Posttraumatic stress disorder (PTSD) as a diagnosed condition did not exist before the 1980’s. In fact it had obviously been around for as long as man had been traumatizing man. In World War I it was referred to as “shell shock”. Any time through history when there was a natural disaster when people may have been severely traumatized, the condition would undoubtedly have occurred.
Causes of PTSD
Amongst the most common causes of PTSD are: combat, sexual assault, physical abuse, domestic violence, crime and violent motor vehicle accidents.
In the case of children, it can be any inappropriate sexual experience, regardless of whether or not there is violence involved. Bullying in children is a problem, not only being on the receiving end, but even being a witness.
The sense of helplessness as a witness in a traumatic event is something that all PTSD patients are seriously troubled by for a very long time.
Symptoms of PTSD
To be able to diagnose PTSD, an individual should have symptoms for at least a month following the trauma. These include:
- Extreme fear
- Feelings of helplessness
- Re-living the trauma
- Avoidance of people, places and situations which feel threatening or remind the individual of the trauma
- Numbness
- Hyperarousal – excessive response to minor stimuli, e.g. a door slamming
- Sleep disturbance
- Impairment of cognitive function
- Impairment of function in the work place
The sleep disturbance specifically includes nightmares related to the trauma, nightmares unrelated to the trauma and panic attacks.
Treatment of PTSD
Various different modes of treatment have been used in dealing with PTSD, with varying success. These fall into the main groups of pharmacotherapy and non-pharmacotherapy.
Pharmacotherapy in PTSD
The most frequently used drugs are as follows:
- Selective serotonin reuptake inhibitors (SSRI’s), e.g. fluoxetine, sertraline and paroxetine are the most frequently and successfully used in treating the anxiety disorder and frequent co-morbid depression which may occur.
- Beta-blockers can be useful for some of the symptoms of hyperarousal.
- Monoamine oxidase inhibitors. May be useful in the panic disorders and depression. An older anti-depressant with many more side effects. These are seldom used.
Non-Pharmacotherapy in PTSD
Psychotherapy is an important part of the treatment, and is found to be most beneficial if it can be introduced very early after the traumatic event. Prolonged exposure (PE) or flooding, of the individual with the negative stimuli is beneficial to many. Cognitive behavioral therapy (CBT) and desensitization therapy can help. Bright light therapy has been found helpful in treating the sleep disturbance, and is beneficial in terms of avoiding more drugs
The spouses and families are also under a great deal of stress with a family member who is suffering from PTSD. So family therapy is generally needed. .
Complications and Prognosis of PTSD
If patients are left untreated there is a higher than normal risk of the following:
- One of the most prevalent side effects is substance abuse either with alcohol or other drugs.
- Major depression, generalized anxiety disorders, various phobias and obsessive-compulsive disorder.
- Deterioration of family and work relationships.
- Possible suicide or even homicide
- The average time span of symptoms of PTSD in a treated patient is 3 years. In an untreated patient this will be at least 5 years.
- As many as 33% of patients with PTSD never fully recover. Which means that many people will be less than fully functional in the family, society and work situations.
Factors Which Improve a Patient’s Prognosis:
The earliest possible start to ongoing supportive treatment. Patient’s preference in treatment needs to be taken into account in the management process. A positive history prior to the trauma in terms of mental health and lack of substance abuse are in the patient’s favor. Avoidance of further trauma prevents more damage being done to undermine progress in the recovery process.
Support from the family, which means adequate support for the family as well.
The modern age is an age of increasing trauma. The results are affecting society in very many ways, one of which is PTSD. This is a crippling anxiety disorder, mainly caused by mankind. It causes many people, who could otherwise be useful contributing members of society, to lose their self-respect and value and makes them a burden that they would never choose to be. Public understanding of the condition is an essential first step to overcoming the problem.
Reference:
Gore TA, Lucas JZ, March 2010 "Posttraumatic Stress Syndrome" (online) Available: emedicine.medscape.com/article/288154-overview 18 June 2010
Sally Powrie - I am a wife, mother of 5, mother-in-law of 2, grandmother of 2, general practitioner of more than 20 years standing, and for the last 4 ...
