Post Traumatic Stress Disorder - Research Paper Example

Post Traumatic Stress Disorder Post Traumatic Stress Disorder has generally been associated with the military or combat veterans. It has been referred to by other names such as shell –shock and battle fatigue. With increased awareness and understanding of the condition the name is now accepted as Post Traumatic Stress Disorder, (PTSD). The nature of service in war today is causing an increase in the incidence of PTSD. The war in Iraq is touching many lives at a very personal level. The direct relationship between this stress and mental health problems is evident. The intense combat conditions in the present wars in Iraq and Afghanistan are causing increase problems of mental health for the US troops. Another population that is showing emerging increase in PTSD is fire-fighters. More and more cases of major depressive disorder (MDD), generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD) are coming to light, making it important for understanding of the conditions and therefore development of effective treatments. Feczer and Bjorklund (2009) define PTSD as “ an anxiety disorder characterized by a triad of symptoms following exposure or trauma, including persistent re-experiencing of the traumatic stressors through flashbacks, nightmares, and/or intrusive thoughts, avoidance of stimuli associated with the trauma along with the numbing or general unresponsiveness; and persistent symptoms of increased arousal” (p.278). PTSD is classified as an anxiety disorder since although anxiety has many of the symptoms and signs of fear, it also lingers long after the event and the threat associated with it have passed. This is perhaps the most unique characteristic of PTSD. Vieweg et al (2006) follow the development of the definition. In 1980 the third edition of the Diagnostic and Statistical Manual of Mental Disorders first described PTSD as an anxiety disorder. In a later revision in 1987 the diagnostic criteria were revised to emphasize the avoidance phenomenon and in the 1994 edition trauma was redefined. The definition of trauma is important to the understanding of how it is applied to PTSD. Grant et al (2008) define a trauma as “an event involving actual or threatened loss of life or personal integrity such that one experiences extreme fear, helplessness or horror” (p.662). The American Psychiatric Association expands the explanation of the traumatic event saying that it must involve actual or threatened death or serious injury of a threat to one’s physical being. Witnessing the actual death or threat to another’s life or physical well- being can also predispose someone to PTSD. Further conditions include that the person must respond with intense fear and helplessness such that his or her social or other important areas of daily functioning are hampered for at least one month. It is thought that the PTSD is most severe when the traumatic injury is caused by another person rather than by an accident or natural disaster. Any exposure to a traumatic event has the potential of causing PTSD in a person especially if the person faces threatened death or serious injury to self or to others. Initially PTSD was more associated with extreme traumas such as war and natural disasters and was thought to be more of an adult condition. When PTSD was first formulated in 1980 it was not thought to be relevant to children and adolescents. A study of a group of children who were kidnapped and held hostage proved otherwise. Since then there have been reported statistics on the prevalence of PTSD in children and adolescents. A National Comorbidity Survey in the US showed that 65% of men and 46% of women who had been raped developed PTSD. For men other traumas that were associated with a high incidence of PTSD included combat exposure, neglect and physical abuse in childhood. For women the most common causes of PTSD were childhood physical abuse, sexual molestation, physical assault and being threatened with a weapon (Charuvastra and Cloitre, 2008). PTSD is considered an anxiety disorder therefore the symptoms can closely resemble those of other anxiety disorders in some ways. As Grant et al (2008) explain studies show that other major depressive disorders especially Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) can also commonly occur after a trauma so that these can be indistinguishable from PTSD. Some of the symptoms they share include sleep problems and concentration difficulties. For a diagnosis of PTSD however there are more specific symptoms that must occur. The National Institute for Mental Health (undated) describes these symptoms in detail. Generally they are classified into three categories- re-experiencing, avoidance and hyperarousal. The re-experiencing symptoms are generally flashbacks where the victim relives the trauma over and over. In re-living the trauma the physical symptoms are re-experienced such as a racing heart and sweating. Re-experiencing also can occur in bad dreams and frightening thoughts. These intrusive thoughts and images can occur frequently. This re-living of the experience can have disturbing effects on the person’s everyday routine. The second group of symptoms is the avoidance symptoms. The victim literally stays away from anything that reminds him of the event. He may avoid places or even events or people that can act as a reminder of the experience. One of the coping strategies to help with the avoidance is emotional numbness where the victim tries not to be aware of the painful emotions that are associated with the experience. In some cases it is difficult to avoid the feelings of strong guilt and these can lead to depression or worry. Additionally the person can lose interest in activities that they used to enjoy. In other cases there could be trouble remembering the dangerous event. This avoidance can cause the person to change his routine for example if the PTSD results from being in a vehicular accident they may avoid driving a car or may have difficulty even riding in a car as a passenger. The third symptom hyperarousal is characterized by the person being easily startled or feeling tense constantly. In addition sleep problems are common; they have difficulty falling asleep or staying asleep and sleeping peacefully and restfully. Angry outbursts can also be common. The manifestations of the three categories of symptoms may be different in some ways in children who suffer from PTSD. For young children the more common symptoms will include bed-wetting, not being able to talk, unusual clinging to an adult. The child can sometimes be seen to be acting out the scary event during their play. Typically the child can become very disruptive and disrespectful and display destructive behaviors. The most important feature of treatment for people with PTSD is therefore perhaps providing a sense of safety. PTSD is commonly treated with either a form of psychotherapy (or talk therapy), medication or a combination of both. Psychotherapy can be individual or in groups. The National Institute for Mental Health points out that some types of psychotherapy target the actual symptoms of PTSD directly whereas others focus on the associated social, family and job- related problems that result from PTSD. The most common form of psychotherapy for PTSD is Cognitive Behavioral Therapy (CBT). This involves different stages. One stage is exposure therapy which helps the victim to face and control his fears. The victim is exposed to the trauma in a safe way by using mental imagery or writing or even in some cases actually visiting the placed where the trauma occurred. Cognitive restructuring is actually helping the victim to revise his thoughts concerning the trauma. This helps to make sense of bad memories. Sometimes the person has distorted memory of the details of the event and may carry a great deal of guilt and shame when in fact he is not to be blamed for the event. The therapy helps him to look at the events in a more realistic way. And the third stage is teaching the client to reduce anxiety. Four other forms of psychotherapy that have been effective are described by Antonellus et al (2006). EMDR (Eye movement desensitization and reprocessing) is one of these techniques. In this technique the individual brings to mind the traumatic incident, the negative emotions associated with it and the positive thoughts that he would like to have. The therapist uses a series of hand movements and the patient uses eye movements to follow the hand movements. These eye movements in some way help the patient to release the negative emotions. Neuro Linguistic Programming (NLP) is based on using our five senses to see the incident and respond to it in a different way. A third technique is Thought Field Therapy (TFT) which involves tapping on certain acupressure points to unblock the energy flow that has been hampered by the disturbing thought patterns. Trauma Incident Reduction (TIR) involves repeatedly reviewing the traumatic event with the therapist providing safety which helps to minimize the stress associated with the incident. PTSD has also been treated with drug therapy. There are two medications that the US Food and Drug Administration has approved- Zoloft and Paxil. Both of these are anti-depressants. Their major role is to help control symptoms such as sadness, worry, anger and feeling numb. They therefore do not alleviate the actual symptoms of PTSD but make it easier to go through psychotherapy. There are other medications that doctors may prescribe to help with relaxation, sleep problems and other anxiety symptoms. As with most medications there are possible side effects of the drug therapy such as headaches, nausea, sleeplessness or drowsiness and sexual problems but these are reported to go away after a while. Charuvastra and Cloitre (2008) point out that the feeling of safety in the client is of utmost importance so that even the therapist must be experienced as someone who is “supportive, warm and interested in the client, who appears to understand the meaning of the client’s traumatic experiences and can identify resources to help the client” (p.318). They describe the importance therefore of social bonds to people with PTSD coming from research that shows that social support is one of the strongest predictors of PTSD where social support protects from PTSD and lack of support increases the likelihood of developing PTSD. For example in one study of American Legionnaires veterans of the Vietnam war with PTSD who were more involved in their community were more likely to show remission of their PTSD symptoms, whereas veterans who perceived more negative community attitudes were more likely to have chronic PTSD (Charuvastra and Cloitre, 2008). The authors sum conclude that low social support leads to low avoidant coping abilities but positive support decreases the PTSD avoidant behaviors. The social network adds to the sense of safety as some social interactions can help the victim to regulate emotions such as fear anxiety and especially mistrust. It is important to note that not every treatment will work for everyone. Each victim must try until he finds the treatment that proves to be most effective for him. Vieweg et al (2006) sums up the treatment in a general principle that the first task is to reduce or eliminate the symptoms and signs of PTSD and any trauma-related comorbid conditions such as depression, anxiety, worry etc. The next step for the clinician is to improve the adaptive functioning of the patient and help them to return to a psychological state of trust and feeling safe. And finally the treatment must focus on limiting any generalizations of the initial trauma and making sure the patient does not suffer any subsequent relapse. Creating safety and providing information about the event are the priority issues in treating children with PTSD. PTSD is indeed a serious issue that affects a wide area of any society. No longer is it only related to war and combat. It is important to understand the onset and the symptoms for accurate diagnosis and therefore appropriate and effective treatment. The hidden effects of PTSD on one’s daily life add to the importance of addressing the issue directly. References Antonellis, P.J., Meshad, F., Stack, D. (2006). Understanding Posttraumatic stress disorder. Fire Engineering. 159 (12), 85-88. Charuvastra, A. and Cloitre, M. (2008). Social bonds and post-traumatic stress disorder. Annual Review of Psychology. 59, 301-328. Feczer, D. and Bjorklund, P. (2009). Forever changed: Posttraumatic stress disorder in female military veterans, a case report. Perspectives in Psychiatric Care. 45 (4), 278-292. Grant, D.M., Beck, J.G., Marques, L., Palyo, S.A. & Clapp, J.D. (2008). The structure of distress following trauma: Post-traumatic stress disorder, major depressive disorder and generalized anxiety disorder. Journal of Abnormal Psychology. 117 (3), 662-672. National Institute of Mental Health (undated). Post-traumatic stress disorder. Available online http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder- ptsd/nimh_ptsd_booklet.pdf Vieweg, W.V., Julius, D.A., Fernandez, A., Beatty-Brooks, M., Hetterma, J.M., & Pandurangi, A.K. (2006). Post-traumatic stress disorder: Clinical features, pathophysiology and treatment. The American Journal of Medicine. 119 (5), 383-390. Read More