Posttraumatic stress disorder
Posttraumatic stress disorder: Excerpt from Professional Guide to Diseases (Eighth Edition)
Characteristic psychological consequences that persist for at least 1 month after a traumatic event outside the range of usual human experience are classified as posttraumatic stress disorder (PTSD). This disorder can follow almost any distressing event, including a natural or man-made disaster, physical or sexual abuse, or an assault or a rape. Psychological trauma, which accompanies the physical trauma, is characterized by intense fear and feelings of helplessness and loss of control. PTSD can be acute, chronic, or delayed. When the precipitating event is of human design, the disorder is more severe and more persistent. Onset can occur at any age, even during childhood.
Causes and incidence
PTSD occurs in response to an extremely distressing event, including a serious threat of harm to the patient or his family, such as war, abuse, or violent crime. It may be triggered by sudden destruction of his home or community by a bombing, fire, flood, tornado, earthquake, or similar disaster. It may also follow witnessing the death or serious injury of another person by torture, in a death camp, by natural disaster, or by a motor vehicle or airplane crash.
Preexisting psychopathology can predispose some patients to this disorder, but anyone can develop it, especially if the stressor is extreme.
Any person who has experienced traumatic relocation due to such events as rioting or other civil strife, extreme natural disasters, or war should be assessed for signs of PTSD.
PTSD can occur at any age. Most cases resolve 3 months after the traumatic event, but some cases can last for years.
Signs and symptoms
The psychosocial history of a patient with PTSD may reveal early life experiences, interpersonal factors, military experiences, or other incidents that suggest the precipitating event. Typically, the patient may report that his symptoms began immediately or soon after the trauma, although they may not develop until months or years later. In such a case, avoidance symptoms usually have been present during the latency period.
Symptoms include pangs of painful emotion and unwelcome thoughts; intrusive memories; dissociative episodes (flashbacks); a traumatic reexperiencing of the event; difficulty falling or staying asleep, frequent nightmares of the traumatic event, and aggressive outbursts on awakening; emotional numbing (diminished or constricted response); and chronic anxiety or panic attacks (with physical signs and symptoms).
The patient may display rage and survivor guilt, use of violence to solve problems, depression and suicidal thoughts, phobic avoidance of situations that arouse memories of the traumatic event (such as hot weather and tall grasses for the Vietnam veteran), memory impairment or difficulty concentrating, and feelings of detachment or estrangement that destroy interpersonal relationships. Some have physical symptoms, fantasies of retaliation, and substance abuse.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing posttraumatic stress disorder, page 470.
Treatment
Treatment of PTSD aims to reduce the target symptoms, prevent chronic disability, and promote occupational and social rehabilitation. Specific treatments may emphasize behavioral techniques (such as relaxation therapy to decrease anxiety and induce sleep or progressive desensitization). Antianxiety and antidepressant drugs or psychotherapy (supportive, insight, or cathartic) may minimize the risks of dependency and chronicity.
Support groups are highly effective and are provided through many Veterans Administration centers and crisis clinics. These groups provide a forum in which victims of this disorder can work through their feelings with others who have had similar conflicts.
Group settings are appropriate for most degrees of symptoms presented. Some group programs include spouses and families in their treatment process. Rehabilitation programs in physical, social, and occupational settings are also available for victims of chronic PTSD.
Many patients need treatment for depression, alcohol or drug abuse, or medical conditions before psychological healing can take place. Treatment of this disorder may be complex, and the prognosis varies.
Special considerations
❑ Encourage the patient with PTSD to express his grief, complete the mourning process, and develop coping skills to relieve anxiety and desensitize him to the memories of the traumatic event.
❑ Keep in mind that such a patient tends to sharply test your commitment and interest. Therefore, first examine your feelings about the event (war or other trauma) so you won’t react with disdain and shock. Such reactions hamper the working relationship with the patient and reinforce his typically poor self-image and sense of guilt.
❑ Know and practice crisis intervention techniques as appropriate in PTSD.
❑ Establish trust by accepting the patient’s current level of functioning and assuming a positive, consistent, honest, and nonjudgmental attitude toward the patient.
❑ Provide encouragement as the patient shows a commitment to work on his problem.
❑ Deal constructively with the patient’s displays of anger.
❑ Encourage joint assessment of angry outbursts (identify how anger escalates and explore preventive measures that family members can take to regain control).
❑ Provide a safe, staff-monitored room in which the patient can safely deal with urges to commit physical violence or self-abuse through displacement (such as pounding clay or destroying selected items).
❑ Encourage the patient to move from physical to verbal expressions of anger.
❑ Help the patient relieve shame and guilt precipitated by real actions (such as killing or mutilation) that violated a consciously held moral code. Help him put his behavior into perspective, recognize his isolation and self-destructive behavior as forms of atonement, learn to forgive himself, and accept forgiveness from others.
❑ Refer the patient to a member of the clergy, as appropriate.
❑ Provide for group therapy with other victims for peer support and forgiveness, or refer the patient to such a support group.
❑ Refer the patient to appropriate community resources.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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