The human mind slowly and gradually develops contemporaneously with the gradual growth of the human and is thus not calibrated for sudden and extreme conditions. These sudden extremities can have a lasting and permanent impact on the careful calibration of the mind. This especially occurs when a life-threatening or scary event takes place to an individual, or in the presence of an individual (Calhoun & Tedeschi, 2014). The action itself will leave an impact that causes sporadic remembrance of itself mainly based on some triggers that can be associated with the event. It may also lead to secondary and seemingly unrelated emotions, thoughts, imaginations or dreams whose extremities are referred to as Posttraumatic stress disorder (PTSD). PTSD mostly occurs based on the reactions by individuals to traumatic situations and not the situations themselves.
Description of the Selected Disorder
The American Psychology Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of 1980 was the first to recognize PTSD as a diagnosable mental disorder. DSM-IV indicated PTSD as an anxiety disorder while DSM-V classified it to be a trauma- and stressor-related disorder (Calhoun & Tedeschi, 2014). It can be defined as a mental disorder that may take place when an individual is exposed to extreme and threatening situations. The definition of the extreme and threatening situation in this context is defined from the context of the individual and not the situation itself. Symptoms of PTSD vary from patient to patient but generally involve negative thoughts and dreams that relate to the traumatic event, extreme avoidance of events relating to the traumatic event, and physical or mental distress triggered by cues that relate to the traumatic event. Another common symptom of PTSD is inordinately high levels of flight or fight reactions to events related or even unrelated to the traumatic event that triggers the PTSD. PTSD is extremely common due to the high proliferation of scare factors with experts indicating that just under 10% of Americans have had PTSD at some point in their lives (The National Institute of Mental Health, 2017). In most cases, PTSD will disappear in a few months with or without intervention.
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Causative Factors of the Disorder
Causation is among the most complex areas in the study of PTSD. Several individuals will undergo the same traumatic event with most of them not developing PTSD yet one or two of them will. From a very general perspective, PTSD is caused by extreme mental trauma, which may or may not be accompanied by physical trauma or even an actual threat of physical trauma. The mental trauma will trigger symptoms relating to the event as outlined above. Research has, however, revealed that most people who face actual mental or physical trauma do not develop any PTSD. This has led to the hypothesis that the causation of PTSD relates to both nature and nurture and their impact on the mental constitution of an individual (Calhoun & Tedeschi, 2014). This constitution determines how the individual’s mind reacts to traumatic, potentially, or perceived traumatic events. It is the reaction, and not the event that eventually causes the PTSD. Finally, events, where the threat comes from another human being, such as physical or sexual violence, create a higher propensity for PTSD.
Diagnosis of the Disorder
The diagnosis of PTSD has been a controversial subject in the practice of psychology. The condition has always existed but was initially not recognized hence no substantive diagnostic procedure was developed for it. DSM-III provided a very rigid diagnostic threshold thus only extreme PTSD cases could be diagnosed as such. This led to a high frequency of false-negatives. DSM-IV of 1994 considered PTSD as an anxiety disorder and overcorrected the diagnosis leading to a doubling of PTSD diagnosis. Eventually, the 2013 DSM-V provided for a four-symptom cluster criterion for the diagnosis of PTSD (Hoge et al, 2014). These symptoms are the re-experiencing of the traumatic event, avoidance of any reminders of the traumatic event, negative alteration of cognition and moods upon cues of the traumatic event, and alterations in reactivity or arousal that is associated with the traumatic event. There are over 12 screening tools that have been developed for PTSD diagnosis with seven of them being specifically for PTSD (Calhoun & Tedeschi, 2014). Among them is Clinician-Administered PTSD Scale (CAPS), which is considered as the standard diagnostic tool. The diagnosis of PTSD also varies based on age and circumstance. Validity, reliability, and accuracy have been a consistent problem in the diagnosis of PTSD. APA has issued a general guide for diagnosis, the American Academy of Child and Adolescent Psychiatry has issued a secondary guide for children and adolescents while the U.S. Department of Veterans Affairs has also developed their own stratagem (Cook et al, 2017).
Treatment of the Disorder
PTSD changes the core assumptions that have been developed in the human mind thus transforming the psychological systems of the individual. Most treatment regimens are based on helping the patient unlearn the core assumptions that developed as a consequence of the traumatic event and also relearn the normal core assumptions (Brewin, 2014). As with all mental health issues, treatment has two major limbs; the main limb is the treatment and management of the disorder. The second limb is the control of symptoms and prevention of adverse conduct against the self or others. PTSD increases the propensity for suicide ideation and attempts in most patients (Arnsten et al, 2015). It also increases the propensity for self-harm or harm to others, mainly due to extreme flight-or -fight reactions. These limbs of extenuation of adverse symptoms are handled based on the nature and extremities of the symptoms. Common interventions include pharmacological intervention and institutionalization.
With regard to the first limb of treatment and management, research has established that a combination of therapy and pharmacological intervention is the most effective. Therapy in this scenario includes Psychotherapy including Interpersonal psychotherapy, Cognitive behavioral therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) (Bisson et al, 2013) . Pharmacological intervention includes antidepressants such as Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines which are not highly recommended, medical cannabis, and Glucocorticoids. The key lies in the combination of both therapy and medication (Cook et al, 2017).
Survey of Current Research on the Disorder
The fact that confirmation of the existence of PTSD only happened a few decades ago and its DSM classification has since changed twice is evidence that a lot of research has been ongoing with relation to PTSD. Among population segment that stands at great risk of PTSD is the US military veterans whose numbers have augmented due to the recent wars that the nation has been involved in (The National Institute of Mental Health, 2017). This has triggered inter alia research on the effectiveness of medical cannabis as a pharmacological extenuation of PTSD. Among the basis for the research is the high cost of most PTSD medication and the relatively low cost of cannabis. Another important research relating to PTSD and American veterans is currently underway in James A Haley Veteran’s Hospital (Tampa) (Ojo et al, 2016). Researchers have managed to develop a means of using animals to test reactions to PTSD intervention, which is a major feat. Finally, as indicated above, there has been a lot of controversy relating to the diagnosis of PTSD due to over-reporting and under-reporting of symptoms, which exponentially reduces accuracy. The issue of false-positives and negatives is also a challenge in PTSD diagnosis and has also led to several research projects (Ojo et al, 2016: The National Institute of Mental Health, 2017).
Conclusion
It is clear from the foregoing that PTSD is not per se about what happened but the reaction to it. Thus, several people will have the same experience with a segment thereof having passive and mild reactions while others will have extreme reactions that will lead to PTSD. Research on PTSD is in high gear, mainly buoyed by the influx of military veterans who have undergone extreme trauma in active combat. Different diagnostic regimens exist but are being standardized. Management includes unlearning the effects of reaction to trauma so as to reset the mind to how it was before the reaction to the trauma took place.
References
Arnsten, A. F., Raskind, M. A., Taylor, F. B., & Connor, D. F. (2015). The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder. Neurobiology of stress , 1 , 89-99
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post ‐ traumatic stress disorder (PTSD) in adults. The Cochrane Library
Brewin, C. R. (2014). Episodic memory, perceptual memory, and their interaction: Foundations for a theory of posttraumatic stress disorder. Psychological Bulletin , 140 (1), 69-97
Calhoun, L. G., & Tedeschi, R. G. (Eds.). (2014). Handbook of posttraumatic growth: Research and practice . New York: Routledge
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., ... & Mallah, K. (2017). Complex trauma in children and adolescents. Psychiatric annals , 35 (5), 390-398
Hoge, C. W., Riviere, L. A., Wilk, J. E., Herrell, R. K., & Weathers, F. W. (2014). The prevalence of post-traumatic stress disorder (PTSD) in US combat soldiers: a head-to-head comparison of DSM-5 versus DSM-IV-TR symptom criteria with the PTSD checklist. The Lancet Psychiatry , 1 (4), 269-277
Ojo, J. O., Mouzon, B., Algamal, M., Leary, P., Lynch, C., Abdullah, L., ... & Crawford, F. (2016). Chronic repetitive mild traumatic brain injury results in reduced cerebral blood flow, axonal injury, gliosis, and increased T-tau and tau oligomers. J Neuropathol Exp Neurol , 75 (7), 636-655
The National Institute of Mental Health. (2017). Post-traumatic stress disorder. Retrieved November 24, 2017, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
