Post Traumatic Stress Disorder.p

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					Post Traumatic Stress

          By: Eglantina Di Mase
   Post traumatic Stress Disorder, or PTSD, is
    a psychiatric disorder that can occur following
    the experience or witnessing of life-
    threatening events such as military combat,
    natural disasters, terrorist incidents, serious
    accidents, or violent personal assaults like

   PTSD is marked by clear biological changes
    as well as psychological symptoms. PTSD is
    complicated by the fact that it frequently
    occurs in conjunction with related disorders
    such as depression, substance abuse,
    problems of memory and cognition, and other
    problems of physical and mental health. The
    disorder is also associated with impairment of
    the person's ability to function in social or
    family life, including occupational instability,
    marital problems and divorces, family discord,
    and difficulties in parenting.
   People who suffer from PTSD often relive
    the experience through nightmares and
    flashbacks, have difficulty sleeping, and
    feel detached or estranged, and these
    symptoms can be severe enough and last
    long enough to significantly impair the
    person's daily life

 Intrusive Symptoms
 "Re-experience" of the trauma
 This usually occurs in nightmares
 Sometimes comes as a sudden, painful
  onslaught of emotions that seem to have no
   Symptoms of Avoidance
   Person avoids close emotional ties with family, colleagues and
   At first, person had diminished emotions and can complete only
    routine, mechanical activities
   Avoid situations that are reminders of the traumatic event because
    the symptoms may worsen

   Symptoms of Hyperarousal
   May have trouble concentrating or remembering current information
   May develop insomnia
   Children may develop stomachaches and headaches, in addition to
    symptoms of increased arousal

   Associated Features
   Rid themselves of their "re-experience" by abusing alcohol or other
    drugs as a "self-medication"
   May show poor control over his or her impulses
   May be at risk for suicide
 PTSD is not a new disorder. There are written accounts of similar
  symptoms that go back to ancient times, and there is clear
  documentation in the historical medical literature starting with the
  Civil War, when a PTSD-like disorder was known as "Da Costa's
 Careful research and documentation of PTSD began in earnest
  after the Vietnam War. The National Vietnam Veterans
  Readjustment Study estimated in 1988 that the prevalence of
  PTSD in that group was 15.2% at that time and that 30% had
  experienced the disorder at some point since returning from
 PTSD has subsequently been observed in all veteran
  populations that have been studied, including World War II,
  Korean conflict, and Persian Gulf populations, and in United
  Nations peacekeeping forces deployed to other war zones
  around the world. There are remarkably similar findings of PTSD
  in military veterans in other countries. For example, Australian
  Vietnam veterans experience many of the same symptoms that
  American Vietnam veterans experience.
   PTSD formally entered into psychiatric
    nomenclature in the DSM-III (1980). The
    DSM.-III-R (1987) expanded the definition of
    the concept of stressors of PTSD, rearranged
    the symptoms in all the clusters, increased the
    range of items in both the re-experience and
    avoidant cluster symptoms, and revised
    criteria to include items representing PTSD in

   PTSD has most often been studied in soldiers,
    but clearly many types of natural and civilian
    catastrophes, criminal assaults, rape, terrorist
    attacks, and accidents may precipitate it
   Although the etiology of PTSD is unknown, most investigators
    believe that a personal predisposition is necessary for symptoms to
    develop after a traumatic event. Clinically significant symptoms
    following a traumatic event occur in a minority of persons. Those
    likely to develop PTSD tend to have a pre-existing depression or
    anxiety disorder, or a family history of anxiety and neuroticism.

   From a biologic perspective, the body's failure to return to its
    pretraumatic state differentiates PTSD from a simple fear response.
    In a normal fear response, the immediate sympathetic discharge
    activates the "fight-or-flight" reaction. Increases in both
    catecholamines and cortisol occur relative to the severity of the
    stressor. Cortisol release stimulated by corticotropin-releasing factor
    via the hypothalamic-pituitary-adrenal (HPA) axis acts in a negative
    feedback loop to suppress sympathetic activation and cause further
    release of cortisol.
   In patients with PTSD, ambient cortisol levels are lower than normal;
    this state has been attributed to chronic "adrenal exhaustion" from
    inhibition of the HPA axis by persistent severe anxiety. However,
    recent data note that cortisol levels in the immediate aftermath of a
    motor vehicle wreck were significantly lower in persons who went on
    to develop PTSD. In a related study, cortisol levels immediately after
    rape were lower in women with a previous history of rape. Some
    investigators have hypothesized that the HPA axis and the
    sympathetic nervous system are disassociated in persons who
    develop PTSD, which may allow for an uncontrolled
    catecholamine release that affects formation of memories
    during the trauma and perhaps exacerbates symptoms when
    that person is exposed to cues after the trauma.
         Treatment- Learning
   ·learning skills for coping with anxiety (such
    as breathing retraining or biofeedback) and
    negative thoughts ("cognitive
   ·managing anger,
   ·preparing for stress reactions ("stress
   ·handling future trauma symptoms,
   ·addressing urges to use alcohol or drugs
    when trauma symptoms occur ("relapse
    prevention"), and
   ·communicating and relating effectively with
    people (social skills or marital therapy).
   Pharmacotherapy (medication) can reduce the anxiety,
    depression, and insomnia often experienced with PTSD,
    and in some cases, it may help relieve the distress and
    emotional numbness caused by trauma memories.
    Several kinds of antidepressant drugs have contributed
    to patient improvement in most (but not all) clinical trials,
    and some other classes of drugs have shown promise.
    At this time, no particular drug has emerged as a
    definitive treatment for PTSD. However, medication is
    clearly useful for symptom relief, which makes it possible
    for survivors to participate in psychotherapy.
                 Treatment - Cognitive

   Cognitive-behavioral therapy involves working with
    cognitions to change emotions, thoughts, and behaviors.
    Exposure therapy is one form that is unique to trauma
    treatment. It uses careful, repeated, detailed imagining
    of the trauma (exposure) in a safe, controlled context to
    help the survivor face and gain control of the fear and
    distress that was overwhelming during the trauma. In
    some cases, trauma memories or reminders can be
    confronted all at once ("flooding"). For other individuals
    or traumas, it is preferable to work up to the most severe
    trauma gradually by using relaxation techniques and by
    starting with less upsetting life stresses or by taking the
    trauma one piece at a time ("desensitization").
             Treatment –Cognitive
   Eye Movement Desensitization
    and Reprocessing (EMDR) is a
    relatively new treatment for
    traumatic memories that
    involves elements of exposure
    therapy and cognitive-behavioral
    therapy combined with
    techniques (eye movements,
    hand taps, sounds) that create
    an alternation of attention back
    and forth across the person's
    midline. While the theory and
    research are still evolving for
    this form of treatment, there is
    some evidence that the
    therapeutic element unique to
    EMDR, attentional alternation,
    may facilitate the accessing and
    processing of traumatic material
  Who is affected by PTSD?
 Up  to 10% of the population
 Strikes more females than males
 Can occur with children as well

   American Psychiatric Association. Diagnostic
    and statistical manual of mental disorders. 3d
    ed. Washington, D.C.: American Psychiatric
    Association, 1980:232-3