2. Post-Traumatic Stress Disorder
Definition
Post-Traumatic Stress Disorder (PTSD) is a specific form of anxiety that
comes on after a stressful or frightening event.
Description
While some stressors are a predictable part of most people's lives - for
example, bereavement or chronic illness - others lie outside the range of
these common experiences. These include hurricanes, floods and other
natural disasters; airplane accidents and car crashes where
considerable injury occurs; rape and assault; and armed combat,
torture, and existence in a death camp. Such traumatic events would
produce distress in almost everyone at any age. In some, they give rise to
PTSD.
3. Causes
PTSD is one of the few psychological disorders with a clear point of origin.
Although there are some people who have been exposed to trauma and do
not develop PTSD, there are certain susceptibility characteristics in people
who develop PTSD. These susceptibility factors include the following:
Previous chronic exposure to stress. Susceptibility depends primarily
on the survivor's interpretation of the event. Thus, an event that is merely
troublesome to one person can be devastating to another. Moreover, each
of us may have a stress threshold, so that those who have endured more
stress in life are considered more susceptible to PTSD.
Preexisting psychological disorders. People who suffer from
depression or anxiety or have a family history of anxiety are more likely to
develop PTSD.
Inadequate support systems. A failure by loved ones to acknowledge
the trauma, or loved ones who downplay its importance and place blame
on the victim, increase the risk of PTSD.
Genetic predisposition.
Recent (acute) stressful life changes.
Feeling of lack of control. The state of having "learned helplessness" or
giving total control to another individual can give rise to PTSD.
Recent excessive alcohol intake.
4. Symptoms
The post-traumatic reaction often begins immediately but may emerge after
days, weeks, months or even years after the event. There are three kinds
of symptoms, hyperalertness/hyperarousal, intrusion and emotional
constriction or numbing.
1. Hyperalertness/hyperarousal. People are often edgy, irritable, easily
startled, constantly on guard, have poor sleep habits, are agitated and find
it difficult to concentrate.
2. Intrusion. People tend to re-experience the event in painful
memories, flashbacks, dreams or nightmares. People with PTSD also may
experience a worsening of their symptoms when they find themselves in
situations that resemble the original trauma or that may be taken as
symbols of it - for example, a spell of hot, humid weather for a Vietnam
veteran, or a dark street for a woman who has been raped. In avoiding, or
attempting to avoid, such situations, an individual's ability to function
socially and at work may be severely impaired.
3. Emotional constriction or numbing. Another symptom is called
"psychic numbing" or "emotional anesthesia." Sufferers exhibit a pervasive
feeling of being detached from other people, from the outside world, and
from activities that used to be enjoyable.
5. They also have a greatly diminished ability to experience emotion,
especially tenderness and the feelings associated with intimacy and sex.
Other symptoms reflect an over-aroused autonomic nervous system.
Sufferers have difficulty falling asleep or staying asleep; they are keyed up
and their startle response is heightened.
Anxiety and depression are common in those with PTSD. Irritability is a
further problem. Guilt about surviving when others did not, and about the
behavior that was necessary for survival, may be constant and painful.
Some of those with this disorder turn to alcohol or drugs for escape, others
may become self-defeating or suicidal.
Diagnosis
According the Diagnostic and Statistical Manual of Mental Disorders the
following symptoms must be present for a diagnosis of PTSD:
Recurrent and intrusive distressing recollections or dreams about the event
Feeling as if the traumatic event were recurring, such as through
hallucinations and flashbacks
Intense psychological distress at cues that symbolize the event
Additionally, these symptoms must endure for more than a month and must
cause clinically significant distress or functional impairment.
6. Treatment
As with many other psychiatric disorders, the most effective treatments are
psychotherapy and drug treatment.
Psychotherapy
If functional impairment occurs, or if the symptoms are severe and
prolonged, some form of psychotherapeutic treatment is indicated.
With psychodynamic psychotherapy, the individual has the opportunity to
discuss the event, relive it, and achieve a better understanding of why it
has triggered so severe a psychological and physiological reaction.
Cognitive-behavioral techniques may be used to reduce anxiety and
depression, aid with insomnia, and treat any phobic symptoms that may
have developed.
Psychotherapists treating PTSD try to provide a way for the patient to feel
safe in confronting the traumatic event and linking it emotionally as well as
intellectually to the symptoms. Patients must learn to think about the
trauma without intrusive reliving and exercise self-control without avoidance
and emotional numbing.
7. Some patients are reluctant to talk because they believe the therapist
cannot possibly understand what they have been through. Some resist any
suggestion that the traumatic event is related to their symptoms. Their
helplessness is confirmed by nightmares and flashbacks that remind them
of their inability to protect themselves during the trauma. Some have
become convinced that the world is hopelessly unjust, others that they
themselves are defective or evil. Some patients make emotional demands
and direct their accumulated anger at the therapist, they may quit therapy
because they can no longer tolerate being exposed to their feelings about
the trauma.
Drug Treatment
Drug treatment is aimed at relieving fear and anxiety and restoring normal
sleep patterns. Tricyclic antidepressants, such as Tofranil and Elavil, or
SSRIs such as Prozac or Zoloft, are helpful. Additionally, Catapres and
Inderal are known to relieve agitation, while Xanax may help some people
sleep.
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Link: http://www.healthcentral.com/encyclopedia/408/332.html?ic=506048
