POST-TRAUMATIC STRESS DISORDER: SYMPTOMS AND CAUSES - PSYCHOLOGY - 2024

The posttraumatic stress disorder (PTSD) is an emotional disorder following a trauma or traumatic event, such as death of a loved one, natural disasters, car accidents, physical aggression, wars, threatened with weapons, psychological abuse, among others.

Many other traumatic events can also lead to PTSD, such as robberies, robberies, plane crashes, torture, kidnappings, terrorist attacks, and other extreme or life-threatening events.

To develop this disorder, there must be an exposure to a traumatic event during which fear, pain or helplessness is experienced. Later, the victim experiences this event again through nightmares or memories and avoids any situation or thing that reminds them of the traumatic event.

As a consequence of the trauma, the victim may be unable to recall some aspects of the event or may unconsciously avoid experiencing the emotion. On the other hand, the victim can become easily frightened, chronically over-activated, easily angered, or chronically over-activated.

The traumatic events that lead to PTSD are usually so strong and feared that they would provoke emotional reactions in anyone. When the sense of security is destroyed, it is normal to feel disconnected or paralyzed, it is common to have nightmares, to feel fear or not being able to stop thinking about what happened.

However, for most people, these symptoms are short-lived. They can last several days or weeks, but gradually diminish.

In PTSD, these symptoms do not decrease and the victim does not begin to feel better; in fact, you start to feel worse. Children are less likely to develop PTSD than adults, especially if they are under 10 years of age.

Symptoms

Symptoms of PTSD can begin three weeks after the traumatic event, although they sometimes appear after several years.

Generally, symptoms are grouped into four types (detailed in the "diagnosis" section):

• Intrusive memories.
• Avoidance.
• Negative changes in thinking and mood.
• Changes in emotional reactions.

The symptoms of PTSD vary in intensity over time. They can be had more when the stress level is high or when there are memory stimuli of the trauma.

Causes

The etiology of PTSD is clear: a person experiences trauma and develops the disorder.

However, whether a person develops it depends on biological, psychological and social factors.

Intensity of trauma

In general, the more intense the trauma, the more likely it is that PTSD will develop.

A 1984 investigation found that in Vietnam veterans, 67% developed PTSD.

Biological factors

There is a greater chance of developing PTSD if there is a history of anxiety disorders in the victim's family. In fact, research has found that generalized panic disorder and anxiety share 60% of the genetic variance with PTSD.

There is evidence that susceptibility to PTSD is heritable. About 30% of the variance is due to genetic factors.

There is also evidence that people with a smaller hippocampus are more likely to develop PTSD after a traumatic event.

Psychological factors

When the intensity of the event is high, PTSD is much more likely to develop and there is no relationship with psychological factors.

However, when the intensity of the event is medium or low, factors such as family instability can increase the chances of developing it.

On the other hand, being prepared for events or having experience act as protective factors.

Social and cultural factors

People with strong social support are less likely to develop PTSD after trauma.

Diagnosis

Diagnostic criteria according to DSM-IV

A) The person has been exposed to a traumatic event in which 1 and 2 have existed:

The person has experienced, witnessed or been explained one (or more) event (s) characterized by deaths or threats to their physical integrity or that of others.

The person has responded with intense fear, hopelessness, or horror. Note: in children these responses can be expressed in unstructured or agitated behaviors.

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

1. Recurring and intrusive memories of the event that cause discomfort and that include images, thoughts or perceptions. Note: in young children this can be expressed in repetitive games where characteristic themes or aspects of the trauma appear.
2. Recurring dreams about the event, which cause discomfort. Note: in children there can be terrifying dreams of unrecognizable content.
3. The individual acts as if, or feels that, the traumatic event is occurring. It includes the sensation of reliving the experience, illusions, hallucinations and dissociative flashback episodes, even those that appear when waking up or being intoxicated. Note: Young children can re-enact the specific traumatic event.
4. Intense psychological distress when exposed to intense or external stimuli that symbolize or recall an aspect of the traumatic event.
5. Physiological reactivity when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event.

C) Persistent avoidance of stimuli associated with trauma and blunting of the individual's general reactivity (absent before the trauma), as indicated by three (or more) of the following symptoms:

1. Efforts to avoid thoughts, feelings, or conversations about the traumatic event.
2. Efforts to avoid activities, places, or people that trigger memories of the trauma.
3. Inability to remember an important aspect of the trauma.
4. Sharp reduction in interest or participation in meaningful activities.
5. Feeling of detachment or alienation from others.
6. Restriction of affective life.
7. Feeling of a bleak future.

D) Persistent symptoms of increased arousal (absent before trauma), as indicated by two (or more) of the following symptoms:

1. Difficulty falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle responses.

E) These alterations (symptoms of criteria B, C and D) last more than a month.

F) These alterations cause significant clinical discomfort or social, occupational or other important areas of the individual's activity.

Acute: symptoms last more than 3 months.

Chronic: symptoms last 3 months or more.

Moderate onset: at least 6 months have passed between the traumatic event and the onset of symptoms.

ICD-10 diagnosis (World Health Organization)

The diagnostic criteria for PTSD, stipulated by the World Health Organization, is summarized as follows:

• Exposure to an event or situation (short or long term) of exceptional threat or catastrophic in nature, which is likely to cause widespread malaise in most of the world.
• Persistent recall or reliving circumstances associated with the stressor (not present before exposure).
• Avoidance of circumstances that resemble or associated with the stressor (not present before exposure).

1. Inability to remember, partially or completely, some of the important aspects of the period of exposure to the stressor.
2. Persistent symptoms of increased psychological sensitivity and arousal shown by two of the following:

• Difficulty sleeping or staying asleep.
• Irritability or outbursts of anger.
• Difficult to focus.
• Hypervigilance.
• Exaggerated startle response.

Risk factor's

People considered at risk may include:

• Having a job that increases the risk of exposure to traumatic events: military personnel, emergency medical care.
• Victims of natural disasters.
• Having suffered abuse in childhood.
• Concentration camp survivors.
• Having other disorders, such as anxiety disorders.
• Have little social support.
• Victims of violent crimes.
• Witness any of the above events.
• It can be developed by children or adults who have suffered bullying.

Treatment

From a psychological point of view, it is important for the victim to cope with the trauma, to develop coping strategies that work, and to overcome the effects of the disorder.

Cognitive behavioral therapy

Cognitive behavioral therapy seeks to change the way in which the victim perceives the trauma and works by changing the patterns of thought and behavior responsible for negative emotions.

One goal of this treatment is for the victim to learn to identify the thoughts that make them feel fear or discomfort and replace them with non-threatening thoughts.

One of the most widely used techniques is exposure, which requires the victim to re-experience the traumatic event to facilitate habituation and emotional processing of the trauma.

This technique includes both the confrontation in imagination and exposure in real life to stimuli that recall the event.

Re-exposure to trauma is best done gradually. Although re-experiencing memories can be scary, it is therapeutic when done properly.

Eye movement desensitization and reprocessing

Eye movement desensitization and reprocessing is a form of psychotherapy developed and studied by Francine Shapiro. She found that when she was thinking about traumatic memories, her eyes flicked. When she controlled her eye movements, her thoughts were less stressful.

This technique is supported by the theory that eye movements can be used to facilitate emotional processing of memories.

The therapist initiates rapid eye movements while the person focuses on memories, feelings, or thoughts about a particular trauma.

Although beneficial effects of this therapy have been shown, more research is needed to clarify its effects.

The authors of a 2013 meta-analysis confirmed: 'We found that people treated with eye movement therapy had greater improvement in their PTSD symptoms than people treated without eye movement therapy. Second, we found that in laboratory studies the evidence concluded that thinking about unpleasant memories and simultaneously doing a task that facilitates eye movement reduced the discomfort associated with unpleasant memories.

Medication

Fluoxetine or paroxetine may decrease symptoms in a small amount. Most medications do not have enough evidence to support their use. With many drugs, residual symptoms that follow treatment are the rule rather than the exception.

Side effects of drugs such as paroxetine are headache, nausea, poor sleep, and sexual problems.

• The first line of drug treatment are SSRIs (selective serotonin reuptake inhibitors): citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine.
• Benzodiazepines: They are not recommended for treating PTSD due to lack of evidence.
• Glucocorticoids: could be used in the short term to protect neurodegeneration caused by stress, but can promote neurodegeneration in the long term.

Others

Physical activity can have an impact on people's psychological and physical well-being. It is advisable to practice 3-5 times a week, at least 30 minutes a day to distract yourself from disturbing emotions, improve self-esteem and increase the feeling of control.

In the case of war veterans, programs that assist in the creation of social support, readjustment to civilian life, and improve communication skills, especially with family members, are recommended.

Disaster treatment

Sometimes a large number of people are affected by the same traumatic event, such as in natural disasters, wars or terrorist attacks.

Most people have some symptoms of PTSD in the first few weeks after the event, which is a normal response to trauma, and for most people the symptoms decrease over time.

The basic support is:

• Go to a safe place.
• See a doctor in case of injury.
• Get food and water.
• Contact relatives.
• Know what has happened and what the help procedure is.

However, sometimes people who have experienced a major traumatic event do not recover on their own.

In that case, brief cognitive behavioral therapies can be used in the first weeks.

epidemiology

In a WHO study carried out in 21 countries, more than 10% of the respondents declared that they had witnessed acts of violence (21.8%) or had suffered interpersonal violence (18.8%), accidents (17, 7%), exposure to armed conflicts (16.2%) or traumatic events related to loved ones (12.5%).

It is estimated in the study that 3.6% of the world's population has suffered from post-traumatic stress disorder (PTSD) in the last year.

Complications

Post-traumatic stress disorder can have negative consequences in several areas of life: work, relationships, health, and quality of life in general.

Having PTSD can increase your risk of developing other mental disorders such as:

• Depression and anxiety.
• Drug and alcohol abuse.
• Eating disorders.
• Suicidal thoughts and actions.

When to visit a professional

It is advisable to visit a professional -psychologist or psychiatrist- if you have thoughts or feelings about the traumatic event for more than a month, if the symptoms are severe and if you have problems leading a normal life.

References

1. "International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2007". World Health Organization (UN). 2007. Retrieved October 3, 2011.
2. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271-280. ISBN 978-0-89042-555-8.
3. Zoladz, Phillip (June 2013). "Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature." Neuroscience and Biobehavioral Reviews 37 (5): 860–895. doi: 10.1016 / j.neubiorev.2013.03.024.
4. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. ISBN 0-89042-061-0.; on-line.
5. Breslau N, Kessler RC (2001). "The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation". Biol. Psychiatry 50 (9): 699–704. doi: 10.1016 / S0006-3223 (01) 01167-2. PMID 11704077.
6. Mayo Clinic staff. "Post-traumatic stress disorder (PTSD)". Mayo Foundation for Medical Education and Research. Retrieved 2011-12-16.
7. "The ICD-10 Classification of Mental and Behavioral Disorders" (PDF). World Health Organization. pp. 120–121. Retrieved 2014-01-29.
8. "Mortality and Burden of Disease Estimates for WHO Member States in 2004". World Health Organization.
9. Image source.