Ask Dr. V: Post Traumatic Stress Disorder
Venus Nicolino, PhD of clinical psychology, answers your questions in this section. This week: Post Traumatic Stress Disorder
Dear Dr. V,
My twenty-year-old son, a student at Virginia Tech, has been diagnosed with PTSD. To me, it seems sort of early to be diagnosing him with a disorder? I hear about PTSD all the time but would like a more detailed description.
Post-traumatic stress disorder is defined in terms of the trauma itself and the person’s response to the trauma. Trauma occurs when a person has experienced, witnessed or been confronted with a terrible event that is an actual occurrence. Alternatively, like in the case of your son, the person may have been threatened with a terrible event, perhaps injury (physical or psychological) or death to themselves or others. Then, the person’s response to the event or to the threat involves intense fear, helplessness, and/or horror.
It is important to note, however, that having strong reactions to trauma is normal. What’s more, there is a range of expected reactions depending on a person’s prior exposure to trauma and even on hereditary (genetic) factors. My thought is that your concern regarding your son’s diagnosis may involve another set of questions to answer. For example, what is the difference between normal grief and the pathological (abnormal) PTSD illness? What are the transient (temporary) posttraumatic stress symptoms that anyone would be expected to experience? And, at what point in the duration of symptoms would some treatment make sense?
In general, post-traumatic stress disorder can be seen as an overwhelming response of the body’s normal psychological defenses against stress. So, after the trauma, there is abnormal function (dysfunction) of the normal defense systems, which results in certain symptoms. The symptoms are produced in three different ways:
* Re-experiencing the trauma
* Persistent avoidance
* Increased arousal
First, symptoms can be produced by “re-experiencing” the trauma, whereby the individual has distressing recollections of the event. For example, the person may relive the experience as terrible dreams or nightmares, or as daytime flashbacks. Also, external cues in the environment may remind the patient of the event. As a result, the psychological distress of the trauma is brought back by internal thoughts, memories, and even fantasies. Individuals can also experience physical reactions to stress, such as sweating and rapid heart rate. (These reactions are similar to the “fight or flight” responses to emergencies.) It can feel very real, and the patient’s posttraumatic symptoms can be identical to those symptoms experienced when the actual trauma was occurring.
The second way that symptoms are produced is by persistent avoidance. The person tries to avoid trauma-related thoughts, feelings, activities or situations that may trigger memories of the trauma. This so-called psychogenic (emotionally caused) loss of memory of the event can lead to a variety of reactions. For example, individuals may develop a diminished interest in activities that used to give pleasure; they may detach from other people, and restrict their range of feelings.
The third way that symptoms are produced is by an increased state of arousal of the affected person. These arousal symptoms include sleep disturbances, irritability, outbursts of anger, difficulty concentrating, increased vigilance, and an exaggerated startle response when shocked.
Anyone can normally have any combination of the above-described symptoms during the first month after a significant trauma. If, however, these symptoms persist for more than one month, and cause significant distress or impair the person’s ability to function, then the diagnosis of PTSD can be made. If the duration of symptoms is more than three months, a diagnosis of chronic PTSD is made. In some cases, oddly enough, the onset of symptoms is not until six months after the stressful events. This situation is referred to as delayed onset of PTSD, for which the outcome (prognosis) is often worse.
Research has shown that when symptoms are immediately stifled, it can be harmful. In other words, allowing an early peaking of the symptoms of depression and other PTSD problems is appropriate and preferable. Therefore, many of the treatments that psychiatrists recommend include the reviewing of the critical incident. That is, we meet with the victims as soon as possible after the traumatic event. The purpose of the meeting is to discuss the event in detail with those most involved, as well as with those individuals who are involved at some distance.
The specific goal is not to push the trauma away, but to get the people to talk about all aspects of the trauma and how it is affecting them.
Gathering this information will lead to a more rapid, specific diagnosis. It has been found that with early intervention techniques, people are less likely to develop full-blown PSTD. So, once PTSD has been diagnosed, what are the most successful ways to treat it?
The basic tools for the treatment of post-traumatic stress disorder are:
* Individual therapy for specific symptoms
* Peer group support, especially for chronic PTSD
Various professionals have their own methods for treating PTSD. A survey of PTSD experts, however, seems to conclude that for early, milder PTSD, stress debriefing and counseling are especially important. For more severe acute PTSD, medication, stress debriefing, and group and individual psychotherapy should be started in combination.
Note: All information in the Ask Dr. Venus column is for educational purposes only. For specific medical advice, diagnosis and treatment, please feel free to call Dr. Venus, or consult your doctor.
Please feel free to email Dr. Venus a question for posting at drvenus@TheSavvyGal.com; questions may be edited for grammar and length; emails are only read by Dr. Venus.