Post-Traumatic Stress Disorder
Bryan Hines
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Abstract
Posttraumatic Stress Disorder is a very dangerous mental health condition. It effects a great many people who have been victims of traumatic events that change their outlook on life and the world around them. The purpose of this paper is to provide basic insight to the disorder, the risk factors, symptoms, and treatment options used by the many trained professionals to assist people with PTSD.
Keywords: PTSD, Cognitive Therapy, Exposure Therapy, Eye movement desensitization and reprocessing (EMDR), intrusive memories.
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is defined as a mental health condition that’s triggered by a terrifying event by either witnessing it or experiencing it. According to Dr. Matthew Friedman, Ph.D, M.D., “Individuals can only develop PTSD if they have been exposed to a traumatic event. As operationalized in the DSM-IV (2) and shown in Table 1 (as the “A1” criterion), traumatic events “involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.” (Friedman, 2000). Post-Traumatic Stress is not new to us.
For most, Post Traumatic Stress Disorder is mainly associated with military veterans and active duty soldiers who have been deployed to a combat zone and have been involved in or have witnessed very traumatic events. However, Post Traumatic Stress Disorder does not just affect military members. It can affect first responders, such as Police, Fire Fighters, and hospital Emergency Room staff. People who have been in natural disasters such as floods, tornados, hurricanes, Tsunamis, to name a few can also be inflicted with PTSD. PTSD can and does affect a great many people.
There is a difference, however, from PTSD and severe stress. Not everyone is susceptible to PTSD. Many who experience a traumatic event or an extremely stressful event often after a few months have no further thoughts or dreams about the event. PTSD refers to the individuals who have these symptoms for a prolonged period and for those who may never lose these symptoms. The hard part is to identify these symptoms and help those who need help but do not believe they have problems. The key is being able to identify these symptoms.
Symptoms
The symptoms are grouped into four types according to the Mayo Clinic. The first is intrusive memories. Intrusive memories involve reliving the event again as if it were happening all over again in the present. Having recurring memories of the event over and over again and not being able to get away from it. Intrusive memories also include having recurring dreams about the event as we all have seen in movies where the person affected by these “dreams” and seems to be reliving these events in the dreams. Intrusive memories also include being very emotional and distressed about something that reminds them of the event. Anything could trigger this reaction in someone. A certain noise or surroundings, something someone says which may have occurred prior to the event or during the event could trigger these intrusive memories.
Avoidance, is exactly what it implies. Some people go to extremes to avoid anything that will remind them or trigger anything that will remind them of the event. Often going miles out of their way, when it involves and accident they witnessed or were in, to avoid bringing up the negative images in their minds. They will avoid people they knew for many years, because they remind them of the incident or event.
For those who have driven on the streets of Iraq, they are often very aware of their surroundings when driving even when they get back home. If closely observed, one can see the anxiety and the “head on a swivel” motion of these individuals, where they look rapidly and in all directions. They become very anxious when they see debris on the side of the road or new construction, or even dead animals in the middle of the road, often slowing down or avoiding the spot all together. Negative changes in thinking and mood are often the most obvious signs of PTSD but certainly not the only signs. These changes deal with how the person perceives themselves. They have lost self-worth, and see very little hope into the future. They have problems dealing with loved ones and often fail to have or remain in a relationship for any length of time. This may be because they no longer feel anything emotionally. Inability to feel love, or affection toward anyone or anything. They once loved to do things and now have no desire to do anything they once did, such as sports or socializing. They do not see the point of doing anything because they have no desire to or have no thought about the future. They often have memory issues, especially when it comes to the traumatic event. Emotional reactions, or as they are often called, Arousal Symptoms (AS), include difficulty sleeping, concentrating on little things, anxiousness or extreme angst, always on guard as in the example above. Individuals will always be looking for something to happen, and can be easily scared or startled, which may bring along with it a very negative and destructive reaction. This is caused by irritability, anger, and outbursts or aggressive behavior, which are prominent emotional reactions in those that are affected by PTSD. The severity and frequency of these symptoms are dependent on the nature and severity of the traumatic event and the ability of the person to cope with these emotions.
Risk Factors
Risk factors vary with respect to the individual. Theses certain risk factors include family history of mental illness, depending on age what childhood years were like, what life was like prior to traumatic event, having other mental or health issues, and of course how often one is exposed to traumatic events. Being exposed repeatedly to these types of risk factors has a significant effect on whether one develops PTSD. However, if a person has strong support system of family, friends, and trained psychiatric personnel significantly diminishes the effects that these stressors have on a person, and can often help to ward off significant stress and the potential to develop a stress disorder. For some, however, no matter how often we are able to talk to someone, these events can trigger a reaction from any event in the past. According to Dr. Friedman physical attributes also play a part in PTSD, he states “Abnormalities in brain structure and function have been demonstrated in PTSD patients. In three independent laboratories, magnetic resonance imaging (MRI) has shown reduced hippocampal volume among male and female PTSD patients who had been exposed to combat trauma, sexual assault or motor vehicle accidents” (Friedman, 2000). If identified then one should expect that identification of such findings could result in identifying potential PTSD issues in individuals attempting to join the military, first responders, and even those jobs which are susceptible to higher stressors. This could lead into some rather serious discussions into what would be legal into prescreening candidates for certain positions. But that is a different subject. If risk factors are pre-identified then it should be possible for those individuals to obtain the necessary treatment to and to learn strategies to manage their stress levels.
Women according to the Veterans Administration are more likely to succumb to chronic PTSD than their male counterparts. Which is probably the result of women being more at ease with talking about their concerns and thoughts and seeking treatment. Men are less likely to do so. It is also noteworthy that recent openings of combat jobs in the military has exposed women to more stressful and traumatic events than in previous years. Coupled with the fact that women more likely the victims of sexual assault, or at least more likely to report it, than men are. According to studies 34% of women will experience some sort of sexual assault in their lifetime both as adults and as children. Women are twice as likely to be diagnosed with PTSD as men are.
Children are especially susceptible for obvious reasons, especially in their younger years since they have not built up the cognitive skills required to deal with such stressors as child abuse, sexual molestation, being neglected, the death of a parent or sibling, or domestic violence. Younger children are often susceptible when one or both parents have PTSD and would possibly suffer the same consequences as they grow older because the neural development occurs faster when children are at a younger age and is determined by their experiences. Extended exposure to this type of trauma at such an early age can change the development of the brain and cause major damage to the mental state of a child.
It has been shown that the elderly also are at risk for PTSD. There a few reasons for this. One reason is that with age cognitive function is diminished somewhat. With this declining function it becomes more difficult to cope with stressors that occur during this period of time. The fact is that elderly people feel a decreased role in society as they are often “pushed” aside for younger people in the workforce and often times in to nursing homes when they reach a certain age. These health problems show us that we are slowly but surely withering away, which is a depressing thought. Our desire to feel needed is also affected as we get older. Children often become too busy to visit, or have others take care of their aging parents and relatives. Money also is an added stressor for the elderly. It is quite often the case that once the retirement age is reached financial income is not the same as it used to be, and the ability to create more income is extremely difficult. The cost of medications from chronic illness, which normally increase as we get older. Even if one prepares for retirement, it is a burden to live within means based upon a fixed income and having no means of adding income to counter rise of medication dn healthcare costs, insurance, and growing living costs.
Military personnel and first responders are at an increased risk for PTSD simply based upon the operational environment that they may find themselves in. For the military the constant stress of daily life of being combat situations plays a tremendous role on the psyche. The images and horrors of war, having been viewed or seen can have an extreme traumatic effect on one’s mental state. These exposures are often the major cause of PTSD in military veterans. First responders also have to deal with very gruesome events when responding to accidents, shootings, or just death in general. It is quite possible that just one event could trigger PTSD. Even while remaining in this type of environment, the individual can show signs and symptoms and need to be diagnosed and treated as soon as possible.
There is increased risk for all of these different groups when these individuals have dealt with some sort of traumatic event in the past or have other mental health issues that may make them more susceptible to a new traumatic event. Without a strong support system many of these individuals will certainly be more at risk to succumb to PTSD. Delayed diagnosis makes treatment more difficult. There are numerous treatment options available depending on what stage the individual is in and what severity the traumatic event occurred.
Treatment
Although there are many potential treatments for PTSD, the primary treatment is psychotherapy. In some cases medication may be prescribed to assist with the therapy and will be combined to assist the more extreme or difficult cases.
Exposure therapy is a behavioral treatment for PTSD. For PTSD patients it targets the behavior that the patient has learned in order to “deal” with the traumatic event. Most often this deals with avoidance. In this treatment type, these individuals are asked to try and recount the traumatic event, without the trauma of the event, with hope that new learning via extinction will occur and allow the patient to hinder the effects of the traumatic thoughts versus eradicating them entirely.
Cognitive therapy assist the person by allowing them or giving them a new way to deal with the detrimental thoughts they are having about the traumatic event and to help them understand the event or events that took place. It helps by showing how the event changed the thought process of how they view the world, people, and themselves. The way we see things and what we perceive to be accurate has been skewed by the traumatic event. By learning about the symptoms, the way they view things and the way they feel, and understanding how the event changed what they believe in, cognitive therapy arms the person with a new way of dealing with this trauma.
Eye movement desensitization and reprocessing (EMDR) according to the Mayo Clinic, combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to traumatic memories.” (Mayo Clinic Staff, 2014). EMDR is a therapy based upon physiology and helps a person see, in a similar way to what they see during Rapid Eye Movement (REM) sleep, these disturbing events in a new and less troublesome or traumatic way. After going through the session EMDR a patient should no longer view these events in a similar view that they had prior to the therapy session. The event will still be in memory, however, how the patient views the event should be less traumatic for them.
Pharmacotherapy is another approach to dealing with PTSD. While most drugs cannot remove symptoms they can offer assistance in dealing and coping with them. Antidepressants, anti-anxiety, and other drugs that assist with sleep issues may be prescribed. Pharmacotherapy should not be viewed as a primary treatment. According to The Journal of Behavioral Health Services & Research, “While i¬?rst-line pharmacotherapy for PTSD, depression, and anxiety/panic disorder is a SSRI, consensus statements recommend that patients with PTSD also have specialized MH counseling, with structured cognitive behavioral therapy (CBT) or psychotherapy, as part of a comprehensive treatment plan.” (73521271)
Patients requiring drugs to assist in the treatment of PTSD should ensure that a list of current medications is provided to their therapist in order to prescribe proper medication and avoid negative interaction.
Summary
Posttraumatic stress can affect anyone at any given moment. Exposure to any type of traumatic event could set off previous events that have been buried in the past. As we get older we develop new ways to avoid thinking about certain events that have occurred in our lives. If we are no longer bothered by the event after a few months then it would not be classified as PTSD, rather a stressful event that was traumatic. If another event triggered a more significant and longer lasting effect, then it would be considered PTSD. For those of us who have seen PTSD and have known or have had traumatic events may recognize the symptoms. Even if there is any doubt, the first thing one should do is to let the person know that there is no shame in getting assistance and we are all there for them. It is essential to have a great support group and it is even more essential that the one affected by a traumatic event knows there is help and support. We are often too ashamed or unaware of what we do, or how we act unless someone else points it out to us. The key here is to know the signs and symptoms and then do something about it.
References
Meltzer, E., Averbuch, T., Samet, J., Saitz, R., Jabbar, K., Lloyd-travaglini, C., & Liebschutz, J. (2012). Discrepancy in Diagnosis and Treatment of Post-traumatic Stress Disorder (PTSD): Treatment for the Wrong Reason. The Journal of Behavioral Health Services & Research, 39(2). (2012, April 1). Retrieved August 10, 2014.
Yehuda, R. (1999). Biological Factors Associated With Susceptibility to Posttraumatic Stress Disorder. Canadian Journal of Psychiatry, 44(1), 34-39. (1999, January 1). Retrieved August 12, 2014.
Mayo Clinic Staff. (2014, April 15). Diseases and Conditions Post-Traumatic stress Disorder (PTSD). Retrieved August 10, 2014, from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540
Friedman, M. (1995, January 1). Post-Traumatic Stress Disorder. Retrieved August 9, 2014, from http://www.acnp.org/g4/GN401000111/CH109.html
