Post-traumatic Stress Disorder (PTSD)

Post-traumatic Stress Disorder (PTSD)
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What is Post-traumatic Stress Disorder (PTSD)?

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II. But PTSD does not just happen to combat veterans. PTSD can occur in all people, in people of any ethnicity, nationality or culture, and any age.

PTSD affects about 8 million American adults (3.5%), and can occur at any age, including childhood. Women are more likely to develop the disorder than men, and there is some evidence that it may run in families. PTSD is frequently accompanied by depression, substance abuse, or anxiety disorders. When other conditions are appropriately diagnosed and treated, the likelihood of successful treatment increases.

One in five post 9/11 veterans came home with PTSD and an estimated one in 11 people will experience PTSD in their lifetime. Post-Traumatic Stress Disorder occurs after experiencing extreme trauma or a life-threatening event. Over 540,000 Veterans have been diagnosed with PTSDRoughly 30 percent of Vietnam veterans developed PTSD. The disorder also has been detected in as many as 10 percent of Gulf War (Desert Storm) veterans, about 6 percent to 11 percent of veterans of the Afghanistan war, and about 12 percent to 20 percent of veterans of the Iraq war.

 

Most people who experience a traumatic event will have reactions that may include shock, anger, nervousness, fear, and even guilt. These reactions are common, and for most people, while the consequences of PTSD can be severe, full recovery is possible if you can identify the symptoms in time.

People with PTSD continue to have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

Traumatic events that can cause PTSD include

  • War or combat
  • Natural disasters
  • Car or plane crashes
  • Terrorist attacks
  • Sudden death of a loved one
  • Rape
  • Kidnapping
  • Assault
  • Sexual or physical abuse
  • Childhood neglect

 

Symptoms and Diagnosis of PTSD

Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.

  1. Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
  2. Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
  3. Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.
  4. Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.

Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person with PTSD, however, symptoms last for more than a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning.

Many people with PTSD tend to re-experience aspects of the traumatic event especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event, similarities in person, place or circumstance can also trigger symptoms. People with PTSD also experience intrusive memories or flashbacks, emotional numbness, sleep disturbances, anxiety, intense guilt, sadness, irritability, or outbursts of anger, and dissociative experiences. Many people with PTSD may try to avoid situations that remind them of the ordeal. When symptoms last more than one month, a diagnosis of PTSD may be relevant.

Symptoms associated with reliving the traumatic event:

  • Having bad dreams, or distressing memories about the event
  • Behaving or feeling as if the event were actually happening all over again (known as flashbacks)
  • Dissociative reactions or loss of awareness of present surroundings
  • Having a lot of emotional feelings when reminded of the event
  • Having a lot of physical sensations when reminded of the event (heart pounds or misses a beat, sweating, difficulty breathing, feeling faint, feeling a loss of control)

Symptoms related to avoidance of reminders of the traumatic event:

  • Avoiding thoughts, conversations, or feelings about the event
  • Avoiding people, activities, or places associated with the event

 

Symptoms related to negative changes in thought or mood:

  • Having difficulty remembering an important part of the original trauma
  • Feeling numb or detached from things
  • Lack of interest in social activities
  • Inability to experience positive moods
  • Pessimism about the future

​Arousal and reactivity symptoms:

  • Sleeping Difficulties including trouble falling or staying asleep
  • Irritability and outbursts of anger
  • Difficulty concentrating
  • Feeling easily startled
  • Excess Awareness (hypervigilance)

Other symptoms related to depersonalization (feeling like an observer to one’s body and thoughts/feelings) or derealization (experiencing unreality of surroundings) may also exist for some individuals.

Causes and Risk Factors

Doctors aren’t sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Stressful experiences, including the amount and severity of trauma you’ve gone through in your life
  • Inherited mental health risks, such as a family history of anxiety and depression
  • Inherited features of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, such as:

  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life, such as childhood abuse
  • Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders
  • Having other mental health problems, such as anxiety or depression
  • Having problems with substance misuse, such as excess drinking or drug use
  • Lacking a good support system of family and friends
  • Having blood relatives with mental health problems, including anxiety or depression

Acute Stress Disorder

Acute stress disorder (ASD) was introduced to identify people who, shortly after trauma exposure, are high risk for subsequent development of post-traumatic stress disorder (PTSD). This contribution outlines the evidence for ASD as a predictor of subsequent PTSD. Available evidence in adults and children indicates that whereas people with ASD are high risk for PTSD, the majority of people who develop PTSD do not initially display ASD.

The diagnosis of acute stress disorder was introduced in DSM-IV. Like posttraumatic stress disorder (PTSD), acute stress disorder is defined in DSM-IV as a disorder that follows experiencing, witnessing, or being confronted with events involving actual or threatened death, physical injury, or other threats to the physical integrity of the self or others. In addition, to meet the definition of an appropriate stressor , the person’s response has to involve intense fear, helplessness, or horror. Whereas PTSD reflects disturbance that has lasted for more than 1 month, acute stress disorder must last for a minimum of 2 days and can only be diagnosed up to 1 month after the stressor. Acute stress disorder also differs from PTSD in being explicitly formulated as a dissociative response to trauma. Thus, a diagnosis of acute stress disorder requires at least three dissociative symptoms  but only one symptom from each of the re-experiencing, avoidance , and arousal categories. Impairment  is also necessary and is formulated somewhat differently from that specified for PTSD. At this early stage in the formulation of acute stress disorder, little empirical evidence is available for the specific assumptions incorporated in DSM-IV.

The symptoms of ASD include:

Dissociative symptoms

You’ll have three or more of the following dissociative symptoms if you have ASD:

  • feeling numb, detached, or being emotionally unresponsive
  • a reduced awareness of your surroundings
  • derealization, which occurs when your environment seems strange or unreal to you
  • depersonalization, which occurs when your thoughts or emotions don’t seem real or don’t seem like they belong to you
  • dissociative amnesia, which occurs when you cannot remember one or more important aspects of the traumatic event

Reexperiencing the traumatic event

You’ll persistently re-experience the traumatic event in one or more of the following ways if you have ASD:

  • having recurring images, thoughts, nightmares, illusions, or flashback episodes of the traumatic event
  • feeling like you’re reliving the traumatic event
  • feeling distressed when something reminds you of the traumatic event

Avoidance

You may avoid stimuli that cause you to remember or re-experience the traumatic event, such as:

  • people
  • conversations
  • places
  • objects
  • activities
  • thoughts
  • feelings

Anxiety or increased arousal

The symptoms of ASD may include anxiety and increased arousal. The symptoms of anxiety and increased arousal include:

 

  • having trouble sleeping
  • being irritable
  • having difficulty concentrating
  • being unable to stop moving or sit still
  • being constantly tense or on guard
  • becoming startled too easily or at inappropriate times

Distress

The symptoms of ASD may cause you distress or disrupt important aspects of your life, such as your social or work settings. You may have an inability to start or complete necessary tasks, or an inability to tell others about the traumatic event.

If you or your loved one is suffering from ASD or PTSD then consult earliest with the psychiatrist.

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Alabama Clinics: 334-712-1170