Posttraumatic Stress Disorder
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Throughout life the vast majority of people are going through physical and mental traumas. Involvement in an emotionally or physically traumatic event (participation in operations, death of a loved person) leads to the reaction of physical and mental shock. This reaction is normal and helps a person come through severe stress. For example, sensitivity to pain is reduced (physical reaction), which helps go through pain. Also, emotional blunting is shown (psychological reaction), which allows a person, without showing a strong emotional response to terrible events, continue to act purposefully. After suffering shock people typically get back to a normal emotional state. Past physical or mental trauma loses its significance and does not disturb human life. However, physical and mental traumas often leave an indelible mark on person’s mind, violating his/her inner peace for a long time. They may lead to a condition known as posttraumatic stress disorder.
Analysis of the vast clinical experience of mental disorders after stress (fighting, natural disaster, torture, physical and sexual violence, robbery, or fire) established that victims have a number of common and recurring symptoms of mental disorders with specific features. Taking into account that these disorders did not fit any of the accepted clinical entities, they were identified as a distinct syndrome called "posttraumatic stress disorder" (PTSD). This term has been promoted in medical practice since 1980. It is included in the official American nomenclature of mental disorders DSM-III as a condition caused by severe stress disorders (Kinchin, 2004).
PTSD is an answer to a traumatic event that can be shock to almost anyone - such as natural disaster, serious accident, rape, assault, or participation in military operations. These events are beyond the range of normal human experience. Sometimes, the standard allowance of mentality is not enough to go through stressful experiences. Respectively, this disease develops after an experienced event that poses real threat to life and health. It should be pointed out that not only direct victims of traumatic situations can develop this emotional disorder. People, who are witnesses of violence, as well as natural or social disasters, are also at risk. If a person was a participant or witness of traumatic events, and after suffering psychological shock he/she cannot return to normal life for a considerable period of time (several months), if he/she is often concerned by memories of the trauma experienced, and as a result of this he/she feels helpless and defenseless in the face of dangerous and ruthless world, it is almost certainly shows that this person has posttraumatic stress disorder (Shiromani, Keane & LeDoux, 2009).
However, posttraumatic stress is not only the presence of traumatic events in the past. These events are only a part of the picture, the external factor that played a role in the disease process. The other side of posttraumatic stress is related to the inner world of the individual and is associated with his reaction to events experienced. We all react differently: a tragic accident can cause serious injuries to one and hardly affect the psyche of the other. It is also important to consider at what time an event occurs, since one and the same person may react differently at different times.
So, speaking about posttraumatic stress, we mean that a person experienced one or more traumatic events that deeply affected his/her psyche. These events are so different from all previous experience or have caused such severe suffering that a person responds to them with wild negative reactions. It is natural that sanity in such situation seeks to alleviate discomfort: a survivor of such reaction radically changes his/her attitude towards the world. A person tries to make his/her life a little easier. Doctors believe that the event that has all features of traumatic will have its effect on almost everyone. This means that the loss of emotional balance and violent mental manifestations in this case are quite normal. If the injury was relatively small, the increased anxiety and other symptoms of stress will pass off gradually over a few hours, days or weeks. If the injury was severe or traumatic events were repeated many times, painful reaction can persist for many years. For example, hum of low-flying helicopters or a sound like an explosion can cause acute stress reaction in modern combat veterans.
At the same time, a person tends to think, feel and act in a way to avoid painful memories. Just as we acquire immunity to a particular disease, our mind develops a mechanism for protection from painful experiences. For example, a survivor of the tragic loss of loved ones subconsciously avoids establishing close emotional contact with other people in future. "Combat reflexes" do not seem unusual if a person is in a war zone. However, when he comes back home, these reflexes appear to affect his psyche in a weird manner.. A thousand times, directly and indirectly, in many different ways a person is pointed out that it is time to stop behaving like in a war zone. Though, no one explains the veteran, how to do it. For some veterans who were lucky, the house became a place where they had love, where they felt safe and had a chance to reflect experience and discuss it with family and friends. This atmosphere allows analyzing their feelings. Then they can internally accept their experience and term with the past in order to move forward in life (Fullerton & Ursano, 2009).
Posttraumatic stress disorder is a general form of disorder in victims of extreme events, which is the most difficult to treat and correct. It is manifested by psychological, social and somatic changes. For the first time, this notion was introduced in connection with violations that were found in soldiers who fought in Vietnam. It was found that these soldiers had malfunctions in terms of their mental and physical health. Moreover, they could not adapt to the society. Overall, 25-80% of injured people have posttraumatic stress disorder. PTSD continually affects about 1% of the population, while 15% of the population has some of its symptoms. Duration of posttraumatic stress disorder ranges from a few weeks to a few decades. An extreme event, in other words, an event that is outside normal human experience acting as a universal psychological trauma, is the cause of PTSD. So, for example, no one goes without physical and (or) psychological losses through any war. In 1881, the soldier's heart syndrome was described, which is manifested by irritability, irascibility, false angina, tachycardia, sleep disturbance, and depressed mood (Fullerton & Ursano, 2009).
Traumatic events that often lead to the development of posttraumatic stress disorder include war, terrorism (for example, taking of hostages), natural disasters, car accidents, plane crashes, assault, rape, and serious medical procedures. Causes of PTSD are not limited by the above list. To posttraumatic stress disorder can lead any event that represents real or potential threat to life and health, and which initially caused a state of great emotional turmoil or physical shock. The first reaction to a traumatic event is acute stress, which is accompanied by intense fear, helplessness, and a state of terror. This is very painful reaction, almost unendurable, which can cause momentary insanity or psychosis. However, the human body has a defense, softening the first minutes and hours of acute stress and pain. This protective mechanism is called shock. At the time of shock a person is found to be in a state of anesthesia, since his/her sensitivity disappears. However, despite shock, human reaction to a traumatic event does not disappear. The above feelings and physical pain really exist, although a person temporarily does not feel them. If a person unfortunately experienced a traumatic situation that caused symptoms of acute stress conditions (intense fear, helplessness, and a state of terror), he/she should immediately ask for help. In the case of acute stress, it is necessary to seek psychological help in the next 36 hours. If a person received such emergency psychological help immediately after an injury, posttraumatic stress disorder following shock and stress, would have the least impact on his/her psyche. Symptoms of PTSD will be reduced . There are even cases when emergency psychological assistance helps a person avoid PTSD. Thus, posttraumatic stress disorder is a disorder that requires serious psychotherapeutic treatment (Kinchin, 2004).
When a person has no possibility to discharge internal stress, the body and psyche somehow find a way to apply this voltage. This, in principle, is the mechanism of posttraumatic stress. Its symptoms, which all together look like mental disorder, are nothing but deep-rooted behaviors associated with extreme events in the past. The main symptoms of PTSD can be divided into 4 groups:
- Re-experiencing of the traumatic event.
- Obsessive bad memories about the experienced traumatic event. Perhaps this is the most important symptom of giving the right to speak about the presence of PTSD. In the memory of the patient, scary and ugly scenes relating to the traumatic event suddenly crop up. These memories can occur both during sleep and while awake. In reality they appear when the setting reminds about what happened during the traumatic event: smell, sight, or sound seem to have come from that time. Vivid images of the past fall on the psyche and cause a lot of stress. The main difference from conventional memory is that post-traumatic unwelcome memories are accompanied by feelings of fear and anxiety.
- "Flashbacks" is a condition occurring in the form of attacks, during which a person has intense feelings and ideas that the traumatic event is experienced again.
- Nightmares (it can be a dream about the experienced traumatic event, or other scary pictures). Dreams of this kind are usually of two types: the first one reproduces the traumatic event as it is imprinted in memory. In dreams of the second type situations and characters may be different, but at least some of elements (face, situation, and feeling) are similar to those that were present in the traumatic event. A person wakes up from such dreams completely broken. His/her muscles are tensed and he/she sweats.
- Different sensations of intense psychological distress (fear, stress, depression) or physical discomfort (heart palpitations, shortness of breath, nausea, sweating) if someone or something reminisce about the traumatic event.
- Symptoms of avoidance.
- A person tries to avoid any activities, people and situations which can remind him/her of the experienced traumatic event.
- A person cannot recall important aspects of the trauma.
- Symptoms of emotional impoverishment and social exclusion.
- Decreased interest in daily life events.
- Feeling of emotional emptiness and alienation from other people. Sometimes a person wholly or partially loses the ability to display emotions. It is difficult for him/her to have close and friendly relations with other people. It is difficult to feel joy, love, creativity growth, playfulness and spontaneity.
- Feeling of broken and limited life (a person believes that he/she will never have a good job, a normal family, and that he will not live long). In the post-traumatic stress, depression reaches the most dark and gloomy depths of human despair, when it seems that everything is meaningless and useless. This feeling of depression is accompanied by nervous exhaustion, apathy and negative attitude.
- Symptoms of increased excitability of the nervous system.
- Difficulty with falling asleep or restive, shallow sleep.
- Irritability and temper tantrums. A person has desire to solve problems by brute force. Although, as a rule, it concerns the physical force action, but there is also mental, emotional, and verbal aggressiveness. Simply stated, a person tends to apply pressure on others whenever he/she wants to achieve something, even if the aim is not essential.
- Frequent (permanent) stay in the cautious state.
- A person shudders for frivolous reasons (a phone call, a signal of a car); a person flings at the slightest surprise.
- Unmotivated vigilance. A person closely follows everything that is going on, as if he/she is constantly in danger.
- A person has difficulty when he/she wants to concentrate or remember something. At least, such difficulties arise under certain circumstances, while at some points concentration may be great. However, if any stress factors appear, a person is no longer able to concentrate (Shiromani, Keane & LeDoux, 2009).
Other PTSD symptoms include: headaches, loneliness, feelings of guilt and shame, thoughts of suicide, as well as somatic (bodily) diseases, such as malfunction of hormonal metabolism, hostility towards other people, paranoid reaction to the idea of harassment and various phobias. People can also suffer from vague pains in the heart and abdomen, headaches, bloating (flatulence), alternation of diarrhea and constipation, dryness of the skin, or, conversely, greasy skin, hand shake, and chilliness. Social changes, however, like all others, may not seem related to the influence of an extreme situation, but after a while it can be noted how much an injured person has changed: pugnaciousness in the family and the team, rejection of the old medium of communication, frequent job changes, vagrancy, quarrelsomeness, isolation, propensity for aggression against other people. Different people have different symptoms and a different number of them. However, there is a common disorder that is observed in all people with PTSD. This is destruction of the customary order of life, destruction of stability, and the loss of meaning of life. The main problem is that many people do not seek help even suffering from symptoms of posttraumatic stress disorder. Some people do not attach any importance to these symptoms or do not have the ability to ask for help. Thus, they suffer from PTSD for months, years or even decades. If a person has experienced an emotionally or physically traumatic event and retains some symptoms for a long period of time (weeks or months), it is desirable for him/her to see a doctor, who will determine an accurate diagnosis and, if necessary, prescribe treatment (Kinchin, 2004).
There are diagnostic criteria for posttraumatic stress disorder.
- Criterion A has two main attributes:
- A traumatic event
- Feeling of helplessness and fear at the time of the traumatic event;
- Criterion B: the traumatic event is compulsively repeated in human experience, which is accompanied by autonomic reaction and fear;
- Criterion C: constant avoidance of thoughts, feelings, and actions associated with the trauma;
- Criterion D: changes in the somatic sphere;
- Criterion E: social changes.
Posttraumatic stress disorder is diagnosed not earlier than one month after the traumatic event with mandatory signs of category A and at least three signs of the remaining categories (Kinchin, 2004).
In spite of severe suffering, people with posttraumatic stress disorder rarely seek professional help from a psychotherapist. They retire into their shell and sometimes cure with the help of alcohol. If a person experienced an extreme situation, it is important for him to understand that almost any person can have the same symptoms. Sometimes a person with symptoms of PTSD avoids to recourse to a psychotherapist, because of fear of misunderstanding. It is important in these cases to convince him/her that the doctor-psychotherapist can understand the suffering and assist a person. There are always additional reserves in human mind, and an expert knows how to activate them. If, after one or more weeks after an accident (or a situation of threat to life and health), there are some of above symptoms, it is desirable to see a doctor as early as possible. If the diagnosis is confirmed at the initial consultation, the specialist will offer a course of psychological rehabilitation for posttraumatic stress disorder (in duration from 6 to 8 months). PTSD symptoms will pass in a few months. This disorder can be effectively treated by applying some of techniques of behavioral therapy, art therapy, as well as various medical means to facilitate painful symptoms. Psychotherapy can help people with post-traumatic stress disorder get rid of the experienced trauma and cope with current circumstances more effectively. This type of therapy aims to modify dysfunctional thoughts, behavior and feelings that are associated with the experienced traumatic event. Supporting or group therapy for people suffering from similar experiences (participation in hostilities or rape) may be also useful (Fullerton & Ursano, 2009).
A person should begin treatment as soon as possible and implement it in comprehensive and long-term manner. Medications:
- Sedatives (valerian extract, 1-2 tablets 3 times a day, tincture of valerian, motherwort, peony root - 20-30 drops 2-4 times daily in duration from 3 to 4 weeks).
- Antidepressants of the selective serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram. The dose is adjusted individually.
- Beta-blockers. Metoprolol (25-50 mg) or atenolol (20-30 mg) is usually used (Shiromani, Keane & LeDoux, 2009).
Psycho treatment should be led with drugs. As a rule, it is based on the methods of progressive muscle relaxation. One of the most important methods of treatment is cognitive-behavioral therapy. This therapy involves three major steps. First, a therapist will teach a person to deal with feelings and stress arising in memories - relax the body and be distracted from pain. Secondly, the therapist will help a person learn how to wrap memories. The doctor will help the patient tell the story of the incident. The more he/she does it, the less painful memories are. Finally, the therapist will teach how to change negative thinking and cope with current life problems. Many studies have shown that cognitive-behavioral therapy improves health of people with PTSD - war veterans, victims of rape, robbery and other traumatic incidents. Treatment time depends on a number of circumstances - a number of traumatic events that caused suffering, as well as their severity, the severity of symptoms at the moment, a number of other problems in a person’s life. For people who had a single traumatic event, 12-20 sessions are usually enough (Foy, 1992).
Posttraumatic stress disorder cannot be prevented just as in most cases it is impossible to avoid man-made or environmental disaster. However, early psychological support encourages frequent self-healing from post-traumatic stress disorder in later periods. Such assistance should be provided to everyone regardless of how exactly the victim suffered in a catastrophe, because the severity of post-traumatic stress disorder is independent of the primary reaction.
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