Post Traumatic Stress Disorder; Symptoms, Test, Treatment

Post traumatic stress disorder 
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Post traumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats on a person’s life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk for suicide and intentional self-harm.

Types of Post Traumatic Stress Disorder

Are there different types of PTSD
  • Delayed-onset PTSD – if your symptoms emerge more than six months after experiencing trauma, this might be described as ‘delayed PTSD’ or ‘delayed-onset PTSD’.
  • Complex PTSD – if you experienced trauma at an early age or it lasted for a long time, you might be given a diagnosis of ‘complex PTSD’.
  • Birth trauma – PTSD that develops after a traumatic experience of childbirth is also known as ‘birth trauma’.

Causes of Post Traumatic Stress Disorder

  • Genetic – Anxiety disorders tend to run in families. People who have first-degree relatives who struggle with anxiety disorders are at a greater risk for developing the disorder themselves. While not a definitive cause for PTSD, it does make a person more vulnerable to developing the disorder after a traumatic event.
  • Brain Structures – It’s believed that certain areas of the brain that regulate emotions and fear are different than those who do not develop PTSD after a traumatic event.
  • Environmental  – Those who have a history of trauma and stress are more likely to develop PTSD than those who do not have a similar history. Also, children who grow up in families where addiction is present are at greater risk for developing a post-traumatic stress disorder.
  • Psychological – People who struggle with certain types of mental illness, notably anxiety and depression, are at a higher risk of developing a post-traumatic stress disorder.

Others causes are following

  • War or combat
  • Natural disasters
  • Car or plane crashes
  • Terrorist attacks
  • The sudden death of a loved one
  • Rape
  • Kidnapping
  • Assault
  • Sexual or physical abuse
  • Childhood neglect
  • Serious road accidents
  • Violent personal assaults, such as sexual assault, mugging or robbery
  • Prolonged sexual abuse, violence or severe neglect
  • Witnessing violent deaths
  • Military combat
  • Being held hostage
  • Natural disasters, such as severe floods, earthquakes or tsunamis
  • A diagnosis of a life-threatening condition
  • An unexpected severe injury or death of a close family member or friend

Effects of Post Traumatic Stress Disorder

The effects of PTSD touch every area of an individual’s life leaving virtually nothing unscathed. The longer that PTSD exists without treatment, the greater the effects of PTSD on a person’s life. The most common effects of post-traumatic stress disorder may include:

  • Pseudo-hallucinations
  • Eating disorders
  • Paranoia
  • Difficulty regulating emotions
  • Inability to maintain stable relationships
  • Dissociative symptoms
  • Depression
  • Anger
  • Nightmares
  • Difficulty feeling emotions
  • Guilt
  • Sleep problems
  • Substance abuse
  • Social phobia
  • Difficulty maintaining job
  • Agoraphobia
  • Self-harm; self-mutilation
  • Suicidal thoughts attempts or completed suicide

Types with Symptoms

There are four main types of symptoms.

 Re-experiencing the traumatic event

Avoidance and numbing

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  • Inability to remember important aspects of the trauma
  • Loss of interest in activities and life in general
  • Feeling detached from others and emotionally numb
  • Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)

Hyperarousal

Negative thought & mood changes

  • Guilt, shame, or self-blame
  • Feeling alienated and alone
  • Feelings of mistrust and betrayal
  • Difficulty concentrating or remembering things
  • depress

Symptoms over all of 

You might notice

Diagnosis of Post Traumatic Stress Disorder

PTSD can be particularly difficult to diagnose because numerous factors can lead to over-reporting (e.g., disability) and under-reporting (e.g., avoidance) symptoms, dysfunction, and distress.

Screening and assessment

A number of screening instruments are used for screening adults for PTSD, such as the PTSD Checklist for DSM-5 (PCL-5) and the Primary Care PTSD Screen for DSM-5(PC-PTSD-5).

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There are also several screening and assessment instruments for use with children and adolescents. These include the Child PTSD Symptom Scale (CPSS), Child Trauma Screening Questionnaire, and UCLA Posttraumatic Stress Disorder Reaction Index for DSM-IV.

Diagnostic and statistical manual

PTSD was classified as an anxiety disorder in the DSM-IV but has since been reclassified as a “trauma- and stressor-related disorder” in the DSM-5. The DSM-5 diagnostic criteria for PTSD include four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/mood, and alterations in arousal and reactivity.

International classification of diseases

The International Classification of Diseases and Related Health Problems 10 (ICD-10) classifies PTSD under “Reaction to severe stress, and adjustment disorders.”The ICD-10 criteria for PTSD include re-experiencing, avoidance, and either increased reactivity or inability to recall certain details related to the event.

Differential diagnosis of Post Traumatic Stress Disorder

A diagnosis of PTSD requires that the person has been exposed to an extreme stressor such as one that is life-threatening. Any stressor can result in a diagnosis of adjustment disorder and it is an appropriate diagnosis for a stressor and a symptom pattern that does not meet the criteria for PTSD, for example a partner being fired, or a spouse leaving. If any of the symptom pattern is present before the stressor, another diagnosis is required, such as brief psychotic disorder or major depressive disorder. Other differential diagnoses are schizophrenia or other disorders with psychotic features such as Psychotic disorders due to a general medical condition.

The symptom pattern for acute stress disorder must occur and be resolved within four weeks of the trauma. If it lasts longer, and the symptom pattern fits that characteristic of PTSD, the diagnosis may be changed.

Treatment of Post Traumatic Stress Disorder

  • Trauma-focused cognitive-behavioral therapy –  involves gradually “exposing” yourself to feelings and situations that remind you of the trauma, and replacing distorted and irrational thoughts about the trauma with a more balanced picture.
  • Family therapy  – can help your loved ones understand what you’re going through and help the family work through relationship problems.
  • EMDR (Eye Movement Desensitization and Reprocessing) – incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. These techniques work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.CBT can help you change these ‘extreme’ ways of thinking, which can also help you to feel better and to behave differently.
  • Psychotherapy – All the effective psychotherapies for PTSD focus on the traumatic experience – or experiences – rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life.
  • EMDR (Eye Movement Desensitisation & Reprocessing) – This is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience.  It may sound odd, but it has been shown to work.
  • Group therapy This involves meeting with a group of other people who have been through the same, or a similar traumatic event. It can be easier to talk about what happened if you are with other people who have been through a similar experience.
  • Medication – SSRI antidepressant tablets may help to reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.
  • Antidepressants Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may have some benefit for PTSD symptoms. Tricyclic antidepressants are equally effective but are less well tolerated. Evidence provides support for a small or modest improvement with sertraline, fluoxetine, paroxetine, and venlafaxine. Thus, these four medications are considered to be first-line medications for PTSD.
  • Anti-anxiety medications – These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
  • Prazosin  – If symptoms include insomnia with recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.
  • Benzodiazepines Benzodiazepines are not recommended for the treatment of PTSD due to a lack of evidence of benefit and risk of worsening PTSD symptoms. Some authors believe that the use of benzodiazepines is contraindicated for acute stress, as this group of drugs promotes dissociation and ulterior revivals. Nevertheless, some use benzodiazepines with caution for short-term anxiety and insomnia. While benzodiazepines can alleviate acute anxiety, there is no consistent evidence that they can stop the development of PTSD and may actually increase the risk of developing PTSD 2–5 times.
  • Glucocorticoids Glucocorticoids may be useful for short-term therapy to protect against neurodegeneration caused by the extended stress response that characterizes PTSD, but long-term use may actually promote neurodegeneration.
  • Cannabinoids Evidence as of 2017 is insufficient to determine if medical cannabis useful for PTSD. Despite the uncertain evidence, use of cannabis or derived products is widespread among U.S. veterans with PTSD. The cannabinoid nabilone is sometimes used off-label for nightmares in PTSD. Although some short-term benefit was shown, adverse effects are common and it has not been adequately studied to determine efficacy. Additionally, there are other treatments with stronger efficacy and less risks (e.g., psychotherapy, serotonergic antidepressants, adrenergic inhibitors). The use of medical marijuana for PTSD is controversial, with only a handful of states permitting its use for that purpose.
  • Exercise, sport and physical activity – Physical activity can influence people’s psychological and physical health. The U.S. National Center for PTSD recommends moderate exercise as a way to distract from disturbing emotions, build self-esteem and increase feelings of being in control again. They recommend a discussion with a doctor before starting an exercise program.
  • Play therapy for children – Play is thought to help children link their inner thoughts with their outer world, connecting real experiences with abstract thought. Repetitive play can also be one way a child relives traumatic events, and that can be a symptom of trauma in a child or young person. Although it is commonly used, there have not been enough studies comparing outcomes in groups of children receiving and not receiving play therapy, so the effects of play therapy are not yet understood.
  • Military programs  – Many veterans of the wars in Iraq and Afghanistan have faced significant physical, emotional, and relational disruptions. In response, the United States Marine Corps has instituted programs to assist them in re-adjusting to civilian life, especially in their relationships with spouses and loved ones, to help them communicate better and understand what the other has gone through. Walter Reed Army Institute of Research (WRAIR) developed the Battlemind program to assist service members to avoid or ameliorate PTSD and related problems. Wounded Warrior Project partnered with the US Department of Veterans Affairs to create Warrior Care Network, a national health system of PTSD treatment centers
  • Cognitive Processing Therapy (CPT)  – where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
  • Prolonged Exposure (PE) – where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
  • Eye Movement Desensitization and Reprocessing (EMDR)  – which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through traumatic memories.
  • Body-focused therapies – These don’t help PTSD directly, but can help to control your distress and hyperarousal, the feeling of being ‘on guard’ all the time. These include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They can help you to develop ways of relaxing and managing stress.
  • The way of best works  At present, there is evidence that EMDR, Cognitive Behavioural Therapy, behavior therapy, and antidepressants are all effective. There is not enough information for us to show that one of these treatments is better than another. There is not yet any evidence that other forms of psychotherapy or counseling are helpful for PTSD.
  • Getting better – Try to start doing the normal things of life that have nothing to do with your past experiences of trauma. This could include finding friends, getting a job, doing regular exercise, learning relaxation techniques, developing a hobby or having pets. This helps you slowly to trust the world around you.
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Lack of trust in other people – and the world in general – is central to complex PTSD. Treatment often needs to be longer to allow you to develop a secure relationship with a therapist –  to experience that it is possible to trust someone in this world without being hurt or abused. The work will often happen in 3 stages:

  • Stabilization – learn how to understand and control your distress and emotional cutting-off, or ‘dissociation’. This can involve ‘grounding’ techniques to help you to stay in the present – concentrating on ordinary physical feelings to remind you that you are living in the present, not the abusive and traumatic past.start to ‘disconnect’ your physical symptoms of fear and anxiety from the memories and emotions that produce them, making them less frightening. Start to be able to tolerate day-to-day life without experiencing anxiety or flashbacks.
  • Trauma-focussed Therapy – EMDR or Cognitive Behavioural Therapy can help you to remember your traumatic experiences with less distress and more control. Other psychotherapies, including psychodynamic psychotherapy, can also be helpful. Care needs to be taken in complex PTSD because these treatments can make the situation worse if not used properly.
  • Reintegration – You begin to develop a new life for yourself. You become able to use your skills or learn new ones and to make satisfying relationships in the real world. Medication can be used if you feel too distressed or unsafe, or if psychotherapy is not possible. It can include both antidepressants and antipsychotic medication – but not usually tranquillisers or sleeping tablets.
  • Exercise, sport and physical activity – Physical activity can influence people’s psychological and physical health. The U.S. National Center for PTSD recommends moderate exercise as a way to distract from disturbing emotions, build self-esteem and increase feelings of being in control again. They recommend a discussion with a doctor before starting an exercise program.
  • Play therapy for children – Play is thought to help children link their inner thoughts with their outer world, connecting real experiences with abstract thought. Repetitive play can also be one way a child relives traumatic events, and that can be a symptom of trauma in a child or young person. Although it is commonly used, there have not been enough studies comparing outcomes in groups of children receiving and not receiving play therapy, so the effects of play therapy are not yet understood.

 

For friends, relatives & colleagues

Do …….

  • watch out for any changes in behaviour – poor performance at work, lateness, taking sick leave, minor accidents
  • watch for anger, irritability, depression, lack of interest, lack of concentration
  • take time to allow a trauma survivor to tell their story
  • ask general questions
  • let them talk, don’t interrupt the flow or come back with your own experiences.

Don’t …….

  • tell a survivor you know how they feel – you don’t
  • tell a survivor they’re lucky to be alive – it doesn’t feel like that to them
  • minimise their experience – “it’s not that bad, surely …
  • suggest that they just need to “pull themselves together.

Risk Factors and Resilience Factors for PTSD

Some factors that increase risk for PTSD include:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse
  • Seeking out support from other people, such as friends and family
  • Finding a support group after a traumatic event
  • Learning to feel good about one’s own actions in the face of danger
  • Having a positive coping strategy, or a way of getting through the bad event and learning from it
  • Being able to act and respond effectively despite feeling fear
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Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology.

As well as many of the symptoms of PTSD described above, you may find that you:

  • feel shame and guilt
  • have a sense of numbness, a lack of feelings in your body
  • can’t enjoy anything
  • control your emotions by using street drugs, alcohol, or by harming yourself
  • cut yourself off from what is going on around you (dissociation)
  • have physical symptoms caused by your distress
  • find that you can’t put your emotions into words
  • want to kill yourself
  • take risks and do things on the ‘spur of the moment’.

It is worse if

  • it happens at an early age – the earlier the age, the worse the trauma
  • it is caused by a parent or other care giver
  • the trauma is severe
  • the trauma goes on for a long time
  • you are isolated
  • you are still in touch with the abuser and/or threats to your safety.

Support to prevent furthers PTSD

If stress and other problems caused by a traumatic event affect your life, see your doctor or mental health professional. You can also take these actions as you continue with treatment for post-traumatic stress disorder:

  • Follow your treatment plan – Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan and routinely communicating with your mental health professional will help move you forward.
  • Learn about PTSD – This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
  • Take care of yourself – Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety.
  • Don’t self-medicate – Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road, interfere with effective treatments and prevent real healing.
  • Break the cycle – When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
  • Stay connected – Spend time with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
  • Consider a support group – Ask your mental health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory.

Remember that you can’t change someone. However, you can

  • Learn about PTSD – This can help you understand what your loved one is going through.
  • Recognize that avoidance and withdrawal are part of the disorder –  If your loved one resists your help, allow space and let your loved one know that you’re available when he or she is ready to accept your help.
  • Offer to attend medical appointments – If your loved one is willing, attending appointments can help you understand and assist with treatment.
  • Be willing to listen – Let your loved one know you’re willing to listen, but you understand if he or she doesn’t want to talk. Try not to force your loved one to talk about the trauma until he or she is ready.
  • Encourage participation  – Plan opportunities for activities with family and friends. Celebrate good events.
  • Make your own health a priority –  Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
  • Seek help if you need it – If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your stress.
  • Stay safe –  Plan a safe place for yourself and your children if your loved one becomes violent or abusive.

References

Post Traumatic Stress Disorder

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