Post-Traumatic
Stress Disorder (PTSD) is a debilitating condition that follows
a terrifying event. Often, people with PTSD have persistent frightening
thoughts and memories of their ordeal and feel emotionally numb,
especially with people they were once close to. PTSD, once referred
to as shell shock, was first brought to public attention by war
veterans, but it can result from any number of traumatic incidents.
These include kidnapping, serious accidents such as car or train
wrecks, natural disasters such as floods or earthquakes, violent
attacks such as a mugging, rape, or torture, or being held captive.
The event that triggers it may be something that threatened the
person's life or the life of someone close to him or her.
The person has experienced or witnessed or was confronted with
an unusually traumatic event that has both of these elements:
The event
involved actual or threatened death or serious physical injury
to the person or to others,
and
The person felt intense fear, horror or helplessness
The person repeatedly relives the event in at least 1 of these
ways:
Intrusive,
distressing recollections - thoughts, images.
Repeated, distressing dreams.
Through flashbacks, hallucinations or illusions, acts or feels
as if the event were
recurring.
Marked mental distress in reaction to internal or external cues
that symbolize or
resemble the event.
Physiological reactivity - such as rapid heart beat, elevated
blood pressure in response to these cues.
The person repeatedly avoids the trauma-related stimuli and has
numbing of general responsiveness (absent before the traumatic
event) as shown by 3 or more of:
Tries to
avoid thoughts, feelings or conversations concerned with the
event.
Tries to avoid activities, people or places that recall the
event.
Cannot recall an important feature of the event.
Marked loss of interest or participation in activities important
to the patient.
Feels detached or isolated from other people.
Restriction in ability to love or feel other strong emotions.
Feels life will be brief or unfulfilled (lack of marriage, job,
children).
At least 2 of the following symptoms of hyperarousal were not
present before the traumatic event:
Insomnia
(initial or interval)
Irritability
Poor concentration
Hypervigilance
Increased startle response
The above symptoms have lasted longer than one month.
These symptoms cause clinically important distress or impair work,
social or personal functioning.
Important
Gender Differences:
The most
common precipitating events for PTSD in women were rape and
physical assault (33.8% and 32.3% of reported events, respectively).
For men,
seeing someone seriously hurt or killed and physical assault
were the most prevalent (25.3% and 20.3%). Women and men were
equally likely to have been exposed to trauma.
Women, however,
were more likely than men to meet criteria for lifetime and
current PTSD.
Adjusting
for gender differences, subjects who were severely dependent
on cocaine were
more likely than moderately dependent subjects to meet lifetime
criteria for PTSD.
PTSD also
was more prevalent in subjects with a history of major depression,
antisocial
personality disorder, and cannabis dependence, but not alcohol
dependence.
Depressed
Mood
Somatic
or Sexual Dysfunction
Guilt or Obsession
Addiction
Differential
Diagnosis:
Some disorders display similar or sometimes even the same symptom.
The clinician, therefore, in his/her diagnostic attempt, has to
differentiate against the following disorders which he/she needs
to rule out to establish a precise diagnosis.
Adjustment
Disorder
Brief Psychotic Disorder.
Conversion Disorder.
Major Depressive Disorder.
Acute Stress Disorder
Obsessive-Compulsive
Disorder
Schizophrenia
Mood Disorder
With Psychotic Features
Delirium
Substance-Induced
Disorders
Psychotic Disorders Due to a General Medical Condition
Malingering
Cause:
PTSD
can occur at any age as it is dependent upon the experience of
a traumatic event. Such events include:
Military
Combat
Violent Criminal Attacks
Sexual Assaults
Serious Accidents
Life threatening natural disasters
The cause
is not known, but psychological, genetic, physical, and social
factors may contribute to it. In studies of Vietnam war veterans,
those with strong support systems were less likely to develop
PTSD than those without or poor support systems and PTSD
develops immediately after they experience the traumatic event.
However, in other people, signs of the disorder do not develop
until several weeks, months, or even years after the event.
