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Post-Traumatic Stress Disorder (PTSD)

Introduction

Post-Traumatic Stress Disorder or PTSD is a mental health disorder that occurs due to a traumatic experience that a person has suffered from during a particular stage of their life. Although it was initially discovered in combat veterans, modern-day studies in psychology and mental health illnesses conclude that PTSD can occur in any person, regardless of their age, gender, ethnicity, or profession.

PTSD is considered a part of anxiety disorders. Its root cause originates from any traumatic or shocking experience that renders a person incapable of moving forward with their regular life without recalling that event subconsciously. The trauma or distress encountered during such an event can carry on throughout a person’s life and may affect their routine activities to a considerable level. It affects mentally and can also bear effects on the overall physiological health of a person if not addressed or treated correctly.

Causes

The primary cause of Post-Traumatic Stress Disorder is suffering through a trauma that leaves a deep imprint on one’s mental health for the entirety of their lives. Researchers have performed multiple types of research to figure out why few persons having undergone a traumatic experience suffer from PTSD while others don’t. Through collective data, it has been stated that at least one out of three people who have gone through a severe trauma develops PTSD.

Various causes of Post-Traumatic Stress Disorder include:

·   Serious traumatic incidents faced during war or combat

·   Physical or sexual assault (worse symptoms if occurs at a young age),

·   Abuse during childhood

·   Domestic abuse,

·   Physical or mental torture/abuse,

·   Bullying at the expense of one’s race, sexuality, or identity factor

·   Exposure to traumatic events at work,

·   Undergoing a significant accident involving physical injury,

·   Serious health issues, including a long-term stay at a healthcare institute,

·   Loss of a loved one or a close family member,

·   Miscarriage of a baby,

·   Surviving a natural disaster

·   Being diagnosed with a terminal, life-threatening condition.

Signs and Symptoms

The Symptoms of Post-Traumatic Stress Disorder can present during the initial stage after facing a traumatic experience or manifest themselves later at some point in life, even after a year or so in some instances. These symptoms can influence the life of a person in multiple ways, ranging from distress among close relationships, inability to maintain a healthy social circle, unsatisfactory performance in professional tasks, and difficulty in carrying out simple readings of routine life.

The symptoms of PTSD are generally classified into the following types.

i)   Re-Experiencing Symptoms: These are the symptoms that make the individual suffering from PTSD feel as if they are reliving the traumatic experience that disturbed their mental health. It can manifest in recurrent flashbacks of the event, intrusive memories, or nightmares. There is no limit of age or time, and these can occur at any point in life, even during a simple task such as dishwashing.

 

ii)   Avoidance Symptoms: They include avoiding situations or activities that can trigger memories of the traumatic event and make the person incapable of keeping a hold on themselves from reliving the past. Usually, people who have PTSD avoid any topic of discussion that revolves around that particular event. Some individuals may even feel the need to realign their whole routine to avoid any stimulus that might remind them of their traumatic experience.

iii)   Cognitive Symptoms: They usually include thoughts or behavioral patterns towards oneself or others. A person experiencing cognitive symptoms of PTSD will have constant negative thoughts about their personality and focus more on their weaknesses than their strengths. These symptoms might manifest in the form of guilt, anger, or frustrations towards one's self.

iv)   Hyper-Arousal (Reactivity) Symptoms: occur without being stimulated by an external source or a bad memory. Such symptoms can be present constantly without being consciously aware of them. These can include stress, anxiety, anger, or the tendency to get easily startled. Other worse manifestations may consist of disturbance in sleep or difficulty in concentration.

Diagnosis

The first step towards a diagnosis of PTSD is to get in touch with a professional who has been trained to deal with mental health and anxiety disorders. Often people have a hard time voluntarily recalling their memories of a traumatic event and specifications associated with it that can aid in diagnosis. It is always essential to prioritize patients’ consent and ask them to disclose as much as they are comfortable within the early stages of diagnosis.

The primary diagnosis of PTSD can be divided into two components:

·        Psychological evaluation

Psychological evaluation of a person suspected with PTSD involved detailed history taking, discussion about the traumatic incident, the onset of symptoms and their effect in routine life, changes in behavioral patterns, etc. The most preferred method of making an accurate diagnosis of PTSD is applying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria issued by the American Psychiatric Association (ASA).

According to the DSM-5, the person must fulfill the following criterion to be diagnosed with Post-Traumatic Stress Disorder:

1) Criterion A: Presence of a stressor. The person either went through a traumatic incident directly or got involved indirectly by witnessing another person’s trauma (secondary trauma).

2) Criterion B: The person displays at least one re-experiencing symptom.

3) Criterion C: The person displays at least one of the avoidance symptoms.

4) Criterion D: The person displays at least two cognitive symptoms.

5) Criterion E: The person displays at least two hyper-arousal and reactivity symptoms.

6) Criterion F: The symptoms have been for more than one month.

7) Criterion G: The symptoms cause disturbance in routine activities or lead to functional impairment (e.g., occupational, social, relationships, etc.)

8) Criterion H: Symptoms are not related to any other illness, medication use, or substance abuse (e.g., alcohol, smoking, opioid overdose, etc.)

·   Physical examination

It involves detailed questions about any physical symptoms the person might experience after the traumatic event. These can include irregular breathing patterns, increased heart rate, palpitations, chest pain, headaches, changes in appetite, increase or decrease in weight, nausea or vomiting, etc. It is necessary to specify whether these symptoms occur in coherence with other signs of PTSD or are experienced from another mental/ physical illness.

Types

PTSD can be divided into five types based on diagnostic criteria, each of which can be followed with a particular set of treatment and therapy. The five types of Post-Traumatic Stress Disorder are as follows:

1) Normal Stress Response: It occurs before the onset of PTSD and does not necessarily lead to a full-blown disorder. Accidents, illnesses, injuries, etc., can cause distress which can be managed with ease with love and support from family and peers.

2) Acute Stress Disorder: It occurs soon after the traumatic incident. While it might not present with PTSD-related symptoms in the initial stage, it can develop fully into PTSD if left untreated for a long duration.

3) Uncomplicated PTSD: It occurs due to a single traumatic event (e.g., war, rape, traffic accident, etc.) rather than multiple ones. The symptoms mainly revolve around that event, and the person is easily triggered at the mention of such an incident.

4) Complex PTSD: Contrary to uncomplicated PTSD, complex PTSD can occur due to multiple traumatic events or the same event happening various times (e.g., child abuse, domestic abuse, bullying, etc.). The symptoms experienced at the expense of reliving the same trauma more than once are much more intense and challenging to treat.

5) Comorbid PTSD:  As the name suggests, this type of PTSD usually occurs with other or physical disorders. It can also be a result of continuous substance abuse or addictions. Such conditions need to be addressed side by side, and the patient shall be counseled accordingly.

Treatment

The treatment of Post-Traumatic Stress Disorder is usually a combination of psychotherapy and medication. It is highly dependent on the severity and recurrence of symptoms. Before beginning with any intervention, it is essential to figure out the type of PTSD a person is suffering from with the help of the diagnostic criterion. This will facilitate the treatment procedure and prevent the overuse of medications if the person can only be treated with therapy and counseling. Also, it is essential to reassure the person that PTSD is treatable and its management can significantly improve the quality of their life.

The major types of psychological therapies used are treating and counseling patients who have PTSD. These include:

Cognitive Behavioral Therapy (CBT): aims to change how a person feels or acts by modifying their thought process, behavioral patterns, or both responsible for negative thoughts and emotions. The primary purpose of CBT is to replace the distressing thoughts of a particular trauma or incident with positive reviews that help the person move forward with their life. The person is asked to recall their traumatic incident and face it upfront while the therapist constantly reassures them throughout the procedure. The therapist also helps gain control over negative thoughts and redirects the person towards their strengths. These are usually 60-90 minutes long sessions divided over eight to twelve weeks, one session per week.

Eye Movement Desensitization and Reprocessing (EMDR): Eye Movement Desensitization and Reprocessing is a modern technique in the field of behavioral therapies which has proven to be effective in patients with PTSD. In this case, the therapist initiates voluntary eye movements, e.g., moving them side to side, following the therapist’s finger, etc. At the same time, the person is asked to recall their traumatic experience simultaneously. Other methods include hand tapping or playing a tone.

Group Therapy: Group Therapy is another effective measure to relieve the symptoms of PTSD by talking to other people who have undergone similar experiences. The presence of a professional counselor is necessary during such sessions to help overcome any signs of distress faced while discussing the traumatic event. Different kinds of group therapies are available, depending on the trauma experienced. It is also essential to support family or close friends while undergoing such treatment procedures.

Other treatment therapies like Prolonged Exposure Therapy (PE), Brief Eclectic Psychotherapy (BEP), Narrative Exposure Therapy (NET), and Stress Inoculation Training (SIT) have also been proven to be effective in the treatment of PTSD.

Medication

Medication is an essential component of treating PTSD that goes hand in hand with therapy and counseling. In most cases, medication is not required, and the patient recovers well from treatments alone. But in some instances where the person does not feel relieved despite attending multiple therapies or having other co-morbid mental illnesses, medication might become necessary. Most commonly prescribed medicines for PTSD include fluoxetine, paroxetine, and venlafaxine. If the patient is experiencing symptoms of depression, SSRIs or benzodiazepines might be prescribed considering the duration and severity of symptoms. Medications for associated physiological symptoms like nausea or vomiting, headaches, insomnia, etc., might be defined as well.

Management/Lifestyle Modifications

Standard management measures include:

·   Regular exercise or walking

·   Play therapy for children

·   Military programs to help war veterans adjust to civilian life

·   Use of advanced technology to record and regulate symptoms

·   Maintaining a diary of daily activities and improvements

·   Engaging in communication with loved ones.

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