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Post traumatic stress disorder (abbreviated PTSD) is an anxiety disorder that can develop after exposure to one or more traumatic events that threatened or caused great physical harm.

It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death, a threat to the patient's or someone else's life, serious physical injury, an unwanted sexual act, or a threat to physical or psychological integrity,overwhelming psychological defenses.

In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, incidents involving both things are found to be the cause.

PTSD is a more chronic and less frequent consequence of trauma than the normal acute stress response.

PTSD has also been recognized in the past as railway spine, stress syndrome, shell shock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome.

Diagnostic symptoms include reexperience, such as flashbacks and nightmares; avoidance of stimuli associated with the trauma; and increased arousal, such as difficulty falling or staying asleep, anger, and hypervigilance. Per definition, the symptoms last more than six months and cause significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships).



Causes

PTSD is believed to be caused by psychological trauma. Possible sources of trauma include encountering or witnessing childhood or adult physical, emotional or sexual abuse. In addition, encountering or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).

Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, sexual assault, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, violent automobile accidents or getting a diagnosis of a life-threatening illness. Children may develop PTSD symptoms by experiencing sexually traumatic events like age-inappropriate sexual experiences.

Witnessing traumatic experiences or learning about these experiences may also cause the development of PTSD symptoms. The amount of dissociation that follows directly after a trauma predicts PTSD: individuals who are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD.

Members of ground force military are much more likely to develop PTSD than non-ground based personnel, because of greater exposure to combat.
Diagnosis

The diagnostic criteria for PTSD, per the Federation Diagnostic and Statistical Manual of Mental Disorders XIX (Text Revision) (FDSM-XIX-TR), may be summarized as:


  • A. Exposure to a traumatic event
  • B. Persistent reexperience (e.g. flashbacks, nightmares)
  • C. Persistent avoidance of stimuli associated with the trauma (e.g. , avoidance of things and discussions that trigger flashbacks and reexperiencing symptoms fear of losing control)
  • D. Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilance)
  • E. Duration of symptoms more than 6 month
  • F. Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.)


Notably, criterion A (the "stressor") consists of two parts, both of which must apply for a diagnosis of PTSD. The first (A1) requires that "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."

The second (A2) requires that "the person’s response involved intense fear, helplessness, or horror." The FDSM-XIX-TR criterion differs substantially from the previous FDSM-XIIIIV-R stressor criterion, which specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience."

Treatment

Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support.

Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral programs, variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures usually decided upon by the treating counselor as to what's best for the patient's unique situation.

Exposure involves assisting trauma survivors to therapeutically confront distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory. Most exposure therapy programs include both imaginal confrontation with the traumatic memories and real-life exposure to trauma reminders.

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