Post Traumatic Stress Post Traumatic Stress DisorderDisorder

PTSDPTSD

By: Eglantina Di MaseBy: Eglantina Di Mase

PTSDPTSD Post traumatic Stress Disorder, or PTSD, is Post traumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following a psychiatric disorder that can occur following

the experience or witnessing of life-the experience or witnessing of life-threatening events such as military combat, threatening events such as military combat, natural disasters, terrorist incidents, serious natural disasters, terrorist incidents, serious accidents, or violent personal assaults like accidents, or violent personal assaults like rape.rape.

PTSD is marked by clear biological changes PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is as well as psychological symptoms. PTSD is complicated by the fact that it frequently complicated by the fact that it frequently occurs in conjunction with related disorders occurs in conjunction with related disorders such as depression, substance abuse, such as depression, substance abuse, problems of memory and cognition, and other problems of memory and cognition, and other problems of physical and mental health. The problems of physical and mental health. The disorder is also associated with impairment of disorder is also associated with impairment of the person's ability to function in social or the person's ability to function in social or family life, including occupational instability, family life, including occupational instability, marital problems and divorces, family discord, marital problems and divorces, family discord, and difficulties in parenting. and difficulties in parenting.

SymptomsSymptoms People who suffer from PTSD often relive People who suffer from PTSD often relive

the experience through nightmares and the experience through nightmares and flashbacks, have difficulty sleeping, and flashbacks, have difficulty sleeping, and feel detached or estranged, and these feel detached or estranged, and these symptoms can be severe enough and last symptoms can be severe enough and last long enough to significantly impair the long enough to significantly impair the person's daily lifeperson's daily life

Intrusive Symptoms Intrusive Symptoms "Re-experience" of the trauma "Re-experience" of the trauma This usually occurs in nightmares This usually occurs in nightmares Sometimes comes as a sudden, painful Sometimes comes as a sudden, painful

onslaught of emotions that seem to have no onslaught of emotions that seem to have no cause cause

SymptomsSymptoms Symptoms of Avoidance Person avoids close emotional ties with family, colleagues and friends At first, person had diminished emotions and can complete only routine,

mechanical activities Avoid situations that are reminders of the traumatic event because the

symptoms may worsen

Symptoms of Hyperarousal May have trouble concentrating or remembering current information May develop insomnia Children may develop stomachaches and headaches, in addition to

symptoms of increased arousal

Associated Features Rid themselves of their "re-experience" by abusing alcohol or other

drugs as a "self-medication" May show poor control over his or her impulses May be at risk for suicide

HistoryHistory PTSD is not a new disorder. There are written accounts of similar

symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome."

Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.

PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, Korean conflict, and Persian Gulf populations, and in United Nations peacekeeping forces deployed to other war zones around the world. There are remarkably similar findings of PTSD in military veterans in other countries. For example, Australian Vietnam veterans experience many of the same symptoms that American Vietnam veterans experience.

HistoryHistory PTSD formally entered into psychiatric PTSD formally entered into psychiatric

nomenclature in the DSM-III (1980). The nomenclature in the DSM-III (1980). The DSM.-III-R (1987) expanded the definition of DSM.-III-R (1987) expanded the definition of the concept of stressors of PTSD, rearranged the concept of stressors of PTSD, rearranged the symptoms in all the clusters, increased the the symptoms in all the clusters, increased the range of items in both the re-experience and range of items in both the re-experience and avoidant cluster symptoms, and revised avoidant cluster symptoms, and revised criteria to include items representing PTSD in criteria to include items representing PTSD in children children

PTSD has most often been studied in soldiers, PTSD has most often been studied in soldiers, but clearly many types of natural and civilian but clearly many types of natural and civilian catastrophes, criminal assaults, rape, terrorist catastrophes, criminal assaults, rape, terrorist attacks, and accidents may precipitate itattacks, and accidents may precipitate it

EitiologyEitiology Although the etiology of PTSD is unknown, most investigators Although the etiology of PTSD is unknown, most investigators

believe that a personal predisposition is necessary for symptoms to believe that a personal predisposition is necessary for symptoms to develop after a traumatic event. Clinically significant symptoms develop after a traumatic event. Clinically significant symptoms following a traumatic event occur in a minority of persons. Those following a traumatic event occur in a minority of persons. Those likely to develop PTSD tend to have a pre-existing depression or likely to develop PTSD tend to have a pre-existing depression or anxiety disorder, or a family history of anxiety and neuroticism.anxiety disorder, or a family history of anxiety and neuroticism.

From a biologic perspective, the body's failure to return to its From a biologic perspective, the body's failure to return to its pretraumatic state differentiates PTSD from a simple fear response. pretraumatic state differentiates PTSD from a simple fear response. In a normal fear response, the immediate sympathetic discharge In a normal fear response, the immediate sympathetic discharge activates the "fight-or-flight" reaction. Increases in both activates the "fight-or-flight" reaction. Increases in both catecholamines and cortisol occur relative to the severity of the catecholamines and cortisol occur relative to the severity of the stressor. Cortisol release stimulated by corticotropin-releasing factor stressor. Cortisol release stimulated by corticotropin-releasing factor via the hypothalamic-pituitary-adrenal (HPA) axis acts in a negative via the hypothalamic-pituitary-adrenal (HPA) axis acts in a negative feedback loop to suppress sympathetic activation and cause further feedback loop to suppress sympathetic activation and cause further release of cortisol.release of cortisol.

EitiologyEitiology In patients with PTSD, ambient cortisol levels are lower than normal; In patients with PTSD, ambient cortisol levels are lower than normal;

this state has been attributed to chronic "adrenal exhaustion" from this state has been attributed to chronic "adrenal exhaustion" from inhibition of the HPA axis by persistent severe anxiety. However, inhibition of the HPA axis by persistent severe anxiety. However, recent data note that cortisol levels in the immediate aftermath of a recent data note that cortisol levels in the immediate aftermath of a motor vehicle wreck were significantly lower in persons who went on motor vehicle wreck were significantly lower in persons who went on to develop PTSD. In a related study, cortisol levels immediately after to develop PTSD. In a related study, cortisol levels immediately after rape were lower in women with a previous history of rape. Some rape were lower in women with a previous history of rape. Some investigators have hypothesized that the HPA axis and the investigators have hypothesized that the HPA axis and the sympathetic nervous system are disassociated in persons who sympathetic nervous system are disassociated in persons who develop PTSD, develop PTSD, which may allow for an uncontrolled which may allow for an uncontrolled catecholamine release that affects formation of memories catecholamine release that affects formation of memories during the trauma and perhaps exacerbates symptoms when during the trauma and perhaps exacerbates symptoms when that person is exposed to cues after the trauma.that person is exposed to cues after the trauma.

TreatmentTreatment

Treatment- LearningTreatment- Learning ·learning skills for coping with anxiety (such ·learning skills for coping with anxiety (such

as breathing retraining or biofeedback) and as breathing retraining or biofeedback) and negative thoughts ("cognitive negative thoughts ("cognitive restructuring"), restructuring"),

·managing anger, ·managing anger, ·preparing for stress reactions ("stress ·preparing for stress reactions ("stress

inoculation"), inoculation"), ·handling future trauma symptoms, ·handling future trauma symptoms, ·addressing urges to use alcohol or drugs ·addressing urges to use alcohol or drugs

when trauma symptoms occur ("relapse when trauma symptoms occur ("relapse prevention"), and prevention"), and

·communicating and relating effectively with ·communicating and relating effectively with people (social skills or marital therapy). people (social skills or marital therapy).

Treatment-BioTreatment-Bio

PharmacotherapyPharmacotherapy (medication) can reduce the anxiety, (medication) can reduce the anxiety, depression, and insomnia often experienced with PTSD, depression, and insomnia often experienced with PTSD, and in some cases, it may help relieve the distress and and in some cases, it may help relieve the distress and emotional numbness caused by trauma memories. emotional numbness caused by trauma memories. Several kinds of antidepressant drugs have contributed Several kinds of antidepressant drugs have contributed to patient improvement in most (but not all) clinical trials, to patient improvement in most (but not all) clinical trials, and some other classes of drugs have shown promise. and some other classes of drugs have shown promise. At this time, no particular drug has emerged as a At this time, no particular drug has emerged as a definitive treatment for PTSD. However, medication is definitive treatment for PTSD. However, medication is clearly useful for symptom relief, which makes it possible clearly useful for symptom relief, which makes it possible for survivors to participate in psychotherapy. for survivors to participate in psychotherapy.

Treatment - CognitiveTreatment - Cognitive

Cognitive-behavioral therapy Cognitive-behavioral therapy involves working with involves working with cognitions to change emotions, thoughts, and behaviors. cognitions to change emotions, thoughts, and behaviors. Exposure therapy Exposure therapy is one form that is unique to trauma is one form that is unique to trauma treatment. It uses careful, repeated, detailed imagining treatment. It uses careful, repeated, detailed imagining of the trauma (exposure) in a safe, controlled context to of the trauma (exposure) in a safe, controlled context to help the survivor face and gain control of the fear and help the survivor face and gain control of the fear and distress that was overwhelming during the trauma. In distress that was overwhelming during the trauma. In some cases, trauma memories or reminders can be some cases, trauma memories or reminders can be confronted all at once ("flooding"). For other individuals confronted all at once ("flooding"). For other individuals or traumas, it is preferable to work up to the most severe or traumas, it is preferable to work up to the most severe trauma gradually by using relaxation techniques and by trauma gradually by using relaxation techniques and by starting with less upsetting life stresses or by taking the starting with less upsetting life stresses or by taking the trauma one piece at a time ("desensitization"). trauma one piece at a time ("desensitization").

Treatment –Cognitive Treatment –Cognitive Eye Movement Desensitization Eye Movement Desensitization

and Reprocessing and Reprocessing (EMDR) is a (EMDR) is a relatively new treatment for relatively new treatment for traumatic memories that traumatic memories that involves elements of exposure involves elements of exposure therapy and cognitive-behavioral therapy and cognitive-behavioral therapy combined with therapy combined with techniques (eye movements, techniques (eye movements, hand taps, sounds) that create hand taps, sounds) that create an alternation of attention back an alternation of attention back and forth across the person's and forth across the person's midline. While the theory and midline. While the theory and research are still evolving for this research are still evolving for this form of treatment, there is some form of treatment, there is some evidence that the therapeutic evidence that the therapeutic element unique to EMDR, element unique to EMDR, attentional alternation, may attentional alternation, may facilitate the accessing and facilitate the accessing and processing of traumatic material processing of traumatic material

Who is affected by PTSD?Who is affected by PTSD?

Up to 10% of the population Up to 10% of the population Strikes more females than males Strikes more females than males Can occur with children as wellCan occur with children as well

Biography Biography

http://www.ncptsd.va.gov/http://www.ncptsd.va.gov/ http://www.aafp.org/afp/20031215/2401.htmlhttp://www.aafp.org/afp/20031215/2401.html http://www.fbhs.org/PTSD.htmhttp://www.fbhs.org/PTSD.htm American Psychiatric Association. Diagnostic American Psychiatric Association. Diagnostic

and statistical manual of mental disorders. 3d and statistical manual of mental disorders. 3d ed. Washington, D.C.: American Psychiatric ed. Washington, D.C.: American Psychiatric Association, 1980:232-3 Association, 1980:232-3