WHAT IS POST TRAUMATIC STRESS DISORDER?

Sara Gilman, M.F.T., F.A.A.E.T.S.
Marriage & Family Therapist

Category: TRAUMATIC STRESS & PTSD
Life Force Services, Inc.

In this article we will cover five areas

• What is Trauma?
• What are PTSD and ASD, and how are they different?
• How common is PTSD?
• What is the likelihood of Recovery?
• PTSD as a Co-0ccuring disorder

What is Trauma?

Experiencing trauma is an essential part of the human condition. Some people (and societies) can be very flexible and creative in their adaptation to terrible events. Others, however, become fixated, stuck in the repetitive replaying of the trauma and their lives disintegrate at all levels (physically, emotionally, mentally, socially and spiritually).

During the course of a lifetime, approximately half of all men and women will be exposed to at least one traumatic event, such as assault, military combat, an industrial or vehicular accident, rape, domestic violence, or natural disaster (e.g., an earthquake). Although most people can absorb the psychological impact of such an experience and resume their normal lives, a sizable minority (approximately 8 percent) will suffer significant distress or impairment (Friedman, 2000, Kessler, 1995). Traumatic experiences impact both brain structure and brain processes.

Trauma was first introduced in the Diagnostic & Statistical Manual of Mental Disorders - III (DSM-III) as a catastrophic stressor that "would evoke significant symptoms of distress in most people" (American Psychiatric Committee, 1980). Trauma was characterized as a rare and overwhelming event that differed qualitatively from "common experiences such as bereavement, chronic illness, business losses or marital conflict" (American Psychiatric Committee, 1980). Traumatic events listed in the DSM-III included: rape, assault, torture, incarceration in a death camp, military combat, natural disasters, industrial/vehicular accidents, torture, or exposure to war/civil/ domestic violence. Thus a person was considered "traumatized." Our understanding about trauma has changed significantly since 1980. Researchers discovered that most people exposed to a catastrophic event did not develop PTSD. The critical discriminator is the person's emotional response to the event. If the rape or accident produces an intense emotional response (fear, helplessness, horror) the event is "traumatic." If an event does not produce an intense emotional response, then the event is not considered a "traumatic event" and, according to the DSM definition, cannot cause PTSD (Friedman, 2000).

Trauma is not just an external event. The concept of trauma has changed from a rare, external event (DSM-III), to an individual's psychological response to an overwhelming event (DSM-IV).

For many years, mental health professionals and others have recognized that exposure to trauma produces enduring psychological consequences. Many people mask or self-medicate the symptoms which develop from exposure to traumatic stress, with abusable substances being a favored form of numbing.

What is PTSD & ASD?

PTSD is a serious, debilitating condition, which arises from exposure to very dangerous or life-threatening circumstances. The origin of Post-Traumatic Stress Disorder can be traced to a natural defense mechanism that all human beings share. It is referred to as "Fight, Flight or Freeze." In the face of extreme danger, stress or other life-threatening experience, the body releases a chemical called 'adrenaline', which results in a wide range of psychological and physiological responses. Examples of these are increased pupil size (so more information can enter the eyes), increased heart rate (so that oxygen can be pumped to the muscles and brain), and an overall hyper arousal of all bodily systems to prepare us for either fighting the perceived danger or fleeing from it. A lesser-known fear response, though equally adaptive, is the "freeze" response (immobilization). This reaction to extreme terror often leaves people with the belief afterward, "Why didn't I do something"? Freezing and fleeing are often the defensive responses that are connected to unrealistic and debilitating feelings of guilt and shame in the aftermath of trauma.

The essential feature of PTSD is the development of characteristic symptoms following the exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or the witnessing of any of these events; or learning about unexpected traumatic event of a family member or close associate. The person's response to the event must involve intense fear, helplessness, or horror (American Psychiatric Committee, 1980).

When people experience a traumatic stressor, they may experience severe and incapacitating psychological distress. Symptoms include, but are not limited to:

• Nightmares
• Avoidance of people, places, and other stimuli associated with the trauma
• Visual, auditory and kinesthetic flashbacks
• Intrusive thoughts
• Persistent anxiety, increased arousal or hypersensitivity
• Sleep disturbances
• Diminished interest or participation in previously enjoyed activities
• Feelings of detachment and isolation
• Psychic numbing

When these symptoms occur as a part of the normal, immediate human response to overwhelming events but subside within a month, it can be diagnosed as Acute Stress Disorder (ASD). If, however, the symptoms persist beyond one month, the client may meet the criteria for PTSD (Friedman, 2000).

How Common is PTSD?

Today, PTSD is considered a significant public health problem that can affect millions of Americans. Eight percent of Americans will develop PTSD at some point in their lives (Kessler, 1995). If left untreated, many individuals will never recover. For example, research with World War II veterans and Nazi Holocaust survivors shows that PTSD can persist for over 50 years or, for a lifetime. Vietnam veterans are another example of this (Schnurr, 1991). In the coming years we may find the prevalence of PTSD growing due to events such as 9/11.

What is the Likelihood of Recovery?

PTSD is no different than other medical or psychiatric disorders in that its severity may very from mild to severe. Some people with PTSD are able to lead full and rewarding lives despite the disorder. Some others may develop a persistent, incapacitating mental illness marked by severe and intolerable symptoms; marital, social and vocational disability (Friedman, 1996). The long-term course for most people with chronic PTSD is marked by remissions and relapses. Some make a full recovery, others experience partial improvement, while others never improve. In this day and age we have innovative and integrated treatment models, which improve the likelihood of a healthy recovery. Appropriate treatment can also minimize the negative impact that relapses may cause.

PTSD as a Co-occurring Disorder

Individuals with lifetime PTSD will likely meet DSM-IV diagnostic criteria for at least one other psychiatric disorder. The National Co-morbidity Survey found that approximately 80 percent of all men or women who have ever had PTSD had at least one other affective, anxiety, or chemical use/dependency disorder (Kessler, 1995). Substance Abuse/Chemical Dependency frequently occurs with PTSD. For instance; 51.9% of men and 27.9% of women with PTSD also abuse or become dependent upon Alcohol. Drug abuse is found in 34.5% of men and 26.9% of women with PTSD (Friedman, 2000).

The ongoing symptoms of PTSD are so taxing on a person's nervous system, they often look to the temporary relief or numbing that alcohol and other drugs induce. People suffering from PTSD talk about the need to stop the flashbacks or the intrusive thoughts so they will often turn to chemicals, which are readily available in our culture. Over time this insidious use of substances creates a psychological and physiological dependence. The conditioned relationship between substance use and symptom relief grows over time. This complicates the brain's ability to process information and to re-establish equilibrium following traumatic stress exposure. Although some symptom relief is experienced, the ability of the person to function in everyday life declines. The person begins to experience increasingly serious family problems, financial difficulties, decline in job productivity or job loss, health complications, legal problems, incarceration, etc.

It is clear that PTSD is a debilitating disorder affecting many people. It costs our society greatly. Without proper education of the public and professionals, it often goes untreated. Left untreated, the aftermath of trauma becomes multi-generational, affecting the children of the traumatized, rippling out as it goes. Ask anyone who has grown up in a household of alcoholics or drug addicts (who themselves had an underlying history of trauma), whether they found the experience of living that way as a child "traumatizing". Or perhaps growing up with a chronically depressed mother, where treatment of her depression has produced inconsistent results. Someone who has experienced years of an anxiety disorder may have an underlying history of trauma, which has not been addressed. Our prisons are full of people who have significant trauma in their history. Treating one disorder only is insufficient. It is important to treat the whole person, not just a few presenting symptoms, which may only be expressions of the true underlying needs.

Bibliography

1. American Psychiatric Committee on Nomenclature and Statistics (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: American Psychiatric Association.
2. American Psychiatric Committee on Nomenclature and Statistics (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.).
3. Friedman, Matthew J., M.D., Ph.D., Post Traumatic Stress Disorder, 2000. Kansas City, MO Dean Psych Press Corporation, d/b/a/ Compact Clinicals.
4. Friedman, M.J., Rosenheck, R.A. (1996). PTSD as a persistent mental illness. InS. Soreff (Ed.), The seriously and persistently mentally ill: The state-of-the-art treatment handbook (pp.369-389). Seattle, WA: Hogrefe & Huber.
5. Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
6. Schnurr. P.P. (1991). PTSD and combat-related psychiatric symptoms in older veterans. PTSD Research Quarterly, 2,1-6