Trauma & Stress-Related (PTSD)

PTSD symptoms 2

Symptoms of depression are common and may warrant an additional diagnosis of a depressive disorder. Survivors guilt- In the case of a life threatening trauma shared with others, survivors often describe painful guilt feelings about surviving when other s didn't or the things they had to do to survive. Substance abuse, anger and aggressive behavior , and relationship problems are common. The full symptom picture must be present for at least a month and cause significant interference with social, occupational and other areas of functioning.

DSM5 change

The DSM-5 (2013) PTSD and Adjustment Disorder have been combined under Trauma and Stressor related disorders rather than it being still under Anxiety Disorders

PTSD vs. Acute stress disorder (ASD)

The DSM-5 states that there are similarities between the 2 disorders in terms of precipitating traumatic events and symptoms, but ASD, the symptoms are time limited, up to 1 month following the trauma. If the symptoms last more than 1 month it is diagnosed as PTSD.

PTSD Treatment

- Must tailor treatment the pts ability to tolerate intense f feelings . -Eye movement desensitization and reprocessing (EMDR): traumatic events loss their capacity to elicit anxiety when accompanied by rapid eye movements. Ask the pt to imagine an anxiety. This provokes a traumatic memory. -Other treatments are similar to the holistic, multimodal approach of other anxiety disorders.

ONSET OF PTSD

-Acute PTSD occurs immediately or within six months after a traumatic event. -Delayed-onset PTSD, the symptoms occur anytime later than six months after the traumatic event. This can be 1 year, 20 years, or even 40 years. Example: Previously asymptomatic 60-year old people can develop PTSD in response to having been sexually or physically abused as children

OTHER SYMPTOMS of PTSD

-Aftereffects of an event or series of events severe enough to profoundly alter a person's thinking, feelings, and physical reactions. -A single life-or-death incident lasting as little as a few seconds can be enough to traumatize a person. -Emotions, identity, and sense of the world as an orderly, secure place, can be severely shaken or shattered. -The rupture can be so profound that an individual is unable to get over it no matter how hard he/she try.

PTSD

-Commonly found after sexual abuse ( also physical abuse) or sudden unforeseen death of a loved one) in children or adolescents. -Depending on whether they receive adequate treatment or not, it can continue to adult PTSD. -Childhood trauma is influenced by the following factors: individual coping style, degree of self-blame, parental emotional climate, and reactions of others after the disclosure. If these are negative. It can create maladaptation and PTSD over a life time. -If unresolved the child copes with it by internalizing depression and anxiety (Goenjian, 2005). 0Children from healthy families are more resilient and adaptable and more likely to express their feelings rather than those from chaotic, blaming, and non-supportive unhealthy families.

PTSD DIAGNOSTICS CRITERIA A.

Criterion A: Stressor -The person has been exposed to a traumatic event in which both of the following have been present: 1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others. 2. The person's response involved intense fear, helplessness, or horror. Note: In children, it may be expressed instead by disorganized or agitated behavior.

PTSD DIAGNOSTICS CRITERIA B.

Criterion B: Intrusive Recollection -The traumatic event is persistently re-experienced in at least one of the following ways: 1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. 2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content 3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In children, trauma-specific reenactment may occur. 4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

PTSD DIAGNOSTICS CRITERIA C.

Criterion C: Avoidant/ Numbing -Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: 1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma. 2. Efforts to avoid activities, places, or people that arouse recollections of the trauma. 3. Inability to recall an important aspect of the trauma 4. Markedly diminished interest or participation in significant activities. 5. Feeling of detachment or estrangement from others. 6. Restricted range of affect (e.g. Unable to have loving feelings). 7. Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, other

PTSD DIAGNOSTICS CRITERIA D.

Criterion D: Hyper-arousal Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following: 1.Difficulty falling or staying asleep 2. Irritability or outburst of anger 3. Difficulty concentrating 4. Hyper-vigilance 5. Exaggerated startle response

PTSD DIAGNOSTICS CRITERIA E.

Criterion E: Duration Duration of the disturbance (symptoms in B, C, and D) is more than one month.

PTSD DIAGNOSTICS CRITERIA F.

Criterion F: Functional Significance The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: Acute: If duration of symptoms is less than three months Chronic: If duration of symptoms is three months or more Specify if: With or without delay onset: Onset of symptoms at least six months after the stressor

Depersonalization

During the trauma a person is subject to a process called depersonalization. Depersonalization refers to the stripping away of one's personhood, individuality, and humanity. At the moment of the attack, whether the assailant is a mugger, rapist, enemy soldier, or an earthquake, one does not feel a valuable person with a right to safety, happiness and health. At that moment, one feels more like a thing, a vulnerable object subject to the will of a power or force greater than oneself.

PTSD Rates

Lower among individuals who had been victims of a relatively low stress crime, such as burglary in which no one was home. Higher among individuals who had endured high-stress crimes: those in which the individuals or others were injured, a weapon was involved, or there otherwise was or appeared to be a threat to the individual's life.

PTSD major symptoms

Major Symptoms fall into 3 major groups: 1. Persistent recurrent and intrusive thoughts: flashbacks (a sense of reliving the event), dreams of the trauma, intense psychological distress at exposure to internal or external cues such as smells, sounds, or visual event. 2. Avoidance behaviors or depersonalization- inability to recall certain aspects of the trauma, lack of interest in things that were formerly pleasurable, feelings of detachment or isolation; restriction in range of feelings (unable to feel happy). 3. Biological responses such as emotional numbing, hypervigilance, and autonomic nervous system arousal (APA, 2013)

In general, TRAUMA is reserved for:

Natural catastrophes-hurricanes Floods Fires Earthquakes Man-made catastrophes: War, concentration camp experiences, physical assault, sexual assault, and other forms of victimization involving a threat to life and limb. Victims of vehicular accidents and crimes can also develop PTSD, if they sustain severe injuries

Warning Signs

Nightmares or avoidance Taking risks in recovery efforts Problems with commanders Refusing breaks Alcohol abuse Domestic disturbance Feeling hopeless, suicidal statements

Common Myths' about PTSD

PTSD is an adult psychiatric disorder. Exposure to trauma or disaster always predicts PTSD. PTSD is diagnosed early.

Three different kinds of symptoms

People with PTSD experience three different kinds of symptoms: 1. Reliving the trauma is the first set of symptoms. An individual becomes upset when confronted with a traumatic reminder or a thought about the trauma when he/she is trying to do something else. 2. Staying away from places or people that reminds the individual of the trauma, isolating from other people, or feeling numb is the second set of symptoms. 3. Feeling on guard, irritable, or startling easily is the third set of symptoms

What is PTSD?

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing a traumatic event. A traumatic event is a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or child.

PTSD CAN BE FOUND AMONG

Rescue workers Firefighters Health care workers Police officers Nurses and doctors who served in Vietnam and other wars. Nurses that work in an emergency room in an area with a high rate of violent crime

Natural Disasters vs. Terrorism

-Natural disasters are usually limited in time and space and are often expected, therefore enabling coordination of rescue efforts, sheltering, and deployment of medical services. -Terrorism usually occurs randomly and unexpectedly with regard to place and time. These differences can affect psychological Outcomes among populations highly exposed to terrorist acts. In addition, the emotional, social, and political effects of terrorism are likely to be widespread, nonspecific, accumulative, and enduring, and they may affect large communities and influence not just how entire nations cope with the impact of such events but also how they respond to similar threats in the future

PTSD cont'd

-PTSD was originally known as: hysteria, war neurosis, shell shock, and battle fatigue -Exposure to an overwhelming event, "resulting in helplessness in the face of intolerable danger, anxiety, and instinctual arousal" (Eth & Pynoos, 1984) precipitates and describes traumatic events such as : natural disasters, rape, incest, physical or mental torture, combat experiences, and catastrophic accidents, -Usually have a complex constellation of symptoms. Symptoms usually parallel a traumatic event or circumstance beyond the typical normal human experience.

DSM-5 CRITERIA for PTSD

-The American Psychiatric Association revised the PTSD diagnostic criteria in the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders, in 2013. -Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. -A fifth criterion concerns duration of symptoms and a sixth assesses functioning.

Incidence and Prevalence

-The majority of people will experience at least one traumatic event in their lifetime. -Intentional acts of interpersonal violence, in particular sexual assault, and combat are more likely to lead to PTSD than accidents or disasters. -Men tend to experience more traumatic events than women, but women experience higher impact events. -Women are more likely to develop PTSD in response to a traumatic event than men. This enhanced risk is not explained by differences in the type of traumatic event.

Impairment, disability and secondary problems

-The resulting financial problems are a common source of additional stress, and may be a contributory factor leading to extreme hardship such as homelessness . -The disorder has adverse effects on the sufferer's social relationships. This leads to social withdrawal. -Problems in the family and break-up of significant relationships are not uncommon -Symptoms of PTSD cause considerable distress and can significantly interfere with social, educational and occupational functioning. -It is not uncommon for PTSD sufferers to lose their jobs, either because re-experiencing symptoms, sleep and concentration problems make regular work difficult, or because they are unable to cope with reminders of the traumatic event they encounter at work.

Other PTSD info

-These individuals are not mentally ill but are emotional wounded by life and need to heal those wounds. It is the only diagnosis in the DSM that is not a mental illness. -Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develop PTSD. -PTSD was not officially recognized by the American Psychiatric Association until 1980.

TRAUMA

-True Trauma refers to situation which one was rendered powerless and great danger was involved. -The events must be unusual and out of ordinary, not events that are part of the normal course of life. -Trauma encompasses events of such intensity and magnitude of horror that they would overtax any human being's ability to cope. -Just as the body can be traumatized, so can be the psyche. -Trauma refers to the wounding of an individual emotions, spirit, will to live, beliefs about herself/himself, and the world. It challenges one's dignity, and sense of security.

People at risk of developing PTSD

-Were directly exposed to the traumatic event as a victim or a witness. -Were seriously injured during the trauma. -Experienced a trauma that was long lasting or very severe. -Saw themselves or a family member as being in imminent danger -Had a severe negative reaction during the event, such as feeling detached from ones surroundings or having a panic attack. -Felt helpless during the trauma and was unable to help themselves or a loved one. -Have experienced an earlier life threatening event or trauma. -Have a current mental health issue -Have less education Are younger -Is a woman with lack of social support -Have recent, stressful life changes

PTSD incidence

About 60% of men and 50% of women are exposed to a traumatic event in their lifetime (Department of Veterans Affairs, 20120. Women are more likely to experience sexual assault and childhood sexual abuse, while men are more likely to experience accidents, physical assaults, combat, or to witness death or injury. Although exposure to trauma is high, less than 10% of trauma victims develop PTSD (Breslau, 2009). Puri and Tresaden (2011) describe PTSD as a " reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape or other crimes (p.187)."

PREVALENCE

An estimated 6.8% of Americans will experience PTSD at some point in their lives. 3.6% (5.2 million people) U.S. adults have PTSD during the course of a given year. 9.7%, women 3.6%, men