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oracne - Victoria Janssen
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Notes on PTSD



TYPES OF PTSD
There are three types of PTSD: acute, chronic, and delayed onset. In acute PTSD, symptoms last less than 3 months. In chronic PTSD, symptoms last 3 months or more. In delayed onset PTSD, symptoms first appear at least 6 months after the traumatic event.

PTSD is more prevalent among war veterans than among any other group.

Men with PTSD identify combat and witnessing someone else's injury or death most often as the cause of their condition. Women identify physical attack or threat most often as the cause of their PTSD.

SYMPTOMS OF PTSD ARE GENERALLY OF THREE TYPES:
INTRUSIVE
Dissociative states
Flashbacks
Intrusive emotions and memories
Nightmares and night terrors

Night Terrors Symptoms: Sudden awakening from sleep, persistent fear or terror that occurs at night, screaming, sweating, confusion, rapid heart rate, inability to explain what happened, usually no recall of "bad dreams" or nightmares, may have a vague sense of frightening images…Nightmares occur during the dream phase of sleep known as REM sleep. Most people enter the REM stage of sleep sometime after 90 minutes of sleep. The circumstances of the nightmare will frighten the sleeper, who usually will wake up with a vivid memory of a long movie-like dream. Night terrors, on the other hand, occur during a phase of deep non-REM sleep usually within an hour after the subject goes to bed. This is also known as stage 4. During a night terror, which may last anywhere from five to twenty minutes, the person is still asleep, although the sleepers eyes may be open. When the subject does wake up, they usually have no recollection of the episode other than a sense of fear. This, however, is not always the case. Quite a few people interviewed can remember portions of the night terror, and some remember the whole thing. (http://www.nightterrors.org/)


AVOIDANT: Avoiding emotions; Avoiding relationships; Avoiding responsibility for others; Avoiding situations that are reminiscent of the traumatic event

HYPERAROUSAL: Exaggerated startle reaction; Explosive outbursts; Extreme vigilance; Irritability; Panic symptoms; Sleep disturbance

Intrusive memories and emotions interfere with normal thought processes and social interaction. Flashbacks feature auditory and visual hallucinations. For example, the sounds and images of combat often comprise the content of flashbacks experienced by military veterans. Flashbacks can be triggered by ordinary stimuli such as a low-flying airplane or a loud noise, anything that brings to mind an aspect of the event. Nightmares and night terrors also feature aspects of the traumatic event. Dissociative symptoms include psychic numbing, depersonalization, and amnesia.

People with PTSD commonly avoid stimuli and situations that remind them of the traumatic event because they trigger symptoms.


People experiencing hyperarousal symptoms are always on the alert for danger or threat and are easily startled.

DIAGNOSTIC CRITERIA FOR POSTTRAUMATIC STRESS DISORDER
The person has been exposed to a traumatic event in which both of the following were present:
*The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
*The person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

The traumatic event is persistently reexperienced in one (or more) of the following ways:
Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
*Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
*Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
*Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
*Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
*Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
*Efforts to avoid activities, places, or people that arouse recollections of the trauma
*Inability to recall an important aspect of the trauma
*Markedly diminished interest or participation in significant activities
*Feeling of detachment or estrangement from others
*Restricted range of affect (e.g., unable to have loving feelings)
*Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
Difficulty falling or staying asleep; Irritability or outbursts of anger; Difficulty concentrating; Hypervigilance; Exaggerated startle response

Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

from APA. DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 4th ed. 1994. Washington, DC: American Psychiatric Association (APA).

IMMEDIATE ONSET: Better response to treatment; Better prognosis (i.e., less severe symptoms); Fewer associated symptoms or complications; Symptoms are resolved within 6 months.

DELAYED ONSET: Associated symptoms and conditions develop; Condition more likely to become chronic; Possible repressed memories; Worse prognosis.

People who experience trauma sometimes repress their memories of the event to avoid the pain of thinking about or remembering them. These so-called repressed memories sometimes resurface during therapy or may be triggered by something in everyday experience that reminds the patient of the traumatic event. Working with repressed memories in therapy is controversial, because many therapists doubt their validity and accuracy. Repressed memories are typically retrieved during hypnosis, which many psychiatrists consider an unreliable tool for memory exploration.

Tags: wwi research
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