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Post traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's ability to cope. As an effect of psychological trauma, PTSD is less frequent and more enduring than the more commonly seen acute stress response. Diagnostic symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal—such as difficulty falling or staying asleep, anger, and hypervigilance. Formal diagnostic criteria (both DSM-IV-TR and ICD-10) require that the symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.

True or pure PTSD i.e. psychological impairment following a one off traumatic event is probably "rare" due to the frequent occurrence of earlier traumatic experiences in an individuals life. (see Complex Post Traumatic Stress Disorder - [CPTSD]).

Diagnostic criteria for 309.81 Post Traumatic Stress Disorder

  1. The person has been exposed to a traumatic event in which both of the following were present:
    1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
    2. the persons response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behaviour
  2. The traumatic event is persistently re-experienced in one (or more) of the following ways:
    1. recurrent and intrusive distressing recollections of the event including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
    2. recurrent distressing dreams of the event. Note: In children there may be frightening dreams without recognizable content.
    3. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific re-enactment may occur
    4. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
    1. efforts to avoid thoughts, feelings, or conversations associated with the trauma
    2. efforts to avoid activities, places, or people that arouse recollections of the trauma
    3. inability to recall an important aspect of the trauma
    4. markedly diminished interest or participation in significant activities
    5. feeling of detachment or estrangement from others
    6. restricted range of affect (e.g., does not expect to have a career, marriage, children, or a normal life span)
  4. Persistent symptoms of increased arousal (not present before the trauma), as  indicated by two (or more) of the following:
    1. difficulty falling or staying asleep
    2. irritability or outbursts of anger
    3. difficulty concentrating
    4. hypervigilance
    5. exaggerated startle response
  5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month
  6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Specify if:

Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:

With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

The Five F’s:

Ø Fight, Flight, Freeze,

 A natural physiological survival response to a threatening situation

This response, based on a perceived threat, is encoded into our physiology (through the brain and Sympathetic Nervous System) to preserve life.          

o   Elevation of blood-pressure, heart rate

o   Increased respiration and metabolic rate

o   Diversion of blood-flow to muscles

o   Platelet adhesiveness

o   Effects on immunity and inflammatory hormones (e.g. cortisol, cytokines, interleukins etc)

Ø Fear(tonic immobility), Faint.

  • Characterized by a dramatic drop in blood pressure, respiration and metabolic rate

  •  Loss of consciousness (in preparation for being eaten by the sabre tooth tiger).

These changes are clinically significant largely for those with high SNS reactivity to (perceived) stressful events



History of PTSD

Modern recognition in military settings



Statue, Three Servicemen,
Vietnam Veterans Memorial
 
 

In the early 19th century military medical doctors started diagnosing soldiers with "exhaustion" after the stress of battle. This "exhaustion" was characterized by mental shutdown due to individual or group trauma – prior to the 20th century, soldiers were expected always to be emotionally tough and show no fear in the midst of combat. The only treatment for this "exhaustion" was to relieve the afflicted from frontline duty until symptoms subsided, then return to battle. During the intense and frequently repeated stress, the soldiers became fatigued as a part of their body's natural shock reaction.

According to Stéphane Audoin-Rouzeau and Annette Becker, "One-tenth of mobilized American men were hospitalized for mental disturbances between 1942 and 1945, and after thirty-five days of uninterrupted combat, 98% of them manifested psychiatric disturbances in varying degrees."

Although PTSD-like symptoms have also been recognized in combat veterans of many military conflicts since, the modern understanding of PTSD dates from the 1970s, largely as a result of the problems that were still being experienced by US military veterans of the war in Vietnam.

Previous diagnoses now considered historical equivalents of PTSD include railway spine, stress syndrome, shell shock, battle fatigue, or traumatic war neurosis.

Terminology

The term post-traumatic stress disorder (PTSD) was coined in the mid 1970s, in part through the efforts of anti–Vietnam War activists and the anti-war group Vietnam Veterans Against the War and Chaim F. Shatan, who worked with them and coined the termpost-Vietnam Syndrome; the condition was added to the DSM-III as posttraumatic stress disorder.

Early in 1978, the term was used in a working group finding presented to the Committee of Reactive Disorders. The term was formally recognized in 1980. In the DSM-IV, the spelling "posttraumatic stress disorder" is used, while in the ICD-10 the spelling is "post-traumatic...". Elsewhere, especially in less formal writing, the term may be rendered as two words—"post traumatic stress disorder".
 

 

Lindy Bearup lindybearup@gmail.com
 

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but today well lived - makes every yesterday a dream of happiness and every tomorrow a vision of hope"
old Sanskrit proverb.