Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma.[1][2][3]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,[1]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 post traumatic stress (also known as acute stress response).[4] Diagnostic symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks ornightmares, avoidance of stimuli associated with the trauma, and increased arousal—such as difficulty falling or staying asleep, anger, and hyper-vigilance. 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.[1]

Psychological trauma

PTSD is believed to be caused by experiencing any of a wide range of events[8] which produces intense negative feelings of “fear, helplessness or horror”[9] in the observer or participant.[1] Sources of such feelings may include (but are not limited to):

Children or adults may develop PTSD symptoms by experiencing bullying or mobbing.[11][12] Approximately 25% of children exposed to family violence can experience PTSD.[13] Preliminary research suggests that child abuse may interact with mutations in a stress-related gene to increase the risk of PTSD in adults.[14][15][16] However, being exposed to a traumatic experience doesn’t automatically indicate they will develop PTSD.[17] It has been shown that the intrusive memories, such as flashbacks, nightmares, and the memories themselves, are greater contributors to the biological and psychological dimensions of PTSD than the event itself.[18] These intrusive memories are mainly characterized by sensory episodes, rather than thoughts. People with PTSD have intrusive re-experiences of traumatic events which lack awareness of context and time. These episodes aggravate and maintain PTSD symptoms since the individual re-experiences trauma as if it was happening in the present moment.[19]

Multiple studies show that parental PTSD and other post-traumatic disturbances in parental psychological functioning can, despite a traumatized parent’s best efforts, interfere with their response to their child as well as their child’s response to trauma.[20][21] Parents with violence-related PTSD may, for example, inadvertently expose their children to developmentally inappropriate violent media due to their need to manage their own emotional dysregulation.[22] Clinical findings indicate that a failure to provide adequate treatment to children after they suffer a traumatic experience, depending on their vulnerability and the severity of the trauma, will ultimately lead to PTSD symptoms in adulthood.[23]

 

1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association.ISBN 0-89042-061-0.

2. Satcher D et al. (1999). “Chapter 4.2”. Mental Health: A Report of the Surgeon General. Surgeon General of the United States.http://www.surgeongeneral.gov/library/mentalhealth/chapter4/sec2.html.

3. Brunet A, Akerib V, Birmes P (2007). “Don’t throw out the baby with the bathwater (PTSD is not overdiagnosed)” (PDF). Can J Psychiatry52 (8): 501–2; discussion 503. PMID 17955912. http://publications.cpa-apc.org/media.php?mid=490. Retrieved 2008-03-12.

4. Rothschild, Babette (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York: W.W. Norton & Company. ISBN0393703274.

5. Rothschild, Babette (200). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York: W.W. Norton & Company. ISBN0393703274.

6. Kaplan, HI; Sadock, BJ, Grebb, JA (1994). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences, clinical psychiatry, 7th ed.. Baltimore: Williams & Williams. pp. 606–609.

7. Satcher D et al. (1999). “Chapter 4”. Mental Health: A Report of the Surgeon General. Surgeon General of the United States.http://www.surgeongeneral.gov/library/mentalhealth/toc.html#chapter4.

8. “Post-Traumatic Stress Disorder (PTSD)”. National Institute of Mental Health (NIMH), U.S. Department of Health and Human Services.http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/who-gets-ptsd.shtml. Retrieved 2011-12-16.

9. Mayo Clinic staff. “Post-traumatic stress disorder (PTSD)”. Mayo Foundation for Medical Education and Research. http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=causes. Retrieved 2011-12-16.

10. Fullerton, CS; Ursano, Wang (2004). “Acute Stress Disorder, Posttraumatic Stress Disorder, and Depression in Disaster or Rescue Workers”. Am J Psychiatry 161: 1370–1376.

11. Kelleher I, Harley M, Lynch F, Arseneault L, Fitzpatrick C, Cannon M (November 2008). “Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample”. Br J Psychiatry193 (5): 378–82. doi:10.1192/bjp.bp.108.049536. PMID 18978317.

12. “Are they really out to get your patient?” http://www.innovations-training.com/0804CP_Article4.pdf Current Psychiatry Volume 8 Number 4

13. McCloskey, Laura Ann; Marla Walker (January 2000). “Posttraumatic Stress in Children Exposed to Family Violence and Single-Event Trauma”. Journal of the American Academy of Child & Adolescent Psychiatry39 (1): 108–115. doi:10.1097/00004583-200001000-00023.http://www.sciencedirect.com/science/article/pii/S0890856709661074.

14. Binder EB, Bradley RG, Liu W, et al. (March 2008). “Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults”. JAMA299 (11): 1291–305. doi:10.1001/jama.299.11.1291. PMC 2441757. PMID 18349090. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2441757/.

15. Peggy Peck, Executive Editor (2008-03-09). “Genes May Affect Lifelong Impact of Child Abuse”. MedPage Today.http://www.medpagetoday.com/Genetics/GeneticTesting/dh/8824.

16. Constance Holden (2008-03-18). “Seeds of PTSD Planted in Childhood”. ScienceNOW Daily News.http://sciencenow.sciencemag.org/cgi/content/full/2008/318/2?etoc.

17. Rothschild, Babette (2000). The Body Remembers: The psychophysiology of Trauma and Trauma Treatment. New York: W.W. Norton & Company. ISBN0393703274.

18. Olszewski, Terese M.; Jeanne F. Varrasse (June 2005). “The Neurobiology of PTSD”. Journal of Psychosocial Nursing 43 (6): 40.

19. Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re-experiencing in post-traumatic stress disorder: Phenomenology, theory, and therapy. Memory, 12(4), 403-415. doi:10.1080/09658210444000025

20. Schechter DS, Coates SW, Kaminer T, et al. (2008). “Distorted maternal mental representations and atypical behavior in a clinical sample of violence-exposed mothers and their toddlers”. J Trauma Dissociation9 (2): 123–47. doi:10.1080/15299730802045666. PMC 2577290. PMID 18985165. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2577290/.

21. Schechter DS, Zygmunt A, Coates SW, et al. (September 2007). “Caregiver traumatization adversely impacts young children’s mental representations on the MacArthur Story Stem Battery”. Attach Hum Dev9 (3): 187–205. doi:10.1080/14616730701453762. PMC 2078523. PMID 18007959. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2078523/.

22. Schechter DS, Gross A, Willheim E, et al. (December 2009). “Is maternal PTSD associated with greater exposure of very young children to violent media?”.J Trauma Stress22 (6): 658–62. doi:10.1002/jts.20472. PMC 2798921. PMID 19924819. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2798921/.

23. Clarke, C. et. al. 2007. Childhood and Adulthood Psychological Ill Health as Predictors of Midlife and Anxiety disorders. Archives of General Psychiatry. 64. pp668-678