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Post Traumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more traumatic events that threatened or caused grave physical harm. PTSD affects over 7.8 million people.

It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone’s actual death, a threat to the patient’s or someone else’s life, serious physical injury, an unwanted sexual act, or a threat to physical or psychological integrity, overwhelming psychological defences

In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, incidents involving both things are found to be the cause.

PTSD is a condition distinct from traumatic stress, which has less intensity and duration, and combat stress reaction, which is transitory. PTSD has also been recognized in the past as railway spine, stress syndrome, shellshock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).

Diagnostic symptoms include re-experience such as flashbacks and nightmares, avoidance of stimuli associated with the trauma, increased arousal such as difficulty falling or staying asleep, anger and hyper-vigilance. Per definition, the symptoms last more than six months and cause significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.)

Causes

PTSD is believed to be caused by psychological trauma. Possible sources of trauma include encountering or witnessing childhood or adult physical, emotional or sexual abuse. In addition, encountering or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency services workers).

Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, sexual assault, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, violent automobile accidents or getting a diagnosis of a life-threatening illness. Children may develop PTSD symptoms by experiencing sexually traumatic events like age-inappropriate sexual experiences.

Witnessing traumatic experiences or learning about these experiences may also cause the development of PTSD symptoms. The amount of dissociation that follows directly after a trauma predicts PTSD: individuals who are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.

Members of the Marines and Army are much more likely to develop PTSD than Air Force and Navy personnel, because of greater exposure to combat. A preliminary study found that mutations in a stress-related gene interact with child abuse to increase the risk of PTSD in adults.

PTSD sufferers re-experience the traumatic event or events in some way. As a result, they tend to avoid places, people, or other things that remind them of the event, and are exquisitely sensitive to normal life experiences. Untreated posttraumatic stress disorder can have devastating, far-reaching consequences for sufferers’ functioning in relationships, their families, and in society.

Diagnosis

The diagnostic criteria for PTSD, per the Diagnostic and Statistical manual of mental disorders IV (Text Revision) (DSM-IV-TR), may be summarized as:
A. Exposure to a traumatic event

B. Persistent reexperience (e.g.flashback, nightmares)

C. Persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and reexperiencing symptoms fear of losing control)

D. Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilence)

E. Duration of symptoms more than 1 month

F. Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.)

Treatment

Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support.

Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral programs, variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT ), desensitization and reprocessing (EMDR), and many combinations of these procedures. Psychodynamic psychotherapy, while widely employed, has not been well tested as a treatment for PTSD.

Exposure involves assisting trauma survivors to therapeutically confront distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders.

Indeed, the success of exposure-based therapies has raised the question of whether exposure is a necessary ingredient in the treatment of PTSD. Some organizations have endorsed the need for exposure. Yet other approaches, particularly involving social supports, may also be important.

A recent open trial of interpersonal psychotherapy reported high rates of remission from PTSD symptoms without using exposure.

Comorbid substance dependence

Recovery from post traumatic stress disorder or other anxiety disorders may be hindered or even worsened by alcohol or benzodiazepine dependence. Treating comorbid substance dependences particularly alcohol or benzodiazepine dependence can bring about a marked improvement in the patients mental health status and anxiety levels. Recovery from benzodiazepines tends to take a lot longer than recovery from alcohol but people can regain their previous good health. Symptoms may temporarily worsen however, during alcohol withdrawal or benzodiazepine withdrawal.

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