Post Traumatic Stress Disorder (PTSD)

INTRODUCTION

Up to 69% of men and women will experience a traumatic event at sometime, natural or man made, most will cope. However, up to 8% will not, the trauma mutating into Post Traumatic Stress Disorder (PTSD) from which 40% may never recover, their lives compromised socially and occupationally. If there is recovery, relapse often occurs. PTSD is not new; it was recorded in ancient Greece and Roman literature.

PTSD develops when one experiences, witnesses or is confronted by an event or events that involves actual or threatened death, serious injury or threat to the physical integrity of self and others. Up to 30% of men and women for example exposed to a war zone will develop PTSD. The experience of the trauma causes intense fear, hopelessness and horror with post trauma re - experiencing symptoms occurring. Patterns of avoidance of stimuli associated with the trauma develop, as do symptoms of hyper - arousal. The symptoms of PTSD are listed in Table 1.

Today, the diagnosis of PTSD is made only if the symptoms persist one - month post - trauma. The re - experiencing symptoms, referred to as flashbacks, are often short, intense, distressing events that remind the sufferer of the trauma long after the event. These symptoms may arise spontaneously or via specific reminders, i.e. anniversaries or other factors symbolic of an aspect of the trauma. Avoidance of activities, situations, discussion and people associated with the trauma occurs, behaviours that are protective, for exposure often results in distress.

Symptoms of hyper-arousal are frequently the most apparent often stemming from excessive physiological arousal of the nervous system; the individual becoming hyper - alert with an exaggerated concern for personal safety.

ACUTE STRESS DISORDER (ASD)

Acute Stress Disorder (ASD) is a time limited form of PTSD, the onset of symptoms occurring within one month post - trauma. The significant difference between ASD and PTSD is the onset and prevalence of three or more of the dissociative symptoms (See Table 2) that occur while experiencing or after experiencing the trauma; the symptoms may continue into PTSD.

TABLE 2 Dissociative symptoms in ASD

Dissociation is a bodily defence mechanism that emerges in response to extremely painful experiences. It is an adaptive response with the mind ‘willing off’ the trauma, the sufferer hence gaining relief. In numbing, the sufferer feels that part of them is ‘shut down’. They become detached and no longer respond emotionally to their environment. A reduction of awareness is manifested in the person appearing ‘spaced out’ or ‘not with it’.

WHAT FACTORS MAKE PTSD MORE LIKELY TO OCCUR AND WHO IS AT RISK

The greater the magnitude, duration and proximity to the trauma the greater the probability of PTSD developing. PTSD is more likely if the impact of the trauma is perceived as life threatening, object loss occurs, physical injury is experienced and the trauma stems from a human action, as in the case of physical assault or rape. Those most vulnerable to PTSD are listed in Table 3; however, individuals without any risk factors may develop PTSD if the trauma is extreme. PTSD may develop at any age including childhood; it is twice as common in females.

PTSD DOES NOT OCCUR ALONE

Unfortunately, 79 - 88% of those who suffer with PTSD will develop at least one other psychiatric disorder, if the condition becomes chronic, several disorders may emerge. (See Table 4)

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