Post traumatic stress disorder

Post-traumatic stress disorder is an anxiety disorder caused by exposure to an overwhelming, traumatic event, in which the person later repeated lyre experiences the event.Experiences that threaten death or serious in jury can affect people long after the experience is over. Intense fear, helplessness, or horror can haunt a person.The traumatic situation is repeated lyre experienced, usually in nightmares or flashbacks.The person persistently avoids things that are reminders of the trauma. Sometimes symptoms don’t begin until many months or even years after the traumatic event took place.The person has a numbing of general responsiveness and symptoms of increased arousal (such as difficulty falling asleep or being easily startled). Symptoms of depression are common.

Post traumatic stress disorder affects at least 1 percent of people sometime during their life. People at high risk, such as combat veterans and victims of rape or other violent acts, have a higher incidence.

Symptoms

The traumatic event is persistently re-experienced in one (or more) of the following ways:

 Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Recurrent distressing dreams of the event. Note: In children, there maybe frightening dreams with out recognizable content. acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions,hallucinations, and dissociative flash back episodes, including those that occur on awakening or when intoxicated).

 Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

 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:

a) Efforts to avoid thoughts, feelings,or conversations associated with the trauma b) Efforts to avoid activities, places, or people that arouse recollections of the trauma

c) Inability to recall an important aspect of the trauma

d) Markedly diminished interest or participation insignificant activities

e) Feeling of detachment or estrangement fro mothers

f) Restricted range of affect (e.g., unable to have loving feelings)

g) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

 Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

a) difficulty falling or staying asleep
b) irritability or outbursts of anger
c) difficulty concentrating
d) hyper vigilance
e) exaggerated startle response

Behavioral Theory

Conditioning theory has been helpful in explaining the process through which stimuli that are associated with a traumatic event can alone elicit intense emotional responses in individuals who have PTSD. Cues (i.e., conditioned stimuli) that are present at the time of the trauma (the unconditioned stimulus) become associated with the unconditioned emotional response (fear, helplessness, or horror). Following the traumatic event, these cues alone can then repeatedly elicit the strong emotional response. For example, a woman who has been raped(unconditioned stimulus) in adarkalley(conditioned stimulus) by a man (conditioned stimulus) and has an intense fear response (unconditioned response)may demonstrate a fear response (now the conditioned response)when she sees a dark alley (conditioned stimulus) or is in the presence of a man (conditioned stimulus). Avoidance behaviours develop to decrease anxiety associated with the conditioned stimuli.

Cognitive and Information Processing

Exposure to a severe or unexpected event may result in an inability to process and assimilate the experience adequately or to deal effectively with its impact.For example, people who have suffered severe emotional trauma because of experiences such as combat, natural disaster, crime, etc face sleep disorders or disturbances, flashbacks, anxiety, tiredness and depression. A period of prolonged, difficult and often incomplete assimilation occurs.The experience is kept alive in active memory, intruding itself into awareness either during the day or at night. The pain of the unbidden experience is followed by active attempts to avoid reminders of the trauma. These intrusive and avoidance phases often alternate (Horowitz, 1973).

Genetic–Familial Factors: From the available literature, there is evidence to suggest that anxiety and depression in families is a risk factor for PTSD.

Other Factors

Although systematic research is scant, it may be that individuals exposed to repeated or continuous trauma,particularly of an inter personal nature,may be more likely to develop PTSD. Trauma involving loss of community or support structures is likely to be particularly damaging. Because social support has been held to produce a buffering effect, lack of support might be considered an additional vulnerability factor.Women are at more risk than men for PTSD.

Treatment

Treatment of post traumatic stress disorder involves drugs, behaviour therapy, cognitive therapy and psychotherapy.Antidepressant and anti anxiety drugs appear to provide some benefit.Because of the often intense anxiety associated with traumatic memories, supportive psychotherapy plays an especially important role. The therapist is openly empathic and sympathetic in recognizing the person’s psychological pain.

Cognitive interventions can be used to recognize and change maladaptive cognitions and to replace interpretations of danger by realistic or safer interpretations,with the ultimate hope that the patient will integrate the new information into the fear structure, leading to a more realistic appraisal of the degree of danger.

In behaviour therapy, the person is exposed to situations that may trigger memories of the painful experience. Prolonged exposure depends on the fact that anxiety will be extinguished in the absence of real threat, given a sufficient duration of exposure in vivo or in imagination to traumatic stimuli. In PTSD, the patient retells the traumatic experience as if it were happening again, until doing so becomes a pedestrian exercise and anxiety decreases.Between sessions, patients perform exposure homework, including listening to tapes of the flooding sessions and limited exposure in vivo. The therapist reassures thepersonthather/his response is valid but encourages her/him to face her/his memories during behavioural desensitization therapy.The person also is taught ways to control anxiety, which helps to modulate and integrate the painful memories into her/his personality.