POST-TRAUMATIC STRESS DISORDER
This disorder occurs when a person has experienced a very strong trauma. Post-Traumatic Stress Disorder (PTSD) is characterised by an extreme response to a highly stressful factor and constitutes a response comprising a considerable increase in a person’s level of anxiety, the avoidance of stimuli associated with the trauma and a weakening of one’s emotional reactivity. Although in the past it was well known that traumatic events experienced by soldiers during combat might produce very strong negative effects, this disorder was not characterised as such until the period of the Vietnam War. Its effects however are not only caused by wartime experiences but may be also triggered by extreme physical and sexual violence.
PTSD differs from Acute Stress Disorder, which was described on the previous page, in relation to the duration of its symptoms. While Acute Stress Disorder generally clears up within a month following onset, Post-Traumatic Stress Disorder continues for a much longer period. Almost all people who experience a traumatic event are affected by the stress it has caused (see Stress) but this may not necessarily result in the onset of a disorder in the true sense. One would speak in terms of a disorder when, on account of the symptoms caused by the trauma, the person’s social or occupational or professional functioning is seriously compromised. The inclusion of this disorder amongst those categorised and described by the DSM is a formal recognition of the fact that, regardless of their clinical history, many people suffer considerable negative effects on account of extreme traumatic factors and it is necessary to distinguish this reaction from other pathological states. In other words, the primary cause of Post-Traumatic Stress Disorder lies in an external - and not an internal - event. There are three main symptoms presented by this condition:
1. Those who suffer from the disorder persistently re-live the traumatic event and may also experience nightmares. Stimuli which symbolically represent the event (e.g., thunder, which might remind a war veteran of the noises of the battlefield) or the anniversaries of a certain experience can cause intense psychological pain. The importance of the fact of reliving a traumatic experience cannot be underestimated as this is the probable source of the other categories of symptoms. According to some theories, reliving a traumatic event is the central characteristic of Post-Traumatic Stress Syndrome (Foa, Zinbarg and Rothbaum, 1992; Horowitz, 1986) as the subject would appear incapable of integrating the traumatic event in his or her life experience and former convictions.
2. Another crucial behaviour of this disorder is avoidance of stimuli associated with the event and the lowering of the individual’s general capacity to react. The person tries to avoid thinking about the trauma or being exposed to stimuli that might remind him of it. Sometimes, the subject may be incapable of recalling important aspects of the traumatic event. The diminishing of the individual’s capacity to react becomes manifest in his or her decreased interest in other people, in a sense of detachment and feeling distant from reality and in an inability to experience positive emotions. These symptoms seem to contradict those described above. In fact PTSD is characterised by a kind of fluctuation, whereby the individual goes through alternating phases: the person will forget the traumatic experience for a period of time and then some time later it will resurface violently.
3. The disorder also implies the presence of symptoms denoting a form of augmented physiological activation. These symptoms include a difficulty in falling asleep or insomnia, a difficulty to concentrate, hypervigilance (see glossary) and exaggerated alarm responses. Laboratory studies have confirmed these clinical symptoms, documenting the increase in the physiological responsiveness in patients affected by PTSD, this increase having the purpose of contending with the images produced by their minds and the considerable intensity of their alarm responses (Orr et al., 1995).
Other problems often associated with this disorder are anxiety, depression, anger, feelings of guilt and substance abuse (‘self-medication’ to alleviate distress), marital problems and difficulties at work. Suicidal thoughts and plans are also quite common as are sudden episodes of violence and problems of a psycho-physiological nature linked to stress, such as lumbar pain, headaches and gastrointestinal disorders.Many people suffer a traumatic experience but not all of them develop PTSD. In a recent study it emerged for example that only 25% of subjects that had been a victim of a traumatic event involving physical injury went on to develop this disorder (Shalev et al., 1996). It is thus possible to conclude that the event in itself cannot be the sole cause of the disorder. Current research in this field is trying to identify which factors distinguish individuals who, following a serious trauma, develop PTSD from those who do not.
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Orr, S.P., Lasko, N.B., Shalev, A.Y., & Pittman, R.K. (1995). Physiological responses to loud tones in Vietnam veterans with post-traumatic stress disorder. Journal of Abnormal Psychology, 104, 75-82.
Foa, E.B., Zinbarg, R., & Rothbaum, B.O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychological Bullettin, 112, 218-238.
Horowitz, M.J. (1996). Sress response syndromes. Northvale, NJ: Aronson.
Shalev, A.Y., Peri, T., Canetti, L., & Schreiber. S. (1996). Predictors of post-traumatic stress disorders in injured trauma survivors: A prospective study. American Journal of Psychiatry, 153, 219-225.