PTSD - POST TRAUMATIC STRESS DESORDER

According to the DSM-IV (1994), Post Traumatic Stress Disorder is caused by traumatic events that are outside the range of usual human experiences such as military combat, violent personal assault, being kidnapped or taken hostage, terrorist attack, torture, incarceration as a prisoner of war, natural or man-made disasters, automobile accidents, or being diagnosed with a life-threatening illness. The disorder also appears to be more severe and longer lasting when the event is caused by human means and design (bombings, shootings, combat, etc.). Such incidents would be distressing to almost anyone, and is usually experienced with intense fear, terror, and helplessness. Typically, the initiating event involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person. Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. Not everyone with PTSD has been through a dangerous event. It is important to remember this because not everyone who lives through a dangerous event gets PTSD. In fact, most will not get the disorder. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD. Symptoms of PTSD are often intensified when the person is exposed to situations or stimulus that resemble or symbolize the original trauma in a non-therapeutic setting. Such uncontrolled exposure may lead the person to react with a survival mentality and mode of response that could put the person and others at considerable risk. The essential feature of PTSD is the development of characteristic symptoms that may include: intrusive thoughts and flashbacks, anger, isolation, emotional numbing and constriction, anxiety, depression, substance abuse(such as drugs or alcohol), survivor guilt, hyper-alertness, suicidal feelings

PTSD - POST TRAUMATIC STRESS DESORDER

and thoughts, alienation, negative self-image, memory impairment, problems with intimate relationships, emotional distance from family and others, denial of social problems. Thus it happened a long time in the person life, he can relive those situations in a daily bases in many ways. They may have upsetting memories of the traumatic event. These memories can come back when they are least expecting them. At other times the memories may be triggered by a traumatic reminder (such as when a combat veteran hears a car backfire, a motor vehicle accident victim drives by a car accident or a rape victim sees a news report of a recent sexual assault). These memories can cause both emotional and physical reactions. Sometimes these memories can feel so real it is as if the event is actually happening again. This is called a "flashback." Reliving the event may cause intense feelings of fear, helplessness, and horror similar to the feelings they had when the event took place. A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks with the person who has symptoms of PTSD or someone related to an individual that suspects him/her to have PTSD. Despite increased recognition of prevalence of Posttraumatic Stress Disorder (PTSD) in the general population, it is largely ignored among the severely mentally ill, so with this work we intend to show how the PTSD manifests, their biological bases and how it works, how some people of certain age and gender react to it and their possible treatments through different methods. We will show some treatments works and some trials made by foreign Psychologists (PhD).

PTSD - POST TRAUMATIC STRESS DESORDER

The clinical classification of physical and psychological stress symptoms that can develop after experiencing a traumatic event (e.g., rape, war) can be classified into three types: acute stress, late stress and post-traumatic stress (Waldanne, 2011). Acute stress starts soon after the traumatic event has taken place and it is extremely visible because it exhibits the most dramatic manifestations of emotion such as difficulty sustaining attention, anxiety, panic and sweating (Mitchell & Bray, 1990). The time of occurrence lasts no more than four weeks and one can more readily overcome the trauma and its stress symptoms without needing professional help. In contrast to acute stress, late stress can develop months or even years after the traumatic event. The symptoms of late stress are similar to the acute stress symptoms, they simply occur at a later stage in a persons life. Late stress is difficult to diagnose since the manifestations are not easily associated to the traumatic event due to the long time gap between the traumatic event and the resulting late stress. This type of stress is more resistant and more difficult to recover from so professional help is often necessary (Waldanne, 2011). When an individual cannot overcome the traumatic event and fails to handle the acute stress symptoms can develop Post-Traumatic Stress Disorder (PTSD). Similar to late stress, PTSD is a late short or long-term response which can cause serious psychological disturbance. Its symptoms include intrusive memories of reliving the memories of the trauma (flashbacks), dreams and nightmares; physiological arousal manifesting in alertness and insomnia; and isolation and insensitivity leading to social distancing and difficulty in expressing ones feelings (Astin & Resick, 2003).In other words, since the individual wants to escape of the distressing memories but fails in doing so, the psychological suffering continues incessantly. Furthermore, PTSD can change a persons personality, social behavior, and in the long run can cause extreme fear of leaving home, alcoholism and drugs. While

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self-healing is possible, it is highly recommended to seek medical or psychological help which might consist of therapy and/or medication. The brain areas involved in PTSD are the prefrontal cortex and hypothalamus. Researchers of University of California, Los Angeles (Goenjian, Bailey, Walling, Steinberg, Schmidt, Dandekar, Noble) investigated the role of PTSD on hormonal changes and found that PTSD is related with two genes (TPH1 e TPH2) which are responsible for the production of serotonin which is a neurotransmitter that regulates mood, sleep, and capability of attention. In other words, due to the PTSD created genetic variation the body produces less serotonin. Furthermore, researchers at the Veterans Affairs Medical Center (VAMC) in Bronx, New York (Hellhammer, Wust, Kudielka) conducted a study where discovered that adult children with at least one parent who is a Holocaust survivor have low cortisol levels. The discovery means that low cortisol levels may be predictive of PTSD. Also, the results showed that these cortisol level problems led to a reduction of 8-10% of activity in the prefrontal cortex and hippocampus. Consequently, due to the reduced activity the prefrontal cortex cannot control paranoid behavior, anxiety and depression as effectively which enhances these symptoms in individuals suffering from PTSD. PTSD can be caused by either a positive or negative event. So, while the event may start out as a traumatic occurrence, this is not an absolute requirement. Trauma is defined as physical, mental and emotional pain that goes beyond our control caused by an event which is initiated by our environment, other people or even ourselves. Physical pain occurs from an impact to our physical self and results in bruising, bleeding, cuts, fracture sand tears to our body parts. Emotional pain stems from our emotions after being told negative information, being threatened, or after being describing in demeaning and derogatory words. Consequently, our memory implants this pain-related information and our skeltonmuscular system becomes imprinted with memory. Because of this imprinting in our visual,

PTSD - POST TRAUMATIC STRESS DESORDER

auditory and ol-factory sensory systems our fight or flight responses are triggered. More specifically, someone suffering from PTSD can exhibit strong negative reactions when confronted with just a smell, certain sounds, or even the sight of something.

Literature Review The study the Vietnamese refugees traumatized about the effectiveness of treatment CBT (Cognitive-Behavioral Therapy) has shown, unfortunately, be inconclusive. Moreover is not assured, taking into account the observed symptoms (panic attacks and PTSD) if treatment would be the best alternative therapy such as cognitive therapy, which possibly have the same similar degree of benefit. All study patients were taking medication, which means that future studies should consider medication dosage, both as an outcome measure and as a possible confounding variable. Researchers B. Christopher Frueh & Anouk L. Grubaugh & Karen J. Cusack & Matthew O. Kimble & Jon D. Elhai (2009) in their study, an open trial, tried to, through exposure-based cognitive behavioral treatment of PTSD improve adults with schizophrenia. Sequelae of PTSD typically include increased arousal and distress, social isolation and interpersonal conflict, and generally poor occupational and social functioning. for that they used treatment of prominent psychotic symptoms, such as hallucinations, delusions, and bizarre behavior, often take precedence in treating individuals with persistent psychotic disorders, leaving PTSD symptoms unaddressed. The premise and evidence indicating that psychosocial stressors play a critical role in the onset and relapse of psychotic episodes in individuals with schizophrenia suggests that ongoing anxiety and trauma related symptoms is likely to precipitate increases in symptoms or relapses in vulnerable individuals (Rosenberg, Lu, Mueser, Jankowski, & Cournos, 2007).

PTSD - POST TRAUMATIC STRESS DESORDER

The results of this study of manualized exposure-based cognitive-behavioral therapy showed, according to the researchers preliminary optimism. They found out that significant improvements were not noted in depressive symptoms, general anxiety symptoms, frequency of self-reported social activities, or physical health status however they considered clinical outcome efficacy for PTSD at post-treatment and 3-month follow-up is extremely promising because in the clinical interviews data for completers showed significant symptom reductions on most of them. The study of the effectiveness of both methods of treatment compared with the control group, they are: The method of treatment CBT (Cognitive-Behavioral Therapy) in reducing symptoms and healing PTSD (according to studies by Bisson and Andrew Jennings, Friedman, Taylor and Ahmadizadeh Aslani et al.) This has shown that patients in group CBT for the benefit of cognitive-behavioral skills (and based on the shock) could overcome the problems through cognitive restructuring and reflection to provide answers / projection of emotions during exposure to the damaging event. In this method, patients were taught to think in dealing with the problems causing the patient to achieve self-efficacy in dealing with problems and potentially solve them know. On the other hand, the results obtained EMDR to treat PTSD be shown to be effective for the recovery of emotional shocks in the short term. Thus, it can be concluded that there was virtually no difference between the efficacy of both treatment methods, both showing be similar achieve recovery and reduction of symptoms. Monson & Rodriguez & Warner (2005), in their study Cognitive-Behavioral Therapy for PTSD in the Real World they pretended to show if interpersonal relationships make a real difference in treating Vietnam Veterans (VV) with PTSD and the purpose of the study was to investigate the role of pretreatment in interpersonal relationship functioning in

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two forms of group cognitive-behavioral treatment (CBT) for veterans with PTSD and the role of interpersonal relationship functioning in treatment outcomes. In short the researchers found that despite pretreatment did not contribute to the prediction of PTSD, only the violence associated with PTSD in VV decreased. These findings run contrary to concerns that trauma-focused treatments increase the potential for dangerous behavior due to symptom exacerbation. In fact, there was no difference in violence perpetration by treatment type at lower levels of intimate relationship functioning, and violence perpetration was less likely in the trauma-focused group with better intimate relationship functioning. Similarly, there were no differences in alcohol abuse at follow-up between the two treatments. Discussion In our paper our goal was to show what PTSD was, how it begins and manifests, their biological bases and how it works, how some people of certain age and gender react to it and their possible treatments through different methods. We showed how some treatments worked and some trials made by foreign Psychologists In summary, PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event because when we are in danger, it is natural to feel afraid and this fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This fight-or flight response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they are no longer in danger. In the U.S. military PTSD is recently called and recognized by the Pentagon as an invisible wound because we cannot see at the naked eye due to concussions or trauma to the forehead because of explosions and stress environments of war, that has their original bases in the hormonal system such as the levels of cortisone and serotonin in your body.

PTSD - POST TRAUMATIC STRESS DESORDER

PTSD occurs frequently in the military domain since the physical, emotional, cognitive and psychological demands of a combat environment place enormous stress on military personnel. Rizzo, Reger, Gahm, Difede, and Rothbaum (2009) have argued for the use of a Virtual Reality (VR) system for PTSD treatment that can be offered to veterans returning from combat. VR can be used as a gradual exposure therapy treatment for PTSD since imaginal therapy has been shown to be ineffective since some patients refuse to participate and while other patients are willing they cannot express their emotions or senses (Difede & Hoffman, 2002). Rizzo et al. (2009) designed a Virtual Iraq PTSD VR from the virtual assets that were initially developed for a combat tactical training simulation, which then served as the inspiration for the X-Box game entitled "Full Spectrum Warrior". This VR therapy enables the therapist to adapt the therapy to the individual patients needs by creating some trigger stimuli which interact with relevant patient feedback throughout his life within the VR. The results from their studies indicated post-treatment improvement on all PTSD measures and maintenance of these gains at a 6-month follow-up (Rizzo et al., 2009. Additionally, VR exposure treatment has been used in previous treatments of PTSD patients with reports of positive outcomes. In our opinion this work is quite extensive with a lot of things to talk about and write but anyway, is very curious and informative, there is just too much information online and we had to make a short version of this subject because we did not had the space and time to cover all branches of PTSD. References Ahmadizadeh, Eskandari, Falsafinejad, Borjali(2010). In Iranian Journal of Military Medicine Fall 2010, Volume 12, Issue 3; 173-178 Frueh, Grubaugh, Cusack, Matthew, Kimble, Elhai,Knapp(2009). In Anxiety Disord. 2009 June; 23(5): 665675. doi:10.1016/j.janxdis.2009.02.005

PTSD - POST TRAUMATIC STRESS DESORDER

Hellhammer, Wst, Kudielka(2009). In Psychoneuroendocrinology (2009) 34, 163171 Hinton, Pham, Tran, Safren, Otto,Pollack(2004). In Trauma Stress. 2004 October ; 17(5): 429433. doi:10.1023/B:JOTS.0000048956.03529.fa Monson, Rodriguez, Warner (2005). In Journal of Clinical Psychology, vol. 61(6), 751761 (2005) Rizzo, A. A., Reger, G., Gahm G., Difede, J., & Rothbaum, B. O. (2009). Virtual reality exposure therapy for combat related PTSD. In P. Shiromani, T. Keane, & J. LeDoux (Eds.), Post-traumatic stress disorder: Basic science and clinical practice (pp. 375 399). New York: Humana Press. Yehuda, Bierer, Schmeidler, Aferiat, Breslau, Dolan (2000). Low cortisol and risk for PTSD in adult offspring of Holocaust survivors. Am J Psychiatry 157: 1252-59.