What is Post-Traumatic Stress Disorder?
What is Post-Traumatic Stress Disorder?
What is Post-Traumatic Stress Disorder?
One of the first descriptions of PTSD was made by the Greek historian Herodotus. In 490BCE, he described, during the Battle of Marathon, an Athenian soldier who suffered no injury from war but became permanently blind after witnessing the death of a fellow soldier. Battled-associated stress reports appear as early as the 6th century B.C. PTSD-like symptoms have also been recognized in combat veterans of many military conflicts. The modern understanding of PTSD dates from the 1970s, largely as a result of the problems that were still being experienced by Vietnam veterans. ("Posttraumatic Stress Disorder," 2009, p. 11)
The term post-traumatic stress disorder or PTSD was coined in the mid 1970s. Early in 1978, the term was used in a working group finding that was presented to the Committee of Reactive Disorders. The term was formally recognized in 1980. In the DSM-IV, which is considered authoritative, the spelling "posttraumatic stress disorder" is used, but elsewhere, "posttraumatic" is often rendered as two words- "post-traumatic stress disorder" or "posttraumatic stress disorder" especially in less formal writing on the subject."Posttraumatic Stress Disorder" (2009, p. 11). Vietnam veterans were unable to receive benefits for this condition, when it was removed as a diagnosis from the DSM-III, this led Chaim F. Shatan, who worked with anti Vietnam War activists and the anti war group Vietnam Veterans against the War to coined the term post-Vietnam Syndrome. The condition was added to the DSM-III as posttraumatic stress disorder. ("Posttraumatic Stress Disorder," 2009, p. 11).
In the United States, because of budget concern and apparent inconsistencies in the awarding of compensation by different rating officers, the Department of Veterans Affairs reviewed the provision of compensation to Veterans for PTSD in 2005, which led to a backlash from veterans' rights groups and to some highly-publicized suicides by veterans who feared losing their benefits, which in some cases constituted their only form of income. The diagnosis of PTSD has been a subject of some controversy due to uncertainties in objectively diagnosing PTSD in those who may have been exposed to trauma, and due to this diagnosis' association with some incidence of compensation-seeking behavior. ("Posttraumatic Stress Disorder," 2009, p. 11).
The Diagnostic and Statistical Manual of Mental Disorder (4th ed., text rev., or DSM-IV-TR; Psychiatric Association, 2000)define posttraumatic disorder (PTSD) as an anxiety disorder precipitated by a traumatic event and characterized by symptoms of re-experiencing the trauma, avoidance and numbing, and hyperarousal.(Tolin & Foa, 2008)
Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after one is exposed to one or more terrifying events that threaten or caused grave physical harm. It is also a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death, a threat to the patient's or someone else's life, serious physical injury, or threat to physical or psychological integrity, overwhelming psychological defense. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined. PTSD is a condition distinct from traumatic stress, which has less intensity and duration, and combat stress reaction, which is transitory. PTSD has been recognized in the past as railway spine, battle fatigue, shell shock or post-traumatic stress syndrome (PTSS)."Posttraumatic Stress Disorder" (2009, p. 1).
Posttraumatic stress disorder is believed to be caused by psychological trauma, which includes witnessing or encountering childhood or adult physical, emotional or sexual abuse. It is also caused by an event that is perceived as life-threatening, such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or the experience of, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency services workers)."Posttraumatic Stress Disorder" (p. 2)
According to the National Institute of Mental Health 2008, p.1, anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events.
According to Breslau & Davis, 1992; Breslau et al., 1998;Davidson, Hughes, Blazer, & George, 1991; Helzer, Robins, & McEvory, 1987; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995, as cited by Foa & Tolin, subsequent epidemiological studies have suggested that PTSD may be more prevalent among women and girls than among men and boys. PTSD is also caused by a biochemical changes in the brain (neuroendocrinology)that differ from other psychiatric disorder such as major depression, a change in brain morphology (neuroanatomy) and genetics.("Posttraumatic Stress Disorder," 2009, p. 2) . In addition to the biochemical changes, PTSD also involves changes in brain morphology. According to Gurvitis et al as cited by ("Posttraumatic Stress Disorder"), combat veterans of the Vietnam War with PTSD showed a 20% reduction in the volume of their hippocampus as compared with veterans who suffered no such symptoms. PTSD runs in families of monozygotic twin (identical), if both are exposed to a traumatic event, than dizygotic twins (non-identical). ("Posttraumatic Stress Disorder," 2009, p. 3)
There are many different forms of psychotherapy treatment that are available to treat PTSD, (psychodynamic therapy, cognitive behavioral programs, variants of exposure therapy, stress inoculation training (STI), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many, and many combinations of these procedures("Posttraumatic Stress Disorder," 2009, p. 7) . Cognitive therapy has being considered very helpful in reducing isolation and social stigma.
In order to be treated for PTSD, one has to meet the diagnostic criteria as per the Diagnostic and Statistical Manual of Mental Disorder IV (Text Revision) (DSM-IV-TR) that is as fellow: (A) One should have an exposure to a traumatic event, (B) One should have a persistent reexperience (e.g. flashbacks, nightmares), (C) persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and reexperiencing symptoms fear losing control), (D) persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilance), (E) Duration of symptoms more than one month and (F) significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.) Criterion A (the stressor) of the diagnostic criteria consist of two parts, both of which must be met by the individual before they can be diagnosed with PTSD, and they are A1 and A2. A1 requires that "the person" experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others and A2 requires that "the person's response involved intense fear, helplessness, or horror." There is a difference between the DSM-III stressor criterion and the DSM-IV-TR. The DSM-III stressor criterion specified that the traumatic event should be a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience."("Posttraumatic Stress Disorder", p. 7). Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Education about the condition and provision of safety and support are some of the basic counseling that is available also for the treatment of PTSD. Cognitive behavioral programs/therapy alone with other psychotherapy programs like (stress inoculation training (SIT), eye movement desensitization and reprocessing (EMRD), psychodynamic therapy and variants of cognitive therapy have shown strong efficacy in reducing isolation and social stigma."Posttraumatic Stress Disorder" (p. 7)
Eye movement desensitization and reprocessing (EMDR) is specifically targeted as a treatment for PTSD, because it is largely supported by those with the copyright for EMDR and third-party, but its effectiveness are lacking. Medications on the other hand have shown benefit in reducing PTSD symptoms, but rarely achieve complete remission. Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are among the standard medication therapy that is use in treating PTSD."Posttraumatic Stress Disorder" (p. 8) According to Bradley, Greene, Russ, Dutra & Westen, 2005 as cited by (Forbes et al. 2008), chronic posttraumatic stress disorder(PTSD) is difficult to treat, because half of those treated retain the diagnosis at posttreatment and responders often report considerable residual symptomatology. It is very critical to tailor intervention to presentation type. This can be done by optimizing treatment effectiveness through understanding factors that influence treatment outcome, because according to Frueh, Turner, & Bediel, 1995 as cited by (Forbes et al.), the modesty of treatment gains is particularly notable in combat veteran that returned from the Middle East, they are as high as 15-20%.According to Lee, Scragg, & Turner, 2001; Murray, Ehlers, & Mayou, 2002 as cited by (Stapleton, Taylor, & Asmundson, 2006, p. 19) ,evidence has suggested that rumination about the traumatic event-in which the person dwells on questions such as "why did this happen to me?" "What could I have done to prevent it from happening?" or "How could they get away with doing this to me?"-appears to contribute to PTSD and to persistent anger and guilt. In recent years, there has been growing interest, for both practical and theoretical reasons, regarding the relationship between posttraumatic stress disorder (PTSD) and anger and guilt (Stapleton et al.) Exposure Therapy, Eye Movement Desensitization and Reprocessing (EMDR), and Relaxation Training have shown strong efficacy in the treatment of anger and guilt, but they may not be sufficient for reducing these negative emotions. Relaxation focuses on physiological arousal and therefore is expected to reduce anger and guilt; because it encourages patients to focus on reducing arousal by use of calming imagery and tension-reducing physical exercises and Cognitive restructuring has also shown to be effective, because it has methods that specifically focus on the reduction of anger and guilt (Stapleton et al., 2006).
Clinicians ratings of symptomatology as the primary measure in assessing outcomes for posttraumatic stress disorder (PTSD) during most randomized controlled trials of medication or psychotherapy have being utilized, but patient self-rating of symptoms are often simultaneously assessed, thereby placing less emphasis on the outcomes. Surprisingly there is little research that has evaluated the agreement between clinicians and patients about the direction and degree of changes in symptoms following treatment (Monson, Gradus, Schnurr, Young-Xu, & Price, 2008).
References
(Forbes D Parslow R Creamer M Allen N McHugh T Hopwood M 2008 Mechanisms of Anger and Treatment Outcome in Combat Veterans with Posttraumatic Stress Disorder)Forbes, D., Parslow, R., Creamer, M., Allen, N., McHugh, T., & Hopwood, M. (2008). Mechanisms of Anger and Treatment Outcome in Combat Veterans with Posttraumatic Stress Disorder. Journal of Traumatic Stress, 21(2), 142-149.
(Heckman C J Cropsey K L Olds-Davis T 2007 Posttraumatic Stress Disorder treatment in Correctional Settings: A Brief Review of the Empirical Literature and Suggestions for Future Research)Heckman, C. J., Cropsey, K. L., & Olds-Davis, T. (2007). Posttraumatic Stress Disorder treatment in Correctional Settings: A Brief Review of the Empirical Literature and Suggestions for Future Research. Psychotherapy: Theory, Research, Practice, Training, 44(1), 46-53.
(Monson C M Gradus J L Schnurr P P Young-Xu Y Price J L 2008 Change in Posttraumatic Stress Disorder Symptoms: Do Clinicians and Patients Agree?)Monson, C. M., Gradus, J. L., Schnurr, P. P., Young-Xu, Y., & Price, J. L. (2008). Change in Posttraumatic Stress Disorder Symptoms: Do Clinicians and Patients Agree? Psychological Assessment, 20(2), 131-138.
(NATIONAL INSTITUTE of MENTAL HEALTH 2008 Post-Traumatic Stress Disorder (PTSD()NATIONAL INSTITUTE of MENTAL HEALTH. (2008). Post-Traumatic Stress Disorder (PTSD ([Brochure]. Bethesda: Author.
(Posttraumatic Stress Disorder 2009114)Posttraumatic Stress Disorder. (2009, January 14). Retrieved February 3, 2009, from Wikipedia, the free encyclopedia: http://en.wikipedia.org/wiki/Main_Page
(Stapleton J Taylor S Asmundson G JG 2006 Effects of Three PTSD Treatment on Anger and Guilt: Exposure Therapy, Eye Movement Desensitization and Reprocessing and Relaxation Training)Stapleton, J., Taylor, S., & Asmundson, G. J.G. (2006). Effects of Three PTSD Treatment on Anger and Guilt: Exposure Therapy, Eye Movement Desensitization and Reprocessing and Relaxation Training. Journal of Traumatic Stress, 19(1), 19-28.
(Tolin David F Foa Edna B 2008 Sex Differences in Trauma and Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of Research)Tolin, David F., & Foa, Edna B. (2008). Sex Differences in Trauma and Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of Research. Psychological Trauma: Theory, research, Practice, and Policy, S (1), 37-85.
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