Marla is a 42 year old Hispanic female accountant, that has complaints of trouble sleeping, feeling jumpy all the time, and unable to concentrate. With these symptoms it is causing her issues at work. There are several disorders that Marla could be suffering from but, it seems to be that one stands out from the rest. Post-Traumatic Disorder also known as PTSD, this is caused when a person experiences something traumatic such as a violent crime against them, a car accident, active military combat duty, the loss of a loved one, etc. Marla sat in my office nervous and unsure as if she was even in the right place. I asked her if she was okay and what brought her to see me. Marla told me of her symptoms and said she was unsure if she should even be here. I asked her if she has been to a family doctor to discuss her problems that she was having and she assured me that she had and came out with a clean bill of health. He doctor suggested to come see me and talked about what she was feeling and going through. With this and much reassurance from me telling her she did the right thing.
I proceeded to ask her the following questions: Marla, what would you like to accomplish by being here? “I want to be able to feel normal again and to feel like myself again.” I think that is something that we can do with and I would like to ask you a little bit more about what you are feeling and maybe why you are feeling the way you do. Marla agrees. When did you start to notice the symptoms you are experiencing? “I started to really notice it about a month ago, my boss and some co-workers started to question me where I was not performing at my normal standards and coming into work late from not getting any sleep.” Is there any family history of depression, anxiety, or any mental illness? “Not that I am aware of…. As far as I know none of my family has ever had any issues mentally or been mentally ill.” She seemed kind of curios as to why I would ask such a thing, I ensured her that I am only asking to better help her and understand more about what she may be going through.
Have there been any changes in your life recently? Good or bad? “Not that I can think of.” Have you been a victim of a crime or served in the military on active duty before? “I have never been in the military or been the victim of a crime.” Have you had anything happen to you or somebody close to you? No, but I was a witness to a women walking in the parking lot with her husband and got hit by a car about six months ago.” Really, tell me more Marla. Well I was walking into work and an older women and her husband where walking hand in hand when a car driven by an elderly couple seemed to gain speed and struck the women where she rolled over the top of the car and landed several yards away from where she was. The elderly couple that was driving hit a pole which stopped their car.
The driver had a heart attack and the passenger was hurt pretty bad but did not seem to be critical. When the ambulance and police showed up they called for a helicopter to take the women to the hospital that was struck, she was none responsive and just laid there twitching. There was blood everywhere and seemed to be pooling from the back of her head. I stayed there with the lady and tried to calm her husband that seemed lost and unsure of what to do. I was able to call his adult children to come to his aid and inform them of what happen. The EMT’s lifted her from the ground and laying there on the ground was a lock of her hair that was attached to part of her skull. They air lifted the women to a trauma center but died before they made it there. The couple in the car also passed away from injuries from the accident as well. I will never forget the look on the husbands face as he stood there helpless crying for his wife and pleading for them to help her.
Well Marla I would say that could be pretty traumatic to see, have you talked to anybody about this? Not until now… I did not think I would need to. Have you had any thoughts about this lately or think about it at all? Sometimes I do, I still cannot walk where she was lying on the ground I still see her laying there in my mind and them lifting her up with the piece of skull and hair laying there. I guess I was okay until I saw that. Marla I would have to say that you are suffering from Post-Traumatic Stress Disorder. What is Posttraumatic Stress Disorder? Why would I now be having or suffering from Posttraumatic Stress Disorder now 5 months later? PTSD is not always an instant onset of symptoms. It can come out days, months, or ever years later. Let’s talk more about this PTSD so you better understand it.
Posttraumatic Stress Disorder:
Posttraumatic Stress Disorder can occur in some individuals who have been exposed to a life threatening situation, or a situation which they have been witness in which another person is exposed to danger. The onset of symptoms with PTSD do not always happen immediately following the traumatic event, therefore the association between the symptoms and the initial event is often overlooked.
A person with PTSD will be hyper-vigilant, and can react to an unsettling situation with physiological symptoms such as upset stomach, headache, or dizziness. People with PTSD can also suffer from depression or panic disorder, although this is not always the case. Avoiding stimuli which can trigger an anxious reaction is normal for the PTSD sufferer, and many become withdrawn from social interaction with friends and family members. Some may also have problems continuing an intimate relationship, and angry outbursts for no particular reason can cause problems with interpersonal relationships, as well as jeopardizing one’s employment.
Treatment for PTSD can be relatively straight forward, although not always easy for the patient to endure. Being taught how to effectively relax is paramount, and once this goal has been achieved, the process of systematic desensitization can gradually take place. The desensitization process involves confronting the stimuli which cause the patient to have an anxious episode. Oftentimes, the stimuli from a particular location and for some it may be a certain situation which serves as an unconscious reminder of the traumatic event. The more a person is subjected to the offending location or situation, the less intense the fear becomes. This is achieved by implementing the relaxation strategies at the same time the stimuli are presented. The association between the relaxed state and the stimuli will eventually be achieved, disarming the stimuli and giving control back to the patient. In this situation Marla needs to see that there was nothing she could do.
Being made aware of maladaptive responses to stimuli, patients are better able to identify which anxieties are due to the normal course of life, and which are patterns of irrational thinking related to their disorder. According to DSM-IV, PTSD can occur at any age, to either gender, and the onset of symptoms can be delayed by months or even years (DSM-IV, 1994, p.426).
According to Cognitive-Behavioral theorists, learned behaviors from conditioning can produce unsavory responses; both physically and psychologically. Unfortunately for the patient, these responses can occur whether it is their intent to react in such a way or not. In Marla’s case, the association with the accident she witnessed affected her life and her psychological and physiological having to walk by the certain spot where the accident took place as well as not speaking to or letting out how she felt or was feeling. Learned behaviors can be unlearned, just as new and more effective behaviors can be adopted. Marla, was correct in coming to talk to physiologist as to let out her feelings that she had pent up inside and to release the emotions that she had not expressed before now.
Marla’s hyper vigilance and feelings of anxiousness can be alleviated and bought under control with practice, relaxation such as yoga, breathing technics, praying finding a solace in religion, keeping a diary of how she is feeling, and/or frequent exposure to the offending stimuli knowing that things do happen for a reason and there is nothing we can do to stop it, and in conjunction with Cognitive-Behavioral therapy, she may also benefit by taking an antidepressant (SSRI) such as Prozac, Zoloft or Paxil.
This situation that I put in place for Marla is one that I actually experienced myself while I was at work and still to this day have flash backs of that day when I witnessed it and was placed in charge of handling the situation. It is not something I would ever want to see again or want to experience over. I did how ever take her death to heart and realized that my life had more meaning to it than what I was doing and decided to come back to school to earn my degree so I can help others and feel I make a difference to people. I will not let her death or the couple that died that was driving the car be in vein. I took this as a sign that I cannot waste my life doing something that does not make me happy, life is too short.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.
Faces of Abnormal Psychology, 2007. Posttraumatic Stress Disorder: Treatment Strategy. Retrieved July 4, 2009, from http://www.mhhe.com/socscience/psychology/faces