Human beings, throughout our history, have experienced numerous natural disasters, such as floods, hurricanes, earthquakes, etc., and also, unfortunately, we know the terror that we produce ourselves, such as war, terrorism, violence from gender, crime, etc. These types of events, which today we call traumatic, have been permanently present throughout the history of humanity and in all cultures, to such an extent that some authors point out that the reaction to trauma, the currently called Stress Disorder Post Traumatic (PTSD) is an abnormal reaction to relatively common events. In fact, it is estimated that each year there are more than 150 million people directly affected by a disaster. Authors such as Breslau, Kessler, Chilcoat, Schultz, Davis and Andreski recently pointed out that 90% of North Americans would be exposed to a stressful event, as defined by the DSM-V.
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However, the way of responding to these events is very varied. While in most people its negative effects are mitigated and even disappear with time (indeed, they can even have effects on personal growth), others experience long-term consequences, even life-long, if they do not receive the appropriate treatment. . In a 2000 report, the US Department of Health and Human Services estimated that 9% of people exposed to a stressful event would develop PTSD.
Thus, exposure to a traumatic event is a necessary but not sufficient requirement to develop significant pathological sequelae. 9% is a minority of people who have been exposed to a stressor. Therefore, it is by no means unreasonable to think that there may be natural healing and recovery mechanisms. In this sense, premature or excessively aggressive intervention may even interfere with these natural mechanisms..
Despite the fact that, as we have just indicated, both traumatic events and the pathological responses they can trigger have been present throughout the history of mankind, however, PTSD was recognized for the first time as a differentiated diagnostic entity in in 1980, in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, APA, 1980). Since then, this disorder has been included in the category of anxiety disorders, because it is considered that its fundamental symptoms consist of the presence of persistent anxiety, hypervigilance and phobic avoidance behaviors.
The inclusion of this disorder in the DSM was largely due to pressure from veterans of the Vietnam War. This group wanted to have a diagnostic category that would reflect the psychological consequences of the war and, furthermore, that would justify being able to receive the diagnosis of a “mental disorder”, with its consequent medical and social benefits. Obviously, the disorder has been known since before 1980, and we can find descriptions in the poetry of Homer, Shakespeare or Goethe. In the psychopathological tradition it was known under very different labels, such as Oppenheim's "traumatic neurosis", the "war neurosis", the "Post-Vietnam syndrome", the "battle fatigue", the "bombing shock" shellshock) , etc.
PTSD is currently conceived as a disorder that appears in response to a highly stressful situation. This disorder is characterized by the presence of the following symptomatic manifestations related to exposure to this traumatic event.
PTSD is one of the most common mental disorders. Regarding its global prevalence, it is believed that it ranges between 1 and 14%. This great variability may be due to the fact that different studies have used variable diagnostic criteria and have studied different populations. For example, the data in studies carried out on individuals at risk (war veterans, victims of terrorist attacks, etc.) oscillate between 3 and 58%. Regarding the prevalence throughout life, it is estimated that it ranges between 1.3% and 9% in the general population and at least 15% in the psychiatric population.
As regards its appearance, it can occur at any age, even during childhood. In addition, it usually appears abruptly, and although the symptoms usually appear in the first 3 months after the trauma, it can also manifest after a temporary lapse of months, or even years..
The course can be highly variable over time, and both the symptoms themselves, as well as the relative predominance of each of them, vary greatly throughout the course of the disorder. There are also important variations in the duration of symptoms. Approximately half of the cases usually recover spontaneously in the first 3 months. However, in the other half the symptoms can persist even beyond 12 months after the traumatic event and usually require therapeutic attention for their recovery..
According to different studies, the two most important predictors are the history of previous trauma (those who have been more exposed to previous trauma are more likely to develop a TPET) and the reaction in the moments after the fact (people who show predominantly reactions dissociative have a worse prognosis).
With regard to other predictor variables, the most prominent factors are intensity, duration, and proximity of exposure to the traumatic event. Some studies have also indicated that the quality of social support, family history, childhood experiences, personality traits, and pre-existing mental disorders can influence the development of this disorder, although PTSD can appear in individuals without any predisposing factor, especially when the event is extremely traumatic).
On the other hand, there are also important cultural differences, depending on the value given to human losses in different cultures. Other cultural and religious values can also influence the response to stress. For example, it appears that Buddhist and Hindu philosophies display characteristics that can be considered as protective factors, such as acceptance of pain and suffering, understanding that the future will bring relief through rebirth, and so on. These features could maximize recovery for traumatized people.
Finally, with regard to the characteristics of the traumatic event itself, it seems that certain stressors are more likely to trigger PTSD than others. As we have already indicated, traumatic events inflicted by humans appear to be more likely to trigger PTSD, especially when it comes to direct family members or people who should be trusted, or when there has been pressure to silence the event; Repeated and repetitive events and those experienced at an earlier age are also often more “traumatizing”.
Many of the symptoms manifested by people diagnosed with PTSD can be confused with other psychological disorders, such as depressive disorder, somatization disorder, pretense, borderline personality disorder (BPD), antisocial, and even with some type of psychotic disorder. In these cases, it is necessary to assess to what extent the symptoms are a response to a traumatic event and symptoms of the three previously indicated groups are manifested (re-experimentation, avoidance / dullness and hyperarousal).
It must be taken into account that although PTSD is a relatively easy diagnosis to make when the existence of a traumatic event is known, or when the patient reports the relationship between his symptoms and a highly stressful event, however, when the symptoms are late-onset, this relationship may not be so evident, especially for the patient, so the clinician must assess the existence of such experiences, since the history of traumatic events is a key element for the differential diagnosis.
With regard to comorbidity associated with PTSD, it is extremely high. According to the literature, up to 80% of patients diagnosed with this disorder have at least one more psychopathological diagnosis, the most frequent being alcoholism or drug abuse (60-80%), affective disorders (26% -65%), anxiety disorders (30-60%), or personality disorders (40-60%).
Regarding the association with substance abuse, this is usually a frequent strategy to try to flee or hide the pain associated with the traumatic experience. Studies indicate that patients with both disorders show greater severity and worse response to treatment and tend to abuse “hard” drugs like cocaine and opiates. In addition, the presence of both disorders is often associated with other problems, such as begging, domestic violence, medical problems, and difficulties in therapeutic involvement..
Regarding affective disorders, it is very common to observe subsequent depressive episodes, characterized by loss of interest, decreased self-esteem and even in the most serious cases, recurrent suicidal ideations (present in about 50% of rape victims).
Finally, emphasize the frequent presence of episodes of anger and aggressiveness, which, although they are very common reactions among trauma victims, can in some cases reach disproportionate limits and significantly interfere with the daily functioning of patients..
The first thing to emphasize, and in what most of the authors agree, is that the experience of a trauma in itself is not a sufficient justification for receiving treatment, but that other psychopathological manifestations related to that event must be present, such as listed in PTSD or other diagnosis (depression, anxiety disorders, etc.).
The psychological processes that are considered responsible for the development and maintenance of PTSD is avoidance, both the active avoidance of reminders of the trauma, and emotional blunting, which is seen as an emotional escape when active avoidance is unsuccessful. Therefore, it is not surprising that a common element of many therapeutic approaches has been precisely the exposure and processing of internal and external cues related to trauma..
The main approaches to treating PTSD are.
The use of psychotropic drugs is generally recommended in people whose problems with anxiety, insomnia, etc. They can be very disabling, also those who do not want or can get involved in a psychological treatment focused on the trauma. It is also recommended for those who are under threat of subsequent trauma (eg, domestic violence), or are benefiting little or nothing from trauma-focused psychological treatment, etc..
There are quite a few differences in the therapeutic approaches that have emerged from psychodynamic approaches. Debriefing is the basic strategy to address the acute catastrophic stress reaction, along with the techniques of "abreaction", support and self-cohesion..
The use of hypnosis for the treatment of trauma has a long history, dating back to the works of Freud. There are a number of reasons for using hypnosis and related techniques in the treatment of post-traumatic disorders: First, hypnotic techniques can be easily integrated into various therapeutic approaches, such as psychodynamic, cognitive-behavioral, and pharmacological therapy. Second, PTSD patients tend to be more responsive to hypnotic suggestions than other clinical and 'normal' groups. Third, a high percentage of patients with PTSD experience dissociative symptoms, and hypnosis can help patients to modulate and control the involuntary onset of these phenomena and to recall forgotten traumatic information..
Thus, hypnosis can have several uses in the treatment of PTSD (supportive suggestions, work with traumatic memories, cognitive reinterpretation of traumatic events) and can be used in different stages (establishment of the therapeutic relationship, reduction of symptoms, psychological reintegration , labor and social of the patient).
Eye Movement Desensitization and Reprocessing (EMDR) consists of a form of exposure, accompanied by saccadic eye movements. In this technique, the patient focuses on a disturbing image or memory, while following the movements of one of the therapist's fingers. After each sequence, the patient indicates his subjective level of anxiety and his degree of belief in positive thoughts.
In general, treatments derived from the cognitive-behavioral approach have produced the largest number of controlled studies and the most rigorous studies. This type of treatment usually includes various procedures and strategies, such as psychoeducation, exposure, cognitive restructuring, and anxiety management techniques. It appears that both prolonged exposure procedures and stress inoculation training are the most effective tactics for reducing PTSD symptoms..
Acceptance and Commitment Therapy (ACT) attempts to promote people's abilities to make and keep commitments to change their behavior. In this way, patients are encouraged to identify goals in their lives and to commit to actions that are consistent with those values..
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