A traumatic event causes a different reaction depending on an individual with some of the events leading to mental disorders. Post-traumatic stress disorder (PTSD) is a condition established by a horrifying or life-threatening event. It can occur from a single occurrence or prolonged exposure to an incident. According to statistics, 3% of adults have had PTSD at the instance of their life with the prevalence rate standing at 1.9% - 8.8% (Bisson, Cosgrove, Lewis & Roberts, 2015) . There are significant challenges of trying to predict an individual who is likely to develop PTSD, but patients with the disorder are likely to be exposed to poor health, psychiatric comorbidity and immunology disorder. Such individuals are also am an economic burden since their treatment is expected to cost a significant amount and even the lost productivity.
Symptoms of PTSD
The symptoms of PTSD can significantly affect the life of an individual making it difficult for them to go on with their lives in a healthy way. PTSD can be difficult to spot especially immediately after the incident. The situation is worsened when the happenings are taking place inside one's head, and they cannot differentiate whether its rage or depression. The symptoms affect the entire life of an individual including the way they sleep and how they relate to others. Common signs of PTSD include avoidance of the stimuli that relate to an event that led to PTSD, alteration in cognition, hyperarousal and mood alteration.
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It is common for the memories of a traumatic event to come and bother an individual in the form of a flashback or a nightmare. Such occurrences lead to fear, guilt and suspicion. The emotions can play out physically as the panic attack, heart palpitation, shaking and chills. Individuals with PTSD are likely to have avoidance issues and therefore prefer not to think about the event, or even to talk about it. Such a person is expected to steer away from everything and everyone including activities and places that remind them of the event. An individual can opt to stay away from people leading to detachment and loneliness.
Arousal symptoms are also likely to be seen in a person with PTSD. Such signs have the potential to make one's emotions intense to the extent that they react differently from the usual way that they do. It is also common for an individual with PTSD to find it hard to focus since they always feel like they are in danger or under an attack. An individual can also report mood swings that are unrelated to the event that led to the current situation.
The above symptoms can easily be identified in a person with the disorder. The DSM – 5 criteria recognise the signs needed for PTSD to be diagnosed. They include intrusion symptoms like recurrent involuntary and intrusive distressing memories, intense psychological distress and reaction to the identified cues and dreams. Avoidance related symptoms include avoiding painful thoughts and other feelings that are readily associated with an incident or event. Similarly, an individual can avoid visible reminder.
Symptoms with adverse alterations in cognition and mood include challenges in remembering important issues a condition that can easily be caused by amnesia, persistent or exaggerated negative expectations of self, people and the world. Distorted cognition is yet another symptom and leads to blaming oneself and others. An individual can exhibit negative emotions and a reduced interest to participate in important events.
Alteration related symptoms include irritable behaviours and possessing angry outburst in situations with little or no provocations. An individual can also show recklessness and demonstrate destructive behaviours. Similarly, one can also be hyper-vigilant, possess exaggerated startle response and sleep-related issues.
Prevalence Rates
PTSD arises from the exposure to a traumatic event. The prevalence of the disorder has expanded following an increase in traumatic circumstances. According to community studies, exposure to a life-threatening event ranges from 50% to 90%. Females have higher prevalence rates 10.1% compared to their male counterparts at 4.9%. In a European study, the 63.3% of respondents reported to life-threatening experiences with the prevalence rate for PTSD being 0.5% and 2.32% for males and females. Another study conducted in 1996 in Detroit showed that there is a probability of 9.2% for PTSD following a traumatic incident with 25% of the people exposed to such events developing PTSD (Schlaepfer & Nemeroff, 2012). The figure, however, can be higher for life-threatening events compared to those with low psychological impact. Different studies point out some differences in the sample selection and their outcome.
The prevalence rates in PTSD differs fr.om one country to another. However, the occurrence of the disorder following a life-threatening incident seems to be consistent in the different culture around the world. However, there are slight variation in PTSD across European countries and the U.S. A study of the disorder in Europe noted 28 incidences that can be traumatising with six of the frequencies being closely related to the development of PTSD. Some of the occurrences identified by the study include being beaten by a romantic partner, rape, a sick child, stalking, assaultive violence, sudden or unexpected death of a loved person and past traumatic events. Assaultive violence carries the highest risks for the development of PTSD (Schlaepfer & Nemeroff, 2012). An understanding of the causes of PTSD can go a long way in helping to understand the disorder and how to address it in patients who display the signs that are associated with the condition.
Diagnostic criteria
According to the fifth edition of the American Psychiatry Association, DSM-5 PTSD belong to trauma and stressor-related disorders. DSM-5 has also added avoidance as a diagnostic cluster. Similarly, the negative cognition and traumatic events are not only caused by a reaction of horror, helplessness or fear. The world health organisation has also changed the symptoms of PTSD by eliminating the ones shared by similar conditions. The new changes clarify the understanding of PTSD since past literature identified 55% overlaps for individuals with PTSD in DSM - IV and DSM -5. There is a 30% overlap in DSM – IV, DSM – 5 and ICD – 11. The new criteria for diagnosing the condition showcases negative cognition and worldviews as well as self-denigration while helping the clinicians to reconsider the features of the above requirements in their assessment and intervention ( Shalev, Liberzon & Marmar, 2017 ). Significant differences in the template are a strong pointer to the clinician of the existing gaps in the diagnostic criteria as well as the typical symptoms in an individual.
PTSD Subtypes
An individual can have a dissociative subtype which is a direct defence against a traumatic event. The condition is characterised with derealisation as well as depersonalization. An individual is in a confrontational mood following a past incident where escape was impossible. The patient tries to escape from the internal and external environment distress in situations where such flight is impossible Consciousness is altered in such a, and the overwhelming experiences are taken into account as an individual tries to continue operating under the dangerous conditions ( Levin, Kleinman & Adler, 2014 ). The subtype is associated with defence and overcoming the inherent conditions in one’s life.
Diagnosis, Evaluation and Managing the Disorder
The delayed onset of PTSD raises significant issues concerning the development of the condition. It is common for an individual to exhibit the highest number of symptoms immediately after the incident but the same will diminish over time. However, a study of the disorder identified significant differences from the previously held belief. 25% of the subjects reported a delay in the onset of any symptoms related to the condition. According to the study, such individual show slightly lower symptoms following the start of the traumatic event but the situation changed as the symptoms suddenly increased to surpass the threshold. According to DSM – 5, delayed symptoms associated with PTSD arise once full treatment of the condition has not been addressed six months after the incident.
Patients are likely to exhibit symptoms like depression and substance abuse. Health professionals should understand such occurrences and screen such a patient for evidence of a traumatic event in the past. Some of the symptoms shown by patients in primary care include a headache, sleep disturbance and pain. Those in the mental health clinics show signs of substance abuse, depression and self-harm (Dorrington et al., 2014; Sareen, 2014). It is however common for some patients to show recovery without undergoing any medication with the symptoms declining to the extent that they are not severe enough to negatively affects the daily activities and relationships of an individual. A chronic condition, however, keeps on reoccurring, and the urgent medical attention must be sought.
Diagnosis of the condition can involve a psychiatrist or a psychologist. Such determination must follow a month-long display of the symptoms. Similarly, the patient must show one re-experiencing and avoidance symptoms. Similarly, the patient should display two arousal and reactivity symptoms and at least two mood and cognition symptoms. Once the patient has met the above criteria, the physician will then identify the best approach to treat the condition which can be psychotherapy or medication or even a combination.
References
Bisson, J., Cosgrove, S., Lewis, C., & Roberts, N. (2015). Post-traumatic stress disorder. BMJ , h6161. http://dx.doi.org/10.1136/bmj.h6161
Dorrington, S., Zavos, H., Ball, H., McGuffin, P., Rijsdijk, F., & Siribaddana, S. et al. (2014). Trauma, post-traumatic stress disorder and psychiatric disorders in a middle-income setting: prevalence and comorbidity. British Journal Of Psychiatry , 205 (05), 383-389. http://dx.doi.org/10.1192/bjp.bp.113.141796
Gradus, J. (2017). Epidemiology of PTSD - PTSD: National Center for PTSD . Ptsd.va.gov . Retrieved 20 February 2018, from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
Levin, A., Kleinman, S., & Adler, J. (2014). DSM-5 and Posttraumatic Stress Disorder. The Journal of The American Academy Of Psychiatry And The Law , 42 , 146 -158.
National Center for PTSD. (2017). Treatment of PTSD - PTSD: National Center for PTSD . Ptsd.va.gov . Retrieved 23 February 2018, from http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp
