Post Traumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness that results from exposure to real or threatened injury, death, and sexual/physical assault. These events then typically present in the form of negative changes in cognition and mood, hypervigilance, sleep disturbance, and irritability, among others.

Last Updated: September 27, 2023

PTSD can develop at any age. Children younger than six years old tend to reenact the traumatic event. Older children fantasize actions of revenge. Meanwhile in the elderly population, hyperarousal can happen. It is also interesting to know that medical events and procedures associated with life threats are associated with high rates of PTSD. Having a heart attack (also known as a Myocardial Infarction) is associated with up to 15% of PTSD episodes. Open abdominal aortic aneurysm repair is associated with approximately 20% of PTSD episodes. 

As mentioned above, PTSD develops due to a traumatic event. This traumatic event creates a stress response that leads to behavioral changes that are found to be psychological and observable brain changes. Patients with PTSD have low levels of cortisol but high levels of corticotropin-releasing factor (CRF), which is a hormone in our body that initiates responses such as increased heart rate, blood pressure, increased arousal, and being startled.

People with PTSD will present the following:

  • Recurrent and involuntary memories; 
  • Distressing dreams;
  • Flashbacks;
  • Intense or prolonged psychological distress at exposure to internal or external cues i.e., scents, sounds, words;
  • Negative emotional state; 
  • Diminished interest in significant activities;
  • Detachment; 
  • Inability to experience positive emotions and importantly;
  • Avoid distressing thoughts and emotions and external reminders closely associated with the traumatic event

Doctors use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose patients with PTSD. The criteria below are only applicable for patients at least six years old.

  1. Experiencing or witnessing a traumatic event such as serious injury, sexual or physical violence especially when event involves a family member or a close friend;
  2. Intrusive symptoms such as recurrent thoughts associated with the traumatic event;
  3. Avoiding the distressing memories and avoiding the people, places or activities that are associated with the traumatic event;
  4. Negative alterations in mood, for example viewing one’s self as a bad person or viewing the world as a dangerous place;
  5. Changes in arousal or reactivity such as being irritable or aggressive with little or no provocation.
  6. Finally, the following criteria must also be met:
  • Persistence of symptoms B, C, D, and E for more than one month;
  • Significant distress and impairment in various areas of life, such as at home or at work;
  • The disturbance is not attributable due to substance use, medication, or another medical illness.

Treatment

The following classes of drugs used when function has greatly declined:

  • SSRIs;
  • Mood stabilizers;
  • Atypical antipsychotic.

Trauma-focused psychotherapy is considered as the first-line effective treatment. The treatment includes trauma-focused CBT (cognitive-behavioral therapy), eye movement desensitization and reprocessing (EMDR), cognitive processing therapy, and imaginal exposure.

The first step for prevention and control of PTSD is awareness of its signs and symptoms. This sets up the patient and their families to start early treatment and limit the burden of the illness. It is more important however, to seek professional help or packaged services where psychiatrists, psychologists, nurse practitioners, primary care providers, and social workers work together. 

It is also advisable to develop a growth mindset by utilizing the Post-traumatic Growth Inventory (PTGI). This tool looks for positive responses in five areas:

  • Appreciation of life;
  • Relationships with others;
  • New possibilities in life;
  • Personal strength;
  • Spiritual change.

Use this inventory to reflect on the traumatic event to better handle the disorder whenever it arises. 

References

 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

 

Mann SK, Marwaha R. Posttraumatic Stress Disorder. [Updated 2022 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559129/

 

Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

Last Updated: September 27, 2023
Gallery
763