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POST TRAUMATIC STRESS DISORDER (PTSD).
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Paper Abstract:
Historical review. Use of the diagnosis for military combat victims, concentration camp victims, and other traumatic events and stressors. Characteristics of PTSD victims. Etiology. Symptoms. Assessment. Diagnosis. Progression and prognosis of the disorder. Treatment of PTSD including EMDR, cognitive therapy, imaginal exposure. Current research.
Paper Introduction:
POSTTRAUMATIC STRESS DISORDER
Introduction
This research paper will present a discussion of Posttraumatic Stress Disorder (PTSD). History, etiology, symptoms, assessment and diagnosis criteria, laboratory diagnosis, course and prognosis, and current research will be included in the discussion.
History/Identification of the Disorder
A historical review of posttraumatic stress disorder begins with the use of this diagnosis for military combat victims and concentration camp victims, and then proceeds to include its use for other traumatic events. PTSD is now used as a diagnosis for symptoms that follow exposure to an extremely traumatic stressor such as: violent personal assault (sexual or physical), kidnapping, terror
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Results showed that PTSD subjects demonstrated higher scores forborderline and self-defeating personality disorder. (2 1). Symptoms, Assessment, & Diagnosis Mueser, Salyers, Rosenberg, Ford, Fox, and Carty (2 1) reported onpsychometric evaluation of PTSD. Symptoms, predominance of reexperiencing the trauma, avoidance,and hyperarousal may vary over the course of the disorder. D., Fox,L., & Carty, P. (2 1). Findingssuggest the need for gender-based education and prevention regarding PTSD,for nurses, psychologists, and other health care professionals. (1999). M., Moulds, M. These and other assessment techniques are used to confirm symptomsrequired for classification and diagnosis of PTSD. Health Services Research & Development Service, 14, 1-3. (2 ). Meta-analysisof risk factors for posttraumatic stress disorder in trauma-exposed adults.Journal of Consulting and Clinical Psychology, 68(5), 748-766. PTSD patients had higherHR in the acute posttrauma phase, than controls; resting HR was associatedwith 36% of the variance of numbers of PTSD symptoms. Treatment of posttraumatic stress disorder with comorbid panicattacks combining cognitive processing therapy with panic control treatmenttechniques. Mueser, K. In a National Vietnam Veterans Readjustment Survey of veterans fromthe Vietnam era, a sample of 3, 16 showed that lifetime symptoms occurredin 3 .9 percent of the men and 26.9 percent of the women (APA, 1994;Demakis, 2 ). Individuals who have emigrated from an area withconsiderable conflict may suffer from elevated rates of PTSD; theseindividuals also suffer from being politically vulnerable and are lessinclined to divulge their experiences. Bryant, R. References American Psychiatric Association (APA) (1994). In fact EMDR seems to be no more effective than exposuretechniques and the eye movements may not be necessary. Initially the symptoms may reflect the criteria for Acute StressDisorder. Sleep disturbances andpsychiatric disorders associated with posttraumatic stress disorder in thegeneral population. PTSD victims tend to have concomitant or comorbid illnesses which mostcommonly include alcohol or substance abuse, anxiety disorders, personalitydisorders, major affective disorders, and dysthymia. The duration ofsymptoms can vary; complete recovery occurs within 3 months for half of thecases and symptoms may last over 12 months for others. Theauthors studied 2,949 Gulf War veterans, immediately following war and 2years later. Comprehensive Psychiatry, 41(6), 469-478. History, etiology, symptoms, assessment and diagnosiscriteria, laboratory diagnosis, course and prognosis, and current researchwill be included in the discussion. Findings showed that there was a significantimprovement for all treatments with no differences between treatments.Both therapies were concluded to be partially effective in symptomreduction, but neither resulted in complete recovery. T., Zlotnick, C., Dolan, R., Warshaw, M. Thus, resting HR of>9 beats per minute provided sensitivity (88%) and specificity (85%) forPTSD prediction. It has been noted thatmany PTSD victims also experience comorbid panic attacks and currenttreatments do not address this. T., Salyers, M. Bryant,Guthrie, Moulds, and Harvey (2 ) investigated roles of acute arousal inPTSD, in 146 victims of motor accidents, at one and six month intervals.Heart rate (HR) and blood pressure were assessed. Youth, singlestatus, and previous combat experience were predictors of increased riskfor the first time interval. Course and predictors of posttraumatic stress disorder amongGulf War veterans a prospective analysis.Journal of Consulting and Clinical Psychology, 67(4), 52 -528. A., Guthrie, R. Genderdifferences in risk factors for trauma exposure and posttraumatic stressdisorder among inner-city drug abusers in and out of treatment.Comprehensive Psychiatry, 42(2), 111-117. Brewin, Andrews, and Valentine (2 ) reported on risk factors forPTSD adults. Eye movementdesensitization and reprocessing (EMDR) a meta-analysis. Etiology Causes of PTSD include the experience or witnessing of an event thatis extremely traumatic such as that which involves a threat of death orserious injury or a threat to physical integrity. Therefore rates of PTSD increased over time. Symptoms tend to start within 3 monthsfollowing the trauma however there is a delay of months or years in somecases. Zimmerman and Mattia (2 1) reportedon the Psychiatric Diagnostic Screening Questionnaire (PDSQ), used toassess DSM-IV axis I disorders. Ofthis group, 75% also reported at least one other psychiatric diagnosis. D., Ford, J. Davidson and Parker (2 1)performed a meta-analysis of 34 studied which examined EMDR as a treatmentfor several populations. Wolfe, J., Erickson, D. A., Resnick, H. Ohayon, M. Tarrier, Pilgrim,Sommerfield, Faragher, Reynolds, Graham, and Barrowclough (1999) reportedresults of a randomized trial which included these treatments for a groupof 72 PTSD patients. Brewin, C. Tests used include the Trauma HistoryQuestionnaire, the Clinician-Administered Posttraumatic Stress DisorderScale (CAPS), and the PTSD Checklist. A., King, L. Findings were reportedin the nursing journal, Comprehensive Psychiatry. General medicalconditions sometimes occur as a result of the trauma (APA, 1994). (1999). These tests have demonstratedmoderate to excellent test-retest reliability, with lower levels related topsychosis symptoms. (1998).Confirmatory factor analysis of the Clinician-Administered PTSD Scaleevidence for the dimensionality of posttraumatic stress disorder.Psychological Assessment, 1 (2), 9 -96. The treatment combinescognitive processing therapy and elements of panic control that targetphysiological, cognitive, and behavioral symptoms. Davidson, P. Post-traumatic stress disorder - a problem ofwar and peace. Learning of a familymember or close associate experiencing this type of event or an unexpecteddeath or injury can also result in PTSD (APA, 1994). A prospective study of psychophysiological arousal, acute stressdisorder, and posttraumatic stress disorder. Falsetti, S. B., Nishith, P., & Compton, W. Comprehensive Psychiatry, 41(5), 315-325. (2 1). Diagnostic criteriainclude the following symptoms: (A) exposure to a traumatic event whichincluded both (1) experienced, witnessed, or confronted with lifethreatening or serious injury threatening events, or threats to thephysical integrity of self or others, and (2) responses include intensefear, helplessness, or horror; (B) event is reexperienced in one or moreways (recurrent and intrusive distressing recollections such as images,thoughts, or perceptions; recurrent distressing dreams; acting or feelingas if the event is recurring including a sense of reliving the experience,illusions, hallucinations, and dissociative flashback episodes; intensepsychological distress at exposure to cues; and psychological reactivityfrom exposure to cues); (C) persistent avoidance of associated stimuli andnumbing of responsiveness with three or more of the following: avoidanceof thoughts, feelings, or conversations, avoidance of activities, places,or people, inability to recall trauma aspects, diminished interest inactivities, detachment or estrangement, restricted affect range, and senseof foreshortened future; (D) symptoms of increased arousal with two or moreof the following: sleep disturbances, irritability or anger outbursts,difficulty concentrating, hypervigilance, and exaggerated startle response;(E) disturbance is more than one month; (F) symptoms result in significantdistress of functional impairment (APA, 1994). Personality disorders, history oftrauma, and posttraumatic stress disorder in subjects with anxietydisorders. Journal of Consulting and Clinical Psychology, 67(1), 13-18. H. W. R., & Parker, K. The prognosis isbased on severity, duration, and proximity of the exposure to the trauma.Other factors include social support, family history, childhoodexperiences, personality, and preexisting mental disorders (APA, 1994). Psychometric evaluation of trauma and posttraumaticstress disorder assessments in persons with severe mental illness.Psychological Assessment, 13(1), 11 -117. Gender differences were not found regarding endorsement for atraumatic event. Group Dynamics: Theory, Research, and Practice, 5(4), 252-26 . Other treatments for PTSD which continue to be investigated includethe use of cognitive therapy and imaginal exposure. A new treatment called multiple channelexposure therapy is proposed for treatment of both. S., Davis, J., & Gallagher, N. Findings were that gender, age attrauma, and race predicted PTSD in some populations. Current Research Current research includes the use of eye movement desensitization andreprocessing (EMDR) for treatment of PTSD. G., Phillips, K.A., Brown, P., & Keller, M. Zimmerman, M., & Mattia, J. A. Course, Progression, & Prognosis PTSD is found at any age. Education, previoustrauma, and general childhood adversity were more consistent predictors.All predictors varied according to population studied and methods used.Trauma severity, social support, and additional life stress, were strongerpredictors of effects. Symptoms in children may convert tonightmares or physical symptoms within weeks and assessment must considerthat this group may be unable to report other symptoms such as diminishedinterest or foreshortened future (APA, 1994; Demakis, 2 ). (2 1). Washington, DC:APA. For women, onset age for drug use and event exposure werealmost identical, but for men, drug use preceded event exposure. G.(2 1). The PTSD subscale is reported to have goodto excellent internal consistency and test-retest reliability, and good toexcellent discriminate, convergent, and concurrent validity, as reported inthe nursing journal, Comprehensive Psychiatry. King, Leskin, King, and Weathers (1998) reportedfurther on the CAPS, stating that based on a sample of 524 male militaryveterans, the test measured PTSD symptoms of reexperiencing, avoidance,emotional numbing, and hyperarousal. W., Leskin, G. (2 ). D. Diagnostic andstatistical manual of mental disorders, fourth edition. Shea, M. R., Andrews, B., & Valentine, J. Findings were that women and veterans exposed to high levelsof combat were at increased risk at both time intervals. Findings of a study comparingPTSD in an urban population of 1,832 respondents showed that PTSD victimsreported more violent and injurious behaviors while sleeping, sleepparalysis and talking, and hypnagogic or hypnopompic hallucinations. Results of the National Comorbidity Survey demonstrated that out of8, adults, PTSD was found in 7.8 percent of men and 1 .4 percent ofwomen. Demakis, J. Cottler, L. J., Sharkansky, E. Shea, Zlotnick, Dolan, Warshaw, Philips, Brown, and Keller (2 )reported findings of a study comparing no trauma subjects (n = 4 3), traumabut no PTSD diagnosis subjects (n = 151), and PTSD diagnosed subjects (n =68). P., Rosenberg, S. M. The authors performed a meta-analysis of 14 risk factors,including civilian or military status. A randomized trial of cognitivetherapy and imaginal exposure in the treatment of chronic posttraumaticstress disorder. In an article found in the nursingjournal, Comprehensive Psychiatry, Cottler, Nishith, and Compton (2 1)reported that in a group of 464 drug abusers, women more than men sufferedfrom PTSD. M. The authors concluded that while EMDR was notedas an effective treatment for noncombat PTSD, clear support is notprovided. B. G. Ohayon and Shapiro (2 ) further described the sleep disturbancesand psychiatric disorders that are associated with PTSD as described in thenursing journal, Comprehensive Psychiatry. The past two decades have demonstrated that a comorbidity existsbetween post-traumatic stress disorder and substance use disorders.Current and future research is therefore investigating the role of genderfor the prediction of this trend. (2 ). Tarrier, N., Pilgrim, H., Sommerfield, C., Faragher, B., Reynolds,M., Graham, E., & Barrowclough, C. The treatment wastested on 22 women and findings showed that it resulted in effectivereduction of symptommatology, compared to controls. A future trend in the management or treatment of PTSD is discussed byFalsetti, Resnick, Davis, and Gallagher (2 1). M., & Shapiro, C. The psychiatric diagnosticscreening questionnaire: Development, reliability and validity.Comprehensive Psychiatry, 42(3), 175-189. (2 ). It is estimated thatlifetime prevalence of alcohol abuse or dependence for males is 39.2percent and 5.7 percent for drug abuse or dependence in male veterans.PTSD victims describe associated feelings of guilt for surviving, andphobic avoidance which interferes with interpersonal relationships andemployment abilities. POSTTRAUMATIC STRESS DISORDER Introduction This research paper will present a discussion of Posttraumatic StressDisorder (PTSD). History/Identification of the Disorder A historical review of posttraumatic stress disorder begins with theuse of this diagnosis for military combat victims and concentration campvictims, and then proceeds to include its use for other traumatic events.PTSD is now used as a diagnosis for symptoms that follow exposure to anextremely traumatic stressor such as: violent personal assault (sexual orphysical), kidnapping, terrorist attacks, being held hostage, beingtortured, incarceration as a prisoner of war, natural and manmadedisasters, severe automobile accidents, or diagnosis of a life-threateningillness (APA, 1994; Demakis, 2 ). Laboratory Data for Diagnosis & Progression Autonomic functioning of heart rate, electomyography, and sweat glandactivity can be used to measure increased arousal. Wolfe, Erickson, Sharkansky, King and King (1999) reported thatpredictors and rates of PTSD over time are not completely understood. C. Journal of AbnormalPsychology, 1 9(2), 341-344. L., & Harvey, A., G.(2 ). Journal ofConsulting and Clinical Psychology, 69(2), 3 5-316. A., & Weathers, F. King, D. J., King, D. W., & King,L. I.
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