As military veterans return back to the United States from the wars in Iraq and Afganistan, the public has become for aware of the medical condition of post-traumatic stress disorder (PTSD). As many as 13 percent of the men and women who are inflicted with combat positions demonstrate the symptoms of the mental disability, but the general population of America has more than 6 percent struggling with the illness (Friedman, 2014). The large number of patients that exist both inside and outside the ranks of military personnel makes PTSD a major public health issue (Keane, Marx & Sloan, 2009).
Soldiers are not the only profession susceptible to developing PTSD; emergency responders and workers deployed during disaster at also at risk (Kar, 2011). Individuals are also seen to display symptoms of PTSD after assaults, vehicle accidents, natural disasters, kidnapping, child abuse, and rape. It is estimated that approximately 10 percent of all females and 5 percent of males will contract the disorder in response to traumatic situations that occur at some point. The amount of stress created by an intimidating event such as a bombing may promote 100 percent of the symptoms in participants (Kolassa et al., 2010). Parental abuse or personal loss can affect even children to the point of exhibiting signs of PTSD. For the purposes of this paper, focus will be on adults.
Signs and Symptoms
Clinical indications of post-traumatic stress disorder include disturbing dreams, thoughts that are frightening, and repeatedly experiencing the trauma leading to the illness; these may be associated with physical reactions called “flashbacks” (Shiromani, Keane & LeDoux, 2009). The manifestations of PTSD disrupt the patient’s daily life by negatively impacting job performance, relationships, and routine functioning. Disordered behavior patterns may include gaps in memory about the trauma, lack of interest in previously enjoyable activities, avoidance of reminders of the trauma such as locations or experiences, sensation of emotions, guilt, and depression.
According to Shiromani, Keane & LeDoux (2009), “hyperarousal symptoms” are often present that result in consistent fear and anxiety. Manifestations of hyperarousal symptoms may be insomnia, reflexes that startle easily, tension, and inappropriate outbursts of anger. It is not uncommon for victims of trauma to demonstrate behavior of this type for a period of time following the event, but a diagnosis of PTSD should be considered if the actions become apparent after a significant span of time has passed or is they continue long past when adjustment is expected to take place.
The latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) changed the diagnosis of post-traumatic stress disorder from an anxiety disorder to “Trauma and Stressor-Related Disorders” (Friedman, 2014). Post-traumatic stress disorder is now defined as having an absence of enjoyment in things generally enjoyable (anhedonic), experiencing feelings of unease (dysphoric), changing a mental image into something personally real (externalizing),detachment (dissociation) in addition to the behavior normally associated with anxiety disorders that are fear-based. Following the publication of the DSM-5, articles discussing empirical evidence in support of the changes have been published. The World Health Organization is scheduled to release the International Classification of Diseases (ICD-11) in 2018 and the standard for PTSD in that manual reportedly categorizes the illness as induced by stress and fear-based, and has designated “Complex PTDS” as a diagnosis apart from simple PTSD (WHO, 2015). In order for a patient in the United States to be diagnosed with PTSD using the criteria from the DSM-5, the following symptoms must be present for the period of at least one month: 1) At least two hyperarousal symptoms, 2) at least three symptoms of avoidance behavior, and 3) and least one symptom related to re-experiencing a traumatic event(s) (Nimh.nih.gov, 2013).
The behavioral and perceptual problems associated with post-traumatic stress disorder are compounded by physical health problems that include the affects of the abuse of drugs and alcohol, diabetes mellitus, and heart disease that results from consistent high levels of anxiety (Lund, Alexander, Bernardy & Friedman, 2011).
Early Detection of PTSD
As PTSD is becoming more recognized as a mental health issue at all levels and ages of the population, some current research is directed toward recognition of the illness. There is consideration that inherited predisposition toward retaining fearful memories may play a role in developing full-blown post-traumatic stress disorder when other individuals in the same circumstances do not do so (Nimh.nih.gov, 2013). Shumyatsky et al. (2005) studied the ability of some brains in mice to form excessive amounts of stathmin, a protein needed to form memories of fear. Subjects that did not make stathmin were less likely to “freeze” during frightening situations than mice that produced the protein. The genetic ability to produce stathmin may show a sensitivity to retaining fearful feelings of traumatic experiences.
Some areas of the brain process feelings of fear and unlearning them after the experience has passed. The amygdale learns and unlearns fear and the pre-frontal cortex controls stress by making decisions concerning the termination of danger. It is felt the size of the ventrolmedial pre-frontal cortex might suppress memories of trauma while personal attitudes such as optimism assist in adjustment to past frightening memories.
Some influences promote PTSD in some people while others are resistant. One risk factor includes the amount of social support an individual experiences before, during, and after the event; this is the reason disaster teams have workers devoted to giving comfort to victims. Physical injury promotes PTDS as well as feelings of helplessness and fear. Even unrelated stress following trauma will create additional anxiety that prompts retention of fear. A history of mental illness also predisposes a person toward developing post-traumatic stress disorder. If an individual is provided support following a frightening situation and is capable of responding to the event in a way that allows him to be satisfied with his actions even though he was afraid, strategies for coping are more effective in dealing with the stress.
Therapists have a number of options when considering the treatment of PTSD patients.
Psychotherapy. “Talk” therapy is practiced either in private sessions with a counselor or in groups (Nimh.nih.gov, 2013). A study by Sloan, Bovin & Schnurr (2012) concluded that group therapy is better than no therapy at all, but is less effective than counseling or education concerning the disorder. Psychotherapy usually lasts between six and twelve weeks, but it may continue longer. Psychotherapy relies heavily on the support of family members and friends as caring discussions continue to take place outside the treatment facility. Some types of PTSD psychotherapy focus on symptoms while other deal with the problems caused by the disorder such as poor relationships, work issues, or generally dealing with society. The two types may be combined and skills promoted for dealing with anger and seeking relaxation. Health suggestions such as adequate sleep, exercise, and a good diet are promoted. In the course of the therapy, PTSD victims learn to understand why they are experiencing the feelings of guilt, fear, and shame and develop appropriate ways to react to them.
Cognitive Behavior Therapy (CBT). Although cognitive behavior therapy has been used for many years for the treatment of PTSD, Kar (2011) conducted a study that reports ineffectiveness may be as high as 50 percent. His literature review reports that in 23 clinical trials, the therapy did have less remission that supportive therapies and is as effective as exposure therapy and cognitive therapy. CBT promotes exposure of the frightening memory so patients can control their fear. Safe forms such as visiting the location of the event or a similar one, writing about the event descriptively, or creating mental images are used (Başoğlu & Şalcioğlu, 2011). Learning to control the fear takes place with training in relaxation and breathing techniques, counseling, and coping skills.
Friedman (2014) conducted a study using Prolonged Exposure therapy (PE) with 1931 combat veterans in therapy with 804 clinicians. Measurements before treatment of patients with primary PTSD were compared with those taken after eight sessions. The conclusion of the researcher was that PE is effective in reducing depression and other PTSD symptoms. A decrease of 41.4 percent in evaluations using a checklist for PTSD symptoms resulted. This supportive study assisted in the determination that exposure therapy is the only psychological or psychopharmacologic intervention recommended by the Institute of Medicine (2007) and Forbes et al. (2013).
Medications. According to Sobnoskey (2014), treatment for patients with PTSD may include pharmacotherapy, psychotherapy, or the option of a combination depending on specific needs. The United States Food and Drug Administration has only approved of two medications for the treatment of PTSD: sertraine (Zoloft) and paroxetine (Paxil). These drugs are antidepressants to suppress feelings of anger, anxiety, and lack of emotion so psychotherapy has a better chance of having a positive influence. Other types of medications under consideration are different antidepressants, antiphsychotics, and benzodiapzepines.
Lifestyle changes. To assist therapy and medications, alteration in lifestyle choices are important. Ingesting less caffeine, stimulants, recreational drugs, and alcohol are recommended. Incorporating more anaerobic and aerobic exercise encourages the natural production of endorphins for relaxation. Techniques for breathing, writing in a journal, massage therapy, and acupuncture have all been shown to help patients with PTSD improve control of their symptoms.
Recognition of the symptoms and causes for PTSD has allowed for research and assistance for victims of traumatic events. There are multiple methods for treatment patients suffering from the effects of post-traumatic stress disorder and as new strategies gain supportive research, therapists are required to evaluate the individual needs of their clients in response to the options. Ongoing studies into therapeutic effectiveness and multidisciplinary techniques may provide better answers to assist those suffering from the devastating influence of PTSD on their lives in order to integrate in a healthy manner into society.
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