PTSD arises from exposure to actual or threatened death. It can develop from experiencing traumatic events, like the shooting of a loved one, accident, sexual abuse, and experiencing the death of a colleague. PTSD can affect anyone from six years old. DSM-5 categorizes PTSD as a trauma and stressor-related condition. Determining whether a patient has PTSD can be challenging; however, the DSM-5 criteria can help in diagnosing the disorder. A patient cannot display all the symptoms indicated in the DSM-5 but should meet the requirements of the diagnostic manual (Bisson et al., 2015; Shalev et al., 2017). To understand PTSD, we can use the case of Kate, a 26-year-old lady who was involved in a car accident. The description, in this case, is hypothetical and uses the DSM-5 criteria to describe her symptoms and experiences.
Kate was driving alone on the highway and was using her phone when the car suddenly started to swerve dangerously on the road. She panicked and applied pressure on the brakes, but the car started rolling. Kate was distressed by the incident, and since then, her social interaction has changed. She is unable to work or handle other essential tasks (Shalev et al., 2017). Kate frequently re-experiences spontaneous moments of the accident and, at times, dreams about it when she is asleep. Additionally, Kate experiences flashbacks and psychological distress from the incident (NIMH, 2020). Currently, she has developed a phobia against cars and is afraid to travel even if the driver is someone she is conversant with like her boyfriend or parents. Kate blames herself for the accident (Bisson et al., 2015). Lately, she is engaging in self-destructive behavior and experiences sleep disturbances.
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The accident occurred two and a half months ago, and Kate's situation seems to be worsening. In addition to the identified symptoms, Kate experiences trauma-related thoughts and feelings. Similarly, she can’t recall the key features of the accident and continuously blame her action for the accident. Kate also feels like she is an outside observer or in a dream. According to DSM-5 criteria for diagnosing PTSD, Kate meets the requirements for criterion A, one or more from criterion B and C and two or more from D and E (Shalev et al., 2017). Lastly, she meets the criteria F-H.
The diagnosis of Kate identifies issues like dissociative and delayed expression, which can help id differentiating the condition from other mental disorders. She is experiencing an acute instance of trauma from the accident. Some of the treatments for her condition include cognitive behavioral therapy, which tries to change the way she responds or evaluate different situations, feelings, and thoughts (Shalev et al., 2017). Exposure therapy helps to reduce fear avoidance behavior and anxiety. Acceptance and commitment therapy can also help to alleviate PTSD by reducing the tendency for avoidance.
Stress inoculation training can also reduce PTSD symptoms through anxiety reduction. Lastly, eye movement desensitization and reprocessing can also help to alleviate the condition by allowing the patient to think about trauma and pay attention to other stimuli like the movement of a finger or light thus allowing them to develop new connections (NIMH, 2020; Shalev et al., 2017). Medication can include sertraline (Zoloft) and paroxetine (Paxil). Other remedies include Benzodiazepines, antipsychotics, and antidepressants.
Nursing interventions for support and care of PTSD patients include administering cognitive therapy to help the patient appreciate the impact of harmful thinking patterns like the reoccurrence of an accident. Similarly, trained nurses can give or help exposure therapy to help the patient reduce nightmares and flashbacks. Nurses can also help in psychopharmacology, like administering antidepressants like Prazosin and anxiety drugs. Nurses should be good communicators and have appropriate training to help patients with PTSD (NIMH, 2020; Shalev et al., 2017). Nurses should demonstrate empathy and compassion and consider emotional reactions. It is critical to understand the behavior of the patient and adjust accordingly to ensure that they are comfortable and can open up and share their experiences.
References
Bisson, J., Cosgrove, S., Lewis, C., & Roberts, N. (2015). Post-traumatic stress disorder. BMJ , h6161. https://doi.org/10.1136/bmj.h6161
NIMH. (2020). Post Traumatic Stress Disorders (PTSD). Socialwork.msu.edu. Retrieved from https://socialwork.msu.edu/sites/default/files/Koehler/docs/NIMH%20Post-Traumatic%20Stress%20Disorder.pdf.
Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-Traumatic Stress Disorder. New England Journal Of Medicine , 376 (25), 2459-2469. https://doi.org/10.1056/nejmra1612499
