Personality Disorder Support Community

Personality Disorder Support Community


Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder is an anxiety disorder that starts after a traumatic event. Traumatic events can be categorised as those where we witness or experience terrible danger to ourselves or others.
Some examples are:

  • Assault on the person (sexual or physical and can include robbery, rape etc)

  • Natural disasters

  • Shootings or hostage situations

  • Serious accidents


There are obviously many other situations where a person may witness or experience horrifying events that can be classed as traumatic. Frequently, these type of experiences trigger psychological reactions that can last for months and sometimes years. In most cases, the symptoms start around 6 months after experiencing trauma.

Symptoms

Many people with PTSD experience these symptoms and a formal diagnosis of PTSD will require these symptoms to occur for a period of at least one month.

  • Flashbacks or re-experiencing trauma
    This happens when the sufferer relives it through nightmares or when something ordinary might trigger off a memory of the event, resulting in anxiety and mixed emotions.


  • Hypervigilance
    This is a state where a person is on alert all the time in order to ensure that he is not in danger.


  • Avoidance
    People with PTSD often avoid situations that might trigger off their flashbacks or experiences, so they tend to isolate themselves. Sometimes, they try to distract themselves by preoccupying or fully immersing themselves into their work or other activities so they will not have to feel the anxiety that they will feel otherwise.


In order to be diagnosed with PTSD, you will have to meet the following criteria set by the DSM-IV-TR (2000) or the ICD-10.

The DSM-IV-TR criteria states that the person must have had:

  1. Exposure to a traumatic event. This must have involved:

    1. A loss of 'physical integrity', or risk of serious injury or death, to self or others
    2. A response to the event that involved intense fear, horror or helplessness (or in children, the response must involve disorganised or agitated behaviour).


  2. Persistent re-experiencing.

    One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).

  3. Persistent avoidance and emotional numbing

    This involves a sufficient level of:

    • Avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s)

    • Avoidance of behaviors, places, or people that might lead to distressing memories as well as the disturbing memories, dreams, flashbacks, and intense psychological or physiological distress

    • Inability to recall major parts of the trauma(s), or decreased involvement in significant life activities

    • Decreased capacity (down to complete inability) to feel certain feelings

    • An expectation that one's future will be somehow constrained in ways not normal to other people.


  4. Persistent symptoms of increased arousal not present before

    These are all physiological response issues, such as:

    • Difficulty falling or staying asleep

    • Problems with anger, concentration

    • Hypervigilance.


    Additional symptoms include:

    • Irritability

    • Angry outbursts

    • Increased startle response

    • Concentration or sleep problems.


  5. Duration of symptoms for more than 1 month

    If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute Stress Disorder.

  6. Significant impairment

    The symptoms reported must lead to "clinically significant distress or impairment" of major domains of life activity, such as social relations, occupational activities, or other "important areas of functioning".


The ICD-10 criteria states the following:

  1. The patient must have been exposed to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature which would likely cause pervasive distress in almost anyone.

  2. There must be persistent remembering or reliving of the stressor in intrusive flashbacks, vivid memories or recurring dreams, or in experiencing distress when exposed to circumstances resembling or associated with the stressor.

  3. The patient must exhibit an actual or preferred avoidance of circumstances resembling or associated with the stressor.

  4. Either of the following must be present:

    • Inability to recall either partially or completely some important aspect of the period of exposure to the stressor, OR

    • Persistent symptoms of increased psychological sensitivity and arousal shown by any two of the following:

    • Difficulty falling or staying asleep

    • Irritability or outbursts of anger

    • Difficulty concentrating

    • Hypervigilance

    • Exaggerated startle response


Criteria 2, 3 and 4 must all arise within 6 months of the period of stress. The diagnostic guidelines show that the disorder should only be diagnosed after six months if the symptoms are typical and do not constitute one of the other psychiatric diagnoses such as phobic conditions, other anxiety disorders, depression etc.


Reaction to extreme stress unspecified

If not all of the criteria are met the diagnosis of "reaction to extreme stress, unspecified" may be a more appropriate label. However the criterion of the presence of the extreme stressor must be fulfilled.

Causes

There is no definite cause of PTSD but it is believed that there are both psychological and physical causes for PTSD. It is believed that intense negative feelings evoked when confronted by traumatic events may interact with mutated stress genes to create PTSD in adulthood. Note that not everyone develops PTSD because of a traumatic event – some research shows that the ensuing flashbacks and memories have a greater impact than the event itself.

There are also other theories of evolutionary psychology and genetics, as well as chemical or physiological changes in the body which happen when exposed to traumatic events that may explain the causes of PTSD.

Treatment

Most people with PTSD benefit from some kind of treatment, including psychotherapy, medication and other preventative measures. Therapies such as Cognitive Behavioural Therapy that helps to change the way the sufferer processes his emotions about the memories, and Eye Movement Desensitisation and Reprocessing (EMDR) have been shown to be effective in treating PTSD.

Medication such as antidepressants can also be effective in treating some symptoms of PTSD.

Other kinds of treatment such as meditation and anti anxiety techniques can also be effective in helping ease some of the PTSD symptoms.

If you live in the UK, you may need to contact the DVLA and inform them of a diagnosis of PTSD, as it may affect your driving ability.


References:

http://www.rcpsych.ac.uk/expertadvice/p ... order.aspx
http://www.nhs.uk/conditions/post-traum ... ction.aspx
http://en.wikipedia.org/wiki/Posttrauma ... s_disorder



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