Posttraumatic Stress Disorder: Introduction and Identification

9. Posttraumatic Stress Disorder: Introduction and Identification Sean R. Evers, Ph.D. M.S. Clinical Psychopharmacology The Center for Posttraumatic Studies

15. Outline • History • Current Diagnostic Criteria • Manifestations of PTSD • Summary/ Final Comments

16. History of PTSD PTSD has always been a part of the human condition. It has not always been recognized or called by the same name but it has always been there.

18. Trauma • Man made trauma produce more psychological symptoms then naturally occurring traumatic events. • Trauma is typically accepted to be one major discrete event. (Although PTSD appears to also be a consequence of prolonged exposure to a high stress environment.)

19. Posttraumatic Stress Everyone can, and probably would experience a posttraumatic reaction to a severe enough stressor. Having a stress response is normal. Most stress responses remit in a short time. We begin to cope better and our symptoms go away. Posttraumatic Stress Disorder is a pathological stress response developed after a traumatic event.

21. The Evolution of PTSD • Railway Spine • Micro-lesions • Shell Shock • Combat Fatigue • Functional Disorder • Anxiety Neurosis • PTSD

22. DSM – IV –TR / 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 threat to the physical integrity of self or others, (2) The person’s response involved intense fear, helplessness or horror.”

23. “B. The traumatic event is persistently reexperienced in one (or more) 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) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.”

24. “C. 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: (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma, (2) efforts to avoid activates, 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

25. (5) feelings of detachment or estrangement from others, (6) restricted range of affect (e.g., unable to have loving feelings), (7) sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)”

26. “D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (1) difficulty falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance (5) exaggerated startle response”

27. “E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Acute: if duration of symptoms is less than 3 months Chronic: if duration of symptoms is 3 months or more Specify if: With Delayed Onset: if onset of symptoms is at least 6 months after the stressor”

28. T --Trauma R -- Reexperiencing A -- Avoidance P -- Persistent arousal P -- Persistent Systems E -- D -- Disturbance

29. Additional Factors GWAT Veterans • Stigma of Mental Illness • Societal Estrangement • Issues with the Veteran’s Administration • Unique Demographics of GWOT veterans • PTSD in a Test Tube

30. Epidemiology of PTSD • Lifetime prevalence in the U.S. is about 8% to 9% and approximately twice as common in women then men. • High risk groups have higher rates: -1 in 3 rape victims -1 in 4 combat veterans GWOT veterans present a unique population with regards to PTSD incidence due to multiple combat tours with no end in sight due to wars on multiple fronts.

31. Incidence of PTSD /Multiple Tours???

32. Disturbance of Relationship with the Self • Physiological • Psychological

34. Common Manifestations • Short Temper • Increase Conflicts with Others • Sleep Difficulties • Intrusive Thoughts • Increased Isolation • Feelings of Isolation/ Estrangement • Feelings of Boredom • Increased Risk Taking Behaviors

37. Normalization “Concepts of normalization should also include normalization of help-seeking behavior, because research suggest that many individuals with significant levels of posttraumatic stress symptoms do not use mental health services, even when they are available.”

38. Short Term/Long Term Goals Short Term Goals • Symptom stabilization • Reestablishing equilibrium • Reintegration into relationships • Explore veteran entitlements • Develop a supportive relationship with VA / veteran’s community • Reintegration into society • Getting life back on track • Career development • Reestablishing social contacts • Long term treatment plans to cope with future stressors Long Term Goals

39. Summary Not all wounds are visible. PTSD is just as real and devastating as any other serious injury but because it is difficult to see and has political overtones it is often ignored. Because of our societies treatment of mental health issues the PTSD victim is often viewed with distain and is stigmatized impeding their admitting the problem and seeking treatment.

40. Posttraumatic Stress Disorder is the unseen wound our veteran’s carry home with them from combat. Appropriately identified and addressed this wound need not stigmatize and alienate our veteran’s. PTSD can be successfully treated and weight of the emotional scars our veteran’s carry can be lifted.