Thread: Post-Traumatic Stress Disorder (PTSD) :Causes, Symptoms, Treatment ...

Post-Traumatic Stress Disorder (PTSD): Causes, Symptoms, Treatment ...

Definition

Post-traumatic stress disorder is a type of anxiety disorder that's triggered by an extremely traumatic event. You can develop post-traumatic stress disorder (PTSD) when a traumatic event happens to you or when you see a traumatic event happen to someone else.

Many people who are involved in traumatic events or witness them have a brief period of difficulty adjusting and coping. But with time and some healthy coping methods, such traumatic reactions usually get better on their own. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes, they may even completely disrupt your life. In these cases, you may have post-traumatic stress disorder.

Post-traumatic stress disorder may affect survivors of such traumatic events as sexual or physical assault, war, torture, a natural disaster or an airplane crash. Post-traumatic stress disorder also can affect rescue workers at the site of mass casualties or other tragedies. These kinds of events may cause intense fear, helplessness or horror.

It's important to get treatment as soon as possible to help prevent PTSD from getting worse.

Symptoms

Signs and symptoms of post-traumatic stress disorder typically begin within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not occur until years after the event.

Post-traumatic stress disorder symptoms may include:

•Flashbacks, or reliving the traumatic event for minutes or even days at a time
•Shame or guilt
•Upsetting dreams about the traumatic event
•Trying to avoid thinking or talking about the traumatic event
•Feeling emotionally numb
•Irritability or anger
•Poor relationships
•Self-destructive behavior, such as drinking too much
•Hopelessness about the future
•Trouble sleeping
•Memory problems
•Trouble concentrating
•Being easily startled or frightened
•Not enjoying activities you once enjoyed
•Hearing or seeing things that aren't there

Post-traumatic stress disorder symptoms can come and go. You may have more symptoms during times of higher stress or when you experience symbolic reminders of what you went through. For example, some people whose PTSD symptoms had been gone for years saw their symptoms come back again with the terrorist attacks in the U.S. on Sept. 11, 2001.

When you have PTSD, you may relive the traumatic event numerous times. You may have upsetting memories. Or you may see reminders wherever you go. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape, and feel again the horror and fear of your own assault.

How is PTSD assessed?

For individuals who may be wondering if they should seek evaluation for PTSD by their medical or mental-health professional, self-tests may be useful. The National Institute of Mental Health and offers a self-test for PTSD. The assessment of PTSD can be difficult for practitioners to make since sufferers often come to the professional's office complaining of symptoms other than anxiety associated with a traumatic experience.

Those symptoms tend to include body symptoms (somatization), depression, or substance abuse. Individuals with PTSD may present with a history of making suicide attempts. In addition to depression and substance abuse disorders, the diagnosis of PTSD often co-occurs (is comorbid with) bipolar disorder (manic depression), eating disorders, and other anxiety disorders like obsessive compulsive disorder, panic disorder, and generalized anxiety disorder.

Most practitioners who examine a child or teenager for PTSD will interview both the parent and the child, usually separately, in order to allow for each party to speak freely. Interviewing the child in addition to the adults in their life is quite important given that while the child or adolescent's parent or guardian may have a unique perspective, there are naturally things the young person may be feeling that the adult is not aware of. Another challenge for diagnosing PTSD in children, particularly in younger children, is that they may express their symptoms differently from adults. For example, they may go backward or regress in their development, become accident-prone, engage in risky behaviors, become clingy, or suffer from more physical complaints as compared to adults with PTSD.

Traumatized younger children may also have trouble sitting still, focusing, or managing their impulses and therefore be mistaken as suffering from attention deficit hyperactivity disorder (ADHD).


Sometimes, professionals will use a structured psychiatric interview for children in its entirety or just the portion that assesses PTSD in order to test for PTSD. Examples of such tools include the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), the Diagnostic Interview Schedule for Children-Version IV (DISC-IV), and the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS). There are also some PTSD-specific structured interviews, like the Clinician-Administered PTSD Scale-Child and Adolescent Version, the Child PTSD Checklist, and the Child PTSD Symptom Scale.

For the assessment of the severity of PTSD symptoms in children, structured interviews like the Child Posttraumatic Stress Reaction Index, the Child and Adolescent Trauma Survey, and the Trauma Symptom Checklist for Children are sometimes used. The Child Trauma Screening Questionnaire has been found by some professionals to be useful in predicting which children who endure a traumatic event will go on to develop PTSD.

PTSD At A Glance

•Posttraumatic stress disorder (PTSD) is an emotional illness that was first formally diagnosed in soldiers and war veterans and is caused by terribly frightening, life-threatening, or otherwise highly unsafe experiences.

• PTSD symptom types include re-experiencing the trauma, avoidance, and hyperarousal.

• PTSD has a lifetime prevalence of seven up to 30%, with about 5 million people suffering from the illness in any one year. Girls, women, and ethnic minorities tend to develop PTSD more than boys, men, and Caucasians.

• Complex posttraumatic stress disorder (C-PTSD) usually results from prolonged exposure to traumatic event(s) and is characterized by long-lasting problems that affect many aspects of emotional and social functioning.

• Symptoms of C-PTSD include problems regulating feelings, dissociation or depersonalization; persistent depressive feelings, seeing the perpetrator of trauma as all-powerful, preoccupation with the perpetrator, and a severe change in what gives the sufferer meaning.

• Untreated PTSD can have devastating, far-reaching consequences for sufferers' medical and emotional functioning and relationships, their families, and for society. Children with PTSD can experience significantly negative effects on their social and emotional development, as well as their ability to learn.

• Although almost any event that is life-threatening or that severely compromises the emotional well-being of an individual may cause PTSD, such events usually include experiencing or witnessing a severe accident or physical injury, getting a frightening medical diagnosis, being the victim of a crime or torture, exposure to combat, disaster or terrorist attack, enduring any form of abuse, or involvement in civil conflict.

• Issues that tend to put people at higher risk for developing PTSD include female gender, minority ethnicity, increased duration or severity of, as well as exposure to, the trauma experienced, having an emotional condition prior to the event, and having little social support. Risk factors for children and adolescents also include having any learning disability or experiencing violence in the home.

• Disaster preparedness training may be a protective factor for PTSD.

• Medicines that treat depression (for example, serotonergic antidepressants or SSRIs), decrease the heart rate (for example, propranolol) or increase the action of other body chemicals (for example, hydrocortisol) are thought to be effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event.

• Individuals who wonder if they may be suffering form PTSD may benefit from taking a self-test as they consider meeting with a practitioner. Professionals may used a clinical interview in either adults, children, or adolescents, or one of a number of structured tests with children or adolescents to assess for the presence of this illness.

• Diagnosing PTSD can present a challenge for professionals since sufferers often come for evaluation of something that seems to be unrelated to that illness at first. Those symptoms tend to be physical complaints, depression, or substance abuse. Also, PTSD often co-occurs with manic depression, eating disorders, or other anxiety disorders.

• Challenges for assessment of PTSD in children and adolescents include adult caretakers' tendency to be unaware of the extent of the young person's symptoms and the tendency for children and teens to express symptoms of the illness in ways that are quite different from adults.

• Treatments for PTSD usually include psychological and medical treatments. Education about the illness, helping the individual talk about the trauma directly, exploration and modification of inaccurate ways of thinking about it, and teaching the person ways to manage symptoms and are the usual techniques used in psychotherapy. Family and couples' counseling, parenting classes, and education about conflict resolution are other useful psychotherapeutic interventions.

• Directly addressing the sleep problems that are associated with PTSD has been found to help alleviate those problems, thereby decreasing the symptoms of PTSD in general.

• Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs) and medicines that help decrease the physical symptoms associated with illness. Other potentially helpful medications for managing PTSD include mood stabilizers and antipsychotics. Tranquilizers have been associated with withdrawal symptoms and other problems and have not been found to be significantly effective for helping individuals with PTSD.

• Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the illness, talking to others for support, using relaxation techniques, participating in treatment, increasing positive lifestyle practices, and minimizing negative lifestyle practices.

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'Tetris' May Help Reduce Flashbacks To Traumatic Events

08 Jan 2009

Playing 'Tetris' after traumatic events could reduce the flashbacks experienced in post-traumatic stress disorder (PTSD), preliminary research by Oxford University psychologists suggests.

If this early-stage work continues to show promise, it could inform new clinical interventions for use immediately after trauma to prevent or lessen the flashbacks that are the hallmark symptom of PTSD. Existing treatments can only be provided once PTSD has become established.

The researchers report in the online, peer-reviewed journal PLoS ONE that for healthy volunteers, playing 'Tetris' soon after viewing traumatic material in the laboratory can reduce the number of flashbacks to those scenes in the following week. They believe that the computer game may disrupt the memories that are retained of the sights and sounds witnessed at the time, and which are later re-experienced through involuntary, distressing flashbacks of that moment.

'This is only a first step in showing that this might be a viable approach to preventing PTSD,' says Dr Emily Holmes of the Department of Psychiatry at Oxford University, who led the work. 'This was a pure science experiment about how the mind works from which we can try to understand the bigger picture. There is a lot to be done to translate this experimental science result into a potential treatment.'

The approach relies on three elements.

First, the mind is considered to have two separate channels of thought: one is sensory and deals with our direct perceptual experience of the world, the other is conceptual and draws meaning and narrative from our experiences to give them context. For example, we would use one channel to see and hear someone talk and the other to comprehend the meaning of what they were saying.

Second, there appear to be limits to our abilities in each stream: it is difficult to hold a conversation while doing maths problems, for example.

And third, there is a short time after an event in which it is possible to interfere with the way our memories are retained in the brain.

The Oxford team reasoned that recognising the shapes and moving the coloured building blocks around in 'Tetris' soon after seeing traumatic events should compete with the visions of trauma to be retained in the sensory part of the brain. The narrative and meaning of the events should be unaffected.

'We know there is a period of up to six hours in which it is possible to affect certain types of memories that are laid down in the human mind,' says Dr Catherine Deeprose. 'We have shown that in healthy volunteers, playing 'Tetris' in this time window can reduce flashback-type memories without wiping out the ability to make sense of the event.'

The Oxford team showed a film to 40 healthy volunteers that included traumatic images of injury from a variety of sources, including adverts highlighting the dangers of drink driving. This is a recognised way to study the effects of trauma in the laboratory. After waiting for 30 minutes, 20 of the volunteers played 'Tetris' for 10 minutes while the other half did nothing. Those who had played the computer game experienced significantly fewer flashbacks to the film over the next week.

'We wanted to find a way to dampen down flashbacks - that is, the raw sensory images of trauma that are over-represented in the memories of those with PTSD,' says Dr Holmes. 'Tetris may work by competing for the brain's resources for sensory information. We suggest it specifically interferes with the way sensory memories are laid down in the period after trauma and thus reduces the number of flashbacks that are experienced afterwards.'

The group is now hoping to develop this approach further as a potential intervention to reduce the flashbacks experienced in PTSD, but they are keen to emphasise that these are only preliminary results. Dr Holmes also stresses that no conclusions can be drawn more generally for computer gaming and its effects.