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Victims' Symptom : glossary:ptsd
 
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POST-TRAUMATIC STRESS DISORDER

Introduction

Post-traumatic stress disorder (PTSD) is one of the anxiety disorders that occur after a person sees, is involved in, or hears of an extreme traumatic stressor 1)2). Traumatic experiences involve the potential for death or serious injury resulting in intense fear, helplessness, or horror. Traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ...s include combat or military exposure, sexual or physical abuse/assaults, serious accidents, natural disasters, domestic and family violence, etc. 3). While being exposed to this event, the affected person thinks that his/her life or other's lives are in danger. After exposure to such an event, the person may feel scared, confused, or angry 4). If these reactions continue or get worse, PTSD can develop. Sometimes these reactions are delayed for a certain period of time. Most traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... survivors experience common stressStress is not a useful term for scientists because it is such a highly subjective phenomenon that it defies definition. The term is in use from 1936 when Hans Selye defined stress as "the non-specific response of the body to any demand for change" ... reactions, but some of these reactions may last.

To make the diagnosis, the symptoms must last for more than a month after the event and must significantly affect important areas of life, such as family and work 5).

History of PTSD

Reactions to traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ...s have been recognised for centuries. Descriptions of these reactions have changed over time. The diagnosis of PTSD was formally recognised as a psychiatric diagnosis in 1980 6)7). Similar symptoms found in war veterans were described earlier as a “cardiac neurosis”, “shell shock” or “concentration camp syndrome” 8)9)10). Influence of personality traits is very important as a predictive factor for development of PTSD 11) 12).

Social awareness of the disorder, taking into account human rights, violence and disasters, has been increasing over the last 20 years.

Epidemiology of PTSD

The prevalence of the disorder differs depending on the population that is being investigated, as well as the use of various diagnostic criteria and scales. The lifetime prevalence of PTSD is estimated to be about 8 percent of the general population, although an additional 5 to 15 percent may experience subclinical forms of the disorder. Among high-risk groups whose members experienced traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ...s, the lifetime prevalence range from 5 to 75 percent 13). In almost 80% of cases, PTSD occurs together with depressive disorder, anxiety, panic attacks, alcohol and substance abuse, and personality disorders 14)15)16)17)18)19).

Risk factors for development of PTSD

Most people exposed to traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ...s have some symptoms at the beginning, but not everyone will develop PTSD. The stressor alone is not sufficient to cause the disorder 20). It is not yet clear why some people develop PTSD and others don't. Some people can develop acute stressStress is not a useful term for scientists because it is such a highly subjective phenomenon that it defies definition. The term is in use from 1936 when Hans Selye defined stress as "the non-specific response of the body to any demand for change" ... reaction (ASR). Symptoms of acute stressStress is not a useful term for scientists because it is such a highly subjective phenomenon that it defies definition. The term is in use from 1936 when Hans Selye defined stress as "the non-specific response of the body to any demand for change" ... reaction include: re-experiencingReexperiencing means that the traumatic event is persistently reexperienced ... of traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ..., avoidanceThe principal clinical features of PTSD are painful reexperiencing of the event, a pattern of avoidance and emotional numbing, and fairly constant hyperarousal ... and hypersensitivity of autonomic nerve system (e.g., tachycardia, headache, diarrhea, sweating, etc.), as well as dissociative experiences soon after the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... 21). Dissociative defenses help persons remove themselves from traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... at the time that it occurs but also delay the working through needed to place the traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... in perspective within their lives 22). This can sometimes lead to the development of PTSD 23). There are also some people who will develop PTSD without previous ASR.

The main risk factors for developing PTSD are pre-traumatic factors (such as earlier psychiatric disorders, gender, personality traits, lower socioeconomic status, lower degree of education, ethnic minorities, previous traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ..., and family history of psychiatric disorders); factors important during the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... include severity of traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ..., life-threating experiences, emotions connected with traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ..., dissociationPersons with dissociative disorders feel as though they have no identity, they are confused about who they are, or they experience multiple identities ... during and after the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ..., and post-traumatic factors include lack of social support and subsequent life stressors 24)25).

Symptomatology of PTSD

In acute PTSD, the person develops symptoms within three months of the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... Symptoms of chronic PTSD appear three months or later after the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... Delayed PTSD occurs six months after the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... (this form is very rare).

PTSD includes three main clusters of symptoms:

  1. 3. Persistent symptoms of increased arousal 26).

Re-experiencingReexperiencing means that the traumatic event is persistently reexperienced ... of the traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... (reliving the event) includes actual and intrusive disturbing memories, actual disturbing dreams, behaviour or emotions as if the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... is being re-experienced, intensive psychological distress, and physiological reactivity 27).

Persistent avoidanceThe principal clinical features of PTSD are painful reexperiencing of the event, a pattern of avoidance and emotional numbing, and fairly constant hyperarousal ... and numbing includes efforts to avoid thoughts, emotions, and conversation about situations that remind the person of an event, avoidanceThe principal clinical features of PTSD are painful reexperiencing of the event, a pattern of avoidance and emotional numbing, and fairly constant hyperarousal ... of traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... reminders, psychogenic amnesiaAmnesia is the partial or total inability to recall past experiences; may be of organic or emotional origin (Sadock, 2003) ... (inability to recall an important aspect of the traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ...), reduced interest in activities, feeling of detachment or estrangement from others, a restricted range of affect (e.g. unable to have loving feelings), and a sense of foreshortened future 28).

Symptoms of hyperarousalThe principal clinical features of PTSD are painful reexperiencing the event, a pattern of avoidance and emotional numbing, and fairly constant hyperarousal ... include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and exaggerated startle response 29).

Intrusive thoughts should be differentiated from flashbacksFlashbacks are spontaneous, transitory recurrences .... With intrusive thoughts, the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... is re-experienced in repeated thoughts (memories), in such a way that the person repeatedly experiences the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... by remembering it through thoughts or images. The person does not have control over such symptoms as they appear at different intervals of time, and they are spontaneous. This can happen when some extrinsic stimulus (image, sound or scent) reminds the person of the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... Nightmares related to traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... can also occur 30).

FlashbacksFlashbacks are spontaneous, transitory recurrences ... occur when the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ... is re-experienced as an illusion, hallucination, and dissociative (“flashbackFlashbacks are spontaneous, transitory recurrences ...”) episode. The content of the “flashbackFlashbacks are spontaneous, transitory recurrences ...” is specifically related to traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... It is transitory, occurs spontaneously, and it can be provoked by an extrinsic stimulus 31).

When a person experiences flashbacksFlashbacks are spontaneous, transitory recurrences ..., he/she cannot differentiate the past from present events, and is reliving the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... The person also experiences psychological disturbance usually manifested as fear, anger, and anxiety. When experiencing intrusive thoughts, the person is aware that it is a memory, although it is initiated as an unconscious process 32).

The person with PTSD avoids all activities, stimuli, and situations that can be a reminder of the event, because he/she is afraid that it could provoke feelings of disturbance. Alcohol or substance abuse is often excessive in such people because they are used to block or “blur” memories that are reminders of the traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... Some people have excessive activities, while others have extremely reduced interest in activities that used to be of a great importance to them. They feel detached from other people, think they are unable to experience love and joy, or feel that they are numb. They feel hopeless about the future, despairing, as if their life is over and that they have nothing to expect from life 33).

Constant hyperarousalThe principal clinical features of PTSD are painful reexperiencing the event, a pattern of avoidance and emotional numbing, and fairly constant hyperarousal ... is manifested through difficulties with sleep (trouble with falling asleep or staying asleep). Sufferers often have fear of losing control over expressing anger or hostility, or they sometimes lose their control. They have difficulties with concentration and they are hypervigilant. It is very hard for them to adjust into society 34).

Treatment of PTSD

The current methods for PTSD treatment include medications, psychotherapy and psychosocial treatment 35). Psychotherapy is preferred over medication, especially when symptoms are mild and when the disorder is presented as so-called “uncomplicated PTSD” without without another simultaneous psychiatric disorder (comorbid disorders). In cases of moderate and heavy PTSD with comorbid disorders and post-traumatic personality disorders, psychopharmacology, psychotherapy and psychosocial treatment should be combined.

Prevention of PTSD

Although development of PTSD depends on various factors 36)37), correct and timely psychoeducation plays an important role after exposure to a traumatic eventPsychological trauma can happen soon after witnessing or being the victim of a traumatic event .... In that way, the psychotraumatised person has a higher level of knowledge about this disorder, its symptoms and behaviour patterns. The person should be encouraged to talk to family and friends about the experienced traumaPsychological trauma can happen soon after witnessing or being the victim of a traumatic event ..., and it should be explained how important it is to share emotions with the people he/she trusts.

(T.J.)

See also:

Victims’ Symptom Website:

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