Post Traumatic Stress Disorder (PTSD)
Overview
Post-Traumatic Stress Disorder (PTSD) is a condition that causes the body’s fight or flight stress response to activate in reaction to intrusive thoughts, memories, images, and dreams of a traumatic event.
Not everyone who experiences some kind of trauma will develop PTSD.
The traumatic event can be experienced or witnessed such as a serious accident, a terrorist act, war/combat, a natural disaster, rape or other violent assault.
Repeated exposure to extremely aversive events such as child abuse and very stressful jobs such as firefighters and emergency medical technicians can lead to PTSD.
In some cases just learning that a traumatic event occurred such as a death in the family or losing a friend can lead to PTSD.
Symptoms
Symptoms can begin immediately after the traumatic incident, this is referred to as an Acute Stress Disorder.
Acute Stress Disorder has the same symptoms of PTSD except that Acute Stress Disorder begins immediately after the traumatic event and up to one month after. A person will be diagnosed with PTSD if the symptoms persist beyond 1 month.
How long someone will have PTSD varies. Some people will notice a significant improvement within 6 months, while other people will have symptoms that last longer.
Mental health professionals, such as psychiatrists and psychologists, can diagnose and treat PTSD.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
At least one re-experiencing symptom
At least one avoidance symptom
At least two arousal and reactivity symptoms
At least two cognitive and mood symptoms
Re-experiencing of the traumatic event:
Intrusive memories and images
Intrusive frightening thoughts
Bad dreams of the traumatic event
Flashbacks that make it feel like you are re-living the experience
Intense psychological distress when exposed to things that remind you of the trauma such as sights, sounds, and smells
Panic attacks
Avoidance of things associated with the traumatic event:
Efforts to avoid disturbing memories, thoughts, or feelings about or closely associated with the traumatic event
Avoidance of reminders (people, places, conversations, activities, objects, situations) that trigger distressing memories, thoughts, or feelings about or closely associated with the traumatic event
Cognitive and mood symptoms:
Difficulty remembering an important aspect of the traumatic event
Exaggerated negative beliefs or expectations about oneself, others, or the world. “The world is a dangerous place” “I am a weak person”
Distorted thoughts about the cause or consequences of the traumatic event that lead to self-blame or blaming others
Persistent negative feelings such as fear, horror, anger, guilt, or shame
Loss of interest or participation in significant activities.
Feelings of detachment or estrangement from others
Difficulty experiencing positive emotions such as happiness, satisfaction, or loving feelings
Heightened arousal and reactivity associated with the traumatic event:
Feeling irritable and angry can lead to verbal or physical aggression toward people or objects
Reckless or self-destructive behavior
Hypervigilance or being “On alert” all the time
Exaggerated startle response
Problems with concentration
Difficulty sleeping, difficulty falling or staying asleep, or restless sleep
These symptoms can occur even though there may not have been a specific traumatic event.
An example is a person who experiences a repeated heightened flight or fight arousal over time due to the need to maintain safety such as in combat.
A soldier who did not experience any traumatic events but was on high alert all the time, comes home from combat may have difficulty turning off the fight or flight arousal and will feel out of sync with their environment. This person will feel on alert all the time and tense and jumpy in a restaurant.
PTSD in Children
Children ages 6 and younger experience the same symptoms as adults but with some differences.
Children may show their upsetting intrusive thoughts and memories through play reenactments or story telling
Children might detach from parents or become clingy
They may begin wetting the bed
Children might stop talking
Teenagers may have more difficulty socially and feel that they do not fit in. Their behavior may become aggressive and they might engage in risky behavior.
Who is at Risk
Gender
Women are more at risk than men for PTSD. This might be due to women having a higher likelihood of being exposed to traumatic events such as rape.
Prior mental health diagnosis
People who already have an anxiety disorder or depression may be at increased risk for developing PTSD after a traumatic event.
Environment
Environment and life experiences may play a bigger role in predicting someone’s risk for developing PTSD. People in environmental conditions such as lower socioeconomic status, lower education, and dysfunctional family systems may be more at risk.
You also may have watched and learned from a parent ineffective ways to respond to stress and anxiety.
Early experiences with loss, abandonment, trauma, abuse, being bullied in school, and any other stressful experiences could have instilled a sense of uncertainty and helplessness.
These experiences contribute to the development of your beliefs and attitudes about yourself and about the world. This increases the risk of developing PTSD.
Genetics
Possible genetic links to anxiety and/or protective factors.
To this date, however, no single gene or genetic makeup has been identified to be responsible for the development of anxiety disorders.
Researchers have only been able to identify a link or association between some genes and anxiety. These genes appear to only predispose people to experience anxiety and not directly cause anxiety.
Protective Factors
Well-adjusted family environment.
Good social support system and willingness to seek support.
Personal competence, good self-esteem, and an optimistic attitude.
Positive view of one’s self, of others, and of the world.
Access to mental health and health resources.
Treatment
If you believe you could have Post Traumatic Stress Disorder it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Medication
Antidepressant medications are usually prescribed to take the edge off of the emotional symptoms of PTSD such as sadness, anger, anxiety, and fear.
Benzodiazepines typically are not prescribed for PTSD because they interfere with mental processes necessary for effective psychotherapy. Research has also suggested that benzodiazepines worsen symptoms for patients with PTSD.
A medication called Prazosin can be helpful at decreasing nightmares associated with PTSD.
Beta Blockers normally used to treat high blood pressure, heart arrhythmias, and migraines can also be used to help reduce the physical symptoms associated with heightened arousal and reactivity.
A beta blocker by the name of propranolol also has the ability to block the neurotransmitters involved in reconsolidating memories.
Medication alone, however, is usually not enough for treating PTSD. Certain medication can be more helpful when combined with psychotherapy.
Psychotherapy
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving. You learn different ways of responding to the symptoms of PTSD and to your feelings of anxiety.
CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring automatic thinking.
CBT sessions also provide education on the symptoms of PTSD and how to manage the emotional and physical symptoms of anxiety such as how to stop a panic attack.
Cognitive Restructuring
Cognitive restructuring is used to identify and dispute unhelpful, automatic, and irrational thinking so that you can create highly effective thoughts with the power to alter your emotions and behavior.
An example of an irrational thought is “What happened is my fault” or “I should have been able to handle the situation.”
Automatic thoughts get programed into us by our past experiences and what we learn from our parents.
We develop beliefs about ourselves, other people, and the world. These beliefs influence how we think.
If you believe that the world is basically a dangerous place, then your thoughts will follow. If you believe that you are defective and not a capable person, then your thoughts will reflect those beliefs.
Cognitive restructuring will help you make sense of the traumatic event and help develop more balanced beliefs about what happened.
Exposure Therapy
Exposure therapy, also known as prolonged exposure, is a form of CBT.
As with most anxiety disorders, in order to learn how to overcome the symptoms of anxiety and to know that you can cope with anxiety and master the symptoms, you need to have the experience of successfully managing the symptoms.
This often means exposing yourself to the fear of the thoughts, images, and memory of the traumatic event and applying the coping strategies until the thoughts, images, and memories no longer produce the same level of fear.
Exposure therapy gradually exposes people to the trauma through;
First imagining it (Imaginal exposure). You will get relaxed, close your eyes, and imagine the event. You will describe in as much detail as you can what happened while you are being tape recorded.
Second, listening to a tape recording of the traumatic event story.
Finally, visiting the place where the trauma happened or any place that has been avoided.
By repeatedly imagining and listening to your description of the traumatic event and at the same time learning to decrease your symptoms of anxiety and develop more balanced beliefs, you will become more desensitized to the memory.
This is similar to the effect of watching a moving 10 times.
The first time you see the movie, it can have a strong emotional impact on you (i.e. funny, scary, or dramatic). By the 10th viewing the movie, you will have become habituated to the content, and the movie will no longer have the same emotional impact.
Reconsolidating Memories
Your brain can learn to reconsolidate the memories into other parts of your brain instead of only the emotional parts.
When a traumatic memory is recalled, new information can be added to it. Then, the original memory and the new information are both reconsolidated back into your brain together.
The new information has the effect of removing the intense emotional reaction so that the next time it is remembered, it won’t have the same negative emotional impact that the original memory had.
The beta blocker, propranolol, may help in the process of reconsolidating traumatic memories.
Propranolol blocks the effects of the neurotransmitter, norepinephrine in the brain.
Norepinephrine enhances emotional learning and is involved in memory storage.
Taking propranolol during exposure therapy may block the emotional fear component of the memory when it is reconsolidated.
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