Post traumatic stress disorder [PTSD]

Overview

   Post-traumatic stress disorder (PTSD) is a disorder that develops in some group of people after going through a shocking, frightening or traumatic event.  PTSD is a psychiatric disorder that usually occurs in people who have experienced or witnessed a traumatic event, series of events or set of circumstances which are emotionally or physically harmful or life-threatening and may affect mental, physical, social, and/or spiritual well-being.

    For instance, witnessing a physical or sexual assault, abuse, an accident, a disaster, or other serious events may cause post-traumatic stress disorder later. However, it doesn’t happen in everybody who undergoes these circumstances but it is common in a few emotionally vulnerable people go through stressful events. People who have PTSD may feel stressed or frightened, even when they are not in danger. Post-traumatic stress disorder may result from exposure to real or threatened serious injury or sexual assault also

   People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. Symptoms such as increased heart beat or sweating, having recurring memories or dreams related to the event and distressing thoughts are common in this disorder.

   PTSD may also occur as a result of repeated exposure to horrible details of trauma. Narrating the same incidence or similar situations may trigger the symptoms of PTSD.

   Signs and symptoms of PTSD are thought to be arising from complex interactions of psychological and neurobiological factors. Studies have found significant changes in the amygdala, prefrontal cortex, hippocampus, and anterior cingulate, and corpus collosum of brain as well as altered functioning of the hypothalamic pituitary axis (HPA) in people having PTSD.

   The course of the disorder varies from person to person. In some people recovery may take place within 6 months, while in others symptoms may persist long [more than 1 year or longer].

 In some people having PTSD often depression, substance use, or anxiety disorders may coexist. PTSD can occur also in children after experiencing emotional trauma, witnessing traumatic events, deaths, accidents etc.

  PTSD is adults and children needs psychotherapy as well as medications.  It is found often that psychotherapy from a board certified psychiatrist or registered mental health provider may be more effective than medication. However, destructive behaviors and depressive episodes need medications immediately.

Signs & symptoms

To diagnose a case of PTSD, the person must be observed continuously at least for one month and in this[adult] person following symptoms must be present for at least 1 month:

·       At least one re-experiencing symptom

·       At least one avoidance symptom

·       At least two arousal and reactivity symptoms

·       At least two cognition and mood symptoms

Re-experiencing symptoms include:

Having distressing thoughts

Reliving the traumatic event or past experience, including physical symptoms of the stress such as increased heart beat or sweating

Having recurring memories or dreams related to the traumatic event

Experiencing physical signs of stress  with raised heartrate, perspiration etc.

Thoughts and feelings can trigger these symptoms, just like words, objects, or situations that are related to the event.

Avoidance symptoms include:

 Avoiding or staying away from places, events, or objects that are reminders of the traumatic experience

Avoiding thoughts or feelings related to the traumatic event

Avoidance symptoms may include avoiding certain regular activities after a trauma or accident. For example, avoid driving or riding in a car after a serious car accident.

Arousal and reactivity symptoms include:

Easily get startled

Feeling tense, on guard

Having difficulty in concentrating or focusing attention

Difficulty in falling asleep or staying asleep

Feeling irritable, angry or aggressive outbursts

Engaging in risky, reckless, or destructive behavior

Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

Difficulty in remembering key details of the traumatic event

Experiencing negative thoughts about oneself or the world

Having exaggerated feelings of blame directed toward oneself or others

Having ongoing negative emotions, such as fear, anger, guilt, or shame

Losing interest in enjoyable activities

 Feelings of social isolation

 Difficulty  in feeling positive emotions, such as happiness or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.

Post-traumatic stress disorder in children

PTSD can occur also in children after experiencing emotional trauma, witnessing traumatic events, deaths, accidents etc.

The symptoms include:

·       Forgetting sentences and words during talk or being unable to talk

·       Acting out the scary event during playtime

·       Being unusually clingy with a parent or other adult

·       Wetting the bed after having learned to use the toilet

   In older children and adolescence symptoms are similar to those in adults. They may show disruptive, disrespectful, or destructive behaviors. They may feel guilty for not preventing injury or deaths. They may also possess thoughts of revenge.

Risk factors that predispose to PTSD include:

Being exposed to previous traumatic experiences, particularly of childhood.

Traumatic events such as loss of a loved one, pain and injury, or loss of a job of parents or divorce in parents etc.

Getting hurt or seeing people in trouble

Seeing accidents or trauma

Feeling horror, helplessness, or extreme fear in situations of that kind.

Having little or no social support after the trauma, feeling isolated.

Having a personal or family history of mental illness or substance use

    In some people PTSD symptoms are accompanied by persistent or recurrent depersonalization or derealization. Help from mental health provider or psychiatrist is very important in such cases.

Complications of PTDS

Depression and anxiety

Drug or alcohol abuse

Eating disorders

Suicidal thoughts and actions

How to prevent PTSD?

Factors that may help to reduce the likelihood of developing PTSD include: 

Supporting friends, family, or other groups are very important to prevent the occurrence of PTDS after an emotional trauma.

Having a coping strategy for overcoming the situation and learning from the traumatic event is important. Learning to feel alright  even after a traumatic event will help feel well.

Being prepared and able to respond to upsetting events as they occur, despite having fear, tension etc.

Developing these coping skill may help. For all these help or assistance from a mental health professional psychiatrist is important.

Treatment

 People having PTSD also may experience panic disorder, depression, substance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an important part of recovery.

Some people having PTSD, there may be a currently ongoing another trauma also. In these cases, the effective strategy would be addressing both the traumatic situation and the symptoms of PTSD.

Psychotherapy

  Psychotherapy is a treatment option mental health professionals use to help people identify and change the emotional instability, distressing thoughts, and behaviors through well planned communication with the patients. Psychotherapy provides support, education, and guidance to people with PTSD and their families.

Psychotherapy may be provided as one on one session or in a group involving family and friends. It is a series of sessions which usually lasts 6 to 12 weeks but can last longer.

Cognitive behavioral therapy

 It includes exposure therapy and cognitive restructuring.

   Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the factor that caused it. As part of exposure therapy, people having PTSD may be persuaded by the therapist to think or write about the trauma or visit the place where it happened. This therapy can help people having PTSD reduce their distressing symptoms of fear, anxiety etc.

   Cognitive restructuring helps people by  making sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something happened, but that may not be their fault. Cognitive restructuring can help people with PTSD think in a realistic way about the traumatic event.

Evidence-based therapies for PTSD include:

·       Trauma Focused Cognitive Behavioral Therapy (TF-CBT)

·        Prolonged Exposure (PE)

·        Cognitive Processing Therapy

·        Eye Movement Desensitization and Reprocessing (EMDR).

Trauma Focused Cognitive Behavioral Therapy is an evidence-based treatment for children and adolescents that include trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.

Medications

Some antidepressants such as SSRIs and SNRIs (selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors), are commonly used to treat the core symptoms of PTSD.

Complementary and alternative therapies

Homeopathy

Some constitutional individualized remedies are chosen based on the symptoms manifested in the person or child. A few medicines are Aurum met, Argentum nitricum, belladonna, natrum sulphuricum etc.

Homeopathic medications are often given along with psychotherapy.

Nutritional interventions & mind body exercise programs are also chosen methods of managing PTSD as adjuvant therapies.

References

1.    https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd#:~:text=Post%2Dtraumatic%20stress%20disorder%20(PTSD)%20is%20a%20disorder%20that,or%20respond%20to%20potential%20danger.

2.    https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

3.    https://www.cdc.gov/childrensmentalhealth/ptsd.html