Post-Traumatic Stress Disorder (PTSD) is becoming a prevalent condition affecting most individuals across the world. The number of humans being diagnosed with the disorder is gradually increasing thus the need to understand how people respond to the trauma. Comprehending the responses is the first step towards devising ways to treat the condition. American Psychological Association characterizes PTSD as a disorder that arises from responding to emotional or physical trauma (Hori & Kim, 2019). The severity of the condition depends on the nature of the event experienced to steer the traumatic emotions.
The first symptom of PTSD is individuals re-living the event through flashbacks, vivid nightmares, and unwanted memories and distressing. Some people can experience heart palpitations, difficulties in breathing, and feeling upset. Another sign is individuals tending to avoid places, activities, feelings, and people that remind them of the horrifying event. As such, the victims have negative feelings and thoughts that lead them to guilt, anger, and fear for a longer period. Some people blame themselves or others for the events that led to the trauma while others separate themselves from their families and friends (Girgenti et al., 2021). They also lose interest in doing their daily activities because of the reduced concentration. Other symptoms include insomnia, depression, being startled easily, taking risks, and feeling easily irritable.
Various criteria exist for diagnosing the condition among victim individuals across the globe. The first criterion (A) is based on the stressor that is the events that exposed the person to the condition such as death, serious injury, or sexual violence. The mode of exposure could be direct encounters, witnessing the event, learning that a close friend or family member was exposed to a traumatic event, and indirect encounters to the horrifying details of the event, especially at the verge of professional duty (Speer et al., 2018). The second criterion (B) focuses on intrusion signs when the event is re-experienced persistently through nightmares, flashbacks, emotional distress, physical reactivity, and upsetting memories.
Criterion C accounts for trauma-related avoidance of external reminders, feelings, and thoughts. In most cases, the victims of the condition do not associate themselves with aspects that remind them of the traumatizing incident. The avoidance is followed by negative alterations of mood and cognitions that is diagnosed via criterion D (Maeng & Milad, 2017). The negativity often comes in different ways including feeling isolated, decreased interest in daily activities, exaggerated self-blame, negative assumptions and thoughts about life as well the inability to remember critical trauma features.
Another criterion is analyzing possible alterations in reactivity and arousal that often worsen after the event. The alterations may be in the form of troubled sleeping, hypervigilance, irritability, destructive characters, difficulties in concentration, and hyperactive startles. Respectively, Criteria F G and H focuses on signs that last more than a month, symptoms that result in functional distractions, and signs that do not come from illness, medications, or substance abuse (Hori & Kim, 2019).
Aside from the criteria discussed, the other two specifications to be considered include dissociative and delayed responses. Dissociative specification may be in the form of derealization where the victim undergoes distortion, distance, and unreality as well as depersonalization (being detached from one’s self-being). Delayed specifications involve the prolonged full diagnosis of the condition approximately six months after the traumatic event (Speer et al., 2018).
In most cases, clinicians may have trouble in diagnosing PTSD because of the vagueness and the presentation of the signs. However, the final diagnosis can be made when the victim starts to develop emotional responses to the memories of the events. Furthermore, failing to manage negative emotions serves as a distinctive feature of the condition that leads to its diagnosis. Most counselors, psychologists, and clinicians often depend on self-reported signs to help in the diagnosis (Girgenti et al., 2021). However, the major challenge presented by the mode of diagnosis is difficulties in differentiating pathological and normal signs. To curb this, most psychologists use various questionnaires and instruments to assess the severity of the symptoms.
Causes of PTSD
Post-Traumatic Stress Disorder results from various events that individuals undergo, learn, or see. It may involve serious injuries, violations, and threatened or actual death. Many doctors are unsure why most individuals are diagnosed with the disorder because most psychological conditions occur from combined situations such as stress, depression and anxiety, and temperamental features. Traumatic events that can lead to PTSD include combat exposures, physical assault, accidents, sexual violence, and physical abuse during childhood (Speer et al., 2018). Other events may involve natural disasters, terrorist attacks, plane crush, mugging, torture, and fire.
Different factors increase the risk of suffering from Post-Traumatic Stress Disorder despite the ages of individuals. Examples include substance abuse such as drug use or excess drinking, mental health issues in the form of depression or anxiety, and jobs that increase the exposure to traumatic events as in military people and medical responders (Hori & Kim, 2019). Other risk factors include less support from friends and family, the experience of long-lasting intense trauma, and having relatives with histories of mental problems such as depression.
The outcomes of neuroimaging research often provide excellent fact-based data regarding the possible processes and causes of PTSD. Recent neuroimaging results link amygdala activation from traumatic exposure as the common cause of Post-Traumatic Stress Disorder. The activation is followed by inhibitory activities within the prefrontal cortex, which serves to regulate emotions in humans effectively. The events often impair the ability of an individual to control their feelings thus resulting in the disorder (Maeng & Milad, 2017). It means that the events change the functioning of the brain leading to hypervigilance that may increase with time. The changes determine the complexity and nature of the symptoms presented during PTSD diagnosis.
Treatment Options and Efficacy
The identification of PTSD symptoms is the first step towards both mental and physical health examination of the victims before administering proper treatment. Research conducted about PTSD has provided various shreds of evidence concerning treatment options of the condition. For example, the American Psychological Association listed various alternatives including cognitive therapy, cognitive processing therapy, prolonged exposure therapies, eclectic psychotherapy, and narrative exposure therapy (Girgenti et al., 2021). Cognitive Behavioral Therapy serves as the first-line medication for PTSD because it helps the victims to change the patterns and directions of their thoughts and behaviors.
Typically, cognitive behavioral therapy can assist to break the links between the victim’s memories and the respective emotional responses. The psychologists encourage the victims to review the event as well as their responses to decrease the avoidance of horrifying cues. The idea encourages them to reconstruct their mind and comprehension of trauma. The essence of the therapy is to improve the symptoms of the victim, teach them the skills to handle trauma, and restore their self-esteem (Hori & Kim, 2019). Concentrating on the fears of the victim helps to administer the most appropriate behavioral therapy.
Cognitive Processing Therapy is another treatment approach often offered as twelve 60-90 minutes sessions. It helps the victims of the disorder to modify and challenge unhelpful thoughts linked to the traumatic events. As such, the patient creates a new conceptualization and understanding of the event to reduce its negative impacts on their lives. The treatment starts with psychoeducation that targets PTSD-related emotions and thoughts (Turgoose et al., 2018). Here, the victim gains knowledge on the relationship between emotions and thoughts, which helps him/her determine the automatic thoughts that maintain the symptoms of the disorder (Speer et al., 2018). The patient can note down an impact statement detailing their current understanding of why and how the event happened and influenced their life.
The next step is the formal processing of the trauma where the victim writes in detail the account of the traumatizing events. The patient then reads the experiences in the following session to reduce the avoidance of feelings and thoughts linked to the trauma. The psychologist utilizes Socratic questionnaires and other approaches to assist the victim to question their unhelpful emotions regarding the event (Kaplan et al., 2018). The essence of the process to eliminative any form of maladaptive thinking such as self-blaming.
Once the victim has developed suitable skills for addressing and identifying unhelpful thoughts, he/she uses the skills to modify and evaluate other beliefs linked to the events. At this point, the psychologist is assisting the victim to use the adaptive approaches to improve their overall functioning and view of life (Maeng & Milad, 2017). The major focus is on intimacy, trust, safety, control, power, and esteem, which are the main areas influenced by the experiences. The CPT Sessions can be delivered individually or in-group sessions with patients having out-of-session assignments.
Another treatment method is Prolonged Exposure Therapy: a manualized protocol and an evidence-based strategy. Numerous studies regarding the approach ascertained that it reduces PTSD signs as well as the symptoms of anger, depression, and anxiety. It also restores confidence among the patients aside from instilling a sense of mastery in them. The victims can disseminate safe and unsafe events thus improving their day-to-day functioning. The approach is rooted in Emotional Processing Theory that links the occurrence of PTSD signs to behavioral and cognitive avoidance of trauma-related activities, reminders, thoughts, and situations. As such, blocking behavioral and cognitive avoidance is key towards interrupting and reversing the disorder (Maeng & Milad, 2017). It also helps to introduce corrective information that facilitates the processing and organization of trauma memories, beliefs, and thoughts. The patients can accomplish a successful reverse process through imaginal and in-vivo exposure.
In vivo exposures includes engaging in behaviors, situations, and activities that the patients avoid repeatedly. The essence is to reduce fear and other emotions while encouraging the victims to recognize that the activities they are avoiding are not dangerous. Imaginal exposure, on the other hand, relates to revisiting the experiences and describing them aloud in detail. The session is recorded and the patients listen to the recordings to maximize the value of the therapy (Turgoose et al., 2018). The essence is to allow the individuals to process the emotions and thoughts of the trauma within safer contexts. It also encourages the patients that they can cope up with the distress linked to the trauma memories. The therapy often involves 8-15 90 minutes sessions where the victims are taught breathing techniques meant to curb their anxieties in the early sessions.
Eye Movement Desensitization and Reprocessing is also another effective approach for treating Post Traumatic Stress Disorder. The strategy does not require the patients to give their experiences but rather concentrate on the actions of the therapists. The sessions are done weekly for three months with the goal of assisting the patients to think positively as they remember their experiences. The clients are often exposed to emotionally distracting content in sequential doses while looking at the external stimulus (Maeng & Milad, 2017). The lateral eye motions of the therapists are mostly used as external stimuli alongside other activities like audio stimulation and hand tapping.
It is hypothesized that EMDR sessions help to access memory networks to enhance information processing. As a result, the associations cause complete new information processing that helps in learning, elimination of distress, and establishment of cognitive insights. The therapy uses three distinct protocols:
- the processing of past events that led to the dysfunction to forge new links with adaptive information;
- desensitization of external and internal triggers of the condition and targeting current situations that elicit emotional distress;
- incorporation of imaginal templates of future circumstances to help the patients acquire skills for adaptive functioning (Turgoose et al., 2018).
Simply, the method posits that the mind can heal from trauma just as the body heals from physical injuries. The information processing system of the brain moves naturally towards mental health to make the treatment possible. Millions of people have been treated using the same strategy in the past 25 years making it an effective process against PTSD (Turgoose et al., 2018).
Additionally, individuals can learn how to handle stress on their own with more focus placed on how to release the stress. The process is referred to as Stress Inoculation Training that allows individuals to practice breathing and massage techniques to help in easing emotional distress. In situations where the mentioned cognitive approaches seem to be less effective, the victims are subjected to specific types of medications to manage their situations. The medications help the victims to stop thinking about and reacting to the traumatizing experiences (Cipriani et al., 2018). Some medications steer an overall positive outlook about life making patients feel normal. The drugs work by affecting the chemistry of the brain linked to anxiety and fear. In this case, the norepinephrine and serotonin types of neurotransmitters are targeted first with medications like Fluoxetine, Paroxetine, Venlafaxine, and Sertraline. Other medications that may be administered include antidepressants, Monoamine oxidase inhibitors, beta-blockers, benzodiazepines, antipsychotics, and Second-Generation Antipsychotics (Cipriani et al., 2018). The type of medication given depends on the severity of the condition and the types of symptoms displayed by the victim.
Impacts of the Disorder
PTSD often comes with a wide range of symptoms that pose direct impacts on the family and friends of the victim. The changes in their functioning may impair their role of meeting family needs thus causing stress. The condition also makes it challenging to live with the individual. The occurrence of signs like flashbacks and nightmares can affect vulnerable members of a family. For example, if the PTSD patient is a parent, the children will be affected directly (Kaplan et al., 2018). Therefore, it becomes difficult for such parents to take care of the children and provide all the required support. As a result, the kids may end up being stressed from the situation of their parents. On the other hand, Post-Traumatic Stress Disorder symptoms may cause issues with problem-solving, trust, communication, and closeness (Bonfils et al., 2018). The occurrence may tarnish the relationship that the victim has with other individuals in their surroundings.
In most cases, the health status of workers with PTSD worsens with time leading to problems in their occupational functioning. The inability to complete the assigned tasks in their workplaces may result in job losses and early retirement. Furthermore, the symptoms affect the ability of PTSD victims to undertake normal day-to-day operations including maintaining their work relationships. Lack of concentration triggered by emotional distress also means that the patients become overwhelmed with simple job tasks (Lee et al., 2020).
Research has shown that individuals with severe symptoms may find it hard to return to their places of work in a bid to avoid situations and places that remind them of the catastrophic events. Memory-related problems like panic attacks, anxiety, fear, poor coworker relationships, and difficulties in staying awake may trigger self-esteem issues that make the victims want to isolate themselves (Lee et al., 2020). Such a case makes it more cumbersome to appear in their workplaces on time and complete the tasks required of them.
Recent psychological, epigenetics and neurobiological studies show that traumatizing events among children diminish their memory, concentration, and their language capabilities needed to achieve proper academic performance. For some victims, this can cause issues in forming relationships with other students in schools. The foundations of learning for every student involves reading, writing, taking part in discussions as well as solving mathematical problems (Kaplan et al., 2018). Self-regulation abilities, emotions, behaviors, and attention are also prerequisites for proper learning. Therefore, the occurrence of trauma can disrupt the development of the students in all the mentioned learning foundations.
PTSD can also undermine the establishment of languages and skills for communication thus thwarting the completion of classroom instructions and tasks. It also interferes with the management of new information making it difficult for victims to grasp cause and effect associations, which are important in effective information processing in school. Lastly, some PTSD victims may find a school as a battleground that targets to sabotage their emotions further (Revelant & Keegan, 2018). As such, they will register higher absenteeism levels to protect their feelings and to feel safe from the catastrophic events of the trauma. It means that the victim will have poor relationships with his/her peers thus interfering with their learning outcomes.
Stigma Related to PTSD
There is a very strong stigma surrounding post-traumatic stress disorder especially with stereotypes that blame the victims for the illness. Some victims may seek medical help because of embarrassment, shame, or the fear of being hospitalized. They often receive stigma from the community, friends, workmates, and family members. The stigma may take various forms depending on the source of discrimination. For example, public stigma results from the discrimination that the public may hold against mental health victims. The victims may internalize the beliefs of others thus resulting in self-stigma. The outcome is labeled avoidance that occurs when the patients perceive public stigma making them avoid treatments. At this point, the victims become subjects of institutional policies thus structural stigma (Revelant & Keegan, 2018).
Bonfils, K. A., Lysaker, P. H., Yanos, P. T., Siegel, A., Leonhardt, B. L., James, A. V.,… & Davis, L. W. (2018). Self-stigma in PTSD: Prevalence and correlates. Psychiatry Research, 265, 7-12.
Cipriani, A., Williams, T., Nikolakopoulou, A., Salanti, G., Chaimani, A., Ipser, J., & Stein, D. J. (2018). Comparative efficacy and acceptability of pharmacological treatments for post- traumatic stress disorder in adults: a network meta-analysis. Psychological Medicine, 48(12), 1975-1984. doi:10.1017/s003329171700349X
Girgenti, M. J., Wang, J., Ji, D., Cruz, D. A., Stein, M. B., Gelernter, J., & Duman, R. S. (2021). Transcriptomic organization of the human brain in post-traumatic stress disorder. Nature Neuroscience, 24(1), 24-33 doi:10.1038/s41593-020-00748-7
Hori, H., & Kim, Y. (2019). Inflammation and post‐traumatic stress disorder. Psychiatry and Clinical Neurosciences, 73(4), 143-153 doi:10.1111/pcn.12820
Kaplan, G. B., Leite-Morris, K. A., Wang, L., Rumbika, K. K., Heinrichs, S. C., Zeng, X., Wu, L., Arena, D. T., & Teng, Y. D. (2018). Pathophysiological bases of comorbidity: Traumatic brain injury and post-traumatic stress disorder. Journal of Neurotrauma, 35(2), 210–225.
Lee, W., Lee, Y.-R., Yoon, J.-H., Lee, H.-J., & Kang, M.-Y. (2020). Occupational post-traumatic stress disorder: an updated systematic review. BMC Public Health, 20(1), 12-40.
Maeng, L. Y., & Milad, M. R. (2017). Post-traumatic stress disorder: The relationship between the fear response and chronic stress. Chronic Stress.
Revelant, J., & Keegan, K. (2018). PTSD Stigma: Why It Exists and What We Can Do About It. EverydayHealth.
Speer, K., Upton, D., Semple, S., & McKune, A. (2018). Systemic low-grade inflammation in post-traumatic stress disorder: a systematic review. Journal of Inflammation Research, 11, 111. doi:10.2147/JIR.S155903
Turgoose, D., Ashwick, R., & Murphy, D. (2018). A systematic review of lessons learned from delivering teletherapy to veterans with post-traumatic stress disorder. Journal of Telemedicine and Telecare, 24(9), 575-585. doi:10.1177/1357633X17730443