223. 4 million U. S. citizens have experienced a traumatic event at least once in their lives. This is about 70% of adults in the USA. Today 31. 1 million people are struggling with Post Traumatic Stress Disorder (PTSD) (Rosenthal). PTSD is defined as re-experiencing, avoidance, and arousal, due to a traumatic event. The symptoms are either long lasting or have a delayed onset (Oltmanns & Emery, 2012). A traumatic event that involves actual or threatened death or serious injury to self or others, can create intense feelings of fear, helplessness, or horror (Oltmanns & Emery, 2012).
This traumatic event then can lead to a serious anxiety disorder such as PTSD. Examples range from witnessing another individual in a life or death crisis to experiencing a life or death crisis first. While PTSD affects a large percentage of the world’s population, only recorded incidents are placed in statistics. However around the world traumatic events are not uncommon, with the cases of genocide in Rwanda to war torn counties in the Middle East, and all the way back to the survivors of 9/11 and US troops back from Iraq, it is no wonder that PTSD is one of the most common disorders.
This paper will summarize symptoms, causation, prevention and treatment of PTSD. There are four main categories that the symptoms of PTSD are grouped into. The first is re-experiencing the traumatic event or incident. There are a few different ways one can re-experience the trauma. Some may repeatedly visualize distressing images of either the incident or something closely related. There may be a constant thought of the event as it unfolded. Some may focus on how they could have done things differently assuming there might have been a better ending or the event would have been avoided entirely.
Others will experience horrifying dreams or night terrors that will either be an exact flashback from the traumatic event or a metaphor of some sort that is equally traumatic. For example, a woman with PTSD who was a paramedic and was dispatched to the scene of the twin towers on 9/11 experienced nightmares of a fire breathing dragon. A friend of hers stated that it was as if there was a fire breathing dragon with all the fire and trauma that engulfed the paramedics (Psych Lab Video Case).
Last are flashbacks that one will re- experience. “Flashbacks are sudden memories during which the trauma is replayed in images or thoughts often at full motional intensity” (Oltmanns & Emery, 2012). The next symptom of PTSD is avoidance. One who suffers from PTSD will avoid all stimuli associated with the trauma. This means avoiding feelings, thoughts, people, places, and activities that remind them of the trauma. One critical symptom of avoidance is a numbing of responsiveness or emotional anesthesia, which causes sufferers to withdraw from others and hide or conceal their emotions. This is known to have a large effect on family and loved ones who attempt to help (Oltmanns & Emery, 2012). The last symptom of PTSD is arousal or anxiety.
PTSD is grouped in the DSM-IV-TR as an anxiety disorder because of the effects of arousal and the secondary anxiety it causes. Anxiety may show itself through hyper-vigilance, restlessness, agitation, irritability, exaggerated startle responses, and excessive fear reactions to unexpected stimuli (Oltmanns & Emery, 2012). In order to assess and diagnose a person with PTSD, a person must re-experience the traumatic event at least once, they must have at least three symptoms of avoidance, two hyperarousal symptoms, and symptoms that make it hard to go about their daily life such as school, work, etc. nimh. nih. gov).
If a majority of the world’s population experiences many or at least one traumatic event, how is it that not everyone develops PTSD? There a few factors that cause PTSD. Trauma is necessary for PTSD to develop but is not the only cause (Oltmanns & Emery, 2012). Social factors include the amount of trauma the individual would be subjected to. For example, a police officer would have a higher rate of developing PTSD because of the exposure they commit themselves to as part of their career. Individuals are more likely to develop PTSD depending on the severity of the event.
Some people can be categorized as “risk takers” which would make them more vulnerable to developing PTSD such as a police officer or paramedic. Other risk factors include having a history of mental illness, getting hurt, living through traumas, having no social support or dealing with extra stress after the traumatic event such as loss of loved one (nimh. nih. gov). Prevention of PTSD is possible and circumstances can take place that would help individuals prevent the disorder from developing even though traumatic events that could lead to PTSD are unknown or may come as a surprise.
Federal Emergency Management Agency (FEMA) provides mental health assistance after a tragic event. An early intervention is critical. Incident stress debriefing is a five hour group meeting where citizens share events and tragedies after a disaster (Oltmanns & Emery, 2012). Police officers and all emergency personnel are given some sort of PTSD prevention therapy (Sanford). This is due to the fact that they have a high risk exposure to traumatic events. Treatment for PTSD varies and there several different types of psychotherapies that can be used to treat the disorder as well as medication.
The main therapy currently used is cognitive processing therapy, or CPT. Cognitive processing therapy can be done in an individual or a group setting. A therapist will help a patient reevaluate how they feel about a traumatic situation. For example, many victims of sexual violence and rape place the blame on themselves. The efficacy of the therapy has held up. Recently, Congolese women who survived the intense conflict in their country and were subjected to rape and sexual violence underwent months of CPT to ease the post-traumatic stress.
The results were promising, though the women appeared to respond better to the group therapy. “After four months, the proportion of women with probable PTSD dropped from 60 percent to 8 percent in the cognitive processing therapy group; the proportion of those with depression or anxiety plummeted from 71 to 10 percent. Their functional impairment scores dropped by half. In the women who received individual support counseling, rates of probable PTSD, depression or anxiety declined less, from 83 percent to about 54 percent. ” (Seppa, 2013) Another helpful PTSD therapy is Prolonged Exposure Therapy or PE.
PE requires the patient to expose themselves to safe but uncomfortable situations that they have been avoiding due to their PTSD. The patient is also taught breathing relaxation techniques in order to lessen the anxiety associated with reintroducing themselves to traumatic tasks (U. S. Department of Veterans Affairs). The patient is also asked to talk repeatedly about the traumatic situation which eventually leads to habituation or a neutral response to the once negative stimuli. Medication is the other option for treatment of PTSD. Though it is not completely curable, it can be managed by a wide variety of medications.
Currently, the evidence base is strongest for the selective serotonin reuptake inhibitors (SSRIs). The only two FDA approved medications for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil) (1, 2)” (Jeffereys). There are also some obstacles to overcome in getting patients to best respond to this treatment. Patients are often concerned about the side effects of the medication, about learning to rely on the medication rather than fixing the root problem, about getting addicted and they may begin to abuse the medications by mixing them with alcohol if the PTSD is severe (Jeffereys).
In addition, recent studies have suggested that long term exposure to anti-depressants may actually hamper a patient’s ability to respond positively to therapy (Nauert, 2013). A new study conducted by researchers at Emory, University of Miami and Scripps Research Institute has showed promise in prevention of PTSD. The results of the study suggest that exposing victims of trauma to morphine immediately after experiencing the distressing event may do more than just ease physical pain. Morphine may also play a role in “fear learning”.
When the drug was administered to a group of mice after exposure to a stressful event, they “could still learn to become afraid of sounds and shocks, but the fearful memories were not as durable and the mice did not freeze as much in response to the sound alone two days later, even if they had been previously exposed to stress” (Eastman , 2013). Some other “out of the box” potential treatments include channeling all energy into martial arts training or service dog training (London, 2013). The idea here would be to distract the brain away from the negative thoughts by focusing all the patients’ resources into positive activities.