What is Post-Traumatic Stress Disorder?

an upsetting traumatic, dangerous or life-threatening event. This exposure can be in three ways:

(1) Experience trauma directly in which the individual directly faces life-threatening events.

(2) Experience trauma indirectly in which exposure to life-threatening events occurred to a close family member or friend.

 (3) Witnessing in person i.e. the life-threatening event or trauma experienced by others. An example is bystanders in case of a road traffic accident.

Following is the list of events that can cause PTSD:

  • The natural or man-made disaster

  • A terrorist acts

  • A serious road accident/traffic collision

  • War/battle

  • Rape/sexual assault

  • Domestic violence

  • Childbirth experience, such as losing a baby

  • Torture

  • Other violent personal assault or threats of a person’s life.

Symptoms of Post-Traumatic Stress disorder are severe and can persist even after years of traumatic events. One of the common symptoms of PTSD is flashbacks. The patient feels as if the traumatic event is reoccurring. Another common symptom is the avoidance of reminders to that event. For example, after a road traffic accident, a patient with PTSD refuse to travel or go outside. Sometimes symptoms are severe enough to lead a person towards maladaptive behaviors. These behaviors include drug abuse and self-harm. Not every person exposed to traumatic even suffers from this disorder. Some persons are prone to develop this disorder. These will be discussed later.

Main clusters of PTSD symptoms

  1. Re-experiencing Symptoms

The person finds himself in a situation that mimics a traumatic event. This can take three forms

  • Nightmare or frightening dreams about the traumatic event may occur.
  • Flashbacks; these are vivid imaginary. A person suddenly becomes lost and sees intense vivid scenes just like a trauma event is re-appearing.
  • Distressing memories and thoughts also appear
  1. Avoidance Symptoms

  • These include avoidance of the trauma-related situation. For example, a patient experienced a road traffic accident while driving a car. He refuses to sit in the car even after years of trauma. Some patients avoid going to the very place. 
  • In addition, avoidance can also occur in mental reminders related to trauma. He tries not to talk about that. Sometimes he forgets important details related to trauma.
  1. Hyperarousal and negative thoughts

  • These include easily getting startled and seemed as if keyed up and also consists of problems concerning sleep and concentration. Verbal and physical aggression towards people or objects may also be present.
  • Negative thoughts that usually appear in PTSD are of guilt. “It was my fault that it happened, why I was not there? Why I didn’t refuse my son to travel?” “the world is completely dangerous” etc. accompanied by a negative emotional state like fear, anger, etc.

Who is likely to develop PTSD after a traumatic event?

Not all people who are exposed to trauma develop PTSD. However, there are factors that predict the likelihood of this disorder

These are divided into three factors:

  • Pre-traumatic factors

    ; these are the characteristics that prone the individual to develop this disorder if exposed to trauma.
  • Temperamental:

    The person already has issues related to mood regulations, anger issues and tantrums.
  • Genetic and physiology:

    People with a family history of anxiety or PTSD might be more likely to experience one of these mental health conditions by themselves.
  • Personality Traits:

    these persons are isolated and introvert. They have few confiding relations
  • Gender: After which women have more probability to get PTSD than men. 
  • Environmental:

    These include lower socioeconomic status, lower education, childhood adversity e.g. economic deprivation, family dysfunction, parental separation or death, cultural characteristics e.g. fatalistic or self-blaming coping strategies, lower intelligence.
  • Nature of trauma:

  • Longer the duration of trauma, the more chance of developing this disorder
  • The severity of trauma also increases the risk of this disorder. For example death or severe injury
  • The intensity of emotional experience during the trauma such as fear is also a good predictor
  • Interpersonal violence especially if caused by a caregiver significantly increases the risk. Battered wives and battered children are examples.
  • Posttraumatic factors:

    These are the factors and behaviors that are present after trauma
  • Negative thoughts;

    after the trauma event, negative thoughts or perceptions are evolved about world views or may towards themselves. A feeling of guilt and self-blaming also prolongs this disorder.
  • Coping strategies:

    Inappropriate coping strategies such as avoidance or drugs of abuse
  • Social network:

    A social network is the best coping factor but suddenly losing your social network can increase the risk of PTSD. 

Six protective factors against developing PTSD 

These are the factors that decrease the chance of developing this disorder after the exposure to a traumatic event

  • The need for effective communication between the patient and the family is of pivotal importance since this will serve as a way of liberating emotions.
  • Switching back to the previous routine is important since it helps in making the individual functional again. 
  • In children with PTSD, parental support and care are essential which can be provided by listening to them and giving them enough room to express emotions (usually observable when children playing with their toys) in order to help them cope with negative emotions effectively. 
  • Coping with the circumstances helps in normalizing the individual and adapting an effective strategy rather than avoiding it. 
  • Sharing the traumatic event and confiding in the close family members helps in relieving the bottled-up emotions.                                       

Three Behaviors Complicating the Recovery Process

Use of illicit drugs; This is a common complication of PTSD. The patients use these to get rid of disturbing memories, but these further serve as interrupting the recovery process.

Self-harm or destructive behavior; The patients of PTSD have a great deal of self-guilt. They are in a habit of derogating themselves and in order to overcome it, they use ineffective ways of coping and among which self-harm is common.

Aggression; One of the bad coping styles is aggression often being directed towards people or objects. It doesn’t help to recover from trauma. Yet causes further complications

Treatments for Posttraumatic Stress Disorder (PTSD)

1.Watchful Waiting

Not all patients who are a victim of trauma suffer from PTSD. So, after the traumatic event, the first step is to identify those who are at risk. Risk factors are described above. The next step is following those people whether they develop symptoms of PTSD.

2. Self-help techniques

These are simple techniques that can be taught to the patient. They can prevent the development of this disorder. Similarly, they are also a strategy of choice with an early and less severe form of PTSD. These are

  • Encourage the victim to talk about trauma.
  • If possible, restoration of routines that were before trauma is highly helpful.
  • Persuade the victim to recall the details of the event
  • Going to the place of trauma. In the case of a road traffic accident, going where the accident occurred is helpful
  • Try not to avoid things that are reminders to trauma
  • Breathing exercises
  • Relaxation techniques

3. Psychotherapy

There is a need for structured psychotherapy when the above measures are not working or when the symptoms are severe. Common techniques are exposure therapy, CBT, and EMDR. The major benefit of psychotherapy is that it is highly effective. Most patients recover from illness.

  • Exposure therapy

In this technique, the patient is exposed to reminders of traumatic events. This exposure can be imaginative. For example, the patient tells details of a traumatic event to the therapist. Similarly, it can be a real-life exposure. The example is going to the place road traffic accident.

  • Cognitive therapy.

Cognitive errors are common in PTSD. The aim of this is to target the negative thoughts and behaviors and to enable the patient to use effective ways of coping.

Drug Treatment

In most cases, there is no need to start medicine. This is because, most patients recover with the above interventions. However, if the symptoms are severe or other psychiatrist illness is present then there is need for medicine. These are usually antidepressants. Sedative drugs should be avoided as maximum as possible.

Case study

Mr. M.A. a 50-year-old businessman was admitted to the hospital shortly after he tried to kill himself. His wife had filed a divorce against him, and he felt as though his life was falling apart. He was angry, hostile, frustrated, distrusting and chronically anxious. The detailed history revealed that he experienced a road traffic accident one year back. This happened while he was driving a car and his very close friend died in that accident. In the hospital, he said he was distressed by the memories of his past. He frequently experienced the flashbacks as if the accident is occurring again. He became very much disturbed whenever someone tried to talk about that event. He even stopped driving sitting in a car. Till now he is using public transport. Another important finding was that he started excessive smoking. He considered himself responsible for the death of his friend. And he tried to commit suicide twice. The diagnosis of PTSD is made. The psychiatrist noticed that his excessive thoughts of guilt, bad copying style such as smoking, and avoidance of traveling in any car are prolonging the illness. He was managed on lines of CBT.

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