Without any doubt, the word stress is one of the most widely used in scientific terminology. People usually use it to indicate that they suffer from nervous tension and that they are depressed or tired. However, the most dangerous is the stress that occurs after a life-threatening event (Friedman, Resick, Bryant, & Brewin, 2011, p. 2; James & Gilliland, 2012, p. 152). An analysis of the accumulated over the years clinical cases of mental disorders, which appeared after suffering from stress (hostilities, natural disasters, tortures, physical and sexual violence, and other emergency settings), has shown that victims share a number of common and recurring symptoms of mental illnesses with some specific severe features. Therefore, it was proposed to unite them into an independent syndrome called post-traumatic stress disorder (PTSD). This paper is aimed at dealing with common symptoms and patterns connected with PTSD.
What is PTSD?
PTSD is a delayed reaction to extremely traumatic or stressful events or states in life of different duration (James & Gilliland, 2012, p. 152). To result in a PTSD, a stressful event should be of an exceptionally threatening or catastrophic nature, which could cause major distress (for instance, disasters, combats, accidents, exposure to tortures, terrorism, rape, or other severe crimes). This term is being actively introduced into medical practice since 1980. It is listed in the official nomenclature of mental disorders DSM-V as an illness provoked by severe stress disorders (Friedman et al., 2011, p. 2-3).
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Symptoms, Prevalence and Dynamics (DSM-V)
Typical symptoms include re-experiencing of the traumatic event in the form of intrusive memories, dreams, or nightmares, accompanied by a chronic feeling of "numbness" and emotional dullness, alienation from people, lack of response to surroundings, anhedonia, as well as escaping from activities, events and situations, which are reminiscent of the trauma (WHO, n.d). Occasionally there are dramatic, sharp flashes of fear, panic, or aggression, provoked by stimuli that cause a sudden recollection of the trauma or the original reaction to it. Usually there is a heightened state of excitability of the autonomic system with increased wakefulness, increased startle reaction, and insomnia (Gradus, n.d.). Anxiety and depression, suicidal ideation, and excessive use of alcohol or drugs are usually combined with the above symptoms and signs and are often a complicating factor.
Despite the fact that traumatic events happen every day to a great amount of people, statistical data says that the majority of people do not experience PTSD after extremely traumatic and stressful events. According to the WHO statistic of PTSD, only 8% of people develop PTSD or Stress syndrome after the event of a disastrous nature (WHO, n.d.). In the U.S, the condition occurs in 3.8% of men and in 9.7% of women on the long-term basis. Additionally, the incidence of PTS among war veterans is much higher than in other individuals and raises up to 30% (Gradus, n.d.).
The dynamic criteria of the condition (DSM-V of 2005) are as follows:
A. Experiencing death or a life-threatening situation, direct exposure to serious injury or sexual violence, direct visual witnessing of the traumatic event, obtaining the information about trauma or re-experiencing it.
B. The presence of one or more of the following symptoms associated with an event:
1. Periodic repetitive involuntary, intrusive, and distressing memories.
2. Dissociative reactions (e.g. flashbacks, delusions, and hallucinations).
3. Intensive heavy emotions that have been caused by an external or internal situation, which reminds about the traumatic events or symbolizes them.
4. Physiological reactivity in situations that symbolize aspects of the traumatic event.
C. Permanent avoidance of stimuli, associated with the event, accompanied by such signs:
1. Avoiding any attempt to recall unpleasant memories, thoughts, and feelings.
2. The avoidance of any external reminders of the traumatic events.
D. Negative changes in cognitive processes and attitudes, related to the traumatic event:
1. Inability to recall important aspects of the traumatic experience.
2. Stable and exaggerated negative beliefs about oneself, others, and the world.
3. Stable distorted judgments about the causes and/or effects of the events.
4. Persistent negative emotions (such as fear, anger, guilt, and shame).
5. The marked decline or lack of interest in participating in particular events.
6. A sense of distance.
7. Sustainable inability to experience positive emotions.
E. Significant changes in excitation and reactivity, associated with the event (two or more signs of the following):
1. Irritable behavior or outbursts of anger.
2. Reckless risks or self-destructive behavior.
4. Over-reaction to fear (increased startle physiological reaction).
5. Problems with concentration.
6. Sleeping disorders.
F. Deviations (criteria B, C, D and E) last longer than one month.
G. Clinically significant distress and impaired functioning of the body in the professional, social, or other important areas of life.
H. Deviations in perception not related to the physiological effects of any substance use (e.g., medications, drugs, and alcohol) or manifestation of epileptic seizures (Friedman et al., 2).
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Maladaptive Patterns and Residual Impact of PTSD
PTSD has an overall negative and hazardous effect on human psychological state and has many complications, residual impacts, and maladaptive patterns associated with it. PTSD usually includes the following most common aspects: death imprint, survivors guilt, desensitization, estrangement, and emotional enmeshment (James & Gilliland, 2012, p. 161-162). As the traumatic event can be associated with observing someones death, it creates a clear vision of the physiologic death in biological terms. For instance, veterans, who observed death very closely and on a frequent basis, continue to identify themselves with it and even search for sensations, connected with being on the edge of death. The guilt can be expressed in intrusive thoughts, such as I could have done more or It is me who was supposed to be in someones place, etc. The other two residual effects are interconnected. Desensitization and estrangement occur as a result of constant fear and guilt, which are connected to the stressful event, and a person desensitizes him-/herself, refuses to accept the events, and gradually starts to feel the unimportance of close relationship with others. Finally, emotional enmeshment arises as the inability to find any significance in life (James & Gilliland, 2012, p. 161-162).
Treatment and Interventions
Nowadays there is no established point of view on the treatment types and outcomes. Some researchers believe that PTSD is a treatable disorder, while others think that its symptoms cannot be completely eliminated. PTSD usually causes impairment in social, occupational, or other important areas of life (Najavits, 2012). However, the one thing, which is clear, is that the treatment of PTSD is a lengthy process, and it can take several years. In this process one can distinguish psychotherapeutic, psychopharmaceutic, and rehabilitation aspects.
Clinical features, leading to the current psychopathological symptoms, determine the psychopharmaceutic treatment. Elimination of the most acute symptoms facilitates therapeutic and rehabilitation activities. The latter implies the existence of social support from society, especially, from the closest people, restoration of the former social status, and the ability to hold a durable financial position. However, the most useful and widespread treatment method is psychotherapy of different types (James & Gilliland, 2012).
Psychotherapeutic methods of PTSD treatment is an integral part of recovering measures, since it is necessary to reintegrate mental activities, impaired due to injury, and to enable a patient to move beyond the trauma in further activity. This therapy is aimed at creating a new cognitive model of life, affective reassessing of the traumatic experience, and recovering the value of self. To date, specific differentiated ways and interventions, aimed at working with traumatized patients, are developed. Their effectiveness is determined by objective evaluation. They can include individual counselling, group counselling, cognitive-behavioral therapy, desensitization trainings, and anxiety coping trainings. Additionally, modern psychology is able to provide an outstanding number of other interventions, when dealing with PTSD (Najavits, 2012).
Family and Interpersonal Context
PTSD is a syndrome that occurs for different reasons, and these reasons depend on the nature of the incident event, characteristics of the injured person, and the quality of the environment, affecting the healing process (James & Jilliland, 2012). It is important to understand that, in spite of the pain, the symptoms can make positive changes in the social role of the individual. In order to function properly, a person must first define his or her needs, to be able to understand how to satisfy them and how to create an appropriate action plan. In this case the family is one of the most important sources, which can stimulate the individuals psychological and cognitive growth (Najavits, 2012).
The presence of PTSD symptoms in a family member has an impact on his or her functioning. Individuals with PTSD, suffering from the symptoms of the disease, may also display a morbid sense of guilt and, therefore, their phobic avoidance of situations or activities that resemble or symbolize the main trauma can interfere with the interpersonal relationships and lead to marital conflict, divorce, or job loss. Nevertheless, family and family stability serve as a powerful social support by having a compensating influence on cognitive, emotional and, instrumental state of a patient (Najavits, 2012).
Post-traumatic stress disorder is an anxiety condition, caused by exposure to traumatic events. A significant portion of the world's population is subjected to traumatic events, many of which can be life threatening. These events are beyond ordinary human experiences. Frequently, an ordinary mental reserve is not enough to deal with stressful experiences. It may take PTSD a week or a year after the emergency to develop. In most cases, this condition has a strong negative effect on both the person who experienced it and the people around him/her.