Post Traumatic Stress Disorder (PTSD): An Introduction
PTSD is a well-known acute anxiety syndrome that is created after an experience to any incident which is considered as threatening and causes psychological distress. Normally, the PTSD is created following the exposure to a horrifying incident or trauma in which grave bodily harm has taken place or was endangered. The distressing incidents that can activate PTSD consist of violent personal physical attacks such as rape or robbery, natural as well human-created calamities, mishaps in military warfare. PTSD can be at times turns to be an extremely disabling condition.
These traumatic events may invoke the risks of death to oneself or to some other person, or to a person’s own or somebody else's physical, sexual, or emotional integrity. Moreover, the distressing events can cause a single occurrence or continued or recurring events that utterly make the individuals incapable to cope. Stress is created by the victim's failure to incorporate the thoughts and feelings created as a result of the distressing incident. The mental state of affairs can be delayed for some time. Hence, in a psychological distress, PTSD is less frequent however more long-term, harmful and debilitating than the other acute stress syndromes.
Traumatic events can be created by various shocking incidents. For instance, psychological events for military forces who fought in the Vietnam and in the Gulf Wars, 9/11 rescue workers, survivors of various accidents, assaults, and other crimes, people who witness shocking events are amongst those people who are prone to develop PTSD as well the families of the victims.
Yet, there are a number of common rationales of for the cause of PTSD. Mostly, the dangers to one's life are major factors. There is generally a desecration of the person's thoughts regarding the world and of their human rights that puts the concerned person in a state of intense disorder and uncertainty. This is especially noted when all-time trusted people or society infringe, discredit or delude the person in some unpredicted manner. Psychological shocks may accompany with physical suffering or exist discretely of it. Acute distress can be the consequence of facing, observing or being bullied with physical abuse, intimidation or domestic violence. PTSD is common to the people when such disturbing incidents are faced in childhood. Warfare or other mass violence and natural disasters sometimes cause psychological distress. Besides, continuous experiencing of extreme poverty conditions or verbal ill-treatment can be disturbing.
It may be noted that various sections of people respond in a different way to similar events. An individual may face an incident as being very disturbing whilst another person facing the same incident does not consider it upsetting at all. It is true that not all people who face a traumatic incident in fact would acquire PTSD.
PTSD is generally acquired by re-experiencing of recurring traumatic event together by symptoms of intense provocation and by evasion of stimuli related to the traumatic event. A serious calamity, a natural catastrophe, or criminal assault can thus cause PTSD. When the consequences of traumatic events hamper with normal daily routines, the individual may be experiencing PTSD. The establishment of PTSD as a psychological disorder has helped in the identification and treatment of PTSD people.
PTSD can happen at any age, and disturbing state can be built up over the lifetime. Reactions of PTSD cause feelings of phobia, vulnerability or revulsion.
Types of Stressors
There are 3 main types of stressors for PTSD patients:
- Threatened with death or critical injury to individuals, for example: being the victims of physical assault or brutal crime
- Learning about the news of the death of the beloved, or a critical injury to family members or friends
- Witnessing the deaths of the beloved or critical injury to another person
A number of people with PTSD constantly re-experience the suffering in the form of flashback events, memories, nightmares, or scary thoughts, particularly when they come across incidents or objects similar to the trauma. Anniversaries of traumatic events can also cause PTSD symptoms. PTSD patients also experience emotional deadness and sleep troubles, despair, nervousness, and bad temper or sudden outburst of irritation. Thoughts of strong remorse are also frequent. The majority of PTSD patients tries to avoid any reminiscent or thoughts of the traumatic events. PTSD patients are diagnosed when symptoms continue for more than a month.
PTSD Symptoms
Following are some salient symptoms of PTSD patients:
- Re-Experiencing the EventSuch symptoms are disturbing thoughts and reminiscences or persistent nightmares of the traumatic events.
- Avoidance BehaviorThe PTSD patients avoid activities, situations, people, or discussions they relate with the disturbing incidents.
- Affective or Emotional NumbnessThe PTSD patients show indifference or general disinterest of the world around. This indifference is shown by the growth of a limited choice that causes a poor responsiveness to the external world.
- Hyper arousal The PTSD patients have a restless sleep, nervous thoughts, exaggerated response, hyper-vigilance, poor focus, bad temper and belligerent behavior. Symptoms in the PTSD patients generally start within 3 months of traumatic events; however at times it arises after several years. Such delayed symptoms are generally caused by the anniversary of the traumatic events or with the experience of the other distressing event.
PTSD Patients at Military
Military veterans or troops experience critical psychological challenges that included continuous, battle-ready, hyper-vigilant state. Following several months of operation in a war zone in which there is a constant threat to life and limb as well as surprise attacks, direct assaults, mass killings, unintentional civilian deaths, and life escapes, can be quite traumatic.
Many military personnel individually cope with their return from the war zones to their homes with different levels of success. A few of them realize this changeover within some weeks. Others patients need somewhat more counseling. However, a large population of troops is unable to face the traumatic incidents successfully.
The counselors managing such war personnel should identify the intricate nature of readjustments. They must note that post-deployment problems for military personnel may be considered as a trivial impediment in various readjustments courses. Besides, they must aware of the fact the prospects that the troubles are indications of a medical or a psychiatric syndrome.
Survival after serious injury
A lot of military personnel wounded in the war zones are surviving with their injuries. As a result of advanced technology, 90% of injured personnel now survive critical injuries (Gawande, 2004). Past study with war veterans has shown that those injured in war zones are at greatest danger of acquiring PTSD (Schlenger et al, 1992). Thus, mental health condition should be evaluated regularly as part of any post-injury treatment.
Risk & Caring Factors
Suicidal risks
An evaluation of suicidal risks in PTSD individuals can be significant. The present data show a positive relationship of past distressing incidents and the chances of attempted suicides. Moreover, PTSD is generally comorbidity with various syndromes that are linked to suicidal behaviors (APA, 2004).
Risks to others
The present data imply that PTSD patients have no dangers to other people. As with the evaluation other patients, the counselor should establish the availability of weapons or firearms, the display of violent behaviors, and the comorbidity existence of persecutory illusions.
Ongoing stressors
Following the excitement from the war zones, the military personnel may be experiencing with new home problems before their deployments to war zones. Most commonly, such stressors create family discords. Ongoing stressors are considered as being risk issues for the growth of PTSD amongst the individuals. As well, military personnel with PTSD generally have a poor capability to deal with the routine stresses of life.
Risky behaviors
Similar to other psychiatric syndromes, clinical assessments must deal with alcohol and drug misuse and addiction, impulsivity, prospects for further experience of violence, sexual behaviors, and non-conformity to medical treatment.
Personal characteristics
Military personnel facing acute traumatic events show a wide range of post-traumatic reactions, from severe susceptibility to strong flexibility. In fact, the majority of people experiencing traumatic incident does not acquire PTSD (Kessler et al, 1995). Various individual traits that seem to be applicable are coping abilities, interpersonal skills, attachment, disgrace, dishonor sensitivity, past distress history, and compliance for medical treatment (Hoge et al, 2004; APA, 2004).
Social Help
Social help and assistance is one of the most influential protective factors. The safety elements are affected by the capability of a person to approve or use social help (Benight & Bandura, 2004). Approval of social help can be particularly difficult in PTSD patients, where symptoms harm the affected person’s capability to gain from accessible familial and social assistance.
Comorbidity
The prospects that PTSD patient fulfill the standards for a minimum one psychiatric syndrome are about 80% (Kessler et al, 1995). Such PTSD patients are in fact at greater risks for various ailments. Thus, any evaluation of normal risks must take into account the assistance of comorbid emotional and medical syndromes.
Its Treatment
There exist effective various psychotherapeutic and pharmacological programs in the medical field for PTSD patients. Detailed discussion of such studies can be examined in recently published practice guidelines for PTSD (APA, 2004; Foa et al, 2000).
Psychotherapeutic interventions
Cognitive behavior therapy (CBT) is a well-known treatment for PTSD patients. CBT methods deal with the intense anxiety and cognitive deformities related to PTSD. Continued exposure is in effect a disappearance paradigm in which PTSD patients are repeatedly exposed to painful memories by means of imaginal experience. These patients are asked to build accounts about the worst disturbing events they can remember. With constant therapist-guided treatment to such memories, they are able to progressively reduce distress levels (Rothbaum et al, 2000).
Cognitive therapy and cognitive processing therapy concentrate on the distress-related flawed thoughts related to PTSD. General flawed cognitions cause viewing the world as a dangerous place, considering oneself as helpless or inadequate, or thoughts of guilt for the consequences that could not have been avoided. Cognitive reformation is the method by which the therapists deal with such erroneous thoughts, thus helping the PTSD patients to prevail over the unbearable trauma-related thoughts like guilt and disgrace (Rothbaum et al, 2000).
In practice, the medical analysts have applied both exposure and cognitive treatments with equal efficacy. These types of treatment are considered to be the major programs for PTSD patients (APA, 2004; Foa et al, 2000). A requirement for exposure therapy treatment is a true reminiscence of the disturbing incident so as to dissociate the disturbing memory from the unbearable psychological states in which it is related to the PTSD patients.
As regards cognitive therapy treatment, the motivation is mostly on the repeated and mistaken cognitive that is related to distressing reminiscences. In view of the shortage of qualified CBT psychoanalyst, no alternative may exist. If both alternatives exist, the option for CBT treatment must perhaps depend as to understand the condition of the patients to remove unbearable fear-based reminiscences and avoidance approach for the core medical syndrome is a disturbance regarding the patients themselves or others. In effect, exposure therapy treatment is efficiently applied to deal with wrong cognitive, and cognitive therapy treatment is effectively being applied to deal with terror-based evident approach. These remarks are founded on my medical data, as there is at present a deficiency of methodical study on treatment PTSD patients that would guide some patients with exposure treatment as well as to cognitive therapy treatment.
As regards the Eye movement desensitization & reprocessing (EMDR), PTSD patients are asked to visualize an agonizing reminiscence and the related negative cognitions whilst visually observing on the fast action of the psychoanalysis finger movements (Shapiro & Maxfield, 2002). Though many researches have proved these activities are not required for Eye movement desensitization & reprocessing to be successful, evidenced-based practices rules point out that the program is a useful treatment in spite of deficient basis for its treatment. However, many issues continue with the program as an alternative of Cognitive Base Treatment and being as efficient as CBT. In spite of such issues, all clinical rules have observed recognition of the program as an evidenced-based psychoanalysis that may be useful for PTSD patients (APA, 2004; Foa et al, 2000).
Medications
Many treatments are examined for PTSD patients. For instance serotonin inhibitors (SSRIs) are well-known medical treatment. A couple of SSRIs have been certified by the US FAO as designated cure for PTSD patients. Treatment outcomes with serotonin inhibitors are particularly successful since these medications are large array of agents that improve all the symptomatic groups of PTSD. Many useful RCTs are performed with the serotonin inhibitors. Augmentation experiments using atypical anti-psychotic agent in SSRI non-responders are quite successful. In view of the complicated psychobiology of Post Traumatic Syndrome patients, it is improbable that other medications and various agents presently under study may finally prove more efficient than SSRIs (Friedman, 2002). Lastly, it is significant to give stress to the fact that RCTs with benzodiazepines have had harmful consequences; hence, this type of treatment is not suggested for PTSD patients (APA, 2004).
The physicians should observe the existence of comorbid disorders when deciding the type of medication. Currently, SSRIs are well-known as primary agents.
Clinical management
There are significant problems with the amount of management the physicians can realize from the available practice rules for PTSD (APA, 2004; Foa et al, 2000). Except for a few exceptions, the majority of RCTs has examined only a specific monotherapy, whilst the mainstream PTSD patients are given two or more treatments concurrently. In addition, treatment generally causes negligible improvement rather than complete cure, particularly for PTSD patients with complex cases. Several key issues have yet to be examined analytically, including which treatment to choose, how to identify pragmatic goals, how to incorporate different treatments and when to accept experimental letdown. With the emergence of new psychotherapeutic and pharmacological methods, it is hoped that these vital unanswered issues will also be taken in hand. Meanwhile, it is vital that the physicians choose evidence-based treatments whenever feasible.
Conclusions
Though the majority of military veterans homecoming from war zones may be successful and will readjust effectively to lifestyles, a large minority will show Post Traumatic Syndrome Disorder or other emotional syndromes. The professionals should regularly ask the PTSD patients about the events of war suffering and the related symptoms when carrying out psychiatric evaluations of the patients. The treatment of PTSD patients should be started quickly, to improve PTSD symptoms, to prevent the growth of comorbidity and other psychiatric syndromes and to evade interpersonal or professional functional harm. If evidenced-based procedures are used, it is expected that the complete reduction can be realized in about 50% of PTSD patients, and limited health progress may be realized by the majority of patients. It can be expected that future advancements in scientific research will improve the capacity to assist PTSD patients.
References
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