Post- traumatic Stress Disorder is commonly referred to (PTSD) which is an anxiety disorder that affects people who experienced a traumatic event in their life. This condition causes intense suffering and damage to various aspects of life, such as work and relationships. Learn about proven effective treatment options, such as psychotherapy. Post-traumatic stress disorder (PTSD) is an anxiety disorder that manifests as a result of the carrier having experienced violent acts or traumatic situations. Approximately 15% to 20% of people who have been involved in urban violence, physical assault, sexual abuse, terrorism, torture, assault, kidnapping, accidents, war, natural or provoked disasters in some way develop this type of violence disorder.
However, most only seek help two years after the first crises.
Several types of terrifying or threatening experiences can lead to the emergence of post-traumatic stress, such as: Physical or sexual violence; Assault or kidnapping; Car accident; Natural disasters.
It is noteworthy that even those who were not direct victims of such situations can receive the diagnosis.
Witnessing an assault or being informed that a family member has suffered a serious accident, for example, are also possible triggering factors. Although anyone exposed to some kind of psychological trauma can develop the disorder, women are twice as hard hit as men (Atwoli et al. 2015).
Post- traumatic stress disorder (PTSD) consists of intense and unpleasant dysfunctional reactions that begin after an extremely traumatic event. Life-threatening events or serious injuries can cause severe and long-lasting distress. It is possible for the affected person to relive the event, have nightmares, and avoid anything that might remind them of the event.
These events may be experienced directly (for example, seriously injured or threatened with death) or indirectly (witnessing other persons suffering serious injury, dying, or being threatened with death or becoming aware of traumatic events that occurred with family or close friends). The person may have experienced a single traumatic event or, as is often the case, multiple traumatic events (Atwoli et al. 2015).
It is not known why the same traumatic event can cause lifelong PTSD in some people but not cause any symptoms in others. Also, it is not known why some people witness or experience the same trauma many times over the years without PTSD and can develop sometime after a similar incident. Disturbance of post-traumatic stress (PTSD) or post-traumatic stress disorder (PTSD) is a mental disorder that can be brought on from a tragic event such as, sexual assault, war, car accident or other threat to one’s life. The most common symptoms are thoughts, feelings, or dreams, disruptive events related to the traumatic event, physical or psychological stress on exposure to signs or memories of the trauma, efforts to avoid trauma-reminding situations, changes in thinking and feeling, and increased fighting or flight response (Atwoli et al. 2015).
Most people who are exposed to a traumatic event do not develop PTSD. The likelihood of developing the condition is higher in people who experience interpersonal trauma, such as child rape or abuse, compared with people who experience trauma without aggression, such as road accidents and natural disasters. Children are less likely to develop the condition following trauma than adults, especially those under ten years old. The diagnosis is based on the presence of specific symptoms following a traumatic event (Cusack et al. 2016).
The onset of the condition can be prevented by behavioral therapy in people who exhibit early symptoms, although it is not effective when performed on all people exposed to trauma. Treatment of people with PTSD is done with psychiatric counseling and medication. There are several types of positive effect therapy. When treating PTSD medication is generally the first stage in the treatment of PTSD with antidepressants from the selective serotonin reuptake inhibitor group., which are shown to be effective in about half of people. However, the benefits of medication are lower than those of therapy. It is not yet clear whether the combination of medication and therapy has the greatest benefits. Use of other medications is not supported by sufficient evidence (Yehuda et al. 2015).
In most countries, in any given year the condition affects between 0.5% and 1% of adults. The incidence is higher in zones of armed conflict. PTSD seems to be increasingly more in women than men. Symptoms of mental disorders associated with traumatic events have been documented since at least Greek antiquity. The study of the condition intensified during the two world wars and was then known by various terms as “combat neurosis”. The term “posttraumatic stress disorder” began to be used in the 1970s to describe the diagnosis of US Vietnam War veterans (Cusack et al. 2016).
Symptoms can show at any age and take months or years to appear. They are usually grouped into three categories:
The traumatic event may recur repeatedly in the form of involuntary unwanted memories or recurring nightmares. Some people have flashbacks, during which they relive events as if they were really happening instead of simply remembering them.
The person persistently avoids everything – activities, situations, or people – that might remind him of the trauma. For example, she may avoid entering a park or office building where she has been assaulted or avoid talking to people of the same race as the person who assaulted her.
The person may feel emotionally numb or disconnected from other people. The depression is common, and the affected person shows less interest in activities they used to enjoy.
A person’s impression of the event may be distorted, leading him to blame himself or others for what happened. Feelings of guilt are also frequent. For example, it is possible for a person to feel guilty for surviving situations in which others died. She may feel only negative emotions, such as fear, horror, anger or embarrassment, and may not be able to feel happiness, satisfaction or love.
The person may have difficulty falling asleep or concentrating. She may become overly vigilant for the presence of risk warning signs. It is possible that she is easily frightened. It is possible that the person may become less able to control his reactions, resulting in reckless behavior or tantrums (Yehuda et al. 2015).
Some people perform ritual acts designed to ease their anxiety. For example, victims of sexual violence may repeatedly bathe to try to remove the feeling of dirt. Many people with PTSD use alcohol or narcotics to try to relieve their symptoms and end up developing a substance use disorder.
The doctor diagnoses PTSD when The person was exposed directly or indirectly to the traumatic event, symptoms have been occurring for a month or more, symptoms cause significant distress or significantly impair activity performance, the person has some symptoms from each of the symptom categories associated with post-traumatic stress disorder (intrusion symptoms, avoidance symptoms, negative effects on thinking and mood, and changes in alertness and reactions). The doctor also checks if the symptoms could have been caused by the use of a drug or other disorder. PTSD is often undiagnosed as it causes such varied and complex symptoms. In addition, the presence of a substance use disorder can distract the person from the presence of PTSD. When a delay in diagnosis and treatment occurs, PTSD can become chronically debilitating.
Traumatic memory experiences include wars, domestic violence, sexual abuse, industrial accidents, natural disasters, crimes, traffic accidents, etc. It is an event that poses a threat to the life and body of that person and those around him. PTSD is accompanied by strong emotional reactions such as fear, helplessness, and warfare to such events, and even after many years, characteristic symptoms corresponding to such stress are seen. For example, the patient may re-experience the traumatic experience in a repetitive and intrusive manner (flashback), have a nightmare when the traumatic experience is replayed, or actually experience the event now or act. Or avoid activities, situations, and people that remind you of such events, as a result of being isolated, suffering from emotional paralysis, difficulty concentrating, and insomnia, and always being overly alert (Yehuda et al. 2015).
?There are six diagnostic criteria for PTSD from A to F, and all of them must be satisfied for diagnosis. In other words, PTSD is not a general term for traumatic psychiatric disorders, but has typical symptoms related to trauma experience (re-experience, avoidance, paralysis, increased arousal, dissociation, etc.) with typical traumatic experiences. In addition to PTSD, mental disorders that can occur after trauma include depression, panic disorder, dissociative disorder, behavioral disorder, somatic disorder, conversion disorder, adaptation disorder, eating disorder, self-harm, borderline There are many such as personality disorder, addictive diseases such as alcohol and drug abuse. These are also often seen as complications of PTSD. By the way, PTSD has the feature that it is easy to merge other mental disorders (the merger rate is 80% or more).
DSM-IV distinguishes PTSD from acute and chronic. If the duration of symptoms is less than 3 months, it will be acute and 3 months or more will be chronic. After a traumatic experience, if reactive symptoms such as dissociation, re-experience, avoidance, and anxiety persist for more than 2 days and disappear within 4 weeks, it is called Acute Stress Disorder. If PTSD manifests more than 6 months after trauma, it is called delayed onset (Shalev et al. 2017).
Psychotherapy is the main treatment for PTSD. Learning about PTSD can be an important initial step in treatment. The symptoms of PTSD can cause extreme confusion and it is often very helpful for people with PTSD and their loved ones to understand that it can include seemingly unrelated symptoms. The stress management techniques, such as breathing, and relaxation are important. Exercises that reduce and control anxiety (e.g., yoga, meditation) can alleviate symptoms and prepare the person for treatment that involves stressful exposure to trauma memories.
The mainstream of thought favors the use of structured and focused psychotherapy, usually a type of cognitive behavioral therapy (CBT) called exposure therapy that helps erase the fear left by the traumatic event. In exposure therapy, the therapist asks the affected person to imagine being in situations associated with the previous trauma. For example, the therapist may ask the person to imagine that he or she is visiting the park in which he or she has been beaten. It is possible for the therapist to help the person re-imagine the traumatic event itself. Due to the often-intense anxiety associated with traumatic memories and for exposure to advance at the right pace, it is important for the person to feel supported. The person who has been traumatized may be especially sensitive to being traumatized again and therefore treatment may be stationary if it is administered too quickly. Often, treatment can change from exposure therapy to more open and supportive treatment and thus
Broader and more exploratory psychotherapy can also facilitate a return to a happier life when, for example, one focuses on relationships that may have been damaged by PTSD. Other types of supportive and psychodynamic psychotherapy may also be useful as long as they do not divert the focus from exposure therapy treatment.
Eye movement desensitization and reprocessing (EMDR) desensitization and reprocessing therapy (EMDR) is a type of treatment in which the person is asked to follow the therapist’s finger movement with their eyes while imagining being exposed to trauma. Some experts believe that eye movements themselves help in desensitization, but EMDR therapy is probably effective because of exposure rather than eye movement.
Antidepressants are considered the first line treatment for PTSD, even for people who do not have major depressive disorder as well. Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants such as mirtazapine and venlafaxine are often recommended more often. To treat insomnia and nightmares, a doctor sometimes prescribes medicines such as olanzapine and quetiapine (also used as antipsychotic medicines) or Prazosin (also used to treat high blood pressure). However, these medications do not treat PTSD itself (Cusack et al. 2016).
Cognitive behavioral therapy is more effective than medication, but medications produce effects faster, reducing symptoms by 70% in the first month. Another alternative is treatment with sertraline, an antidepressant that works on serotonin and norepinephrine by improving mood and decreasing anxiety and causing few side effects, with insomnia being the only one more frequent in participants taking sertraline than in those taking placebo. Of the sertraline-treated PTSD patients, 53% reported major symptom relief.
Factors contributing to the development of PTSD include:
Between 50 and 90% of the population experience at least one highly traumatic episode in life. The WHO classification cannot be diagnosed in the first month after the traumatic event, in this case it is an acute stress reaction, not more than two years after the event, when it becomes classified as lasting personality changes. Similarly, DSM-IV classifies reactions within the first month after trauma as acute stress disorder (Raskind et al. 2018).
According to the DSM-IV, the criteria needed to make the diagnosis are:
Affective insensitivity, identifiable by: Significant decrease in interest in performing common or meaningful activities, especially if it has anything to do with the traumatic event; Sensation of distancing in relation to other people; Decreased affectivity; Pessimism about the future itself;
To be considered a psychological disorder this disorder must cause clinically significant distress or impairment in social or occupational functioning or other important areas of an individual’s life.
Children are more vulnerable to traumatic events because they have less experience, preparedness and resources to deal with disasters or defend themselves against abuse.
Possible symptoms in children:
Facing traumatic events, it is also possible to result in a dissociative disorder (such as a separation from oneself). In dissociative amnesia one strongly represses memories of the traumatic event, in dissociative escape one represses an entire period of one’s life and forms a new identity and in dissociative identity disorder one creates multiple personalities to deal with traumatic events.