Post Traumatic Stress Disorder (PTSD)

Introduction

Post-traumatic stress disorder is a disorder which is related to anxiety and depression. An individual may develop this disorder when he is exposed to a series of traumatic events or a single event which can include a serious injury, sexual assault, or a death threat. The disorder can be clinically diagnosed when symptoms like disturbing flashbacks recur, memories of the event continue to disturb, and high levels of anxiety take place even after months of the event. It is not necessary that all people suffering from traumatic events develop this disorder. It will most likely affect the people with sensitive minds and hearts, and who experience severe traumatic events. Women are said to suffer post traumatic stress disorder more than men because they tend to experience a comparatively severe impact. Children will be less likely to experience post traumatic stress disorders especially if they are less than 10 years while war veterans are most likely to be at risk for such a disorder. The causes, symptoms, treatment, and diagnosis of the post traumatic stress disorder will be discussed and analyzed in this paper.    

Basically, we all have encountered someone who has fought in one or more of the wars, even those that have fought a personal war.  Here lately, though more and more Veterans of the past and present conflicts are being medically discharged for suffering from PTSD or Post Traumatic Stress Disorder. This disorder (PTSD) does not “just usually happen” to people, however, it does seem in a sense to. PTSD is like when you are walking along the sidewalk and suddenly you are shoved into a van, you have been kidnapped; this event therefore causes you to develop PTSD.  It is in fact that most traumatic responses particularly happen to women and children that happen in the context of intimate relationships (Kolk, B. & Najavits, L.M., 2013).

Defining post traumatic stress disorder:

PTSD is” a major, life-altering disorder that strikes several people who survive a traumatic experience. PTSD is a type of invisible epidemic that affects millions of people of every age, every walk of life, and many suffer alone and in silence” (Goulston, M.; 2008). Cheryl Lawhorne and Don Philpott describe PTSD as “a traumatic stress injury that fails to heal such that the symptoms and behaviours it causes remain significantly troubling or disabling beyond thirty days after their onset (Lawhorne, C. & Philpott, D. ; 2010).

It’s a natural phenomenon that people tend to feel afraid when they are in danger. The fear causes a sudden change in the body which is when the body prepares to defend or avoid the fear. This is a reaction which indicated that the person is healthy and can protect himself from harm. However, individuals with the post traumatic stress disorder tend to have a damaged reaction. These people feel stressed even when they are out of the danger. PTSD develops in the mind of the individual when he has been involved in a traumatic event of physical harm or threat of harm. The individual who develops the disorder might have been in danger himself, or experienced harm happening to a loved one, or may have witnessed harm happening to a stranger or loved one (Yehuda, 2002).

What are the triggers?

According to James Butcher, Susan Mineka, and Jill Hooley; “Most people function well in catastrophes, and many behave with heroism. Whether or not someone develops post-traumatic stress disorder depends on a number of factors. Some research suggests that personality can play a role in the reduction of vulnerability to stress when the stressors are unforgiving. “Basically, we all have our own breaking points, the difference being that during really high levels of stress, the average person can be expected to materialize some psychological hardships that can be long or short term after the traumatic event.

In all cases of post-traumatic stress, conditioned fear which is associated with the trauma appears to be a key causal factor. Therefore, it prompts psychotherapy following a traumatic experience which is considered important in the prevention of conditioned fear before it becomes something that can be changed later (Butcher, J.M. & Mineka, S. and Hooley, J.M.; 2007) .

Genes is one of the causes for PTSD as many scientists have concluded that genes play a major role in creating memories. Fearful memories have to be understood in order to help in refining them or finding new interventions to reduce the PTSD symptoms. Scientists have found out that genes make a protein, which is needed to produce fear memories, called Stathmin. The test for this protein was made on mice in which those mice that produced this protein tended to be less likely to be shocked when facing danger or a fearful experience. These mice showed lesser fear and explored open places rather willingly than other mice. GRP is a chemical which is released in the brain during emotional events. GRP controls the fear response and lack of GRP leads to lasting memories and effects of fearful experiences. Researchers have found out that there are many chemicals that are present inside the brain created by our genes which directly or indirectly affect our fear memories, emotional responses, and moods. These chemicals affect the PTSD disorders and their functioning in the brain.

Another cause of the PTSD is the functioning of the parts of brain and how they help the individual to deal with the fearful experiences and stress that follows those events. The brain structures respond differently to all actions and one of them is known for the role it has in emotions, memory, and learning. This part of the brain is attentive when the body is at risk of harm or danger and helps in learning the fear such as someone running to hit you. This area of the brain also helps in managing the fear at an early stage and learning to control fear (Wiederhold, 2005).

Another area of the brain deals with storing unforgettable memories and reliving the original response of fear repeatedly by remembering those experiences. This part of the brain makes it difficult for the individual to make decisions, solve problems, and make judgements. Such functions of the brain affect the individuals suffering from PTSD. The brain does not allow these people to forget their fears and fearful responses to specific events. When these fears live in the brain, they start affecting the personalities of the individuals. The brain stores the fearful memories and affects the ability of the brain to work wisely.    

The genes and brain parts are different in every individual and these differences may affect the performance of PTSD individually. An example of this is a head injury or a traumatic event experienced in childhood where the growth of the brain is affected. Other factors affecting the brain areas are personality and cognitive development factors that are different in every individual as psychologists say that individuals respond differently to same situations. The way individuals look at life and the world around them can be positive or negative affecting the growth of the brain and responding to social factors. This affects the way individuals face traumatic events in life and how they deal with the social support to adjust with the trauma. The research study with the combination of these factors can analyse in the future that which individuals would face PTSD after traumatic events and which would not (Fisher, 1994).        

Researchers have focused on the prevention of PTSD as an important goal in the last decade because of the great number of cases that were being reported and the rapid progress in the study of mental and brain foundations make it possible to conclude preventions. There are many ongoing researches on the prevention of this disorder by targeting the causes and enhancing the personality, cognitive, and social factors to fall in PTSD after the traumatic event. Other researchers are working towards developing an effective treatment for the PTSD patients to ensure that they are responding well to the clinical procedures. As scientists are researching for the causes of PTSD it will become easier to understand the disorder better and find more effective treatments that may vary individual to individual (Bisson, 2007).   

        

Known symptoms:

Usually the symptoms can be categorized in three groups: re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms. Re-experiencing symptoms are those when the individual experienced flashbacks of the traumatic even long after the event, such as physical signs of sweating or a racing heart. Bad dreams and frightening thoughts are also included in the re-experiencing signs. These symptoms tend to affect the everyday life of the individual and the person starts developing negative feelings and thoughts. A few of these symptoms are; being startled easily, the feeling that the same event is happening once again, having nightmares or the traumatic event, night sweats, feeling more aggressive or violent, suffering addiction, thinking of suicide, not sleeping well, staying away from social events/places, disassociation of friends you once were close to, having flashbacks triggered by a smell, sound, even a feeling or loud noises, feeling of guilt, a lack of trust.  Some of these symptoms overlap what others see as a traumatic event (Lawhorne, C. & Philpott, D.; 2010).

Avoidance symptoms may include staying away from objects or places which are reminders of the traumatic experience, feeling numb emotionally, developing feelings of guilt, worry, and depression, lack of interest in enjoyable activities, and all those things that the individual has started to avoid after the experience which affects the daily routine.

Hyperarousal symptoms include being distracted easily, feeling tensed always, getting angry on small things, having outbursts of tears or anger, having difficulty in sleeping, and other symptoms that are usually constant and are seen regularly in the personality of the individual. These symptoms eventually make the person stressed or emotionally imbalanced. These symptoms tend to be natural when someone has experienced a traumatic event but when these signs become long lasting; it develops into PTSD (Scott, 2006).

While most of the case studies and information revolve around the military, their others who suffer from PTSD that are excluded from these studies and the needed help offered. As mentioned earlier, it was shortly after the PTSD diagnosis came into being, that it was noticed that other populations besides veterans were suffering from major traumatic problems. They were victims of incest, child abuse, and domestic violence, even those in law enforcement. These victims problems overlapped with those of soldiers that saw combat, however they were different in that they never had the skills of the soldiers before their war trauma(s). These sufferers lacked a large aspect of normal emotional, cognitive and neurobiological development: meaning these sufferers disassociate, and have major problems with chronic hyperarousal, somatisation and concentrations, not to mention that they blame themselves for what has happened to them (Lawhorne, C. & Philpott, D.; 2010). Family members of soldiers suffering from PTSD also suffer, they just suffer with the fallout from the family member; such as mood swings, nightmares, and increased alcohol intake as well as drug use illegal or prescription. 

It can also be seen that children have different reactions to these events. They can either have severe reactions to the events or none. Symptoms of children facing PTSD are different from adults such as bed wetting, enacting the scary event playfully, forgetting how to talk, or being clingy with an adult or parent unusually. These are symptoms in very young children; children who are in their teens tend to show symptoms like those of adults. Additionally these children may develop disrespectful behaviors, thoughts for revenge, and guilt (Zohar, 2000).

Who is at risk?

PTSD can affect millions of people as it can occur in any age from childhood to adulthood. Women are more likely to develop such a disorder than men while in some researches it is found that this disorder may be hereditary. PTSD can occur at any age, at any time after the traumatic event has taken place. It is also seen that PTSD is not always developed in those who have been through a traumatic event; some people may also experience this disorder when they witness a loved one being harmed. Moreover, it is also important to note that everyone going through a traumatic event does not necessarily suffer PTSD. People who are more likely to develop this disorder will have a history of mental illness, living through traumatic events and dangers, feeling extreme fear or helplessness, getting hurt, having no emotional support after the event, or suffering from additional stress after the event (Wilson, 2004).

Diagnosis:

As we know not every person develops PTSD after a traumatic event. The symptoms usually start after the event within a course of three months but the signs may recur years later as well. PTSD is considered when a person undergoes the symptoms for more than a month at least. The duration of the illness varies from person to person and the recovery time also varies. For some people, the symptoms last for 6 months while for others they may last for much longer. This condition can also become chronic in some people. A psychologist or psychiatrist can diagnose PTSD in a person by talking to the person and identifying the symptoms. A person diagnosed with PTSD must have symptoms of re-experiencing the event, three avoidance symptoms, and at least two symptoms of hyper-arousal. Other symptoms that may be considered are when people find it hard to carry on with their daily routines at work or with friends. Depression is also a common symptom which is collectively diagnosed with PTSD.

Prevention is a major factor which needs to be considered when diagnosing PTSD. Critical Incident Stress Management is a way to prevent PTSD by early detection of the disorder, psychological debriefing, risk-targeted interventions, and medications. Those who have experienced trauma are given preventive care to ensure that they do not develop PTSD. Psychologists have the ability to identify and treat the PTSD before it has developed into a severe syndrome. There are many biological chemicals that are identified and are related to the development of PTSD in individuals who have faced traumatic events. These biological chemicals may be difficult to identify, test, and examine but the latest technologies and advanced studies have helped professionals to easily test these chemicals and treat them before they develop into PTSD (Kinchin, 2004).

Global treatments have attempted to avoid the risk of PTSD development by simply treating all those people who have been involved in a traumatic event. This has been effective in many of the cases where people are in a state of shock or fear and their behaviors are studied and monitored to lower the risk of PTSD in the future. The level of care increases where the risk of PTSD development is higher and through this the people can be treated before they deeply get in the disorder.   

Psychological debriefing is another type of preventive treatment in which individuals are encouraged and interviewed to talk about the event immediately after it happened to share their feelings and emotions with their counselors. This helps individuals to structure the memories of the events and develop confidence. Even though this is a commonly used method, it is usually ineffective. Many critics believe that this psychological debriefing is rather harmful as it encourages the victim to talk about the event and not be able to forget it.         

Risk-targeted interventions help the victims to learn specific information of the events. The targeted models can be about controlling anxiety, stop avoidance behavior, and other advice on the instructions to stay relaxed and calm. These videos help the individuals from PTSD development. Medications are used such as antidepressants for those who have been subjected to traumatic events to reduce the risk of PTSD development (Coughlin, 2012).   

What treatments are out there?

Psychotherapy, the talk therapy, is the best known treatment for PTSD along with medications. All individuals are different and the treatments that are used on each are different as well because psychotherapy may work on one person while on the other it may not work at all. Thus, the most important factor in PTSD treatment is to get it treated by a professional who deals with mental health care provision and is experienced in PTSD. The treatments depend on the symptoms and signs that the individual is showing and the professional must ensure that the treatment works on the symptoms being shown.

Psychotherapy is the talk therapy which involves the professional to talk with the individual with PTSD as a treatment to the mental disorder. Psychotherapy can have individual or group sessions which may last for as long as the patient needs. In PTSD, this therapy usually lasts for 6 to 12 weeks depending on the individual needs while some can take longer. Professionals say that the best treatment for PTSD patients is the support from friends and family. There are several types of psychotherapy provided to PTSD people. Some of these types of therapies directly target the PTSD symptoms while other therapies focus on social, emotional, personal, and career related problems. The professional may also combine different types of therapies for one person depending on the needs (Bisson, 2007).  

Cognitive behavioural therapy is one of the most helpful therapies for PTSD. It includes the exposure therapy which helps the people to control or defend their fears. Through this therapy people are exposed to the traumatic experience once again in a safer way to help them cope with their feelings using writing, imagery, and even visits to the place where it happened. Another type of therapy is cognitive restructuring which helps people to make sense of the fearful memories. The therapists help these people to recall and understand the event in a realistic way than how they remember it. People may be guilty or stressed in the way the event happened, so therapists help them to understand the event positively. This therapy also helps people to reduce anxiety levels and think healthy. 

Talk therapies have thus been considered as the most useful treatment for PTSD. They help people to talk about their experiences and reduce their fright towards them. The general goals of these therapies are to use anger and relaxation control skills, teach about trauma and the impact, provide guidelines for healthy sleep, exercise, and diet, and help people deal with their fear, guilt, depression, and shame.

Medications have also been considered to be effective in dealing with PTSD. There are many advanced medications that are approved by the U.S. Food and Drug administration to treat PTSD. The most common of these medicines are sertraline and paroxetine which are antidepressants. These medications strongly treat depression and control symptoms of PTSD such as worry, anger, sadness, and numb feeling. These medications are given to the individuals along with sessions of psychotherapy. The combination of these two treatments is more effective and helps people to overcome their PTSD (Yehuda, 2002).

Conclusion:

However, post traumatic stress disorder can be dangerous and harmful for those who leave it untreated. The disorder directly affects the brain and leads individuals to have flashbacks, uncontrollable thoughts, and severe anxiety due to the traumatic event. Most people who go through traumatic experiences face difficulty in adjusting in their daily routines for a while. These traumatic reactions may get better in some people while in some they may take a different face and develop into PTSD. This disorder tends to shake up the lives of individuals but as discussed in the paper there are many successful diagnoses and treatments for this disorder. If the treatment is successful, the individual can prevent long term stress disorders and problems in living life.

References

Bisson, J. (2007). Post-traumatic stress disorder. Oxford Journals

Coughlin, S. (2012). Post-Traumatic Stress Disorder and Chronic Health Conditions. American Public Health Association

Fisher, L. (1994). Post traumatic stress disorder. Springer

Kinchin, D. (2004). Post Traumatic Stress Disorder: The Invisible Injury. Success Unlimited

Kolk, B. & Najavits, L. M. (2013). Interview: What is PTSD really? Surprises, Twists of History,     And Politics of Diagnosis and Treatment. Journal of Clinical Psychology, 68(5), 516-522

Scott, M. (2006). Counseling for Post-traumatic Stress Disorder. SAGE

Wiederhold, B. (2005). Post traumatic Stress Disorder. American Psychological Association 

Wilson, J. (2004). Treating Psychological Trauma and PTSD. Guilford Press

Yehuda, R. (2002). Post-traumatic stress disorder. The New England Journal of Medicine

Zohar, J. (2000). Post-traumatic Stress Disorder: Diagnosis, Management, and Treatment. Taylor & Francis