What is PTSD? – Exploring Post-Traumatic Stress Disorder
by Allan Dizon in Diseases on Jan 25, 2010
When a person is constantly disturbed by certain past stressful events of his or her life, it is about time that this person should consult a psychiatrist because he or she might be experiencing a Post-Traumatic Stress Disorder. As defined by Mosby’s Dictionary of Medicine (2006), post-traumatic stress disorder (PTSD) is a “psychiatric disorder characterized by an acute emotional response to a traumatic event or situation involving severe environmental stress, such as a natural disaster, airplane crash, serious automobile accident, military combat, or physical torture”. Moreover, PTSD gained prominence in the field of psychiatry during the 1980s, when soldiers who came from the Vietnam War exhibited “regular recurrences of memories or images of the stressful event (‘flashbacks’), especially when reminded of it” (Black’s Medical Dictionary, 2006). Depression, insomnia, feelings of guilt and isolation, an inability to concentrate and irritability would be the other symptoms that would be seen in people with PTSD.
Despite the fact that PTSD was just recently identified as a psychiatric condition, historical medical records indicate people traumatized during the Civil War exhibited “DaCosta’s Syndrome”. PTSD has been observed in people other veteran populations, including World War II, Korean conflict, and Persian Gulf, and in United Nations peacekeeping forces deployed to other war zones around the world. PTSD also appears in military veterans in other countries with amazingly similar findings, which indicates the disorder is by no means culture specific. As specified in Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV, 1994), the diagnosis of PTSD is assigned when four specific criteria are fully exhibited by any patient. First, the person has to have been exposed to a traumatic event in which he or she “experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others”, and the response has to “involve intense fear, helplessness, or horror”. Second, the event must be persistently re-experienced either through intrusive images, thoughts or perceptions; recurrent distressing dreams related to the event; flashbacks; and/or experiencing intense distress or physiological reactivity when faced with actual or symbolic situations that resemble the traumatizing event. Third, the sufferer must exhibit avoidance responses to stimuli that are reminiscent of the traumatic event and do so through a combination of tactics including avoidance, numbing, reduced interest, lack of recall and/or detachment. Lastly, the sufferer has to display at least two signs of increased arousal which can be manifested by such things as increased irritability, hypervigilance, sleep disturbances, exaggerated startle response and/or concentration difficulties. In addition, it is specified that the extent of disturbance must be clinically significant in the extent of distress or psychosocial impairment, and that the duration of disturbance must be more than one month. All of these criteria must be met to assign the diagnosis of PTSD; without one of the four criteria would not be appropriate to tell that the patient has PTSD.
Soldiers who experienced the atrocities of war have the most propensities to develop PTSD. In a study conducted to assess the soldiers who survived the Vietnam War, about 15.2 percent of all Vietnam War zone veterans were found with PTSD and another 11.1 percent with “partial” PTSD. Thus, there was over a 30 percent prevalence rate of PTSD among veterans exposed to heavy combat stressors and among those wounded. Although pre-military and post-military factors also appeared important, the extent and severity of exposure to war trauma appeared to be the most closely associated with PTSD (Kulka et al., 1990). Studies of Haley (1974) and Shatan (1978) separately pointed out that when the soldiers as their patient reported atrocities, therapists have more trouble listening. This could, of course, make patients less likely to report such events. If so, gaining knowledge of the psychological aftereffects of participating could be impaired. Strayer and Ellenhorn (1975) found that participation in atrocities like war brought more symptoms in terms of withdrawal, hostility, and life-outcome maladjustment. Breslau and Davis (1987) commented that participation in atrocities and the cumulative exposure to combat stressors, each independently of the other, conferred a significant risk for PTSD. If left untreated, PTSD would develop into depression that would lead the patient to experience severe psychological problems that would even lead to substance abuse, violence or even suicide.
PTSD can be both treated using pharmacotherapy and psychotherapy. The most commonly prescribed medicines are antidepressants and minor and major tranquilizers and they are used mainly against conditions that co-exist with PTSD, like depression, generalized anxiety, and alcohol and chemical substance abuse (Solomon et al. 1992, p. 634). Although pharmacotherapy is less often used for symptoms specific to PTSD, several drugs have been found to have a modulating effect on intrusive phenomena, such as nightmares and dream recollections, and symptoms of autonomic nervous system arousal, such as irritability, aggressive outbursts, exaggerated startle response, and hypervigilance. Sedatives are also given to patients who have problems falling or remaining asleep, an arousal effect sometimes associated with PTSD. Even when specific symptoms are alleviated by pharmacotherapy, patients characteristically continue to experience significant distress from other symptoms and their effects, most commonly guilt, social impairment, and somatic complaints. Thus, when drugs are employed, it is usually used to complement psychotherapy. On the other hand, psychotherapies for PTSD fall into three broad categories: behavior therapy, cognitive therapy, and psychodynamic therapies (including hypnotherapy).
Indeed, PTSD is not a simple disease that can be easily treated because the patients need to undergo a difficult process in order to free himself or herself from PTSD. It is surprising that each U.S. military venture had brought about a new wave of persons who are directly or indirectly deeply impacted by the trauma of war, as many of our soldiers experienced PTSD after they go home from any war. Minimizing or denying shorter- and longer-term human costs of such wars must be vigorously and repeatedly challenged. This is why the most effective way to reduce the prevalence and incidence of war-related PTSD is to prevent U.S. involvement in “unnecessary” wars. The price of freedom is high enough without unnecessarily adding to the rolls of our nation’s veterans, their families and so many others who continue to be impacted both directly and indirectly by the horrors of war.
Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: APA, 1994.
Breslau, N., & Davis, G.C. “Posttraumatic Stress Disorder: The etiologic specificity of wartime stressors”. American Journal of Psychiatry, 144(1987): 578-583.
Haley, S.A. “When the patient reports atrocities”. Archives of General Psychiatry, 30 (1974): 191-196.
Kulka R. A., W. E. Schlenger, J. A. Fairbank, R. L. Hough, B. K. Jordan, C. R. Marmar & D. S. Weiss. Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel, 1990.
Post-Traumatic Stress Disorder (PTSD). Black’s Medical Dictionary, 41st Edition. 2006. CredoReference. 30 July 2007 . Post-Traumatic Stress Disorder (PTSD). (2006). In Black’s Medical Dictionary, 41st Edition. Retrieved July 30, 2007, from DISPLAYURL “Post-Traumatic Stress Disorder (PTSD).” Black’s Medical Dictionary, 41st Edition. 2006. CredoReference. 30 July 2007 . Black’s Medical Dictionary, 41st Edition, 2006, s.v. “Post-Traumatic Stress Disorder (PTSD),” DISPLAYURL (accessed July 30, 2007). http://www.credoreference.com/entry/5877946
Posttraumatic stress disorder (PTSD). Mosby’s Dictionary of Medicine, Nursing, & Health Professionals. 2006. CredoReference. 30 July 2007 .
Shatan, C. “Stress disorders among Vietnam veterans: The emotional context of combat continues”. In C.R. Figley (Ed.), Stress Disorders Among Vietnam Veterans: Theory, Research, and Treatment. New York: Brunner/Mazel, 1978.
Strayer, R., & Ellenhorn, L. “Vietnam veterans: A study exploring adjustment patterns and attitudes”. Journal of Social Issues, 31 (1975): 81-93.
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