Post-traumatic Stress Disorder

What is Post-traumatic Stress Disorder (PTSD)?

Individuals who experienced a life-threatening, traumatic event may develop post-traumatic stress disorder (PTSD). Traumatic events that can trigger PTSD include experiencing or even witnessing assaults (physical and/or sexual assaults), accidents, combat, natural disasters (e.g., tornados, hurricanes, earthquakes), serious medical conditions, or loss of loved ones.

Individuals with PTSD often feel and act as if the traumatic events were recurring. They experience recurrent intrusive distressing recollections of the event, and nightmares. Re-experiencing is deemed the hallmark of PTSD. Persistent avoidance of thoughts, feelings, activities, places, and people that are associated with the trauma is another common symptom in individual with PTSD. They have trouble recalling an important aspect of the trauma, and experience emotional numbing. In addition, people with PTSD experience increased arousal symptoms, such as sleep problems, irritability, hypervigilance, and exaggerated startle response.

Individuals with PTSD often experience feelings of guilt and shame, anger, dissociative symptoms, sexual dysfunction, and suicidal ideation. 

High rates of comorbid disorders for PTSD were also reported.  Substance abuse/dependence, depression, other anxiety disorders, and personality disorder have been reported as major comorbid disorders in individuals with PTSD .  

A lifetime prevalence of PTSD varies ranging from 1% to 14%, depending on surveys.

 

Diagnostic criteria for PTSD 

A.  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 thereat to the physical integrity of self or others; 2) the person's response involved intense fear, helplessness, or horror 

B.  The traumatic event is persistently re-experienced in at least one of the following ways 1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions; 2) recurrent distressing dreams of the event; 3) acting or feeling as if the traumatic event were recurring; 4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event; 5) psychological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.  

C.  Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, as indicated by at least three of the following: 1) efforts to avoid thoughts, feelings, or conversions 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; 7) sense of a foreshortened future 

D.  Persistent symptoms of increased arousal, as indicated by at least two of the following: 1) difficulty falling or staying asleep; 2) irritability or outburst of anger: 3) difficulty concentrating; 4) hypervigilance; 5) exaggerated startle response 

E.  Duration of the disturbance is more than 1 month. 

F.  The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

 

Treatment 

There are several forms of empirically validated cognitive-behavioral treatments including Prolonged Exposure, Cognitive Processing Therapy, and Stress Inoculation Training.  These treatment protocols typically consist of exposure and cognitive treatment elements.  Prolonged Exposure asks the individual to expose him/herself to the traumatic memory. In vivo situational exposure ask the individual to enter the least fearful real-life situation toward the most fearful situation. These exposure processes guide the individual stay in the imaginal or real-life situations long enough until he/she becomes habituated the trauma-related, fear-provoking situations and the fear levels drop. Writing about the traumatic event was employed in Cognitive Processing Therapy and may be a milder form of exposure.  The cognitive part of therapy helps the person identify negative emotions (e.g., fear, guilt, anger) and erroneous thought patterns (e.g., a similar traumatic event will soon happen to me again) associated with the traumatic event.  The person learns how to modify these erroneous assumptions to more logical ones. In addition, relaxation training and coping skills training may be integrated. 

The TADC offers variety of empirically validated cognitive behavioral treatment methods for individuals (both adults and children) with PTSD. 

 

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association. 

Foa, E. B., & Meadows, E. A. (1997).  Psychosocial treatments for Posttraumatic Stress Disorder: A critical review.  Annual Review of Psychology, 48, 449-480. 

Foa, E.B., & Rothbaum, B.O (1998). Treating the trauma of rape. New York: The Guilford Press. 

Foy, D. W. (1992). Treating PTSD: Cognitive-behavioral strategies. New York: Guilford. 

Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060. 

Resick, P. A. & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage Publications, Inc. 

Veronen L.J., & Kilpatrick, D.G. (1983). Stress management for rape victims. In D. Meichenbaum & M.E. Jaremko (Eds). Stress reduction and prevention. New York: Plenum. ​