Post Traumatic Stress (PTSD) Disorder

By The Fix staff 01/21/15

PTSD Affects More Than Just Veterans

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PTSD Disorder

PTSD has garnered hundreds of hours of attention in the media recently as it pertains to returning members of the military from areas of combat. PTSD occurs as a result of a terrifying experience during which a person may have been in immediate danger of physical harm or experienced actual physical harm. Unfortunately, most people who endure a traumatic event manage to overcome the emotions and turmoil of the event, but for some, the emotional toll of the event progresses into the realm of PTSD, which can be identified by several signs and symptoms as set forth in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM V).

While the prevalence of the disorder continues to be a major concern for the Department of Veterans Affairs, it affects millions more people in the US and around the globe. According to the National Alliance on Mental Illness, 10% of men and 5% of women will suffer from PTSD at some point in their lives. However, women have a doubled risk of developing PTSD compared to men as reported by the Anxiety and Depression Association of America. Unbeknownst to many, PTSD can affect children and often occurs in conjunction with another mental health disorder.

PTSD can be further analyzed by looking at how different factors cause the disorder, the available tests for PTSD, and its treatment options. Although many people know of the existence of this disorder, few take the time to thoroughly look into its nature, which may be affecting someone you love or even yourself without realizing it.

Signs

The signs of PTSD are a direct result of the extreme fear presented to a person in the traumatic experience. Since the signs and symptoms of PTSD closely mirror one another, it's best to categorize the symptoms, which make up three general signs of PTSD. The signs of PTSD include constant fixation on the event, avoidance of the event, or becoming overly alert of non-threatening situations. You may see someone with PTSD jump at sudden noises or exhibit unusual behaviors in differing situations. Furthermore, a person with PTSD can be more vunerable to issues with substance abuse, which includes both illicit and legal substances, per the Department of Veterans Affairs.

Symptoms

According to the National Institute of Mental Health, the symptoms of PTSD are divided amongst the three primary signs of PTSD: re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms

Re-experiencing Symptoms

The re-experiencing symptoms of PTSD are often the most severe because they force the person suffering from PTSD to relive the experience repeatedly in his or her mind. This may include the same physiological response as experienced in the original, traumatic event, such as increased heart rate, rapid breathing, excessive sweating.  In addition, a person may relive the even in horrible dreams or frightening thoughts about the event. These symptoms inhibit a person's ability to perform in an appropriate manner in everyday situations when the thoughts bring the event to the forefront of the mind.

Avoidance Symptoms

During the avoidance symptoms, a person generally avoids anything and everything that reminds him or her of the traumatic event. This may include staying away from places, events, or objects associated with the event, a feeling of overall numbness about the situation, feelings of guilt, depression, or anxiety, a loss of interest in activities that were previously enjoyed, and difficulty recalling the traumatic event. Since these symptoms may mirror symptoms of depression, it may be difficult to distinguish these symptoms from those of someone suffering from depression. However, the presence of the traumatic event and the time period in which it took place can help identify the diagnosis of PTSD versus depression.

These symptoms impact the routine of the person suffering from the disorder, especially for those suffering from PTSD as a result of active war duty. This can also be seen in persons who have had a traumatic car accident when they lose confidence in driving ability or avoid getting into another vehicle.

Hyperarousal Symptoms

This last class of symptoms of PTSD can be among the hardest aspects of PTSD to distinguish as they often remain hidden until activated by a certain trigger point or action. A person suffering from hyperarousal symptoms may be startled easily, have a immense feeling of anticipation, suffer from insomnia, or display aggressive behaviors.

PTSD Versus ASD Symptoms

Although these three sets of symptoms characterize PTSD, some people may not begin to exhibit them for several weeks to several months following the traumatic event. Furthermore, it should be noted that PTSD differs from Acute Stress Disorder. Acute Stress Disorder poses the same symptoms as PTSD immediately following the event. However, Acute Stress Disorder symptoms dissipate after a few weeks whereas PTSD symptoms may become more prominent or severe.

PTSD Symptoms in Children

Although most people tend to think of PTSD as a disorder that commonly affects adults who have suffered through a traumatic experience, children may develop the disorder as well. According to the National Center for PTSD, 3% to 15% of girls and 1% to 6% of boys develop PTSD following a trauma. Children will often experience symptoms of PTSD that are different than the symptoms of adults with the disorder.

  • Ages 5- to 12-Years-Old -- Young children may start bedwetting, incur loss of speech, try to reenact of the event while playing, or becoming excessively attached to a parent or other caregiver. In the case of PTSD as a result of sexual abuse, the child may exhibit unusual preoccupation with his or her genitalia. In addition, children with PTSD may begin sleep-walking or have severe nightmares about the event. Children may also become overly frightened over a normal situation, such as taking a bath or getting ready for bed.
  • Adolescents -- The symptoms for adolescents vary depending upon the unique circumstances to each person. While some adolescents may begin to experience adult symptoms, others may still exhibit child symptoms. However, adolescents are more likely to behave in an impulsive or aggressive manner than children.

Causes

Before you begin thinking about your treatment plan, you need to know what causes PTSD. According to the Mayo Clinic, the most common cause of PTSD remains going through a traumatic life experience.  Little is known about the biological causes of PTSD, but the National Institute of Mental Health identifies genes as one of the known physiological factors influencing PTSD.

Traumatic Experiences

When you go through an experience that changes the way you feel about the world, you may be suffering from PTSD. Some of the common traumatic experiences may include a death in the family, personal injury, experiences during times of war for both civilians and military personnel, sexual assault, domestic violence, or even child abuse. The trauma effects the way that you perceive minimal threats to your safety and well-being. If you have PTSD, minimal threats to your safety may suddenly become one of the most terrifying situations you have ever encountered.

Genetic Causes

Scientists have been working on understanding how fear memories are created as a means of developing an effective treatment for blocking or altering the memories to address those living with PTSD. In some people, genes may be responsible for producing excessive amounts of the proteins necessary for storage of fear memories; therefore, this person with these genetic traits will be more prone to developing PTSD than those without the genetic predisposition.

Tests

According to the Mayo Clinic, testing for PTSD involves evaluation per the Diagnostic and Statistical Manual of Mental Disorders. However, a thorough physical evaluation will be needed to rule out any other medical or physical cause of the symptoms, such as cardiovascular disease or another mental illness. Furthermore, additional testing for physical and mental health may be necessary for those with PTSD who have abused drugs or alcohol as a means of self-medication.

Diagnosis

In order to be diagnosed with PTSD, a person must meet one of the requirements for Criterion A, B, and C and meet two requirements from Criterion D and E in the DSM V. The remaining three criterions for diagnosis serve as a means to specify more information about the specific type of PTSD experienced.

Criterion A - Stressors that include witnessing the event, direct exposure to the event, indirect expose through a close friend or family member, or repeated indirect exposure to the event excluding exposure through media.

Criterion B - The event is consistently relived through recurrent, intrusive memories, traumatic nightmares, flashbacks, intense distress, and changes in body response after exposure to a trauma-related stimulus.

Criterion C - Persistent avoidance of associated stimuli

Criterion D - Negative changes in mind and mood

Criterion E - Changes in reactivity to daily situations following the event

Treatment Options

According to the National Institute on Mental Health, the primary treatment options for PTSD revolve around psychotherapy, medication management, or a combination of both. However, the treatment options may need to be expanded in the presence of a co-occurring mental health disorder, a comorbid disorder, or an issue with substance abuse. For example, someone suffering from substance abuse may need additional treatment through inpatient or outpatient facilities.

Treatment: Psychotherapy

Psychotherapy enables a person to speak with a therapist to discuss the traumatic event in detail. It may occur in a solo or group setting and often lasts for 6- to 12-weeks to be effective. Furthermore, family or friends may be invited into the therapy sessions. Cognitive Behavioral therapy may be used help a person become accustomed to the traumatic event without the immense fears associated with it.  During the course of psychotherapy, you will learn how the trauma affected you, relaxation technique, develop coping skills, and discuss means of changing the thought processes responsible for the extreme fears.

Treatment: Medications

According to the National Institute of Mental Health, the US Food and Drug Administration has only approved two medications for the treatment of PTSD alone: sertraline and paroxetine. These antidepressants are both selective serotonin reuptake inhibitors and work to control the primary symptoms of PTSD. Ultimately, the psychotherapy sessions treat the actual cause of PTSD as memories cannot be simply erased. However, the FDA has issued prominent, Black Box Warnings for these medications when used in teens and young adults as suicidal thoughts or actions may be a side effect in 4% of this age group who take the medications.

Your psychiatrist may also choose to prescribe benzodiazepines, antipsychotics, or other antidepressants depending on the presence of symptoms of other mental health disorders.

PTSD affects much more of the population than what is commonly mentioned on the local news broadcast. You need to fully understand how the disorder progresses, is diagnosed, and treated in order to understand what someone with it endures.

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