Posttraumatic Stress Disorder (PTSD)
The paper discusses posttraumatic stress disorder (PTSD), a common mental illness in both general and specific populations, focusing on its definition, causes, symptoms, prevalence, treatment and prevention. PTSD is a mental illness that develops when a person experiences or witnesses a traumatizing event and continues to show symptoms of distress for an extended period, usually one or more months after the incidence (Schiraldi, 2009, p. 6). With the high frequency of traumatizing events such as sexual abuse, physical violence, armed conflicts, and motor vehicle crashes, people should be aware of the potential impact of these events on their mental health so that they can visit health care centers for check up and treatment and escape the debilitating effect of PTSD.
High incidence rates of PTSD are reported among the military population, especially those returning from combat missions such the operation Iraqi Freedom. For example, one study found that over 68% of U.S. army veterans returning from the war in Iraq and Afghanistan between 2007 and 2008 suffered from PTSD (Lew et al., 2013, p. 3). However, a review of 26 PTSD prevalence studies on this population indicated that only 5-12% of veterans met the criteria for PTSD (Ramchand et al., 2010, p. 67). Ramchand et al. emphasized the fact that studies report different incidence rates of PTSD due to differences in sample, methodology and diagnostic procedures. According to Benson-Martin (2013, p. 49), the prevalence of PTSD among the general U.S. population ranges from 5-9%, but varies significantly with population factors. For example, the prevalence of PTSD in primary care settings is nearly 30%.
People react to traumatic events differently and only those who cannot cope effectively with the trauma develop PTSD symptoms. Some of the risk factors for PTSD include exposure to traumatic events, presence of mental illness, inadequate social support to cope with trauma, and the additional consequences of the traumatic event such as loss of job, physical disability and loss of loved ones (Benson-Martin, 2013, p. 50). Gender is also associated with PTSD in certain settings. For example, Kline et al. (2013) found that female army officers were more vulnerable to PTSD before and after deployment to Iraq. The researchers believed that gender differences in preparedness for combat and unit cohesion mediated the observed gender differences in PTSD. Furthermore, certain factors can reduce the likelihood of developing PTSD. They include social connectedness, availability of social support, and confidence in one’s coping ability.
The American psychiatric association identifies six symptoms of PTSD. First, the person must have witnessed or experienced a traumatizing event that had the potential to kill or seriously injure him/her or others, to which he or she reacted through intense fear, horror and feelings of helplessness (Benson-Martin, 2013, p. 50). Second, the person re-experiences the traumatizing event through flashbacks, distressing dreams, hallucinations and illusions. Certain physical and psychological cues such as places, people, and sounds might trigger re-experience of the traumatizing event or at least cause intense emotional distress similar to the one caused by the actual traumatic event (Schiraldi, 2009, p. 7). Third, the affected person may avoid all cues related to the event in an attempt to suppress emotions generated by the event. This includes avoiding thoughts, objects, people, places, activities and anything that can bring back the memory of the traumatizing event. Avoidance behavior is associated with the inability to remember key aspects of the traumatic experience such as when it occurred and how the event progressed. In addition, avoidance makes the affected person feel distant from others because the person can only tolerate a limited range of emotions and stimuli.
Fourth, a person with PTSD shows symptoms of hyper-arousal such as sleeplessness, irritability, low concentration, hyper-vigilance and increased startle response (Schiraldi, 2009, p.9). Fifth, all the symptoms so far described are present for at least one month after the traumatic event. Finally, the person is unable to function normally in social, cognitive, occupational areas of life because of the psychological distress associated with the traumatizing experience. PTSD can be acute or chronic. Acute PTSD refers to the presence of PTSD symptoms one month after the traumatic event while chronic PTSD is the persistence of symptoms for at least 3 months. Another form of PTSD called delayed PTSD refers to the onset of symptoms six or more months after the traumatizing event (Benson-Martin, 2013, p. 50).
Both pharmacological and psychological treatments of PTSD are widely practiced. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors are the first line medications for PTSD because of their ability to suppress avoidance, re-experience and hyper-arousal symptoms of PTSD (Jeffreys, Capehart & Friedman, 2012, p. 706). The only FDA- (food and drug administration) approved SSRIs for PTSD are paroxetine and sertraline. These two SSRIs and venlafaxine (an SNRI) are quite effective in reducing most symptoms of PTSD. The drugs act on serotonin pathways in the amygdala to repair the fear circuitry. However, SSRIs and SNRIs are only effective in treating acute PTSD. First line medications for PTSD cause many side effects including sexual dysfunction, weight gain and gastrointestinal problems. Other types of medications with the potential to treat specific symptoms of PTSD include prazosin, which reduces nightmares by acting on the central nervous system (Jeffreys, Capehart & Friedman, 2012, p. 707). However, prazosin causes hypotension and thus should be administered with care. Secondary medications for treating PTSD include monoamine oxidase inhibitors (MAOIs) such as phenelzine and tricyclic antidepressants (TCAs) such as amitriptyline and imipramine. These medications are quite effective in reducing PTSD symptoms but have severe side effects than SNRIs and SSRIs.
Psychotherapy is quite effective in long-term treatment of PTSD. Many randomized controlled trials have revealed that trauma-focused cognitive behavior therapy (TF-CBT) is highly effective in the treatment of PTSD (Seedat, 2013, p. 188). The purpose of TF-CBT is to build the client’s capacity to process the distressing emotions associated with the traumatic event in ways that restore normal cognitive, social and emotional functioning. Therapists administering TF-CBT believe that people with PTSD have distorted thoughts that hinder their ability to adapt appropriately to trauma. The distorted thoughts and beliefs are responsible for PTSD symptoms such as fear and powerlessness. TF-CBT includes cognitive, behavioral and family therapy components to enable the client to build positive thoughts, control fear and gain social skills necessary to cope with trauma (Child Welfare Information Gateway, 2012, p. 5). The specific components of TF-CBT include psycho education—teaching the client about trauma and its effects, relaxation training to enable the client to handle emotional distress through visual imagery and focused breathing, self-regulation to enable the client to control impulsive behavior, social skills training to restore social functioning and cognitive coping to enable the client to process the effects of trauma.
Most people exposed to traumatic experiences will show symptoms similar to those of PTSD including fear, hyper-arousal and hyper-vigilance, but most of them are able to recover normally in a few weeks. The purpose of prevention is to enable individuals exposed to trauma to recover quickly and resume normal functioning within a month’s time. Social support is the primary prevention strategy for PTSD (Kearns et al., 2012, p. 837). People suffering from trauma need to surround themselves with people who listen, care and comfort them. Social support includes a loving family, caring faith groups, supportive colleagues at work and health care providers. Finding support early enables the affected person to respond to distressful feelings in healthy ways and recover quickly. Social support may include psychological debriefing but it should be based on evidence. According to Kearns et al. (2012, p. 834), psychological debriefing is widely practiced as a method of preventing PTSD yet it lacks evidence-basis. Besides social support, research on medical solutions to PTSD is ongoing and recent advances in understanding the mechanisms of PTSD will help scientists to develop drugs for quickening recovery from trauma (Kearns et al., 2012, p. 836). However, combining medication and social support strategies is likely to be a more effective approach to PTSD prevention than relying on either of the two approaches.
The effect of PTSD on the general population remains vague considering the constant evolution of knowledge concerning the nature, prevalence and diagnosis of the disorder. With the emergence of DSM-V, the diagnosis of PTSD is likely to change. With many PTSD studies focusing on war veterans, the prevalence of PTSD in the general population will remain vague for some time to come. Yet, PTSD poses a significant health threat to the many people faced with different traumatic events including physical and sexual abuse, serious injuries at work, car crashes, and armed conflicts, loss of loved ones and other tragic events. More research should go into understanding the extent of the problem in the general population in order to respond appropriately with both preventive and treatment strategies.
Benson-Martin, J. J. (2013). Management of trauma and PTSD. CME: Continuing Medical Education, 31(2), 49-52.
Child Welfare Information Gateway, (2012). Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. Retrieved April 29, 2014 https://www.childwelfare.gov/pubs/trauma/trauma.pdf
Jeffreys, M., Capehart, B., & Friedman, M. J. (2012). Pharmacotherapy for posttraumatic stress disorder: Review with clinical applications. Journal Of Rehabilitation Research & Development, 49(6), 703-715. doi:10.1682/JRRD.2011.09.0183
Kearns, M. C., Ressler, K. J., Zatzick, D., & Rothbaum, B. (2012). EARLY INTERVENTIONS FOR PTSD: A REVIEW. Depression & Anxiety (1091-4269), 29(10), 833-842. doi:10.1002/da.21997
Kline, A., Ciccone, D. S., Weiner, M., Interbank, A., St. Hill, L., Falca-Dodson, M., & … Losonczy, M. (2013). Gender Differences in the Risk and Protective Factors Associated With PTSD: A Prospective Study of National Guard Troops Deployed to Iraq. Psychiatry: Interpersonal & Biological Processes, 76(3), 256-272. doi:10.1521/psyc.2013.76.3.256
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Ramchand, R., Schell, T. L., Karney, B. R., Osilla, K., Burns, R. M., & Caldarone, L. (2010). Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: Possible explanations. Journal Of Traumatic Stress, 23(1), 59-68. doi:10.1002/jts.20486
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