PTSD: In-Depth Overview

Head:Overview PTSD RESEARCH PAPER PTSD:Running In-Depth

1

 

PTSD: In-Depth Overview PTSD Research Paper Geries Shaheen Lindenwood University

Author Note PTSD is a condition that affects many individuals. While this research paper may focus on a few select examples of PTSD, it is to be known PTSD may occur in any terrifying ordeal that involves physical harm or the threat of physical harm.

PTSD: In-Depth Overview   PTSD

2

Abstract This is a research paper on the topic of PTSD. The information found in this research paper has been extracted from various reliable sources both online and offline. This research paper covers the definition of PTSD as well as its criteria, symptoms, affects on family and depression, goals, and treatment.

Keywords: PTSD, Causes, Depression, Criteria, Symptoms, Treatment

PTSD: In-Depth Overview PTSD

3

PTSD Research Paper When people feel they are in danger, the body responds naturally and prepares to make many split second decisions. The body prepares to defend against the danger or to avoid it.

This healthy response is called a “fight-or-flight� reaction (Barlow, D. & Durand, 2012). With people that have post-traumatic stress disorder (PTSD), this reaction is altered. People with PTSD may feel stressed or frightened even when the danger does not exist. PTSD occurs when someone is involved with physical harm or the threat of physical harm. That person may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or even strangers (Post-traumatic, n. d.).

PTSD is a physical condition that affects the whole body. It's a collection of reactions that can be both normal or abnormal depending on the situation. These reactions come about after exposure to actual or threatened death, serious injury, or sexual violence (Hoge, 2010).

How It Works PTSD begins with a traumatic event. The medial prefrontal cortex in the brain begins to shut down when there is trauma or stress from combat or other similar events. This causes the limbic system to kick in. The limbic system is primarily responsible for our emotional life, and has a great deal to do with the formation of memories. Limbic system memories are the memories that bring on PTSD. A light reflection from a window or passing car, the smell of diesel fuel, the sound of helicopters or airplanes, someone's name, the news, a calendar date, trash on the side of the road, traffic, kids yelling, raw meat, going into a porta - potty. These experiences are stored as limbic memories, considering they are correlated to a traumatic event that initially triggered the limbic part of the brain (Hoge, 2010).

PTSD: In-Depth Overview PTSD

4

The following is an example of a limbic memory as quoted by a Senior NCO who is diagnosed with PTSD. "All we do is roll on missions and hope we don't get blown up, and then when we get hit there is nothing we can do but watch my dead friends get pulled out in pieces. " -Senior NCO Iraq (Hoge, 2010).

Causes PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes. The DSM 5 points to a few factors that lead to the onset and or severity of PTSD. Pre-traumatic factors include temperamental, environmental beginnings. They also include genetic and physiological roots. Temperamental states that the client may have had emotional problems. By the age of six the child may have been exposed to a traumatic event at a young age or developed a mental disorder. Environmental states that the client may have experienced effects of having a low socioeconomic status, poor education, or family dysfunction.

Lastly, certain genotypes may have an increased risk of PTSD (American Psychiatric Association, & American Psychiatric Association, 2013).

Peritraumatic factors express that the cause of PTSD is linked to the severity of the traumatic event or events. Posttraumatic factors express that PTSD is seen through in appropriate coping strategies, stress disorders, adverse life events negative appraisals, repeated reminders of trauma. Currently, scientists are studying genes responsible for creating fear

PTSD

PTSD: In-Depth Overview

5

memories. PTSD researchers have found genes that make Stathmin, a protein required in the formation of fear memories. In a study on mice that did not make stathmin shows they were less likely than normal mice to “freeze,� after being exposed to a fearful experience. They also showed less innate fear by exploring open spaces more willingly than normal mice. GRP (gastrin-releasing peptide). is a signaling chemical in the brain that is released during emotional events. In mice, GRP seems to help control the fear response, and lack of GRP may lead to the creation of greater and more lasting memories of fear (post-traumatic-stress-disorder, n. d.).

Researchers have also found a version of the 5-HTTLPR gene, which controls levels of serotonin. This brain chemical is related to mood and appears to fuel the fear response.

Different parts of the brain are involved in dealing with fear and stress. Understanding these parts helps researchers focus on new possible causes of PTSD. For instance the amygdala is known for its role in emotion, learning, and memory. It appears to be active in fear acquisition, or learning to fear an event (such as touching a hot stove). , as well as in the early stages of fear extinction, or learning not to fear (post-traumatic-stress-disorder, n. d.).

The prefrontal cortex, as stated earlier, plays a role in fear as well. Storing extinction memories and dampening the original fear response appears to involve the prefrontal cortex.

Certain areas of the prefrontal cortex are responsible for different roles (Hoge, 2010). For instance, when a source of stress is controllable, the medial prefrontal cortex suppresses the amygdala and controls the stress response. The ventromedial prefrontal cortex then helps sustain long-term extinction of the fearful memories. Any shift or differences in these genes or brain areas could set the stage for PTSD without even causing symptoms.

Environmental factors stated earlier, such as childhood trauma, head injury, or a history of mental illness, may increase a person's risk by affecting the early growth of the brain.

PTSD: In-Depth Overview

PTSD

6

Personality and cognitive factors, such as optimism and the ability to see challenges in a positive or negative light, and social factors, such as the availability / use of social support, influence how people adjust to trauma (post-traumatic-stress-disorder, n. d.).

Criteria and Symptoms "War fucked me up mentally. I have bad dreams and I see all kinds of mad ill shit. I see dead people. I sometimes get angry and pissed off and just want to kill somebody. " -Junior enlisted solider post Afghanistan (Hoge, 2010).

The above quote express a few symptoms of PTSD.C.W. Hoge, the author of "Once a Warrior, Always a Warrior, makes an emphasis that what medical professionals deem as symptoms are also combat survival skills. The author explains that PTSD isn't just a problem, but a condition that impacts individuals in a holistic manner. When someone is experiencing PTSD they are affected physically, emotionally, psychologically and behaviorally.

Throughout the book, the author makes a point to express his ideas with underlying notions. For example, he never eludes that there is anything "broken" with individuals experiencing PTSD, but rather they have not been able to learn how to successfully dial up or dial down their warrior skills / responses. They simply have not effectively adapted to their new environment (Hoge, 2010).

PTSD brings with it many symptoms. These symptoms can be grouped into three categories; Re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms.

Re-experiencing symptoms include having flashbacks, having bad dreams, and experiencing frightening thoughts. Flashbacks are described as reliving the trauma over and over, and include physical symptoms such as a racing heart or sweating (American Psychiatric Association, & American Psychiatric Association, 2013).

PTSD: In-Depth Overview PTSD

7

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.

Avoidance symptoms are seen when individuals begin staying away from places, events, or objects that are reminders of the experience. They begin Feeling emotionally numb. They feel strong guilt, depression, and worry. These individuals begin to lose interest in activities that were enjoyable in the past. They also begin having trouble remembering the dangerous event they initially experienced. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car (Hoge, 2010).

Lastly, Hyperarousal symptoms exist with PTSD. Individuals may be easily startled, Feel tense or “on edge”, and have difficulty sleeping. Individuals with Hyperarousal symptoms may also experience angry outbursts. Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. They can make the person stressed and angry. These symptoms make it hard for the individual to accomplish daily tasks, such as sleeping, eating, or concentrating (post-traumatic-stress-disorder, n. d.).

These symptoms are natural after a dangerous event. Sometimes people experience serious symptoms that go away after a few weeks. This is called acute stress disorder. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. Very young children may begin bed-wetting, or forget how to talk. They may act out the scary event

PTSD: In-Depth Overview PTSD

8

or become extremely clingy with parents. Older children and teens usually show symptoms more like those seen in adults. They may develop disruptive behaviors. Older children and teens might feel guilty for not preventing injury or deaths. They may also have thoughts of revenge (post-traumatic-stress-disorder, n. d.).

DSM-5 Criteria The DSM 5 offers criteria and symptoms of PTSD. PTSD is considered a trauma/ stressor related disorder, and is labeled with the following codes 309. 81 (F43. 10) for diagnosis.

The DSM 5 states that PTSD as the exposure to actual or threatened death, serious injury, or sexual violence through Directly experiencing the traumatic event, witnessing, in person, the event as it occurred to others, and Learning that the traumatic event occurred to close and remember to close friend (American Psychiatric Association, & American Psychiatric Association, 2013).

The DSM 5 addresses symptoms that exist at different times of the process. There is a presence of one or more of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred. Recurrent, involuntary, and intrusive distressing memories of the traumatic event occur. Recurrent distressing dreams in which the content and or affect of the dream are related to the traumatic event occur as well.

Dissociative reactions such as flashbacks are attributed to PTSD, as described in the DSM5. These flashbacks make the individual feel or act as if the traumatic event were recurring. Intense prolonged psychological distress also occurs. This happens when the individual is exposed to internal or external cues that symbolize or resemble an aspect of the traumatic event. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event also occur (American Psychiatric Association, &

PTSD: In-Depth Overview

PTSD

9

American Psychiatric Association, 2013).

The DSM5 states that the individual can develop persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred. This is evidenced by the intentional avoidance, or putting effort to avoid, distressing memories, thoughts, or feelings about the traumatic event. The individual may also avoid, or put effort to avoid, external reminders that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

Negative alterations, cognitions, and mood associated with the traumatic event that begin or worsen after the dramatic event occurred are symptoms of PTSD. In this symptom, an individual become unable to remember important aspects of the traumatic event. They may show persistence and exaggerated negative beliefs or expectations about themselves, others, or the world. They may have Persistent, distorted cognitions about the causal consequences of the traumatic event that led the individual to blame him or herself or others. The individual may be in a persistent negative emotional state and feel detached or estranged from others. They may also display persistent inability to experience positive emotions (American Psychiatric Association, & American Psychiatric Association, 2013).

Marked alterations in arousal and reactivity associated with the traumatic event may begin or worsen after the traumatic event occurred. The individual may experience this symptom through displaying irritable behavior and angry outbursts usually expressed as verbal or physical aggression toward people or objects (Barlow & Durand, 2012). The individual may exhibit Recklessness or even self-destructive behavior. Hypervigilance is a criterion for this symptom. The individual may have an exaggerated startle response, and show problems with concentration. Sleep disturbances often occur as a symptom as well (American Psychiatric

PTSD: In-Depth Overview PTSD

10

Association, & American Psychiatric Association, 2013).

The DSM5 indicates specific criteria for these symptoms. The duration of the disturbance must be more than one month. The disturbances must cause clinically significant distress, or impairment, in social, occupational, or other important areas of the individual's functioning. The disturbance must not be attributable to the physiological effects of a substance or another medical condition (American Psychiatric Association, & American Psychiatric Association, 2013).

While observing the symptoms, the DSM5 also expects specifications of depersonalization, derealization, or delayed expression within the individual. It must be noted if the individual feels detached, as if an observer looking into his world. It must be noted if the individual experiences his world in a dreamlike fashion, feeling distant from reality.

Lastly, it must be noted if the individual experiences the symptoms immediately or months later (American Psychiatric Association, & American Psychiatric Association, 2013).

PTSD and Family "Whenever there are crowds I start feeling like I'm in Iraq and have to get out of there fast. " -Junior enlisted soldier post Iraq (Hoge, 2010).

PTSD creates challenges for the diagnosed individual as well as their families. It may be difficult for families to accept the changes PTSD can bring to life. However, family is an important element of recovery. Families rely on one another for support. It is important to know that family members may not always know how to respond when they see symptoms of PTSD. They may be scared, sad, guilty, or even angry about the condition. Talking through

PTSD: In-Depth Overview PTSD

11

PTSD with families helps with coping strategies. It is important to talk about symptoms and what triggers them. Discussing different treatments and how they can help in recover allows families to open up. Family therapy is also a means of accomplishing these discussions (PTSD and Your Family, 2011).

When talking with children about PTSD it is crucial to be honest and listen to what they think. Offering a safe environment for them to ask questions creates progress. Promising that the PTSD will go away does not create progress. Inform the child about PTSD. Explain how it was acquired, and the recovery process (PTSD-Recovery, 2011).

Triggers are sudden reminders of the traumatic event (Barlow & Durand, 2012). They bring about flashbacks and stressful feelings. It is common for individuals with PTSD to avoid their specific triggers. In doing so, it places a hardship on the rest of the family. The family will find itself not engaging in social activities enjoyed previously. It is important for families to know what the triggers entail. Being aware of the triggers may help the individual and the family members cope. These triggers may include attending a bonfire, being at a reunion, or the anniversary of the event itself (PTSD-Recovery, 2011).

Major holidays can be painful for families navigating PTSD. Large family gatherings may now seem stressful. Holidays may now become reminders of life before PTSD. Large family groups may now be tiring and overwhelming. The individual may feel they must act happy, or feel pressured to join activities in which they do not wish to engage. There may even be relatives or people that will ask about life and specifically the PTSD. These experiences may also be lived out by the individual's family (PTSD and Your Family, 2011).

To cope with holidays, families can focus on a few strategies. Families can set limits of time spent participating in activities. Taking breaks and going on walks aids in becoming

PTSD: In-Depth Overview PTSD

12

overwhelmed. Being honest during family gathers about levels of stress sets healthy boundaries for everyone (Jongsma, Peterson & Bruce, 2007).

There are also strategies for family members. If a family member is navigating PTSD during the holidays it is important to accept their mixed feelings about the holiday itself.

Respecting the individual's decisions about involvement in celebration is crucial. Planning ahead and making decisions such as how long to attend can be helpful. Lastly, family members are encouraged to keep their expectations of the individual realistic (Jongsma, Peterson & Bruce, 2007).

Depression Experiencing a traumatic event can leave people feeling very upset. Individuals can experience flashbacks, nightmares, and vivid memories. This causes individuals to be numb and lose interest in things they once cared about (PTSD and Depression, 2011).

In cases of PTSD, depression occurs more often in women than it does in men.

Depression will make the individual feel hopeless, sad, and overwhelmed (Barlow, D. & Durand, 2012). Symptoms of depressive feelings can last a while, or just come and go. Along with hopelessness, individuals with depression may experience weight gain or lose, increase or decrease in sleep, as well as feel guilty or unworthy (Kessler, 1995).

Both PTSD and depression have been strong ties to suicide. Individuals may plan to harm themselves or others. They may talk, write, read or draw about death. Hallucinations may be included in strong cases of depression or PTSD. The individual may report hearing or seeing things that are not real. Contacting emergency services is encouraged if the above descriptions occur (PTSD and Depression, 2011).

Some studies have found a high incidence of PTSD after trauma. A sample of more than

PTSD: In-Depth Overview PTSD

13

2,000 adults women who had personally experienced such trauma as rape, sexual molestation, robbery, and aggravated assault. Participants were asked whether they had thought about suicide after the trauma, attempted suicide, or had a nervous breakdown. The table below displays the findings (Barlow & Durand, 2012).

Table 1

Treatment There are many short term treatment goals and interventions assigned to PTSD that can be found in treatment planners and online resources. While these are effective, it is also important to keep long term goals in focus. Traumatic events can bring cause a negative impact on many aspects of an individuals life. One long term goal is to reduce these negative impacts

PTSD: In-Depth Overview

"

PTSD

14

in order for the individual to return to the pre-trauma level of functioning they once had.

Coping skills can be very helpful in accomplishing this. (Romito & Hamblen, 2011).

The individual must develop and implement effective coping skills in order to carry out normal responsibilities. This will help the individual participate constructively in relationships.

The individual must utilize these coping skills to terminate destructive behaviors. Destructive behaviors serve to maintain escape and denial. Once these destructive behaviors are managed, the individual can focus on implementing behaviors that promote healing, acceptance, and responsible living. (Jongsma, Peterson & Bruce, 2007).

A very large goal is to be able to narrate the traumatic event. An individual can benefit from being able to tell their story. Recalling the traumatic event without becoming overwhelmed with negativity, urges, or bad feelings (Jongsma, Peterson & Bruce, 2007).

Catharsis can be used within psychoanalytic therapy to relive emotional trauma in order to relieve emotional suffering. This can help set the stage for narration. Cognitive therapy is used to correct negative assumptions about trauma, such as blaming oneself in some way or feeling guilty over things outside their control (Cahill, 2009).

Drugs can also be effective for symptoms of PTSD. Prozac and Paxil are effective in relieving anxiety and panic attacks. They are helpful with symptoms of PTSD (Barlow, D. & Durand, 2012). Research of PTSD has lead scientists to focus on prevention and the exploration of new medications. As gene research continues to improve, there will be a higher likelihood to pinpoint when and where PTSD begins. This will allow for targeted treatment, preventing the disorder before it causes harm.

SHORT TITLE (50 CHARACTERS OR LESS). , ALL CAPS

PTSD: In-Depth Overview

Citations and References References

American Psychiatric Association, & American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5.

Barlow, D. & Durand, V. (2012). Abnormal psychology : an integrative approach. Belmont, CA: Wadsworth, Cengage Learning.

Cahill SP, et al. (2009). Cognitive-behavioral therapy for adults. In EB Foa et al., eds. , Effective Treatments for PTSD: Practice Guidelines From the International Society for Traumatic Stress Studies, 2nd ed., pp.139-222. New York: Guilford Press.

Hoge, C. W. (2010). Once a warrior, always a warrior. Guilford: Gpp Life.

Jongsma, A. E. , Peterson, L. M. , & Bruce, T. J.(2007).The complete adult psychotherapy treatment planner.

Kessler RC, et al. (1995). Posttraumatic stress disorders in the National Comorbidity Survey.

Archives of GeneralPsychiatry, 52 (12). : 1048-1060.

Romito, K. , & Hamblen, J. (2011, January 13). PTSD and Your Family - Overview. Retrieved from http://www. webmd. com/anxiety-panic/tc/ptsd-and-your-family-overview Romito, K. , & Hamblen, J. (2011, January 13). PTSD and Depression - Overview.

Retrieved from http://www. webmd. com/anxiety-panic/tc/ptsd-and-depressionoverview Romito, K. , & Hamblen, J. (2011, January 13). Post-traumatic stress disorder recovery.

Retrieved from http://www. webmd. com/anxiety-panic/tc/post-traumatic-stressdisorder-recovery (post-traumatic-stress-disorder, n. d. ). Retrieved fromhttp://www. nimh. nih. gov/health/topics/post-traumatic-stress-disorder-ptsd/index

15