POST TRAUMATIC By Tristan Le

STRESS DISORDER
OVERVIEW

Posttraumatic stress disorder (PTSD) is an anxiety

disorder that a person may develop after
experiencing or witnessing an extreme,
overwhelming traumatic event during which they
felt intense fear, helplessness, or horror.

The dominant features of posttraumatic stress

disorder are emotional numbing (e.g. emotional
nonresponsiveness), hyperarousal (e.g., irritability,
on constant alert for danger), and reexperiencing
of the trauma (e.g., fl ashbacks, intrusive
emotions).

PTSD is as an anxiety disorder. Anxiety disorders

cover several diff erent forms of abnormal,
pathological anxiety, fears, phobias and nervous
conditions that may come on suddenly or gradually
over a period of several years, and may impair or
prevent the pursuing of normal daily routines.
 CASE

J . B i s a 2 7 y e a r- o l d m a l e w h o re c e n t l y m o v e d b a c k i n w i t h h i s p a re n t s a ft e r h i s

fi a n c e w a s k i l l e d b y a d r u n k d r i v e r 3 m o n t h s a g o. H i s fi a n c e , a b e a u t i f u l
y o u n g w o m a n h e d b e e n d a t i n g f o r t h e p a s t 4 y e a r s , w a s w a l k i n g a c ro s s a
b u s y i n t e r s e c t i o n t o m e e t h i m f o r l u n c h o n e d a y. H e s t i l l v i v i d l y re m e m b e r s
t h e h o r r i fi c s c e n e a s t h e d r u n k d r i v e r r a n t h e r e d l i g h t , p l o w i n g d o w n
h i s fi a n c e r i g h t b e f o re h i s e y e s . H e r a c e d t o h e r s i d e , e m b r a c i n g h e r
c r u m p l e d , b l o o d y b o d y a s s h e d i e d i n h i s a rm s i n t h e m i d d l e o f t h e c ro s s w a l k .
N o m a t t e r h o w h a rd h e t r i e s t o f o rg e t , h e f re q u e n t l y fi n d s h i m s e l f re l i v i n g t h e
e n t i re i n c i d e n t a s i f i t w a s h a p p e n i n g a l l o v e r.

S i n c e t h e a c c i d e n t , J . B . h a s b e e n p l a g u e d w i t h n i g h t m a re s a b o u t t h e a c c i d e n t

a l m o s t e v e r y n i g h t . H e h a d t o q u i t h i s j o b b e c a u s e h i s o ffi c e w a s l o c a t e d i n
t h e b u i l d i n g r i g h t n ex t t o t h e l i t t l e c a f w h e re h e w a s m e e t i n g h i s fi a n c e f o r
l u n c h t h e d a y s h e d i e d . T h e f e w t i m e s h e a t t e m p t e d t o re t u rn t o w o r k w e re
u n b e a r a b l e f o r h i m . H e h a s s i n c e a v o i d e d t h a t e n t i re a re a o f t o w n .

N o rm a l l y a n o u t g o i n g , f u n - l o v i n g g u y , J . B h a s b e c o m e i n c re a s i n g l y w i t h d r a w n ,

j u m p y , a n d i rr i t a b l e s i n c e h i s fi a n c s d e a t h . H e s s t o p p e d w o r k i n g o u t ,
p l a y i n g h i s g u i t a r , o r p l a y i n g b a s ke t b a l l w i t h h i s f r i e n d s a l l a c t i v i t i e s h e
o n c e re a l l y e n j o y e d . H i s p a re n t s w o rr y a b o u t h o w d e t a c h e d a n d e m o t i o n a l l y
fl a t h e s b e c o m e
 WHATS THE
DIAGNOSTIC CRITERIA FOR
PTSD?
 CRITERION A: STRESSOR

Criterion A :Stressor
The person was exposed to a traumatic event: death,
threatened death, actual or threatened serious injury, or
actual or threatened sexual violence, in the following
way(s):
Direct exposure
Witnessing the trauma: observing serious injury
or unnatural death of another person due to
violent assault, accident, war, or disaster

Indirect exposure to aversive details of the

trauma, usually professional duties (e.g., fi rst
responders, medics, collecting dead body parts)
 EXAMPLES OF TRAUMATIC EVENTS
EXPERIENCED DIRECTLY
Violent personal assault: rape, physical
attack, robbery, mugging

Military combat

Terrorist attack, taken hostage, torture

Severe automobile accidents

 CRITERION B: INTRUSION

Criterion B: Intrusion Symptoms

The traumatic event is persistently re-experienced in
the following ways:
Recurrent intrusive memories/recollections of the
event
Traumatic nightmares of the event
Flashbacks Sudden acting or feeling as if the event
was recurring
Emotional distress after exposure to things that
resembles or symbolizes an aspect of the trauma
Physical reactivity at exposure to cues that resemble
the event
 CRITERION C: AVOIDANCE

Criterion C: Avoidance
Persistent avoidance of stimuli associated with the
trauma in the following ways:

Avoiding thoughts and feelings about the event

Avoiding trauma-related reminders (eg. people,

places, conversations, activities, objects, or
situations)
 CRITERION D:
NEGATIVE FEELINGS/THOUGHTS
Criterion D: Negative thoughts or feelings that began or
worsened after the trauma , in the following way(s):

Inability to recall features of the traumatic event

Persistent negative beliefs and assumptions about oneself
or the world (Eg. Im bad, The world is completely
dangerous)

Persistent b lame of self or others for causing the trauma

Persistent negative trauma-related emotions (eg. Fear,
horror, anger, guilt, or shame)

Loss of interest in activities

Feeling isolated or d etached from others
Sense of foreshortened future does not expect to have
career, marriage, children or normal life span
 CRITERION E: HYPERAROUSAL

Criterion E:Persistent symptoms of increased

arousal (Not present before trauma):

Irritability or anger outbursts

Risky or destructive behavior
Feeling on edge, hyperarousal/hyper-alertness

Exaggerated startle response

Problems concentrating
Diffi culty falling or staying asleep (Insomnia)
 CRITERIA F & G:
DURATION & IMPAIRED FUNCTION
Criterion F:Duration
Symptoms last for more than 1 month

Criterion G: Signifi cant impairment in

functioning
Symptoms create distress or impairment in functioning
(eg., social, occupational)
 RECAP

A: Exposure to traumatic event (Stressor)

B: 1or more Re-experiencing symptoms (Intrusion)
C: 1 persistent avoidance of trauma cues (Avoidance)
D: 2 or more negative thoughts or feelings that began after
the trauma/event (Numbing/Detach from others)
E: 2 or more increased arousal symptoms (Arousal)

F&G:
All of which must present for a duration of More than 1 month
(Duration) and causes clinically significant distress or
impairment in social, occupational, or other important areas
of functioning (Impaired Function)
 ONSET

Symptoms usually begin within the fi rst 3 months

after the trauma, although there may be a delay of
months, or even years, before symptoms appear.

Acute PTSD symptoms less than three months

Delated Onset: Although symptoms usually begin

within 3 months of exposure, a delayed onset is
possible months or even years after the event has
occurred.

Chronic PTSD - symptoms more than three months

 DIAGNOSIS OF PTSD

There are no laboratory tests to detect PTSD. To

diagnose PTSD, a healthcare provider will consider
the above symptoms together with history of trauma.
He or she will likely also use psychological
assessment tools to confi rm the diagnosis
 DIFFERENTIALS

Some of the disorders that must be ruled out when diagnosing PTSD include the
following:

Acute stress disorder: Must occur within 4 weeks of a traumatic event

(duration up to 4 weeks)

A d j u s t m e n t d i s o r d e r : A n x i e t y a ft e r ex p o s u re t o a l e s s s e v e re s t re s s o r.

D e p r e s s i v e d i s o r d e r s : D e p re s s i o n a ft e r t r a u m a , n u m b i n g a n d
avoidance

Borderline personality disorder

Malingering

O t h e r d i s o r d e r s w i t h i n t r u s i v e t h o u g h t s o r p e rc e p t u a l d i s t u r b a n c e s
t h a t s no t u s u a l l y re l a t e d t o p a s t t r a u m a t i c e v e n t ( o b s e s s i v e
c o m p u l s i v e d i s o r d e r, s c h i z o p h r e n i a , o t h e r p s y c h o t i c d i s o r d e r )
 PREVALENCE
NATIONAL CENTER FOR PTSD
How common is PTSD?
Based on the U.S. Population;
About 8 million adults have PTSD during a given year.
This is only a small portion of those who have gone
through a trauma

About 10 of every 100 women (10%) develop PTSD

sometime in their lives compared with about 5 of every
100 men (5%)

Women about twice as likely as men to develop PTSD

(experience sexual assault or child sexual abuse)

Men more likely to experience accidents, physical

assault, combat, disaster, or witness death or injury
ESTIMATED RISK FOR DEVELOPING
PTSD BASED ON EVENT
 POTENTIAL CONSEQUENCES OF
PTSD
Social & Interpersonal Problems
Relationship issues
Low self-esteem
Alcohol & substance abuse
Employment problems
Homelessness
Trouble with the law
Isolation
WHY PTSD VICTIMS MIGHT BE RESISTANT
TO GETTING HELP

Sometimes hard because people expect to be able to

handle a traumatic even on their own

People may blame themselves

Traumatic experience might be too painful to discuss

Some people avoid the event all together

PTSD can make some people feel isolated making it

hard for them to get help

People dont always make the connection between

the traumatic event and the symptoms; anxiety,
anger, and possible physical symptoms

People often have more than one anxiety disorder or

may suff er from depression or substance abuse
 TREATMENT: PTSD

Requires multiple modalities

Initial education, support and referrals important to

establish trust

Pharmacotherapy

Psychotherapy

Relaxation Training
 TREATMENT: PTSD-
PHARMACOTHERAPY
Duration of at least 8-12 weeks

Adequate dosages

Maintenance treatment for at least 1 year

Antidepressants

Mood stabilizers

Propranolol, clonidine

Atypical antipsychotics
 DRUG TREATMENT OF PTSD

Amitriptyline (Elavil)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Lithium
Paroxetine (Paxil)
Quetiapine
Propranolol
Risperidone
Clonidine
Olanzapine
Valproic Acid
Carbamazepine
 DREAMS MNEMONIC

Detachment
Re-experiencing the event
Emotional eff ects
Avoidance
Month in Duration
Sympathetic hyperactivity or hypervigilance
THANK YOU
 REFERENCES

American Psychiatric Association. (2013) Diagnostic

and statistical manual of mental disorders, (5th ed.).
Washington, DC: Author

National Center for PTSD. http://www.ncptsd.va.gov