Post-Traumatic Stress Disorder (PTSD)

THE BASICS:

INTRODUCTION

As per DSM-5, various Trauma and stressor-related disorders comprise of disorders in which the listed diagnostic criterion is, exposure to a stressful or traumatic event. Various listed disorders are acute stress disorder, disinhibited social engagement disorder, adjustment disorders, reactive attachment disorder, and posttraumatic stress disorder (PTSD).

DEFINITION

Psychological distress followed by exposure to a stressful or traumatic event is quite a dicey situation. Various individuals who have been faced or exposed to a stressful or traumatic event exhibit certain phenotype in which, instead of fear- or anxiety-based symptoms, the most prominent clinical features that show up are ‘anhedonic’ and ‘dysphoric’ symptoms, keeping aside aggressive and angry symptoms, or dissociative symptoms. Due to this variable, the expressions of clinical distress followed by exposure to aversive or catastrophic events, the above-mentioned disorders have been categorized as trauma- and stressor-related disorders.

 

GENDER DIFFERENCES IN RESPONSE TO PTSD

Numerous studies reveal that women are nearly one-third likely to report traumatic experiences, as compared to men. On the contrary, women are twice likely as men, to fulfill the criteria for PTSD. As we proceed in this direction, we should also mention that the coping mechanisms also play a great role, so as to curb the effects of PTSD.

The varying styles of coping between men and women can also be a major highlight of the gender differences in PTSD. Women mostly exhibit emotionally towards stressors and do seek help and support when required. For men, a direct and handy approach is the best way of avoiding stressors.

PREVALENCE AND FACTSHEET ABOUT PTSD

Barely are there any published studies addressing the prevalence of Post-Traumatic Stress Disorder (PTSD) among school-aged children, in primary care setup. However, certain studies specify the persistence of PTSD relating specific traumas which include motor vehicle crashes and causes related to sexual abuse.

Post-traumatic stress disorder is said to arise due to a protracted response towards a stressful catastrophic situation. Certain predisposing factors, namely personality traits or a person’s history of neurotic illness may tend to lower the threshold for the progression of the syndrome or aggravate it.

 

Symptoms

• Typically the symptoms associated include episodes of reliving the traumatic scenes in dreams, numbness, emotional blunting, isolation, etc.
• A state of autonomic hyperarousal with hypervigilance arises.
• The course of recovery fluctuates but rarely exceeds 6 months. We can expect a recovery in the majority of cases.

 

Causes

The mentioned criteria apply to adolescents, adults, and children above the age of 6 years. For children below the age group of 6 years, the following stated criteria applies,

A.) Faced with a serious injury, sexual violence in one (or more) ways, actual or threatened death:

1. Directly exposed to a traumatic event(s).
2. Witnessing the trauma personally.
3. Getting to know that, it happened to a close friend or one among the relative(s). In such cases of miss-happening within such close proximity, the event(s) gets more violent.

B.) Consideration of one (or more) of the mentioned intrusion symptoms:

1. Recurrence of intrusive, upsetting memories of the traumatic event(s).
2. Recurrence of a nightmare(s) with flashbacks of the traumatic event(s). In the case of children, they may have certain horrifying dreams with no particular context.
3. The continuum of dissociative reactions, or flashbacks, where the traumatic event(s) feels like recurring.
4. Prolonged emotional and psychological distress after the exposure to the traumatic event(s).
5. Physiological reactivity succeeding the traumatic event(s).

C.) Persistently avoiding the stimuli

1. Avoidance of the thoughts, or feelings related to the trauma or the stimuli.
2. Avoidance of the thoughts, or feelings related to various external reminders (distressing memories).

D.) Regression in cognitions and mood relating to the traumatic event(s).

1. Inability to recall the major aspects of the traumatic event(s).
2. Persisting negative beliefs about self and others, relating the traumatic experience.
3. Distorted cognitions and constant negative emotional state.
4. Diminishing interest in significant activities or chores.
5. Feelings of isolation estrangement.
6. Difficulty in gathering positive emotions.

E.) Modification in arousal and reactivity relating to the traumatic event(s).

1. Anger outbursts accompanied by irritability.
2. Self-destructive behavior patterns.
3. Hyper alert.
4. Heightened startle response.
5. Concentration related issues arise.
6. Difficulty falling asleep, with a feeling of restlessness.

F.) Duration of the disturbance: It persists for more than 1 month.

G.) These disturbances cause significant functional impairment.

H.) The difficulties or hindrances are not attributable to the harmful effects of medication, alcohol, or any other illness.

 

Risk Factors

Some of the risk factors triggering PTSD may include the below-mentioned pointers:

• Past Traumatic Experiences.
• People who get to experience a certain kind of trauma, at any scale, are more susceptible to PTSD.
• Abused in the past.
• Family history of PTSD or any psychological disorder.
• History of alcohol or substance abuse.
• Poor coping mechanisms.
• Lack of social support or conscious isolation.
• Ongoing Stressors.

 

THEORIES OF PTSD

Early theories associated with PTSD, are as follows:-

• Theory relating to stress response
• Theory of shattered assumptions
• Classical conditioning theory
• Theories relating information-processing
• The most prominent among the current theories is, dual representation, emotional processing, and the cognitive model of PTSD
• Social factors can also be considered as playing a significant role in the maintenance of PTSD.

 

KINDS OF TRAUMATIC EVENTS

Some of the traumatic events include the following:

• Domestic violence
• Community or mass violence (burglary, assaults, bullying)
• Physical or sexual abuse
• Natural calamities like floods, droughts, earthquakes, etc.
• Serious road accidents
• The sudden demise of a friend or known one
• Serious burns or injuries
• War scenarios or political violence

 

PREVENTION AND TREATEMENT

The term prevention can be broadly defined as, the measures taken to avoid or curb the occurrence of disease(s). In other words, prevention can be explained as interventions that can be applied prior to the onset of a clinically diagnosable disorder. The aim of the intervention is to reduce or lessen the new cases of that disorder.

Prevention can be further considered in three phases:

• PRIMARY/ UNIVERSAL INTERVENTIONS

Regardless of the potential for exposure. These interventions are applied to a large population prior to the occurrence of a traumatic event.

• SECONDARY/ SELECTIVE INTERVENTIONS

These interventions are foremost applied to persons who have already been exposed to a certain traumatic event(s). Thus they are considered to be in the high-risk zone for PTSD.

• TERTIARY/ INDICATED INTERVENTIONS

Certain interventions that are aimed at persons with evident symptoms of or are diagnosed with PTSD are considered for improving their functioning.

 

Other Important Articles

• Pandemics and PTSD
• PTSD: Post Sexual Assault
• The Effects of Traumatic School Experiences on Later Life
• Why Trauma Survivors Develop Depression