Post Traumatic Stress Disorder (PTSD)

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David Holt
Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder or PTSD is currently conceived as a disorder that appears in response to a highly stressful or "traumatic" situation. This disorder is characterized by the presence of the following symptomatic manifestations related to exposure to this traumatic event.

Contents

  • Origin and classification of PTSD
  • Main symptoms of PTSD
    • Intrusive re-experimentation of the traumatic event
    • Avoidance
    • Dullness
    • Autonomic hyperarousal
    • Intense emotional reactions
    • Aggressive behaviors towards others and towards themselves
  • Treatment of PTSD
    • References

Origin and classification of PTSD

As discussed in the DSM-V Diagnostic Manual: Many people who survive extremely traumatic events develop PTSD. Survivors of combat are the most frequent victims, but it is also identified in individuals who faced other disasters, both natural and induced. They include rape, floods, kidnappings, and aviation accidents, as well as threats that may involve kidnapping or hostage-taking. Children can develop PTSD as a result of an inappropriate sexual experience, whether or not they are injured. PTSD can be diagnosed even in those who only learned of some intense trauma (or its threat) suffered by someone close - children, spouses, other close relatives. One or two out of every 1,000 patients who undergo general anesthesia later report having been aware of pain, anxiety, helplessness, and fear of imminent death during the procedure; up to half of them may subsequently develop PTSD symptoms.

Stressful experiences of everyday life, such as grief, divorce, and serious illness, are excluded from this classification. Awakening from anesthesia while surgery is still continuing, however, could be considered a traumatic event, as well as learning of the sudden accidental death of a spouse and a life-threatening illness of a child..

After a certain period (symptoms do not usually develop immediately after the trauma), the individual somehow recalls the traumatic event and tries to avoid thinking about it. There are also symptoms of physiological hyperarousal, such as exaggeration of the startle response. PTSD patients also express negative feelings, such as guilt or personal responsibility ("I should have avoided it").

In addition to the traumatic event itself, other factors can play a role in the development of PTSD. Individual factors include a person's innate nature and genetic inheritance. Low intelligence and poor educational preparation show a positive association with PTSD. Environmental factors include low socioeconomic status and membership in a racial or ethnic minority group.

In general, the more excruciating or prolonged the trauma, the more likely it is that PTSD will develop. The risk increases to a quarter of the survivors of intense combat and two-thirds of those who were prisoners of war. Those who faced disasters due to natural phenomena, such as fires or floods, are generally less likely to develop symptoms.

Older adults are less likely to develop symptoms than younger ones, and women tend to have slightly higher rates than men. About half of the patients recover within a few months; others may experience disability for years.

Main symptoms of PTSD

Intrusive re-experimentation of the traumatic event

Symptoms of this type are considered by some authors to be "the hallmark" of PTSD. These are re-experiences of the traumatic event of an intrusive nature, which can provoke in the person a reaction of stress and anxiety very similar to the one that occurred in the face of the original trauma. Symptoms ranging from flashbacks, nightmares, etc. are included here. There are authors who indicate that this re-experimentation can lead to a “re-traumatization”, self-perpetuating the trauma, and “fixing” the person in an event to which they are continually being re-exposed..

Avoidance

Avoidance of reminders of the trauma is one of the core symptoms of PTSD, and it can manifest itself in different ways. On the one hand, the person may present avoidance behaviors so as not to have to face any reminder of the traumatic experience. Reminders can be people, situations, or circumstances that resemble or are in some way associated with the event. On the other hand, people with PTSD often try to push the memories out of their minds and avoid thinking or talking about the event in detail, especially in the worst moments. However, it also often happens that the person ruminates excessively on the aspects that could prevent the event, on the reasons or why it had to happen to them, or on how to take revenge for the event. On the other hand, the person can avoid the memories of the trauma through dissociative mechanisms or symptoms of amnesia. Another form of avoidance that usually develops, and which we will see below, has to do with the experimentation of emotions, especially with emotions that are "intolerable" for the person, trying in many cases to "anesthetize" emotionally, either by showing affective "detachment" , through substance use, excessive dedication to work or other activities, etc..

Dullness

Dullness symptoms are considered by many authors to be a form of avoidance that occurs specifically in PTSD. Numbness can be expressed as depression, anhedonia, lack of motivation, but also as psychosomatic reactions, or dissociative states. It must be taken into account that, as we indicate below, on many occasions people with this disorder have difficulties in controlling their emotions, and precisely for this reason they try to avoid disturbing internal sensations.

Autonomic hyperarousal

Although people with PTSD are usually characterized by emotional constriction, their bodies seem to continue to react to certain emotional and physical stimuli as if the threat still persists, although this autonomic activation no longer has the adaptive function of alerting the body to danger. This hyperarousal is associated with sleep problems. On the one hand, they may be unable to calm down enough to go to sleep, and on the other they may be afraid of their nightmares. Many people with PTSD report that their sleep is interrupted, waking up as soon as they begin to have a dream, for fear that it will turn into a nightmare. On the other hand, these people also report excessive hypervigilance, and exaggerated startle response. The physiological hyperarousal these people experience also interferes with their ability to concentrate. Apart from the problems of amnesia about certain aspects of the trauma, these people often have trouble remembering everyday things. They may even lose maturational achievements, and return to previous stages of coping with stress, such as losing their ability to take care of themselves, excessive dependence, making autonomous decisions, toilet training in children, etc..

Intense emotional reactions

Difficulties appear in the regulation of affect. These people can respond to stimuli with intense and disproportionate reactions (anger, anxiety, panic, etc.), which can even intimidate others. But they can also be paralyzed.

Aggressive behavior towards others and towards themselves

Many studies have indicated that traumatized people can display aggressive behavior towards others or towards themselves. For example, child abuse increases the likelihood of criminal and criminal behavior in adulthood.

Treatment of PTSD

The treatment of PTSD is done with psychotherapy and medication. In psychotherapy, the management of anxiety is worked through relaxation, meditation, learning to replace negative thoughts with positive ones and learning to stop the thoughts that cause anxiety.

Cognitive Therapy and Exposure Therapy, which involves exposing oneself both imaginatively and in reality to situations that recall the trauma, without triggering symptoms.

The drugs used to treat PTSD are antidepressants, from the new generation to the old. In addition, drugs that stabilize the mood and anxiolytic medication can be used for the treatment of anxiety at specific moments where it is not possible to control it..

References

  • American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. (DSM-IV-TR). Washington, D.C .: American Psychiatric Association
  • Barlow, D.H. (1988). Anxiety and its disorders: the nature and treatment of anxiety and panic. New York: Guilford
  • Brende, J. (1985). The use of hypnosis in posttraumatic conditions. In W. E. Kelly (Ed.), Post-traumatic stress disorder and the war patient (pp. 193-210). New York: Brunner / Mazel.
  • Breslau, N., Davis, G.C., and Andreski, P. (1991). Traumatic events and post traumatic stress disorder in an urban population of young adults. Archives of General Psvchiatrv. 48, 216-222.
  • Brewin, C.R., McNally, R.J. and Taylor, S. (2004). Point-counterpoint: two views of traumatic memories and post-traumatic stress disorder. Journal of Cognitive Psychotherpay, 18, 99-114
  • Echeburúa, E. (2004): Overcoming a trauma and treating victims of violent events. Madrid: Pyramid
  • Echeburúa, E. and De Corral, P. (1997). Advances in the cognitive-behavioral treatment of Post-Traumatic Stress Disorder. Anxiety and Stress, 3, 249-264.
  • Foa, E. B., and Rothbaum, B. O. (1998). Treating the trauma of rape. Cognitive-behavior therapy for PTSD. New York: Guilford.
  • Herman, J. L. (1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377-391.
  • Keane, T. M., Zimering, R. T., and Caddell, J. M. (1985). A behavioral formulation of post-traumatic stress disorder. The Behavior Therapist, 8, 9-12.
  • Orsillo, S. M .; Batten, S.V. (2005) Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder Behavior Modification, 29 (1), 95-129

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