Introduction
Post traumatic stress disorder may take place as a result of a person’s reaction to life-threatening or other upsetting circumstances. Why it occurs and how it occurs is the theme of this study. Many disorders mimic a variety of symptoms and unless the diagnosis is made by an expert, or at least by someone thoroughly trained in disorders, confusion may at times result. A case in point may be illustrated here; that is, between PTSD and ASD. Both reveal parallel characteristics that importantly must be identified or classified.
This paper, however, attempts to describe the case of PTSD and its nuances. It seeks to explain its prevalence, characteristic features, and common steps to its diagnosis; what leads to its development, as well as treatment or interventions that the field of psychology and medicine has put into place. It seeks to answer basic questions as “What is PTSD?” “How prevalent is the disorder?” “What methods are employed by therapists to alleviate and treat patients with the illness? The researcher establishes a solid knowledge base by utilizing related studies already made in addition to theoretical evidences.
Historical background
During the American civil war, a syndrome very much like PTSD was observed from the soldiers who survived it. Back then the “illness” was labeled as soldiers’ heart because of the noted occurrence of autonomic cardiac symptoms. Moreover, this was featured in an 1871 paper written by Jacob DaCosta, On Irritable Heart, which was based on a description of the soldiers.
Following World War 1, again the appearance of the variety of symptoms that correspond the disorder came to be known and this time, newly coined as shell shock. This was based on the hypothesis that the symptoms of brain trauma came as a result of shell explosions. Subsequently by World War II survivors of Nazi concentration camps and Japan atomic bombings all feature the same traumatic characteristics (Kaplan et al., p.409).
The correlation of the occurrence of the syndrome and the severity of the stressors (including the most severe of the stresses) that were experienced showed the occurrence of the syndrome in more than 75 percent of its sufferers. This is especially true to those who experienced the Nazi concentration camps trauma (Kaplan et al., p. 409).
Prevalence
Literature shows that in men, trauma is prevalent with those who have had combat experience; while with women, assault and rape are often its sources. In the general population, PTSD may be present in 0.5 percent of men and 1.2 percent in women. While children may also have the disorder (PTSD may occur regardless of age, young adults have the highest incidence precisely due to the precipitating occurrence (Kaplan et al., p. 409).
Theoretical Framework
- Biological factors. The theoretical persuasions of the biologically oriented psychologists posited that PTSD individuals are said to be “premorbidly” inclined to disproportionate autonomic responses to nervous tension or anxiety producing incidents (Kaplan et al., p. 410).
- Psychodynamic Factors. Psychoanalysis views PTSD as a reactivation of conflicts that were not given their resolutions during earlier childhood stage which may include unconscious emotional ordeals that were experienced during the individual’s early days (Kaplan et al, p.410).
However, the cognitive viewpoint looks at it differently by suggesting that the human brain is having difficulty processing so huge an amount of information which the traumatic incident has brought about. It posits that the brain alternates between periods of recognizing and jamming or denying the episode (Kaplan et al., p. 410).
Discussion
Post-traumatic stress disorder (PTSD) is an anxiety disorder that is usually experienced following a traumatic event in a person’s life. The disorder comes about as the person’s reaction to the event (Ehlers et al, 2004) and since different individuals react differently to life situations, not everyone who experiences a traumatic event will develop PTSD. Examples of traumatic life events that may bring on PTSD are natural disasters, physical assault, a serious accident, rape, military combat (“What you should know about PTSD,” 2003).
PTSD primarily affects a person’s emotional well-being and impedes their ability to function in ways that were not present before the trauma occurred. According to the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) someone suffering from PTSD experiences ‘intense fear, helplessness, or horror’ (APA, 1994).
Specifically, occasions or cases where PTSD may arise and/or is correlated, or found to be comorbidly occurring.
Battered women and domestic violence and PTSD
Abusive relationships and its impact definitely cannot be underestimated. In several cases, Lenore Walker, described what she termed as “battered woman syndrome” which certainly can be classified as a PTSD case. The syndrome has the following symptoms: fears that edge around the sensation of terror, sleep and anxiety interruptions, memory of abuse disturbances, and the effects of long-term being abused resulting in an agitated state of vigilance.
However, there were reactions to this classification especially coming from support groups for women. But the advantage to this may come in the form of enhanced identification and diagnosis by crisis workers in understanding the whole complicated impact of repeated abuse and how they will deal with the victim. This is even more significant when the threat is continuously felt even when the abuser is no longer eminently near to the abused; e.g., the victim may develop homicidal tendencies.
Significant to this finding is the persistent thought of danger and not until the batterer will be dead that the victim finally experiences the freedom and release. Otherwise, the victim may resort to suicide or assault and kill her perpetrator. It is advised that counselors remember that these beliefs may persist in the mind of the abused which necessitates appropriate assessment and response to their predicament (Collins and Collins, 2005, p.209).
Childhood sexual abuse and PTSD
“The long-term negative sequelae of childhood are well-documented;” this coming from studies made by Briere & Runtz et al, 1988 in Collins and Collins, 2005, p.373). PTSD symptoms are just among the “co-existing” disorders as common features attendant to this specific abuse. This implies that diagnostic characteristics in persons with PTSD are also present in individuals who survived childhood sexual abuse (Collins and Collins, 2005, p.209).
Disaster trauma and PTSD
Literature is rich with data specific to disaster trauma and the resulting PTSD. It is worth mentioning here that crucial to an individual developing the illness is the predisaster mental health state which is considered the best predictor of postdisaster development (Meichenbaum, 1994; NCPTSD, 2002d; Young, et al., 1998 in Collins & Collins, 2005. p. 474).
Gang-related violence and PTSD
Studies show that children from the third through the eighth grade range exposed to violence occurring among and between warring gangs in school locations have increased possibility of developing PTSD, especially when these gang members use guns. This is consistent with any gang-related violence or aggression occurring as well in pre-pubescent and pubescent individuals. Symptoms like hypervigilance, emotional detachment, problem with concentration and memory which are again, common with PTSD patients (Fehon, et al., 2001; Scarpa, 2001; Slovak & Singer, 2001 in Collins & Collins, 2005, p. 433).
Rape and PTSD
If there is one crime girls and women fear the most it is the incident of rape occurring to them that ranks first. Studies confirm that over 50 percent who survived the assault and rape develop PTSD (Rithbaum, Foa, Riggs, Murdock, & Walsh, 1992 in Collins & Collins, 2005, p. 147). Because of its personally invasive nature, the survivor risks of developing an assortment of damaging mental and physiological ailments and destructive tendencies, specifically personal health (Monnier, Resnick, Kilpatrick, & Seals, 2002 in Collins & Collins, 2005, p. 147).
Risk factors
Risk of PTSD is generally not specific to any particular sector of the population. Since PTSD is associated with trauma individuals who are at a high risk of experience trauma are therefore at a high risk of developing PTSD. Generally anyone who survives a life-threatening event is liable to experience PTSD (Wilson, 2007). Grinage (2003) indicates that about 25 to 30 percent of trauma victims usually demonstrate symptoms of PTSD.
Specifically men who witnessed someone being gruesomely injured or killed during military combat and women who were sexually assaulted or raped are at an increased risk of PTSD. Overall experience with childhood abuse also seems to put an individual at greater risk of PTSD. Mental health patients and relatives of homicide victims also have an increased exposure to PTSD. It is suggested that alcohol and drug abuses are 1.5 times more likely to encounter traumatic events and therefore equally as likely to develop PTSD.
However, the most significant contributor to the development of PTSD, according to the DSM-IV, is “severity, duration, and proximity … to the traumatic event” (APA, 1994). Soldiers who were involved in the war in Afghanistan, victims who survived the World Trade Center bombings, or close relatives of persons who were killed in the September 11 attacks, for example, would be at a greater risk than individuals who simply read about these events.
Wilson (2007) estimates that the disorder is prevalent among ten percent of the female and five percent of the male civilian population but this rate is significantly higher for military personnel. It is believed that 15 percent of war veterans experience PTSD. The international rate of PTSD range from one to 30 percent and is particularly high in regions that have experienced political unrest especially if such involved combat (Wilson, p. 617). The Holocaust, for example, would have contributed to significant rates of trauma among the survivors even long after the even had past putting them at risk of PTSD.
Since the events of September 11 PTSD has been brought into increased focus. Previously the disease had been noticed primarily in military combatants and thus its possible effects on the rest of the general population were not effectively examined. PTSD is noted as an anxiety disorder which tended to be overlooked as a medical condition for years. However research is being conducted into the causes of the diseases and different treatment mechanisms have been developed.
The most effective approach to dealing with PTSD that has been noted so far involves a combination of psychological and pharmacological treatment. Cognitive Behavior Therapy (CBT) has been shown to be effective in treating PTSD in 40 to 50% of patients (Grinage, 2003; Ehlers et al, 2003). This treatment involves attempts to change the distressing thought processes experienced by the patient. CBT is used in collaboration with antidepressant medication particularly serotonin reuptake inhibitors (SSRIs). Research suggests that these combined strategies are probably the most effective in treating PTSD (Grinage, 2003; Wilson, 2007) since they have yielded the best results.
However, one of the main constraining factors in dealing with the disorder is the rate at which trauma victims are diagnosed for the disorder. The first difficulty is that it is difficult to predict which victims are at risk of PTSD following a traumatic event and therefore symptoms are often not picked up early enough. In any case there is the social stigma associated with PTSD particularly when it is evidenced in war veterans.
It is believed that experiencing PTSD is a sign of weakness (Wilson, 2007) and thus war veterans cover up symptoms or avoid seeking treatment. In any case there is usually the position that PTSD should be ignored as it is something that will be overcome with time. This perception of the disorder means that fewer people are willing to come forward with symptoms of the disorder.
Nevertheless there is provision for treatment of the disorder for patients who come forward. There are crisis intervention centers throughout the United States that offer treatment services or can recommend other facilities. Increasingly more mental health professionals are being trained to deal with any of a number of anxiety disorders and thus a patient is able to access treatment from almost any mental health physician.
Within the military population the U.S. Department of Veterans Affairs (VA) along with the U.S. Department of Defense offer health care for soldiers returning from war. However, due to the increasing diagnosis of PTSD and other mental disorders, and the increasing demands being placed on the services offered by these departments, the resources of the system are not completely adequate to meet the demands of the returning veteran population. Wilson (2007) points to research which revealed that positions for licensed clinical psychologists in the U.S. Army and Navy are still vacant. This makes access to care even more constraining. Therefore health care for PTSD, though available to some extent, is not completely accessible.
Evidently in order to improve diagnosis and treatment of PTSD more medical personnel trained to conduct such diagnosis and treatment must be available. Since trauma victims usually report to their primary health care provider either at health centers or in private clinics these general practitioners should be trained, as a part of the standard medical training, in ways of detecting signs of PTSD. Even if these individuals are unable to treat PTSD they should have the necessary capabilities to determine which patients are presenting symptoms and they should also have knowledge of what resources or personnel they could recommend their patients to in order to access effective treatment.
While it may be difficult to ensure that more physicians are trained specifically for mental health care, pursuit of studies in this area should be encouraged. Though data is unavailable to reveal the extent to which mental health training is available at medical training institutes, it is evident that this area is not a major area of emphasis. Some scholarships should be offered to those educational institutions with the requirement that mental health studies be pursued.
Major concerns
One of the major concerns of PTSD is diagnosis. Symptoms are not usually presented until between one and six months following a traumatic event (Grinage, 2003). As a routine there should be a requirement that all victims of traumatic events that come to the attention of the police and health care professions, be required to undergo screening immediately and within a six month follow-up period.
Since the police and medical personnel are often the ones who work closely with most victims, attempts should be made to provide treatment for all involved as a routine rather than an option since it is difficult to determine who will be the most negatively affected by the event in the long run. These factors should enhance detection and thus facilitate early and effective treatment of PTSD.
Interventions
A meta-analysis of the psychotherapy used for PTSD by a team of researchers comprising of Bradley and others made in 2005 point to the efficacy of treatment especially psychotherapy for the recovery of PTSD victims. The published studies on the subject conducted between 1980 and 2003 were subjected to a multidimensional meta-analysis which includes data such as the recovery rate of patients and follow-up data (among others). The data which was published by The American Journal of Psychiatry (2005, February) proved that psychotherapy showed to account for the recovery of more than half of the patients. It concluded that psychotherapy is the leading psychosocial treatment devised for PTSD to date
Conclusions and Recommendations
Post-traumatic stress disorder is a reality that equates with living today with the experiences from a traumatic past. So real is the past experience being relived that individuals with the disorder is incapacitated, continuously raw with pain and hurt, consequently very damaging mentally and physically. If the person will not die from the developing symptoms, he/she will die from self-destruction.
Usually, defusing and debriefing as crisis intervention strategies minimize the occurrence of psychological injury after a traumatic event. These are utilized to provide the victims opportunities for airing their experiences and feelings, the anxiety and gain relief. So far, as studies suggest, these strategies as part of psychotherapeutic technique and treatment have been proven effective in recovery of victims of PTSD.
It is recommended that more studies be made of treatments other than psychotherapy. There are reports of recovery from PTSD employed by those in the spiritual or religious persuasion and this should be given adequate attention and documentation.
References
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. 4th ed. Washington D. C.: American Psychiatric Press Inc.
- Bradley Rebekah, Jamelle Greene, Eric Russ, Lissa Dutra & Frew Western. 2005. A Multidimensional Meta-Analysis of Psychotherapy for PTSD. American Journal of Psychiatry. 162:214-227.
- PTSD in Men and Women. 2003. PTSD in men and women.file:///D:/Documents%20and%20Settings/alan/My%20Documents/ptsd%20in%20men%20and%20wmen.htm.
- Collins, Barbar G., Thomas M. Collins. 2005. Crisis and Trauma: Developmental-Ecological Intervention. Houghton Mifflin Company.pp. 209, 224, 226.
- Ehlers A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C. & Mayou, R. (2003, Oct). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry, 60, 1024-1032.
- Grinage, B. D. (2003, Dec 15). Diagnosis and management of post-traumatic stress disorder. American Family Physician, 68(12), 2401-2408.
- Kaplan, Harold I., Benjamin J. Sadock ; assistant to the editors, Jack A. Grebb.-6th ed. 1988.Synopsis of Psychiatry: behavioral sciences, clinical psychiatry, Williams & Wilkins. USA.
- Post-tramatic stress disorder. (2001, Nov). Postgraduate Medicine, 110(5), 97-98.
- “What you should know about post-traumatic stress disorder.” (2003, Dec 15). American Family Physician, 68(12), 2409.
- Wilson, J. F. (2007, Apr 17). Posttraumatic Stress Disorder Needs to Be Recognized in Primary Care. Annals of Internal Medicine, 146(8), 617-620.
