PTSD

Post-traumatic Stress Disorder, commonly known as PTSD, is a trauma reaction and an Anxiety Disorder that develops for some who experience an extreme and traumatic stressor. Not everyone who experiences a particular traumatic event will develop the disorder. 

Protective Factors

There are some ‘protective factors’ that prevent PTSD from developing or from becoming too prolonged if it does develop. Some of these protective factors are:

·       Family support
·       Social support
·       Telling others about the trauma
·       Seeking help

·       Having effective stress management skills prior to the trauma

·       Spirituality

·       Identifying self as a survivor rather than a victim

·       Helping others
Risk Factors

Some factors may predispose an individual to developing PTSD following a traumatic event. These risk factors include:

·       Having a mental illness at the time of the trauma

·       Having a Substance Use Disorder prior to the trauma

·       Having unresolved trauma from the past

Types of Traumatic Events

The type of traumatic event is not the determining factor of whether one has PTSD following it. It is the individual response to any event that determines whether PTSD is present. Additionally, PTSD may occur in response to multiple stressors, but at least one stressor has to have occurred in order to qualify for the diagnosis.

PTSD can occur following such events as:

·       Sexual abuse
·       Domestic violence
·       Physical assault
·       Rape
·       Prolonged neglect
·       Kidnapping
·       Combat
·       Natural disasters
·       Accidents
·       Illnesses
Complicated Trauma Reaction

Multiple traumatic events can lead to what is known as complicated trauma. This can occur in a single time period during which more than one adverse event occurs. For example, a natural disaster may cause the death of loved ones and the loss of one’s home simultaneously. In such a case, if PTSD is present, symptoms may relate to each of these losses.

Another way in which a complicated trauma reaction may occur is over an extended period of time. For example, sexual abuse in childhood may cause PTSD and a later traumatic event in adulthood such as a natural disaster will exacerbate and complicate trauma symptoms for both events.

The Traumatic Event

The stressor must have been severe enough to involve at least one situation such as the following:

·      the actual or potential death of another

·      the actual or potential physical injury of another

·      the threat of losing one’s own life

·      one’s own actual or potential physical injury

Exposure to the trauma can be direct or indirect. For example, one may directly witness such events, may be actively involved or may hear about such events after they have occurred.

The Impact of the Event

The exposure to such a stressor is considered traumatic when there has been intense fear and/or a sense of helplessness or horror in response to such situations or events.

In order for such traumatic exposure to lead to PTSD symptoms directly related to the trauma must occur. These symptoms are classified into 3 categories: 

·       symptoms of re-experiencing the trauma

·       symptoms of avoidance and numbing
·       symptoms of arousal

Symptoms of Re-experiencing the Trauma

In PTSD the traumatic event can be re-experienced in the following ways:

·       distressful memories
·       nightmares

·       acting or feeling as if the trauma is recurring

·       experiencing psychological distress when reminded of the trauma by internal or external cues

·       experiencing physiological reactions when reminded of the trauma by internal or external cues

Symptoms of re-experiencing can range from mild to severe. The more severe symptoms can interrupt daily functioning and be debilitating. Dissociative episodes in which one becomes detached from the here and now can occur. These are commonly called ‘flashbacks’ and cause one to believe that the trauma is occurring again. Some experience perceptual illusions or hallucinations related to the trauma.

Symptoms of Avoidance and Numbing

Avoidance of thoughts, feelings and conversations about the traumatic event are common in PTSD as is the avoidance of reminders of the trauma. There is typically an effort to limit activities that would trigger distressful recollections and this effort can itself limit one’s level of functioning. A good deal of the avoidance in PTSD appears to occur without effort, however, and takes place as an inability to recall certain aspects of the trauma, a sense of detachment or withdrawal and estrangement from others or activities. These types of symptoms are commonly referred to as symptoms of ‘numbing’ and serve to dull the re-experiencing of the trauma. Many people with PTSD with have a restricted range of emotion and lose interest in usual activities. 

Symptoms of Arousal

Symptoms of arousal involve physiological reactions caused by the trauma such as a heightened startle response and other reactions associated with intense fear such as rapid heart rate, wakefulness and hypervigilance. Irritability and angry outbursts are typical as is distractibility and a lessened ability to concentrate. Symptoms in this category indicate an increased level of being alert and on guard as one would naturally be during an event of intense stress.

 
Types of PTSD

There are 3 types of PTSD. These are:

·       Acute PTSD in which symptoms have been present for less than 3 months

·       Chronic PTSD in which symptoms have persisted for 3 months or more

·       PTSD With Delayed Onset in which symptoms begin at least 6 months after the trauma

Co-occurring Disorders

Other conditions that often co-occur with PTSD are Major Depression, Agoraphobia, Obsessive Compulsive Disorder, Panic Disorder, Generalized Anxiety Disorder, Social Phobia, Bipolar Disorder and Substance Disorders.

Treatment

Treatment for PTSD typically involves a combination of therapies and may include individual and group therapy, education, family therapy and medication among others. Treatment can involve various and multiple approaches and not all are appropriate for everyone. Approaches may include discussing the events to increase understanding, expressing emotions about the events, identifying ‘triggers’ that remind one of the event and establishing a plan to limit exposure to triggers and managing daily stress levels. Some specific techniques used in the treatment of PTSD include EMDR (Eye Movement Desensitization Reprocessing) and CBT (Cognitive Behavioral Therapy). Stress management, relaxation techniques and therapies designed to increase support such as those involving family are beneficial.  

Medication to alleviate symptoms of arousal, improve sleep, decrease anxiety, control flashbacks and hallucinations or improve depression may be required. 

It is not uncommon for treatment approaches to change as needs wax and wane over the course of treatment. During times of increased stress, for example, individuals may need increased therapeutic supports and services. PTSD is treated in a range of therapeutic settings from outpatient clinics to inpatient psychiatric hospitalization depending upon the severity of symptoms and the individual’s needs at a particular time.