PTSD (post-traumatic stress disorder) is a psychiatric disorder that a person can develop after a traumatic event. Often associated with military veterans but can affect people after many different types of extreme stress this disorder can happen to anyone after experiencing or witnessing something terrifying.
PTSD is when a person has difficulty working through the stress of what happened. They often are triggered by images, smells, or sounds that remind them of whatever tragic event caused them to have PTSD. These triggers can bring with them the memories of the event and leave the person frightened and stressed.
When a person experiences extreme stress the hypothalamus and adrenal gland sends a large amount of adrenaline and cortisol as part of the fight or flight mechanism. Adrenaline and Cortisol stop the functions that are not needed during a fight or flight situation. The sympathetic nervous system releases adrenaline which makes the heart beat faster, breathing to quicken, your senses become more acute, which can explain how triggers work. A large amount of adrenaline can interfere with short-term memory and cause confusion.
Studies have shown that PTSD is related to the large amounts of cortisol being sent during an extremely stressful situation this reaction could damage and shrink the size of the hypothalamus and negatively affect the short-term memory. (Bremner et al., 1995).
When a person does not have PTSD it takes about an hour to recover from a fight or flight situation. But when the PTSD patient experiences their extremely stressful even, they are not able to recover fully and are triggered by the senses that where in high alert during the experience setting the person back into the fight or flight mode again.
Risk factors for PTSD
The number one risk factor for PTSD is being exposed to trauma. That is not however something that can be controlled due to outside influences. Some examples of stress factors that can cause PTSD include; long- or short-term abuse, Combat in the military, sexual and/or physical assault. A controlled aspect to this is creating programs to protect people, such as programs to prevent abuse. Creating a support system so that people feel cared for so better able to deal with stress. Therapy for military members, and better preparing them with ways of dealing with the stress of combat. This are controlled risk factors. There are studies that stat that some people may have genetic factors that increase their likelihood of getting PTSD, of course that is an uncontrolled risk factor. It is said that women are more affected by PTSD than men.
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Signs and symptoms of PTSD may not present right away in fact it may take years after the event for signs to become apparent. When they do happen, they can be grouped into four main categories (Mayo, 2018). One category is intrusive memories; this can present as bad dreams about the event, it can be invasive thoughts, it can present as fight or flight symptoms when something triggers a memory of the event. Another symptom of intrusive thoughts is flashbacks, when a person relives the experience in their head.
Another symptom is avoidance, avoiding speaking or thinking about the event this can be particularly hard when trying start treatment. Avoidance includes avoiding the location of the traumatic event, or people associated with the event or even activities that bring back traumatic memories.
In addition to the first two indications is negative reactions and mood including depression, not being interested in things that the patient once enjoyed. This symptom includes memory loss because of the memory not working as well during fight or flight.
The last category for symptoms is the reactions, both physical and emotional. This could include being easily startled, not sleeping well, the feeling of overwhelm. Some people experience the need to numb themselves and drink or take drugs to do so. Some people act out aggressively.
While the symptoms are put into categories every patient of PTSD reacts uniquely, there is no strict code for identifying PTSD or for knowing how a patient will react.
It has been described as the silent scream, it is something that people battle with internally, you can’t look at someone and know that they have PTSD like you would a physical disorder.
Labs and tests
The study that looked at the hypothalamus used imaging to view damages decreases in that part of the brain in patients with PTSD. (Bremner et al., 1995).
When diagnosing a patient for PTSD after a traumatic event a Doctor would perform a physical exam and a psychological evaluation. They would then use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to help them diagnose what the patient is dealing with.
Medications and treatments
The treatment for PTSD includes both psychotherapy and medications. There are so many combinations of therapies and medications that can be tried. As each case is different, PTSD presents uniquely for each individual there are many ways in which healing can occur.
Medications include anti-depressants, anti-anxiety medications and possibly sleep medications.
As for psychotherapy there are endless examples, cognitive therapy which is helping a person understand how they think and react to situations and helping them work through it to live a better life. Exposure therapy helps a person deal with the trauma head on, they must face the memories sometimes using virtual reality to put them into a simulated situation like the trauma. Eye movement desensitization and reprocessing (EMDR) is using a series of rapid eye movements to help the patient process the traumatic memories and how they react to it. It is interesting; I know someone going through it now and they are exhausted after a session. Other types of therapy include music therapy, animal therapy, and many other types. What works for one person may not work for another.
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PTSD is a disorder that may be hidden, it may go undiagnosed and it may be something someone suffers with for a long time. As health care professionals, friends and family it is important to understand the signs and symptoms and be able to help patients with it. It is important to be gentle and kind because you never know what someone is going through.
- Bremner, J. D. (2003, July 1). The Effects of Stress on Brain Function. Psychiatric Times, 20(7), 18. Retrieved from https://libproxy.ecpi.edu:3061/apps/doc/A105044915/HRCA?u=lirn55593&sid=HRCA&xid=5913cba3
- Duax, J. M., Bohnert, K. M., Rauch, S. A. M., & Defever, A. M. (2014). Posttraumatic stress disorder symptoms, levels of social support, and emotional hiding in returning veterans. Journal of Rehabilitation Research & Development, 51(4), 571+. Retrieved from https://libproxy.ecpi.edu:3061/apps/doc/A383047836/HRCA?u=lirn55593&sid=HRCA&xid=15bb4164
- Johnson, K. (2011, January). PTSD research targets memory reconsolidation: treatment, which usually involves propranolol, erases emotional reaction to the traumatic memory. Clinical Psychiatry News, 39(1), 12. Retrieved from https://libproxy.ecpi.edu:3061/apps/doc/A248406997/HRCA?u=lirn55593&sid=HRCA&xid=f6ff37b3
- Post-traumatic stress disorder (PTSD). (2018, July 6). Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
- Post-traumatic stress disorder (PTSD). (2018, July 6). Retrieved from https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/diagnosis-treatment/drc-20355973
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