are easily startled.

Complications:
Complications develop in people with chronic PTSD and delayed onset PTSD. These include the following:

*Alcohol and drug abuse or dependence
*Chronic anxiety
*Depression and increased risk for suicide
*Divorce and separation
*Guilt
*Low self-esteem
*Panic attacks
*Phobias
*Unemployment

Treatments:

1. Debriefing (i.e., crisis intervention): Debriefing sessions are usually conducted as soon after the event as possible. The session usually lasts about 2 hours. A debriefing session typically involves a discussion of the event, the person’s reaction to it, and coping strategies. Debriefing sessions are commonly used to help rescue personnel, classmates of students who die in auto accidents or as a result of a violent attack (e.g., victims of random shootings), and survivors of terrorist attacks (e.g., bombings of public buildings).
2. Psychotherapy: Psychotherapy is generally necessary in the treatment of PTSD, whether it is conducted in individual therapy or in “survivor group” therapy. Survivor groups may be associated with or may refer group members to local community agencies that offer therapy and support for victims of rape, domestic violence, combat, natural disasters, and so on. The goal of psychotherapy in the treatment of PTSD is to help the person address and manage painful memories until they no longer cause disabling symptoms. This begins after establishing a safe relationship between the client and therapist. The process involves gradually working through the traumatic event and the patient’s reactions to it, validating the patient’s experiences, repairing damage done to their identity, and dealing with loss.

3. Community agencies:
4. Eye movement desensitization and reprocessing (EMDR): Eye movement desensitization and reprocessing (EMDR) is a specialized form of psychotherapy that is used almost exclusively for treating PTSD and its associated conditions, including depression. EMDR typically is integrated into a conventional psychotherapy regimen and is not used alone to treat PTSD. The theory behind EMDR is that stimulated rapid eye movement may help in the psychological processing of trauma. It is thought that the day?s events and our reactions to them are processed during REM sleep . In a controlled EMDR session, moving light is used to induce rapid eye movement.
Because it is a new method of treatment, only a relatively small number of patients have been treated with EMDR for PTSD. However, the EMDR Institute reports that there are more controlled studies of EMDR and its effects than of any other trauma treatment. The EMDR Institute states that an estimated 1,000,000 people had been treated by 1995, with varying degrees of improvement. Some, but not all, studies document improvement after relatively few interventions.

*The previous information is located here.

Self-Diagnosis:
Many people suffer from PTSD, but are either unaware that their condition has a name, or they wish to deny it. Here is a site that contains many tests that may help you decide if you are suffering from PTSD.

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