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Posttraumatic Stress Disorder (PSTD)

Posttraumatic Stress Disorder (PSTD)
Introduction
            Posttraumatic stress disorder (PSTD) is a type of an anxiety disorder which is characterized by severe emotional wounds after a traumatic experience. Sufferers of PSTD have a recurrence of memories of fear and persistent threat leaving the individual with a felling of shattered and entirely devastated by events. This condition can affect persons of any age or gender and is a serious psychological disorder whose prevalence continues rise especially with increased exposure to traumatic experiences as technology advances (Kinchin, 2004). The uniqueness of posttraumatic disorder as an anxiety disorder is that in addition to experiencing distressing symptoms, the individual must have had stressful experiences. PSTD is present in 1 in 20 men, 1 in 10 women and highly prevalent during childhood (about 50% of all PSTD patients experienced PSTD during childhood) (Ford, 2009) and it calls for positive diagnosis and prompt treatment. This paper discusses posttraumatic stress disorder by focusing on the etiology, risk factors, symptoms, diagnosis and available treatment of the disorder. PSTD emerges as a serious anxiety disorder which can ruin the lives of victims forever, hence need for prompt positive diagnosis and treatment.
Prevalence
            Although the highest cases of PSTD are seen in persons who have gone through a rape ordeal and combat veterans (prevalence ranging from 10% to 30%), PSTD is also common among other victims of traumatic events. In the United States, about 7-8% of the whole population develops PSTD in lifetime with higher occurrences being seen among African Americans and Native Americans than among Caucasians. Women have a higher likelihood of developing PSTD compared to men (Dryden-Edwards & Stoppler, 2010). Ullman et al (2005) explain that about 10.4% of women develop PSTD during the lifetime. As such, the disorder is a serious public health concern. It is estimated that for 40% of all teens and children who have experienced a traumatic event, six percent of boys and fifteen percent of girls develop PSTD. In the U.S., up to six percent of all high school students who have gone through a traumatic event develop PSTD and almost all children who have experienced direct or indirect trauma including sexual abuse an witnessing a parent being killed end up developing PSTD (Dryden-Edwards & Stoppler, 2010).
Etiology
Posttraumatic stress disorder occurs after a person has been exposed to experiences that are “beyond the range of normal human experience: an event which would markedly distress almost anyone” (Kinchin, 2004, p. 2). A person responds to an abnormal event which may have threatened one’s life, a friend, children or a relative. It is important to note that even though an event may be traumatizing theoretically, the victim has to perceive the event as traumatizing for the condition to be termed as PSTD. There are several incidents that are known as likely to lead to PSTD. Kinchin (2004) mentions that PSTD is on increase mainly due to modern ways of living where technological advance is increasing serious life stressors as well as severe traumatic conditions.
There are a number of traumatic events that can lead to PSTD. These can be naturally occurring events or man-instigated events. Some of the intentional human acts that are traumatic and can lead to PSTD include engaging or witnessing war (combat or civil war), sexual abuse of any form, physical abuse including battering and stalking, emotional abuse such as threats or physical neglect, torture, criminal assault, hijacking, kidnapping, and death threats among other experiences. Some of the unintentional human experiences that may be traumatic to the level of causing PSTD include technological accidents such as a crane crash, automobile accident, nuclear disasters such as the Chernobyl accident, and damage/loss of body part during a surgical process more so when one is at a tender age, fires and others. Natural disasters can also be traumatic enough to cause PSTD and these include floods, earthquakes, hurricane and avalanche, being attacked by an animal, experiencing a famine or losing a close friend or an unborn child in a sudden manner (Schilardi, 2009).
Risk factors
Mere exposure to traumatic experiences does not imply that an individual will develop PSTD. McNally (2003) explains that although a majority of Americans have had an exposure to traumatic incidents, only a small proportion of the population develops PSTD. For instance, among 60.7% of individuals who had been exposed to traumatic conditions, only 8.2% and 20.4% of men and women respectively had developed PSTD in their lifetime. In addition, only 34.3% of all survivors of Oklahoma City bombing developed PSTD. These statistics are a clear indicator that there are certain factors that put some people at a higher risk of developing PSTD than others despite similar exposures to traumatic stressors. Persons who spent their childhood in unstable families are known to have an increased risk of PSTD. It is also more likely to have PSTD developing among individuals who have a preexisting anxiety disorder or people who have a family history of anxiety disorders develop PSTD than the normal population (Mcnally, 2003).
People who have gone through stressful lifestyles and lack social support also tend to develop PSTD as experienced by war veterans who lacked social support after the Vietnam War.Mcnally (2003)highlights that the level of IQ determines an individual’s ability to develop PSTD especially among children. It is indicated that children who have an IQ that is above average hardly develop PSTD compared to children who have an IQ that is below average. The cognitive ability of an individual can also be used to predict the risk of developing PSTD where persons with above-average cognitive ability withstand stress better and hence get buffered from PSTD. Having negativistic personality traits such as paranoia and hypochondriasis also elevates the risk of developing PSTD.
Symptoms
            A variety of symptoms are associated with PSTD but the symptoms can be categorized into three: hyper-arousal, avoidance/numbness and reoccurrence of traumatic experience. Symptoms are usually seen three months after exposure to a traumatic incident (Melinda & Segal, 2010). Symptoms that portray increased arousal may be shown in form of the victim being very irritable and anger comes in outburst. The victim has difficulty with sleeping and he or she is easily startled. It is common to find the PSTD victim having difficulties in concentrating and mostly he or she shows hypervigilance and constant alertness. An individual who is suffering from PSTD will most often present with symptoms that indicate avoidance of the traumatic event as well as emotional numbing. Such a person will try as much to keep away from activities or places that are associated with the trauma or thoughts that would provoke thee individual to remember the trauma. For instance, a PSTD individual who had a serious car accident may avoid any scenes that involve car accidents even if it includes watching such a scene on television.
Some people may present with difficulties in recalling the main aspects of the trauma. It is also possible to have such people lose interest with life and important life issues. As such, the victim may lose hope about future. Emotional numbness and detachment is also a very common symptom. PSTD patients also keep on re-experiencing the traumatic situation with the memories of the trauma being very upsetting and intrusive. Nightmares are very common among PSTD victims. If a PSTD victim remembers the traumatic incident, they usually have severe physical reactions such as rapid breathing. Flashbacks of the trauma are also common symptoms of PSTD (Melinda & Segal, 2010).
Diagnosis
PSTD diagnosis is made using the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR). It is important to note that PSTD is the only anxiety disorder whose diagnosis requires an examination of existence of a traumatic event. The six criteria (DSM-IV) for diagnosis of PSTD include:
“(1) Trauma- the person must be exposed to a traumatic event or events that involve actual or threatened death or serious injury, or threat to the physical integrity of self or others. The person’s response must involve fear, helplessness or horror; (2) intrusive – the event must be persistently relieved by the person; (3) avoidant – the person must persistently avoid stimuli associated with the trauma; (4) physical – the person must experience persistent symptoms of increased arousal, or ‘over-awareness’; (5) social- the disturbance must cause significant distress or impairment in social, occupational, or other areas of functioning important to the person and (6) time – symptoms, linked to 2, 3, and 4 above must have lasted at least a month” (Kinchin, 2004, p. 5).
 
To assess for PSTD symptoms, it is important to follow a systematic and comprehensive strategy, commonly referred to as a diagnostic interview. This is commonly done with instruments such as the Clinician-Administered PSTD Scale (CAPS), the Diagnostic Interview Schedule IV or the PSTD Symptom Scale-Interview Version (Institute of Medicine (U.S.) et al, 2006). It is pertinent to understand that PSTD is clinically diagnosed and currently there has not been any laboratory test that can diagnose the disorder. Although brain-imaging studies have been conducted, there is still no brain-imaging diagnostic technique developed so far. The only laboratory tests that may give a clue to the existence of PSTD include determination of heart rate or sweat gland activity but these should not be depended on due to risk of misdiagnosis (WebMD, 2010).
Treatment
            There are both psychotherapeutic as well as pharmacotherapeutic means of treating PSTD. It is important to highlight that treatment for PSTD does not entirely cure the disorder but instead treatment acts as a reliever of the symptoms associated with PSTD. The individual is helped in coping with the trauma by allowing them to release the emotions associated with the trauma. Cognitive-behavioral treatments (CBT) are the most common forms of psychosocial treatments for PSTD. CBT interventions include treatment programs such as “exposure procedures, cognitive restructuring procedures, anxiety management programs, and their combinations”(Foa & Meadows, 1997, p. 451).The victim can undergo trauma-focused CBT where the individual is gradually exposed to the traumatic feelings and memories. It may also identifying memories that lead to upset and replacing a better picture of the situation. Systematic desensitization is a renowned technique for treating CBT symptoms. A relatively new technique for treating PSTD is the Eye Movement Desensitization and Reprocessing (EMDR) which incorporates CBT with eye movements and helps in “unfreezing” the processing system of the brain making the memory become more cohesive.
            Anxiety management treatments equip the patient to handle anxiety effectively. Some of the most common anxiety management measures include “relaxation training, positive self-statements, breathing retraining, biofeedback, social skills training, and distraction techniques” (Foa & Meadow, 1997, p. 452). Combined treatments involve combining trauma-focused CBT with other psychosocial treatments to have a synergistic effect. Cognitive Processing Therapy (CPT) is a good example of combined treatments which is very effective with rape victims. Family therapy has been cited as an effective treatment for PSTD since it repairs relationship problems in addition to making family members understand the feelings of the victim. Although there are medications for treatment of PSTD, these are only administered as relievers of anxiety or depression symptoms rather than the actual treatment of PSTD causes (Melinda & Segal, 2010).
Effects of PSTD
            As earlier mentioned, posttraumatic stress disorder is a public health concern which leads to severe effects if the disorder is not addressed. It is evident that PSTD affects the brain by reducing the hippocampus thus interfering with the brain’s ability to acquire new memories. Hippocampal atrophy results from prolonged release of glucocorticoids as the body experiences the fight-flight response due to chronic PSTD. Mcnally (2003) explains that the hippocampi of Vietnam veterans have been found to be 8% smaller than non-veterans according to magnetic resonance imaging studies. The left hippocampi are particularly reduced in PSTD patients. Posttraumatic stress disorder also increases the risk of drug and substance abuse. It is cited that PSTD patients usually result into alcohol abuse or excessive use of marijuana as a way of coping with the trauma. This has particularly been reported among women who have developed PSTD after sexual assault (Ullman et al, 2005).
If PSTD is not treated, the sufferer may end up with dire consequences which affect relationships seriously. Emotional problems may overwhelm the life of a pregnant woman who has PSTD not to mention the possibility of developing borderline personality disorder. The pregnant mother is also likely to bear a child who is at a higher risk of developing PSTD due to altered body chemicals. Later in life, PSTD victims are likely to experience reproduction problems as well as poor emotional development among children. The economic consequences of PSTD are high as illustrated by the high cost experienced by the U.S. in 2005 where up to $4.3 billion was spent as compensation for at least 200,000 veterans (Dryden-Edwards & Stoppler, 2010).
Conclusion
            Posttraumatic stress disorder is a challenging psychological disorder brought about by traumatic events and is a great public health concern. The disorder can affect persons of any age and prevalence is higher among females than in males. Live victims of PSTD often have emotional numbness, increased arousal and tend to avoid traumatic events or thoughts. Clinicians should diagnose the disorder using the DSM-IV criteria thus paving way for treatment of PSTD. Psychotherapy and pharmacotherapy should be utilized to relieve symptoms of PSTD. Failure to treat PSTD can lead to dire consequences more so altering the lives of the victims as their relationships and general body health are severely impacted.

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