Traumatic experiences are fairly common among the world’s general population. In the epidemiologic reviews, the oxford journal asserts that more than two thirds of the general population may experience noteworthy distressing incident at some point in their lives. Countries around the globe have been exposed to different kinds of events that cause trauma. These are such as terrorism, child abuse and trafficking, compulsory relocation, violence and conflicts, mass genocides and other killings, natural disasters like hurricanes, floods and earthquakes.
Following exposure to traumatic disasters and events, people develop a psychological disorder, which is clinically referred to as the post traumatic stress (PTSD) disorder. In the previous three decades, PTSD has gotten the attention of mental health experts and the general public at large. PTSD was initially brought into the DSM-III (Diagnostic and Statistical Manual of Mental Disorders) in 1980 (Rosen & Frueh, 2010). The study of PTSD is essential in helping clinicians conceptualize the reactions of patients to horrific and life threatening experiences. In addition, PTSD study also helps mental health experts assist patients with an assortment of stress issues in a better way. The study of PTSD is beneficial in helping the general public understands on ways to adjust in the aftermath of trauma since stressful events are barely unavoidable in the contemporary world. It, therefore, becomes essential to study PTSD in a bid to deal with the ever increasing cases and events of trauma around the globe.
Literature review on Post Traumatic Stress Syndrome
PTSD refers to the disruptive impact that exposure to an extreme threatening stressor(s) may have on the physiological and psychological functioning. Currently, diagnostic statistical manual of mental disorders IV (DSM IV) is used for PTSD diagnosis. The criterion for diagnosis depends on the following factors. One, a patient ought to have had direct individual experience of an occurrence that entails actual or threatened fatality or severe injury, or other hazard to one’s physical veracity. Secondly, diagnosis depends on an individual witnessing an event that involves casualty and injury, or a peril to physical integrity of another person. Learning about unanticipated violent death or severe harm, or danger of death or injury encountered by a family member or a close friend also qualifies for PTSD diagnosis (Yehuda, 2002).
PTSD is characterized by three main symptoms; intrusive/ re-experiencing, avoidance and arousal. The entire diagnosis using the DSM-IV criteria necessitates the incidence of at least one re-experiencing indicator, three avoidance symptoms and two arousal signs. Intrusive events are the unwanted recollections of the event that takes the form of nightmares and distressing images. Avoidance signs are such as efforts to avoid reminders of the incident including thoughts associated with the incident. Arousal indicators take the form of physiological expressions like irritability, hypervigilance and restlessness. Immediate experience of the above reactions following a traumatic event is taken as normal rejoinder. If symptoms continue up to three months, acute diagnosis of PTSD can be made; and signs exceeding three months are taken as chronic. Traumatized persons may be diagnosed with acute stress disorder (ASD) in the first month after a disturbing experience. ASD signs include PTSD elements and awareness reduction dissociative amnesia and detachment. Though ASD is not always followed by PTSD, it is connected to enhanced risk of PTSD (Lunt, & Hartley, 2004).
Both personal characteristics and the incident itself determine the biological and physiological reaction to a distressing event. The first response may be influenced by a person’s subjective interpretation of the event that is in turn influenced by the individual’s past experiences and other risk factors. Knowledge of a distressing incident challenges an individual’s feeling of safety, resulting to feelings of powerlessness and vulnerability. Recovery from the incident entails facing human helplessness in a manner that fosters advancement of resilience (Neria, Nandi & Galea, 2007). A biologic reaction after the occurrence of a traumatic event can bring about a condition of fear that impedes with the restoration of feelings of safety. Avoidance lessens the chances of extinguishing fear reactions and hinders the advancement of efficient strategies for coping leading to interpersonal, social and/or occupational disturbance. Some people recover from stressful incidents while others do not as a result of biological changes. Patients with persistent PTSD have high levels of circulating neropinephrine and high α2-adrenergic reactivity that result in somatic signs of PTSD. These biological responses do not resemble those involving other kinds of stress. For examples, some patients exhibit lesser than normal cortisol levels, even years following a distressing incident. PTSD prevalence varies across different populations and can change over people, place and time. For instance, prevalence of PTSD documented after natural disasters is usually lower than the amounts documented after man-made/technological disasters. Higher PTSD prevalence has been observed among people at the epicenter of a natural disaster as compared to those who are 100 km away (Galea, Nandi & Vlahov, 2004).
Several modes of treatment and medication are available for diagnosis of PTSD. They include counseling and psychotherapy, medication and referral. Counseling is a noteworthy element of treatment of PTSD victims that entails education provision and support from primary caregivers. Educating stress victims helps them understand the nature of their state of affairs and the recovery process. This involvement can help create a therapeutic alliance and help victims understand the need for therapy. Psychotherapy entails therapy through talking that entails talking to a mental health professional. Talk therapy takes 6-12 weeks, but it can take more time depending on the patient as people recover faster than others. Support from relatives and friends have been shown to be a significant aspect of therapy. Several types of psychotherapies target direct sign of PTSD while others focus on family, social and/or work related problems. Different kinds of therapies may be combined depending on each patient’s needs. Cognitive Behavioral Therapy (CBT) is the most significant in PTSD treatment. CBT has several elements: exposure therapy helps trauma victims face and control their fear by exposing victims to the trauma they experience in a safe manner. Therapists use this model to help victims handle their feelings. Cognitive restructuring therapy helps stress victims make sense of the “bad” memories. The therapist aids people suffering from PTSD examine at what transpired during the incident in a realistic approach. Stress inoculation training therapy seeks to reduce PTSD signs by teaching the victim on ways to reduce anxiety (Jongsma & Bruce, 2011).
Medication helps victims eradicate signs of PTSD and improve the entire physiological and psychological functioning. Randomized trials on tricyclic antidepressants and selective serotonin-reuptake inhibitors demonstrate improvement on individuals suffering from PTSD. Sertraline (Zoloft) and paroxetine (Paxil) have been approved for PTSD medication by the U.S food and drug administration. Medication by use of antidepressants results in side effects such as headache, nausea, drowsiness or sleeplessness, agitation and sexual problems like reduced sex drive. These effects fade away within a few days, failure to which the victim should report to a physician immediately. Primary care doctors can opt to refer trauma victims for a particular treatment if initial interventions have not been fruitful or where medication results in side effects. PTSD victims may experience severe psychiatric problems, suicidal thoughts, drug addiction problems that necessitate specialized care (Jongsma & Bruce, 2011).
Literature review on Post Traumatic Stress Syndrome
PTSD refers to the disruptive impact that exposure to an extreme threatening stressor(s) may have on the physiological and psychological functioning. Currently, diagnostic statistical manual of mental disorders IV (DSM IV) is used for PTSD diagnosis. The criterion for diagnosis depends on the following factors. One, a patient ought to have had direct individual experience of an occurrence that entails actual or threatened fatality or severe injury, or other hazard to one’s physical veracity. Secondly, diagnosis depends on an individual witnessing an event that involves casualty and injury, or a peril to physical integrity of another person. Learning about unanticipated violent death or severe harm, or danger of death or injury encountered by a family member or a close friend also qualifies for PTSD diagnosis (Yehuda, 2002).
PTSD is characterized by three main symptoms; intrusive/ re-experiencing, avoidance and arousal. The entire diagnosis using the DSM-IV criteria necessitates the incidence of at least one re-experiencing indicator, three avoidance symptoms and two arousal signs. Intrusive events are the unwanted recollections of the event that takes the form of nightmares and distressing images. Avoidance signs are such as efforts to avoid reminders of the incident including thoughts associated with the incident. Arousal indicators take the form of physiological expressions like irritability, hypervigilance and restlessness. Immediate experience of the above reactions following a traumatic event is taken as normal rejoinder. If symptoms continue up to three months, acute diagnosis of PTSD can be made; and signs exceeding three months are taken as chronic. Traumatized persons may be diagnosed with acute stress disorder (ASD) in the first month after a disturbing experience. ASD signs include PTSD elements and awareness reduction dissociative amnesia and detachment. Though ASD is not always followed by PTSD, it is connected to enhanced risk of PTSD (Lunt, & Hartley, 2004).
Both personal characteristics and the incident itself determine the biological and physiological reaction to a distressing event. The first response may be influenced by a person’s subjective interpretation of the event that is in turn influenced by the individual’s past experiences and other risk factors. Knowledge of a distressing incident challenges an individual’s feeling of safety, resulting to feelings of powerlessness and vulnerability. Recovery from the incident entails facing human helplessness in a manner that fosters advancement of resilience (Neria, Nandi & Galea, 2007). A biologic reaction after the occurrence of a traumatic event can bring about a condition of fear that impedes with the restoration of feelings of safety. Avoidance lessens the chances of extinguishing fear reactions and hinders the advancement of efficient strategies for coping leading to interpersonal, social and/or occupational disturbance. Some people recover from stressful incidents while others do not as a result of biological changes. Patients with persistent PTSD have high levels of circulating neropinephrine and high α2-adrenergic reactivity that result in somatic signs of PTSD. These biological responses do not resemble those involving other kinds of stress. For examples, some patients exhibit lesser than normal cortisol levels, even years following a distressing incident. PTSD prevalence varies across different populations and can change over people, place and time. For instance, prevalence of PTSD documented after natural disasters is usually lower than the amounts documented after man-made/technological disasters. Higher PTSD prevalence has been observed among people at the epicenter of a natural disaster as compared to those who are 100 km away (Galea, Nandi & Vlahov, 2004).
Several modes of treatment and medication are available for diagnosis of PTSD. They include counseling and psychotherapy, medication and referral. Counseling is a noteworthy element of treatment of PTSD victims that entails education provision and support from primary caregivers. Educating stress victims helps them understand the nature of their state of affairs and the recovery process. This involvement can help create a therapeutic alliance and help victims understand the need for therapy. Psychotherapy entails therapy through talking that entails talking to a mental health professional. Talk therapy takes 6-12 weeks, but it can take more time depending on the patient as people recover faster than others. Support from relatives and friends have been shown to be a significant aspect of therapy. Several types of psychotherapies target direct sign of PTSD while others focus on family, social and/or work related problems. Different kinds of therapies may be combined depending on each patient’s needs. Cognitive Behavioral Therapy (CBT) is the most significant in PTSD treatment. CBT has several elements: exposure therapy helps trauma victims face and control their fear by exposing victims to the trauma they experience in a safe manner. Therapists use this model to help victims handle their feelings. Cognitive restructuring therapy helps stress victims make sense of the “bad” memories. The therapist aids people suffering from PTSD examine at what transpired during the incident in a realistic approach. Stress inoculation training therapy seeks to reduce PTSD signs by teaching the victim on ways to reduce anxiety (Jongsma & Bruce, 2011).
Medication helps victims eradicate signs of PTSD and improve the entire physiological and psychological functioning. Randomized trials on tricyclic antidepressants and selective serotonin-reuptake inhibitors demonstrate improvement on individuals suffering from PTSD. Sertraline (Zoloft) and paroxetine (Paxil) have been approved for PTSD medication by the U.S food and drug administration. Medication by use of antidepressants results in side effects such as headache, nausea, drowsiness or sleeplessness, agitation and sexual problems like reduced sex drive. These effects fade away within a few days, failure to which the victim should report to a physician immediately. Primary care doctors can opt to refer trauma victims for a particular treatment if initial interventions have not been fruitful or where medication results in side effects. PTSD victims may experience severe psychiatric problems, suicidal thoughts, drug addiction problems that necessitate specialized care (Jongsma & Bruce, 2011).
There is a potential overlap involving signs of PTSD and those of depression and other anxiety disorders. Practitioners may be hesitant to enquire information that may be distressing, secretive or shameful from their patients. On their part, patients may also avoid mentioning such information to the practitioner without persistent probing. This creates a treatment barrier and may result in missed diagnosis or diagnosis for the wrong problem.
Hypothesis
Is the development of PTSD enhanced by the failure to contain the biologic trauma response at the time of the distress, leading into a flow of shifts that result in intrusive re-experience, avoidance and arousal?
Research Questions
How do biological reactions result in acute and chronic levels of PTSD?
What are the key differences in the biological response to ordinary life stress and stress from a traumatic incident?
How soundly are practitioners trained to handle PTSD and their patients?
