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Post Traumatic Stress Disorder
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Events that can develop into PTSD: • Combat or military exposure • Child sexual or physical abuse • Terrorist attacks • Sexual or physical assault • Serious accidents, such as a car wreck. • Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.
What is PTSD? An anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.
Reliving the event (also called re-experiencing symptoms): • Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger -- a sound or sight that causes you to relive the event. Triggers might include: • Hearing a car backfire, which can bring back memories of gunfire and war for a combat Veteran. • Seeing a car accident, which can remind a crash survivor of his or her own accident. • Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped.
Avoiding situations that remind you of the event: • You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example: • A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes. • A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants. • Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.
Feeling numb: • You may find it hard to express your feelings. This is another way to avoid memories. • You may not have positive or loving feelings toward other people and may stay away from relationships. • You may not be interested in activities you used to enjoy. • You may not be able to remember parts of the traumatic event or not be able to talk about them.
Feeling keyed up (also called hyperarousal): • You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to: • Suddenly become angry or irritable • Have a hard time sleeping. • Have trouble concentrating. • Fear for your safety and always feel on guard. • Be very startled when something surprises you.
People with PTSD may also have other problems. • Drinking or drug problems. • Feelings of hopelessness, shame, or despair. • Employment problems. • Relationships problems including divorce and violence. • Physical symptoms.
DSM-IV-TR criteria for PTSD Criterion A: stressor The person has been exposed to a traumatic event in which both of the following have been present: The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others. The person's response involved intense fear,helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior. Criterion B: intrusive recollection The traumatic event is persistently re-experienced in at least one of the following ways: Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed. Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes,including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event Criterion C: avoidant/numbing Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: Efforts to avoid thoughts, feelings, or conversations associated with the trauma Efforts to avoid activities, places, or people that arouse recollections of the trauma Inability to recall an important aspect of the trauma Markedly diminished interest or participation in significant activities Feeling of detachment or estrangement from others Restricted range of affect (e.g., unable to have loving feelings) Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) Criterion D: hyper-arousal Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hyper-vigilance Exaggerated startle response Criterion E: duration Duration of the disturbance (symptoms in B, C, and D) is more than one month. Criterion F: functional significance The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: Acute: if duration of symptoms is less than three months Chronic: if duration of symptoms is three months or more Specify if: With or Without delay onset: Onset of symptoms at least six months after the stressor Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning.
Cognitive Behavioral Therapy • Cognitive Processing Therapy: Helps the client understand and change thoughts about the trauma and its aftermath. GOAL: Understand how certain thoughts about trauma cause stress and make symptoms worse. • Exposure Therapy: Helps the client talk about the trauma and not be afraid of the memories GOAL: Have less fear about the memories
MEDICATIONS: Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).