Post traumatic stress disorder

Trauma, abuse and bereavement / Category / Emile Du Toit / May 10th 2014

What is PTSD?

Post-traumatic stress disorder is an anxiety disorder that can develop after a terrifying ordeal that involves physical harm or the threat of physical harm.

The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or even strangers.

PTSD and war veterans

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

Categories of symptoms experienced in PTSD

People who are experiencing post-traumatic stress disorder tend to have symptoms that fall under the categories of intrusive symptoms, avoidance and numbing, negative changes in mood and thought, and hyperarousal / hypervigilance.

We will look at these more formally when we examine the diagnostic criteria.

Discussion of symptoms of PTSD

People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive or even become violent.

They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a mugging or a kidnapping. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.

Who is affected by post-traumatic stress disorder?

PTSD affects about 7.7 million American adults.

PTSD can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families. PTSD is often accompanied by depression, substance abuse or one or more of the other anxiety disorders.

When will I know if I have PTSD?

Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

DSM-5 Criteria for PTSD

NB – these criteria are taken from the Diagnostic and Statistical Manual for Mental Disorders 5 (DSM-5), which can be purchased here.

Note that DSM-5 introduced a preschool subtype of PTSD for children ages six years and younger. The criteria below are specific to adults, adolescents, and children older than six years.

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

Direct exposure. Witnessing, in person. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (one required)

  • Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.
  • Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
  • Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
  • Intense or prolonged distress after exposure to traumatic reminders.
  • Marked physiologic reactivity after exposure to trauma-related stimuli.

  • Criterion C: avoidance

    Persistent effortful avoidance of distressing trauma-related stimuli after the event:(one required)

  • Trauma-related thoughts or feelings.
  • Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

  • Criterion D: negative alterations in cognitions and mood

    Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)

  • Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).
  • Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").
  • Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
  • Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
  • Markedly diminished interest in (pre-traumatic) significant activities.
  • Feeling alienated from others (e.g., detachment or estrangement).
  • Constricted affect: persistent inability to experience positive emotions.

  • Criterion E: alterations in arousal and reactivity

    Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)

  • Irritable or aggressive behavior
  • Self-destructive or reckless behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems in concentration
  • Sleep disturbance

  • Criterion F: duration

    Persistence of symptoms (in Criteria B, C, D, and E) for more than one month.

    Criterion G: functional significance

    Significant symptom-related distress or functional impairment (e.g., social, occupational).

    Criterion H: exclusion

    Disturbance is not due to medication, substance use, or other illness.

    Treatment of PTSD

    Different kinds of medications and psychotherapy are used to treat PTSD effectively. However, individuals who suffer acute crises or traumas are encouraged to undergo short-term critical incident debriefing, which is used to help prevent symptoms that immediately follow a trauma (which are entirely normal and adaptive) from becoming chronic, long-term problems that would classify as PTSD.

    CBT and EMDR (eye movement desensitisation and reprocessing) have been shown through controlled research studies to be effective in the treatment of PTSD.

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