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Presented by Victoria Hargan MA Forensic Psychology

Table of Contents
I. Introduction What is Post traumatic stress disorder? DSM-IV- TR Symptoms of post traumatic stress disorder II. A Growing Problem PTSD not only a Veterans Condition PTSD Statistics A community health problem Crime Victimization and PTSD Psychological consequences of crime Crisis reaction and equilibrium Trigger events for crime related PTSD Risk factors Recovery Process Treatment for PTSD Medications for PTSD patients III. Conclusion

What is Post-traumatic Stress Disorder?


According to the National Institute of Mental Health:
Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop

after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat(NIMH, 2009).

Post traumatic stress disorder or PTSD, was once called shell shock, battle fatigue syndrome during WW II. PTSD got its name during the Vietnam war. PTSD is also known as battered womans syndrome. The name derived from battered women victimized by domestic violence.

PTSD Criterion- A.

DSMI-IV-TR
A. Exposure to a traumatic event The person experienced, witnessed, or was confronted with an event/s that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. Response involves intense fear, helplessness, or horror

PTSD Criterion- B.

DSMI-IV-TR
B. Traumatic event is persistently re-experienced in at least one of the following ways: Recurrent and intrusive thoughts or images Recurrent distressing dreams Acting or feeling as if the event were recurring Psychological distress upon exposure to reminders of event Physiological reactions upon exposure to reminders of event.

PTSD Criterion-C

DSMI-IV-TR
C. Avoidance of stimuli associated with the event and numbing of general response, occurring in at least three of the following ways: Efforts to avoid thoughts, feelings, or conversations about the event Efforts to avoid activities, places, or people that remind person of the event Inability to remember an important aspect of the event Significantly diminished interest or participation in activities Feeling of being detached or estranged from others Restricted range of affect Speaks or thinks of not having a future

PTSD Criterion-D

DSMI-IV-TR
D. Increased arousal not present before traumatic event, presenting in at least two of the following ways: Trouble falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hyper-vigilance Exaggerated startle response E. Symptoms last at least one month

F. Symptoms listed above cause significant impairment in daily life

Symptoms Grouped into Three Categories


According to The National Institute on Mental Health:

Re-experiencing symptoms: Flashbacksreliving the trauma over and over, including physical symptoms like a racing heart or sweating Bad dreams Frightening thoughts. Re-experiencing symptoms may cause problems in a persons everyday routine. They can start from the persons own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing. Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience Feeling emotionally numb Feeling strong guilt, depression, or worry Losing interest in activities that were enjoyable in the past Having trouble remembering the dangerous event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. Hyperarousal symptoms: Being easily startled Feeling tense or on edge Having difficulty sleeping, and/or having angry outbursts.

Symptoms
Depression Anxiety

Panic Attacks
Anger Outbursts Hyper-startle response Disturbed Sleep Pattern
Nightmares
Excessive sleep Insomnia

Self medication
Drugs
Alcohol

Symptoms
Hyper-vigilance
Constantly looking out for

danger Weight loss or weight gain Disturbed eating pattern Eating too much Not eating enough Trouble concentrating Agoraphobia Afraid to leave the house A result of feeling that the world is an unsafe place Problems with memory Short Term Memory loss Difficulty recalling details of the event.

Symptoms and Complications


Symptoms can be debilitating, complicating the condition Symptoms can interfere with ADLs (activities of daily living. Many suffers develop substance abuse problems and

addictions PTSD suffers have a high rate of absenteeism often times lose their jobs leading to economic deprivation Suffers may fail in their academic studies and goals. (Salvatore, R., 2009). High rate of suicide

Avoidance
A major symptom that is presented in PTSD is persistent avoidance of

anything that is associated with the trauma, or crime.


Usually begin soon after the traumatic event Referred to as psychic numbing. Psychic numbing is an automatic reflex reaction in which the mind

virtually shuts down to protect the survivor's psyche from further trauma, allowing the victim to do what is necessary in order to function (NCVC 2009).

Avoidance
Examples of avoidance include:
Efforts to avoid thoughts, feelings or conversations associated with

the trauma Efforts to avoid activities, places or people that arouse recollections of the trauma; this is one reason why many victims will not leave their homes. Inability to recall an important aspect of the trauma Diminished response to the external world, or emotional amnesia. Markedly diminished interest or participation in significant activities; with children, they may regress developmentally and may begin bedwetting, or talking like a baby. Feelings of detachment or estrangement from others; Restricted range of affect or reduced ability to feel emotions such as feeling or giving love (NCPTSD 2009).

Triggers and Flashbacks


A trigger is a sound or sight that

causes the survivor to relive the event. Triggers may be exhibited by : Hearing a firework go off- may trigger memories to a gunshot victim or war veteran; may think of memories of gunfire, or war; Seeing a car accident, may remind a crash survivor of their own accident Watching a rape survivor on the news may bring back memories of her/his assault A smell of cologne that was worn by the perpetrator during a sexual assault.

A Growing Epidemic

Crime victims and others

who have experienced traumatic events are vulnerable to PTSD.


PTSD is not just a

veterans condition. Secondary symptoms such as depression, and substance abuse are making this a National health problem.

Crisis Reaction
Victims will react differently to traumatic events Depending on the level of personal violation, their personality,

experiences, and support systems, their state of equilibrium at their victimization (NCVC 2009).
All people have a normal state of equilibrium called homeostasis.
It is influenced by everyday stressors such as:

illness, moving, changes in employment, and family issues. If a persons equilibrium is disrupted our bodies react, however they return to previous functioning levels. The combination of everyday stressors, in addition to being victimized, a persons equilibrium becomes overloaded making the person vulnerable to developing PTSD.

Victims of Crime
Victims of crime may self medication with drugs or alcohol.
In an attempt to psychologically numb Or block out the memories of the event.

Family and friends are often confused and do not understand the

condition. May feel helpless and frustrated Survivor may further deteriorate as a result. May become more depressed Isolated Suicidal Survivors often feel alone Afraid Feel shame May feel like its their fault.

Crime Victimization and PTSD


Trigger events for crime-related PTSD
Events may re-victimize the survivor and their families by:
Identification of the perpetrator
Hearings Trials

Attending or hearing about other criminal justice

proceedings Anniversaries of the event Holidays and other important family life events; such as birthdays.

Re-Victimizing the Victim


Court Proceeding can bring on strong emotions and the victim will relive the traumatic event all over again. Survivors may trigger or flashback during this time.

Survivors are often revictimized by the defense.

Crime Victimization and PTSD


Triggers may be internal or external.
Internal may be a result of the intrusive memories of the

event
External triggers may include seeing something on TV

that reminded the victim of the event.


People with PTSD will avoid things or situations that

trigger memories or flashbacks of the traumatic event. If the condition is left untreated, the victim's life may become dominated by attempts to avoid situations that remind him or her of the event (NCPTSD 2009).

Crime Victimization and PTSD


Survivor may experience a flashbacks.
May feel intense emotions May feel like the event is happening all over again May lead to physical symptoms Fast Heart beat Nausea Vomiting Headache Dry mouth Panic attacks Crying Fear

PTSD and Brain Chemistry


Researchers have found a connection between PTSD and brain

chemistry.

What happens to the brain during and immediately after the

critical, traumatic event will determine how each unique individual will respond, develop, or recover from PTSD.

The chemicals that flood the brain during trauma is a natural

response in order to help the person to survive the event by:


Either by running away Fighting furiously. Or submit to the trauma In some individuals, once the brain goes through this chemical rewiring to survive the trauma, the wiring stays that way. (Briere, J., 2009).

PTSD and Brain Chemistry


We are all born with an innate response to crisis called the fight

or flight response.

The fight and flight response is a natural response that is


Stressful situations produce a variety of body changes: Changes associated with the "fight or flight" response:

produced when our bodies are feeling threatened, or in a high state of stress.

increased blood levels of the hormone, adrenaline (a.k.a. epinephrine). This chemical messenger produces several body changes including elevated blood pressure and increased pulse rate. These actions increase blood flow and, along with increased circulation to arms and legs, allow an animal to increase appropriate physical exertion capabilities (PBS 2009). This is what allows us to run quickly in order to escape an attack from the tiger.

PTSD and Brain Chemistry


Not everyone develops PTSD after a traumatic event

Depending on the unique brain chemistry of each person

will determine development, symptoms and behavioral signs. Two people can experience the same trauma, and one may come out with PTSD, and the other will not (Briere, 2009). Research has also suggested that the hippocampus may shrink and kill neurons.
This may slow down the growth of new neurons. This has lead to understanding why individuals with PTSD

have a hard time concentrating or remembering things.

PTSD and Brain Chemistry


The wiring of the brains neurochemical systems become over

sensitized. Resulting in the symptoms seen in PTSD. The complex chemical-neurological reactivity affects parts of the brain that are all about learning, memory, and fear conditioning (Briere, 2009). A neurochemical that plays a role in chronic stress is cortisol.
Cortisol is a hormone that is produced in the adrenal gland, producing

adrenaline. Also called the stress hormone because it tends to increase blood pressure, blood sugar levels, and has an immunosuppressive effect (Briere, 209).

Secretion of cortisol is prolonged during chronic stress or a traumatic

event. This begins a viscous cycle of symptoms.


Cortisol levels highest in the morning, lowest a few hours after sleep begins

in the average person. This helps explains the disturbed sleep and nightmares many PTSD suffers experience.

PTSD and Brain Chemistry


Parts of the brain most involved in PTSD amygdala hippocampus medial front cortex thalamus hypothalamus Hypothalamic-pituitary-adrenal axis.
Along with these, chemicals in the brain

Since so many structures, hormones and neurotransmitters are involved in PTSD; the complex nature of PTSD has made it difficult in treating patients with one specific medication. Instead a combination of medications tends to work in concert with one another in order to relieve patient symptoms.

such as Noradrenalin Dopamine Serotonin the opiod systems, insulin, and cortisol all play complex roles in the PTSD symptom producing process (Briere, 2009).

Statistics
Families of homicide victimsthe impact of homicide on surviving family

members (Kilpatrick, Amick & Resnick, 1990) indicated that, almost 1 in 4 victims (23.4%) develop PTSD after the death of their loved one.
7.8%, with women (10.4%) twice as likely as men (5%) to have PTSD at some point in their lives.

It is estimated that the prevalence of PTSD among adult Americans is:

Children who are at high risk for developing PTSD include:


Survivors of childhood sexual assault Incest children who witness or are exposed to violence or abuse in the home.

The Silent Victims-Our Children

Children who witness or are exposed to violence or abuse in the home are at high risk of developing PTSD.

Statistics
Rape victims
Are 13.4 times more likely to have two or more major alcohol problems. Are 26 times more likely to have two or more major serious drug abuse

problems.

The National Institute of Justice surveyed adolescents for victimization, mental health, and substance abuse issues.
A survey of 4,023 adolescents ages 12 to 17, 1.8 million adolescents have been

sexually assaulted 3.9 million have been physically assaulted

2.1 million have been subjected to physically abusive punishment 8.8 million have witnessed violence (National Institute of Justice, 1995).

Substance Abuse and PTSD

Secondary symptoms and conditions may develop with PTSD. Co-occurring conditions may exist with PTSD, such as depression, anxiety disorders, and alcohol or other substance use disorders.

Treatment and Recovery Process


Counseling and Psychotherapy
A therapist or counselor can: Help the victim restructure the fragments of their lives Understand and accept some irreversible changes brought about by the trauma. Reopen channels of feeling that may have been repressed. Learn to manage the impact of distressing, invasive thoughts or flashbacks (NVPTSD 2009). As survivors begin to heal, they will regain control,

empowerment and a sense of confidence.

The recovery process can be long and difficult.


Crisis intervention should be implemented as soon as possible.

Treatment and the Recovery Process


Counseling and Psychotherapy
Therapists need to be honest with their clients. They need to inform survivors that although effects of a trauma can be alleviated, they may not always go away (Young, 1992). Therapists should inform their clients that lifes events, holidays, anniversary

dates of the crime, or other potential triggers may trigger memories and cause them to re-experience the stress reactions in the future.

With effective treatment, survivors can learn to cope with symptoms and help to control symptoms of anxiety and depression.

Cognitive behavioral therapy and an integrated approach to therapy has proven effective
Medication may be needed for some survivors.

Treatment and the Recovery Process


Medication s and PTSD
Medications that have proven successful in treating patients with PSTD

include:

Anti-depressants-Help with depression, mood swings and irritability

experienced by sufferers

Benzodiazepines- Help with panic attacks and anxiety


Sleep aids- prescribed sleep aids such as Desyrl (Trazadone), aid in

sleep, and insomnia exhibited by suffers.

Beta blockers-help in the reduction of the fight and flight response.


A problem with medication regimens is that they may lead to

additional symptoms due to medication side effects.

Treatment and the Recovery Process


EMDR and PTSD
EMDR- Eye movement desensitization reprocessing is an intervention that is being used in clients with PTSD. Simple, and non-invasive patient EMDR-helps in the recovery of: PTSD Depression Anxiety Nightmares Distressing nightmares Insomnia Traumatic events and abuse This is a new therapy Research shows that EMDR is rapid, safe and effective. EMDR does not involve the use of drugs or hypnosis.

Treatment and Referrals


Family of homicide victims, especially those having

contact with the criminal justice system, should be screened for the presence of PTSD and provided with counseling referrals.
Due to the high risk for victims and survivors of

developing crime-related PTSD, mental health referrals and services for crime victims should be provided to all victims (NCPTSD 2009).

Conclusion
Crime does not discriminate and it can happen to anyone at anytime. The consequences of crime are devastating and can lead to post

traumatic stress disorder. and reduce symptoms.

Early intervention can help reduce the potential of developing PTSD, Early intervention is vital and has resulted in a better success rate than The connection:
PTSD , trauma, crime victimization, brain chemistry, the

those who do not seek treatment or seek treatment long after the event.

development of secondary symptoms such as: depression, anxiety, and substance abuse disorders are becoming more and more recognized as key components related to the condition making this a National Health Issue.

Conclusion
PTSD was first given its name during the Vietnam war. Society and the medical professions did not fully understand

the dynamics of trauma and its consequences.


We now know that there is a biological connection between

PTSD and brain chemistry.


Crime prevention, education and community awareness should

begin as early as preschool.


By reducing crime, its impact upon victims will also reduce.

Conclusion
With extensive research on PTSD, suffers can be treated and lead

relatively normal lives.


Psychotherapy, medication regimens, EMDR-eye movement

desensitization reprocessing, and support systems are some interventions being used to help treat PTSD.
Research on PTSD and technology are advancing; there is hope that the

rewired bio-chemical system can be rewired one more time through therapy to help people regain the life they had before their traumatic event(Briere, 2009).
The statistics of crime victims with major crime-related mental health

problems make this a major health issue for communities and the nation (NCPTSD 2009).

References
National Center for Post-Traumatic Stress Disorder (2009) What is PTSD? www.ncptsd.org American Psychological Association. (2000) DSM-IV TR. Diagnostic Statistical Manual for Mental Disorders-IV Text revision. Washington DC. American Psychological Association Ackley & Ladwig. (2002). Nursing Diagnosis Handbook. A Guide to Planning Care (5thEd.) St. Louis. Mosby Salvatore, R., (2009). Posttraumatic Stress Disorder: A treatable Public Health Problem. National Association of Social Work, Volume 34, May 2009. Cougle, J.R., Resnick, H., Kilpatrick, D.G., ( 2009). A Prospective Examination of PTSD Symptoms as Risk Factors for Subsequent Exposure to Potentially Traumatic Events among Women. Journal of Abnormal Psychology, 2009. American Psychological Association 2009, Vol. 118, No. 2, 405411. Babcock,J.C., Roseman, A., Green, C. E., Ross, J.M., (2008). Intimate Partner Abuse and PTSD Symptomatology: Examining Mediators and Moderators of the AbuseTrauma Link Journal of Family Psychology 2008, Vol. 22, No. 6, 809818, American Psychological Association

References
Eadie, E., M., Runtz, M.,G., Spencer-Rogers, J., (2008). Posttraumatic Stress Symptoms as a Mediator Between Sexual Assault and Adverse Health Outcomes in Undergraduate Women. Journal of Traumatic Stress, Vol. 21, No. 6, December 2008, pp. 540547 (C _ 2008)

Neria, Y., Olfson, M., Gameroff, M.J., Wickramaratne, P., Gross, R., Pilowsky, D.J., Blanco, Cl, Manetti-Cusa, J., Lantigua, R., Shea,S., Weissman, M.M. (2008). The Mental Health Consequences of Disaster-Related Loss: Findings from Primary Care One Year After the 9/11 Terrorist Attacks. Psychiatry 71(4) Winter 2008 339
Schillaci, J., DeBakey, M.E., Yanasak, E., Harned- Adams, J, Dunn, N, Rehm, L.P., Hamilton, J.D. Guidelines for Differential Diagnoses in a Population With Posttraumatic Stress Disorder. Journal of Professional Psychology Research and Practice. Volume 40. No. 1. (pgs 39-45) National Center for Post Traumatic Stress Disorder http://ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_children.html EMDR-Therapy (2009). Eye Movement Desensitization Reprocessing http://www.emdr-therapy.com/ Briere, J.(2009). The Brain, Brain Chemistry, And PTS. National Child Traumatic Stress Network, SAMHSA. University of Southern California. http://hubpages.com/hub/The-Brain--Brain-Chemistry--And-PTSD

EMDR and PTSD http://www.youtube.com/watch?v=zBtqWrs2-K0


Spect Scan pre post Neurofeedback http://www.youtube.com/watch?v=zjPzjVakyd8

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