Everyday millions of people in the United States alone deal with anxiety disorders that complicate and impair their life. No defiant numbers are available but it is thought to be in the five to seven million range. The lack of numbers is due mainly to people not realizing that there is something wrong with them, often putting off their disorder as over acting or excessive worrying. Another reason that we do not know the exact amount is due to the social stigma of having a mental condition, and how society often looks down upon those that are not as "strong" as the social norms. Some of the stigma is gone in today's society, yet people still feel they must hide any imperfection in themselves from the world. However, there is an exception, there are people who feel they get the attention that they crave by being "sick" and often claim many diseases.
Anxiety disorders are broken down into five subcategories and many smaller categories. The five main subcategories are panic disorder, phobias, generalized anxiety disorder, obsessive compulsive disorder and post- traumatic stress disorder. Panic disorder, which are episodes of intense fear along with distressing psychological and physical symptoms. Phobias are fears of certain social situations, or specific things such as flying and spiders. Obsessive-Compulsive disorder is a ritual based disorder in which the sufferer uses the ritualistic behaviors to push away disturbing thoughts in their heads. They believe if they stop the rituals the thoughts would overwhelm them or something bad will happen to them or someone they love, some even believe the world will end if they stop this behavior. Generalized Anxiety disorder is characterized by a constant feeling of nervousness or unease. Finally, Post-Traumatic Stress disorder, which is a condition that develops after a terrifying experience, such as near death or rape. Common in these sufferers and apparent in a significant amount of patients treated for post- traumatic disorder is depression, anxiety along with flashbacks of the traumatic event and nightmares that plague their sleep. The main focus of this paper is a more in-depth look at post- traumatic stress disorder who it effects, why and how to treat and diagnose people suffering from post- traumatic stress disorder.
Post-traumatic stress disorder is the development of symptoms after an emotionally traumatic event. It is easy to determine why a person would suffer from stress after a traumatic event but often people believe that people suffering from this disorder are being overly dramatic. The main reason is that trauma happens and the person's psychological system can not handle the event in the usual ways that most handle trauma, so their mind reacts in an adverse way.
The symptoms of post- traumatic stress often occur right after the even and with in a short time afterwards. Although this disorder can effect anyone regardless of age, it shows differently in younger children than in adults. Children may become mute refusing to talk or refuse to talk about what has happened to them. Though the child is being silent, he or she is still remembering what has happened to them. The younger the child the less likely they are to know that what they are going through is reliving the past, they believe that what has happened is happening again to them. Often they believe they have monsters in the closet or will reenact the event. One of the weirdest occurrences in children is their change in the way they see the future. Often becoming, in their own thoughts, clairvoyant or thinking themselves able to see future events. Believing they can see the future, though they are not seeing a future marriage, children, or career they see tragic events that are yet to come. Some children seem just to be having more physical illness symptoms, which makes it harder for their parents to see anything emotionally wrong with their children. Common bonds in all children suffering from post- traumatic stress are, disinterest in activities that once held the child's attention and heightened arousal (easily excitable).
There is no evidence that this disorder is prevalent in one sex over the other. Nor is there a number count on the amount of people suffering from post- traumatic stress disorder. The lack of people thinking that they have a disorder after a tragic event that put it down to regular stress or grief keeps the ability to get a number amount of sufferers impossible to achieve. The victims or sufferers are from different social-economic backgrounds with varying ranges in education. There is no set person that will get this disorder. Anyone from any background from royalty to poverty are eligible and able to develop post-traumatic stress disorder.
The on-set of this disorder is a traumatic event, though there is no set event that causes this to be worse or more apt to happen in a patient. However, a few events that most patients have experienced are more likely to cause them to develop post- traumatic stress disorder. Trauma for this even can happen alone or within a group of people. There is no set amount of people present at the event that will either encourage or discourage post- traumatic stress from developing. The development comes from a lack of coping skills within the human psyche. Since each person has a different point in which they can cope with certain situations, each person will come out of an event with some different perspective and way of coping. Some of the events that are most likely to cause the development of post- traumatic stress are, rape or assault, war and military combat, natural disasters, terrorist attacks, car accidents and near death experiences. Though these causes are not the sole stimuli to development of post-traumatic stress disorder they are the most likely stressors.
The traumatic event that sets off the development of post- traumatic stress disorder are relived in variety of ways within the sufferer. From memory flashbacks and disturbing nightmares, the sufferers' mind completely invaded by the traumatic event. In some sever cases of post- traumatic stress disorder the sufferer deals with dissociative states, where they do not know where they are and in their mind they are in the event which triggered their disorder. Yet, the most common characteristic is heightened arousal in the sufferer, which can stimulate the flashbacks even more and make them worse then a flashback than a person without post-traumatic stress disorder would have.
Though trauma is what begins the development of post- traumatic stress disorder, there is evidence pointing to previous psychological conditions in some cases. However, not all of the sufferers have to have a predisposed psychological disorder to develop post- traumatic stress disorder. Anyone of any mental capacity is able to get the disorder all depending on the traumatic event and the amount of stress their own psyche could accept at the onset of the disorder.
The complications of post- traumatic stress disorder vary from very mild to the extremity of severe. With a simple discomfort in certain situations with or without mild depression, which is another complication of post- traumatic stress disorder. On the opposite end is the severe total life encompassing side of the complication. The sufferer's life is completely ruined, they can not have relationships with anyone and often shut themselves of from the whole world. Agoraphobia is not uncommon amongst the worst sufferers of post- traumatic stress disorder. Feelings of guilt, self blame on what happened to them and self hatred are also often present in most cases of post- traumatic stress disorder. Some of the extreme cases tend to be suicidal and emotionally a wreak in all parts of their lives. While impairments are present in even the mildest post- traumatic stress sufferer, the amount of impairments and complications in the severe cases are so many that all of the complications and impairments are not yet known to therapist and psychologist. Anxiety, severe depression and heightened arousal also are factors of post-traumatic stress disorder.
Often miss diagnosed, as post- traumatic stress disorder is adjustment disorder, which is less severe and much easier to cure. Adjustment disorder is more within the human psyche to heal itself. Though it presents many of the same criteria of post- traumatic stress disorder and that is why it is often misdiagnosed as post- traumatic stress disorder. However, it lacks the amount of heightened arousal that is the main characteristic of post- traumatic stress disorder. Adjustment disorder also lacks the amount of aggression that post- traumatic stress sufferers seem to have. The length of time Adjustment disorder last is also much shorter then the average post- traumatic stress period, which without therapy could last the whole of a person's life time.
The following information is taken directly from the DSM and is the diagnostic criteria for post- traumatic stress disorder. Therapist and psychologist must uses this criteria to diagnose their patients correctly.
Diagnostic Criteria for Post- Traumatic Stress Disorder
The person has experienced or witnessed an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threats to one's life or physical integrity; serious threat or harm to one's children, spouse or other close relatives or friends; sudden destruction of one's home or community; seeing another person who has recently been, or is being, seriously injured or killed as the result of an accident of physical violence.
The traumatic event is persistently re-experienced in at least one of the following ways:
recurrent and intrusive distressing recollections of the event (in young children, repetitive play in which themes or aspects of the trauma are expressed)
recurrent distressing dreams of the event.
sudden acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative {flashbacks} episodes, even those that occur upon awakening or when intoxicated)
Intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma.
Persistent avoidance of stimuli associated with the trauma or numbing of the general responsiveness (not present before the trauma), as indicated by at least three of the following:
efforts to avoid thoughts or feelings associated with the trauma
efforts to avoid activities or situations that arouse recollections of the trauma
inability to recall an important aspect of the trauma (psychogenic amnesia)
markedly diminished interest in significant activities (in young children loss of recently acquired developmental skills such as toilet training or language skills)
feeling detachment or estrangement from others
restricted range of affect, e.g., unable to have loving feelings
sense of foreshortened future, e.g., does not expect to have a career, marriage, or children, or a long life
Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:
difficulty falling or staying asleep
irritability or outburst of anger
difficulty concentrating
hypervigilance
exaggerated or startle response
physiologic reactivity upon exposure to events that symbolize ore resemble an aspect of the traumatic event (e.g., a woman who was raped in an elevator breaks into sweat when entering any elevator)
Duration of the disturbance (symptoms in B,C, and D of at least one month)
Specify delayed onset if the onset of symptoms was at least six months after the trauma.
Treatment for post- traumatic stress disorder has changed a lot in the past five years. One psychologist, Dr. John A. Talbott, who is well read and known in the post-traumatic stress study field, said at a conference at the University of Colorado recently, "The state of therapeutics in post traumatic stress disorder can be described in one word as confusing. Frankly, it's a mess. The literature is not great but it's an intriguing field in many ways. It's ever-evolving. It's so different than it was 20 or 30 years ago. (Jancin)" An Example is, therapist once believed that therapy within seventy-two hours of the traumatic event helped to stop the onset of post-traumatic stress. This therapy known as "one shot approach" once common now found ineffective and may even slow down the recovery processes (Sherman). In the last ten to twenty years the one shot debriefing became customary and then in some cases, such as rape, mandatory. Therapist believed that relieving the events and talking about them soon after the event happened would help to relieve any lingering distress about the event. The one shot debriefing was never really studied until the late nineteen nineties, at which time psychologist found many flaws in this process. As studies on this form of therapy continued, increasingly evidence appeared showing that this therapy causes more harm then good. A control group of motor vehicle accident survivors was done breaking into two groups. One group getting the one shot therapy and the other getting forty five weekly sessions of therapy over a two to five week time period after the accident. The studies at first showed no difference with the newer therapy verses the one shot at three months. Though at thirteen-months into the control groups studies showed that the one shot therapy patients doing much worse then the other groups and fifteen percent meeting the criteria for post- traumatic stress disorder. In more studies done over longer time periods it has been found that the victims that receive the one shot debriefing remain more significantly in post- traumatic stress symptom and diagnose criteria area then their counterparts (Sherman).
A more controversial therapy that happened between the one shot debriefing and today's newer therapy was a mix between cognitive behavioral therapy and exposure therapy. The exposure therapy, a modern version of ventilation and reexperiencing therapy, had the patient relieve over and over the traumatic event (Jancin).
Today's therapy is more main stream with the ideology of the time, more so then past therapies. It used to be very controversial to "vent" out your problems to a psychologist; today it seems most people have at least once seen an analyst or therapist or had a close relative or friend see one. These days people joke about being on or needing the psychiatrist wonder drug Prozac. Post- traumatic stress disorder today is a combination of drugs and psychotherapy. The drugs most often prescribed are selective reuptake inhibitor, Zoloft (sertraline) which is started at a recommended 20 mg a day and increased by 10mg if needed until the patient has leveled off generally around 20 to 50 mg. Paxil has also been found effective as drug therapy for post- traumatic stress sufferers. After a twelve-week study of patients, taking Paxil showed that 62% of the patients on 20mg a day and 54% of those on 40mg a day improved significantly. This is in contrast to the 35% on placebo that showed improvement. Paxil users have also made great improvements on reducing the amount of flashbacks and hyperarousal, yet it does not cause patients to have insomnia like Zoloft can (Mechcatie). Side effects of Paxil are impotence, nausea, abnormal ejaculation, diarrhea, somnolence (drowsiness or sleepiness) and asthenia (loss or lack of bodily strength).
Along with drug therapy, cognitive behavioral therapy is still used. The patient is taught to identify the underlying problem and turn the negative thinking around the problem. The patient develops coping skills and the goal is a more positive behavior adaptation about the problem and the way to deal with it.
With therapy and drug treatment many post-traumatic stress sufferers are able to live fairly normal lives. They can get back to their day to day activities and even learn to deal with the past events. Though little is known about the patients that do not seek treatment, we do know that those who do not seek treatment often get worse, and have a fairly high suicide rate. As Dr. Talbott said the field of study on post-traumatic stress disorder is confusing and intriguing all at the same time. Further efforts need to be made and people surviving traumatic events that the authorities know about should have mandatory referrals and checkups on the survivors and families to check for signs of post-traumatic stress.
Reference
American Psychiatric Association [APA], (2000). DSM -IV-TR, p. 465-468
Cruz, Jessi (1998, January 9) Anxiety disorders separated into 5 categories. Knight Ridder / Tribune News Service p.109 v. K7309
Jancin, Bruce (2001, December) PTSD responds to Mix to Drugs, Psychotherapy.(Consider CBT, SSRI). Clinical Psychiatry News p. 40 v. 29
Sherman, Carl (2002, February) Prolonged exposure therapy works, debriefing does not. (In Trauma's Shadow). Clinical Psychiatry News p. 36 v. 30
Mechcatie, Elizabeth (2002, January 15). Paxil. (New and Approved). Internal Medicine News p.8 v.35 i2
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