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Post-Traumatic Stress Disorder (PTSD)

"I was raped when I was 25 years old. For a long time, I spoke about the rape as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling."

"Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the rape. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out."

"The rape happened the week before Thanksgiving & I can't believe the anxiety & fear I feel every year around the anniversary date. It's as though I've seen a werewolf. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."

post traumatic stress disorder - click here now!

Mentally Unstable Soldiers Redeployed to Iraq

Stretched Thin, Army Puts Some Vulnerable Soldiers Back on the Frontlines

Oct. 23, 2008

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ptsd.. it's a little bit of everything ....
what causes post traumatic stress?

Are You Angry or Depressed Because Your Partner has Post-Traumatic Stress Disorder or PTSD?
by Diane England Ph.D., the Official Guide to Post-Traumatic Stress Disorder

Does your partner refuse to do practically anything with you anymore even though you used to go everywhere together? Do you find verbal abuse being slung your way when your partner used to be a kind person?

Are you confused by a suddenly sexless marriage when your partner couldn’t keep his hands off of you previously? If your loved one has been diagnosed with Post-Traumatic Stress Disorder or PTSD, perhaps while you find these changed behaviors upsetting, they shouldn’t surprise you. PTSD symptoms cause problematic behaviors like these - behaviors that can be emotionally painful to you as the partner of a PTSD sufferer.

While you undoubtedly want to be a loving and supportive partner, are you finding it increasingly challenging to do so? Likely, you are either becoming increasingly angry or depressed as your own needs continue to sit there ignored. If this is the case, it might be time to try and change up your thinking. This might help you to have an easier time of it despite the continuing challenges PTSD delivers.

Realize that your partner might not want to go anyplace because he’s fearful of a flashback occurring, one of the symptoms of PTSD. Think of a flashback as an unfolding in your PTSD-suffering partner’s mind of the traumatic event with all its scariness, disturbing visual images, displeasing smells, and whatever sounds were heard in the course of the traumatic event.

When the PTSD sufferer’s brain reacts to a trigger--something in the present that the brain interprets as a pattern similar to what was experienced in the course of the traumatic event— and a flashback occurs, your partner who suffered PTSD after being sexually assaulted, for example, believes she is actually being raped again. Your warrior wounded by PTSD believes he’s back fighting insurgents in Afghanistan or Iraq.

When you think about how disturbing a flashback has to be for your partner, can you better appreciate why your loved one wants to avoid anything that might trigger one? Since your partner has no idea as to what in the present could do so, it shouldn’t surprise you that your wounded warrior wants to avoid public places crowded with people, for example.

When you understand the symptoms of PTSD, it becomes easier to accept your partner’s changed behaviors, or you can avoid taking them so personally. Instead, you can remind yourself that the PTSD results in symptoms that your partner certainly didn’t ask for, and that he’ll be unable to successfully manage these without treatment specific to the type of trauma he endured. While you might prefer your loved one didn’t avoid all forms of intimacy, let’s say, you find yourself able to remind yourself that because the PTSD has made him experience a sense of numbness or emptiness, he is likely fearful of experiencing erectile problems.

Then you can remind yourself that because of his fear that he might not be able to perform sexually as he did previously, and because of his fear that if he gets close and touches you in loving ways you might want to have sex, you can better appreciate why he avoids touching you completely.

If you can bring yourself to think this way versus personalizing things, you’ll undoubtedly find your anger starting to dissipate. Because you are calm, you can start to think about solutions to what you face as a couple. Perhaps you decide to assure your partner that he can touch you without you expecting to have sex - that because you are sensitive to the impact of the PTSD symptoms, you agree not to pressure him to have sex when he doesn’t want to.

However, you might also assure him that you do miss this aspect of your relationship and thus, you encourage him to get treatment for the PTSD symptoms and talk about this problem with his doctor. You hold out hope that after the symptoms have begun to subside because of treatment, he won’t have such fears and thus, intimacy won’t be the problem it is today.

If instead, you were to feed yourself thoughts about how your loved one no longer finds you attractive, that fear might lead you to them think thoughts such as: He might go and find someone else. Such thoughts feed feelings of fear which, in turn, tend to breed anger. Then again, you might find yourself becoming more and more depressed each time your partner brushed off a sexual advance.

Either way, your reaction would not be a good thing for your partner, you, or your relationship. Such negative thinking wouldn’t propel you towards taking constructive action. Furthermore, it will increase the amount of stress your partner feels—something you need to be concerned about when your loved one suffers from PTSD.

Whenever the stress level goes up in the environment in which the PTSD sufferer lives or must function, those PTSD symptoms are apt to occur more frequently or become more severe. Whenever you do things that decrease that stress level, you’re apt to see the frequency and severity of your partner’s PTSD symptoms lessen. Again, this is good news for your partner, you, and your relationship. You stand a better chance of regaining the type of connection you had before—and undoubtedly want to have once more.

Of course, you still might remain frustrated that things are as they are. But then, you likely entered this relationship expecting a partnership versus to travel a one-way street that always ends up leading to your partner and his needs. Certainly, mo one is asking you to deny that what you face is tough. However, by changing the nature of your thoughts, you will come to cope better with what you face.

Again, you should be able to make better choices that positively impact your partner, you, and your relationship. And you will undoubtedly feel better about yourself as you do so, too. Indeed, you will like the person you are being under the challenging circumstances whereas otherwise, you might come to see yourself as uncaring or mean because of your anger or out-of-control reactions.

So, when the going gets tough, keep reminding yourself that your loved one might not have the ability to change emotional reactions until getting more treatment for those PTSD symptoms. Keep reminding yourself your partner’s brain has essentially turned on him or her and become an enemy. But also remind yourself that cognitive-behavioral therapies can help to rewire the brain in ways that will better serve your loved one - and by staying calm and keeping the stress level down in your relationship as well as in the home in general, you increase the odds of this happening. And certainly, this would be a very good thing, wouldn’t you agree?

For more helpful information and tools for coping with a partner with PTSD, check out Dr. Diane England’s self-help book, The Post-Traumatic Stress Disorder Relationship available at bookstores starting August 18, 2009 or go to
www.PTSDRelationship.com and order inline. While at Dr. Diane England’s website, sign up for her FREE newsletter, find links to self-help books and PTSD-related websites the author recommends, and share your own PTSD story.

Author's Bio
Author Dr. Diane England has written a self-help book, The Post-Traumatic Stress Disorder Relationship designed especially to help you if you're the partner of someone with Post-Traumatic Stress Disorder or PTSD. When she was approached by the book publisher to write one or more books about a mental health disorder and how it impacted both the sufferer and the relationship with a partner, and then to give concrete advice on what to do to improve things, she believed she could help people the most by writing a book on the "Post-Traumatic Stress Disorder Relationship." After all, she had lived and worked with military members and their families at a base in Italy as part of their mental health clinc's professional team. Dr. Diane England knew, sadly enough, that former military members would be many of the future sufferers of PTSD. See, this civilian clinical social worker, who implemented the base's family violence and suicide prevention programs, found herself living and working with the military at a time of war.

source site: click here

what causes post traumatic stress?

Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as:

  • mugging
  • rape
  • torture
  • being kidnapped or held captive
  • child abuse
  • car accidents
  • train wrecks
  • plane crashes
  • bombings
  • natural disasters such as floods or earthquakes

People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent.

They avoid situations that remind them of the original incident and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a mugging or a kidnapping.

what causes post traumatic stress?

Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.

Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

PTSD affects about 7.7 million American adults,1but it can occur at any age, including childhood.7 Women are more likely to develop PTSD than men8 and there's some evidence that susceptibility to the disorder may run in families.9

PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.4

Certain kinds of medication and certain kinds of psychotherapy usually treat the symptoms of PTSD very effectively.

source: NIMH

what causes post traumatic stress?
ptsd.. it's a little bit of everything ....

Women Soldiers Respond to PTSD Therapy for Precipitating Event
By Peggy Peck, Managing Editor, MedPage Today
February 28, 2007
WHITE RIVER JUNCTION, Vt., Feb. 28 - For women soldiers being treated for post-traumatic stress disorder, symptoms improve when the therapy homes in on the original index event, no matter how long ago it occurred, researchers here found.

Compared with therapy that aimed at coping with PTSD symptoms in daily life, women whose therapy focused on the past traumatic events reduced symptoms by more than 70% (effect size, 0.27, P=0.03), investigators reported in the Feb. 28 issue of the Journal of the American Medical Association.

Moreover, the women who underwent "prolonged exposure" therapy were also about 2 1/2 times more likely to achieve total remission (15.2% vs. 6.9%; odds ratio 2.43; 95% confidence interval, 1.10-5.37, P=0.01), said Paula P. Schnurr, Ph.D., of the National Center for PTSD at the VA Medical Center here & colleagues.

The "maximum benefits of prolonged exposure are observed immediately after treatment & persist over time," she said.

But while the prolonged exposure therapy was more effective, it also had significantly higher dropout rate: 38% vs. 21% (P=0.002).

The study randomized 277 women veterans & 7 active duty women soldiers to either prolonged exposure or present-centered therapy. The mean age of women was 45 & roughly 31% were married.

The women were enrolled & treated from August 2002 thru October 2005 at 9 VA medical centers, 2 VA readjustment counseling centers & 1 military hospital.

Both therapies were delivered according to standard protocols in 10 weekly 90-minutes sessions.

"Prolonged exposure included education about common reactions to trauma, breathing retraining; prolonged (repeated) recounting (imaginal exposure) of trauma memories during sessions; homework (listening to a recording of the recounting made during the therapy session & repeated in vivo exposure to safe situations the patient avoids because of trauma-related fear) & discussion of thoughts & feelings related to exposure exercises," they wrote.

By contrast, the present-centered therapy focused "on current life problems as manifestations of PTSD."

Sexual trauma was identified as the "worst" trauma exposure by 68.3% of the women, followed by physical assault (15.8%) & war zone exposure (5.6%). The index trauma usually occurred more than 22 years before the women were enrolled in the study.

The high rate of sexual trauma exposure tracked closely studies of PTSD in civilian women, but Dr. Schnurr pointed that 70% women in this study said their sexual trauma exposure was associated with military service.

The study was limited by the small number of active duty women included-the authors theorized that active duty soldiers might be reluctant to seek treatment because they were "worried about the stigmatizing effects of PTSD, a concern that has been expressed by soldiers serving in Iraq & Afghanistan."

Active duty soldiers, they explained, were likely to be younger than veterans & might have responded differently to the 2 treatments.

The study was also limited by a higher dropout rate in the prolonged exposure arm & by the fact that the study was limited to women. But Dr. Schnurr said the findings could "with some caution" be extended to men because published studies suggested that cognitive behavioral therapy was an effective treatment for PTSD in men.

source: Medpage Today

ptsd.. it's a little bit of everything ....
what causes post traumatic stress?

A Quarter of Iraq & Afghanistan Vets Show Mental Health Problems
By Neil Osterweil, Senior Associate Editor, MedPage Today
March 12, 2007
SAN FRANCISCO, March 12 - 1/4 of all veterans treated at VA hospitals after returning home from the wars in Iraq & Afghanistan brought mental health problems back with them, reported investigators here.

When psychosocial & behavioral problems were thrown into the mix, nearly 1/3 of all veterans of Afghanistan & Iraq who sought care at VA facility had a diagnosis of a mental-health-related disorder, reported Karen H. Seal, M.D., M.P.H., from the University of California San Francisco & the San Francisco VA & colleagues.

And more than 1/2 of the returning vets who had a mental health diagnosis were found to have 2 or more mental health disorders, he investigators wrote in the March 12 issue of the Archives of Internal Medicine.

Previous studies have shown that only 1 in 5 veterans returning from combat duty in Iraq or Afghanistan with signs of post-traumatic stress disorder (PTSD) is actually screened for it, the Government Accountability Office reported last May.

Using data provided by the Department of Defense, GAO investigators found in review that 9,145 (5%) of the 178,664 service men & women deployed in Afghanistan or Iraq may be at risk for developing PTSD, but only 2,029 (22%) of the at-risk group were referred for further mental health evaluations.

what causes post traumatic stress?

In March of 2006, researchers from the Walter Reed Army Institute of Research reported in the Journal of the American Medical Association that 35% of Iraq war veterans sought mental health services for any reason in the year after returning home.

Of them, 12% per year received a diagnosis of a mental health problem, the investigators found & an additional 23% per year were seen in mental health clinics but didn't receive a diagnosis.

In the current study, Dr. Seal & colleagues looked at records of US veterans separated from service in either Iraq or Afghanistan, or both, who were first seen at a VA health facility from Sept. 30, 2001 to Sept. 30, 2005.

They used ICD-9 clinical modification (ICD-9-CM) codes to assess the burden of mental health & psychosocial behavioral problems in the vets.

They found that of the 103,788 veterans of the 2 campaigns, 25,658 (25%) received at least 1 mental health diagnosis & of this group, 56% had multiple diagnoses. Specifically, 7,342 (29% of the subgroup) had 2 diagnoses & 6,997 (27%) had 3 or more diagnoses.

PTSD was the most common diagnosis, occurring in 52% of all patients with a mental health problem & 13% of the veterans in the overall sample.

what causes post traumatic stress?

"When we broadened our definition of 'mental health problems' to include those with a mental health diagnosis &/or those receiving a V-code, representing a psychosocial problem, overall, 32,010 Iraq or Afghanistan veterans (31%) were coded as having 'mental health problems'," the investigators wrote.

The mental health problems were diagnosed within a median of about 2 weeks from the first VA clinic visit & almost 2/3 of the initial diagnoses were made in primary care or other non-mental health settings.

Veterans from the ages of 18 to 24 years were most at risk for PTSD & other mental health problems compared with veterans 40 years or older. The youngest vets had a more than 3-fold risk for at least one mental health diagnosis (relative risk 3.32, 95% confidence interval, 3.12-3.54) & a 5 fold risk for PTSD (relative risk 5.04, 95% CI, 4.52-5.62) compared with active-duty veterans 40 years or older.

"Our results signal a need for improvements in the primary prevention of military service-related mental health disorders, particularly among our youngest service members," Dr. Seal & colleagues wrote. "Furthermore, early detection & evidence-based treatment in both VA & non-VA mental health & primary care settings is critical in the prevention of chronic mental illness, which threatens to bring the war back home as a costly personal & public health burden."

The authors said that the findings aren't generalizable to all veterans of Iraq or Afghanistan, because they studied only those vets who sought help at VA facilities & only those who were new users of the VA system who were separated from their overseas service after the start of the war in Afghanistan.

The military personnel included in the study also weren't systematically assessed with validated diagnostic instruments or self-report questionnaires, suggesting that there could have been a bias from misdiagnosis of some cases.

Primary source: Archives of Internal Medicine
Source reference:
Seal KH et al. "Bringing the War Back Home: Mental Health Disorders Among 103 788 US Veterans Returning From Iraq and Afghanistan Seen at Department of Veterans Affairs Facilities." Arch Intern Med. 2007;167:476-482.

post traumatic stress disorder...
ptsd.. it's a little bit of everything ....

An Outline for the Identification & Treatment of Post Traumatic Stress Disorder

by M. Allan Cooperstein, Ph.D., DABFE, DABFM, DABPS, DAPA
Psychotherapy begins with diagnosis, a process of identifying or determining the nature and cause of a disease or injury through a critical analysis of a patient’s history, an examination and a review of empirical data.
One of the most vexing issues to be encountered in psychology is the identification - for clinical and forensic purposes - of Posttraumatic Stress Disorder (PTSD).
The Diagnostic and Statistical Manual of Mental Disorders (1994) lists PTSD (309.81) under anxiety disorders, stating that it may result from direct or indirect exposure to trauma. Its essential features include intrusive and avoidance symptoms and symptoms of hyperarousal, for greater than 1 month and causing clinically significant distress or impairment in important life areas.
Indirect trauma may include observing the serious injury or death of another person through violence, accident, war, or disaster or the chance encountering of a corpse or body parts.
Although Adjustment Disorder and PTSD both require a psychosocial stressor, PTSD is identified by an extreme stressor and specific symptoms, while Adjustment Disorder may be triggered by a stressor of any severity and can involve a wide range of symptoms.

Forensic experts can assess emotional damage - including PTSD - claimed by the patient or family within the context of life histories, including preexisting mental conditions and prior experiences that make a patient vulnerable to trauma.
They can also report on the probability of faking, malingering, or exaggerating symptoms, assessments of this type having value in establishing treatment plans / goals and in helping a jury evaluate the patient’s credibility and damage.

Consequently, to appropriately and comprehensively assess PTSD we must examine the nature and degree of trauma, the trauma history, the pretraumatic state (including chronic strains, negative life experiences in the year before the trauma, health problems over the preceding 10 years, recent life events and personality traits and disorders), the immediate social surround, dynamics of the traumatic episode, the posttraumatic state, social supports and an altered worldview and belief systems.

Although an ever-growing corpus of literature and research information on PTSD is extant, the goal of this article is to provide a brief, introductory overview of the syndrome, its antecedents and precipitants, components of the experience and treatment implications.
Additional writings will examine each aspect in greater depth.

post traumatic stress disorder...

The Contexts of Trauma: Holistic Appraisal of the PTSD Syndrome

At least 7 factors have been found to be associated with PTSD as antecedents, precipitants, or collateral events &/or features of PTSD.

  1. Pre-existing traumas. These have a cumulative or sensitizing effect upon the ease of acquisition of later trauma (Blanchard & Hickling, 1997; Brewin, Dalgleish & Joseph, 1996; McKenzie & Wright, 1996; Resnick, Yehuda & Foy,1995).

  2. The pretraumatic state, the immediate social environment, the nature of the trauma, the dynamics of the traumatic episode & the nature of the posttraumatic state which contribute to the stability of the disorder (Woolston, 1988).

  3. Recent life events, chronic strains & social supports (Ullman & Siegel, 1994). Risk of increased posttraumatic stress (PTS) symptoms following a traumatic event was associated with other life events, sexual assault & household strain. The level of PTS varied according to the trauma after adjusting for demographics. Women & younger adults reported more PTS than other subjects.

  4. Negative life events during the year before the trauma, health problems during the previous 10 years & a personality trait characterized by high emotional reactivity (Tjemsland, Soreide, & Malt, 1998).

  5. Personality disorders. These may occur in 5 - 15% of the population. Patients with personality disorder have not only a maladaptive response to stress but elicit dysfunctional responses by a pervasive pattern of interpersonal stress (Adams, 1997).

  6. Worldview: After trauma, one’s worldview (in German, Weltanschauung) may alter. This is the general perspective used to perceive & interpret reality, the existential beliefs supporting one’s existence. Perceptions of vulnerability are heightened & self-view are significantly diminished for trauma victims, with similar results across different types of trauma (Gluhoski & Wortman, 1996).

  7. The degree of trauma: There's a correlation between the severity of PTSD & the presence of other disorders, including depression, substance abuse disorders, adjustment disorders, psychosomatic disorders & antisocial behavior (Rundell, Ursano, Holloway, & Silberman, 1989).

post traumatic stress disorder...

Asking Mind, Asking Body: Incorporating Psychophysiological Assessment
Blanchard, Kolb, Pallmeyer & Gerardi (1982) found that psychophysiological comparisons between male Vietnam veterans suffering from PTSD & nonveteran controls resulted in the 2 groups responding differently to combat reminders in heart rate (HR), systolic blood pressure & forehead electromyography (EMG).
HR responses led to correct classification of 95.5% of the combined sample. Similarly, in a replication study of physiological measures of:
  • injured motor vehicle accident victims 
  • non-injured controls

Blanchard, Hickling, Buckley, Taylor, Vollmer & Loos (1996) found HR useful in distinguishing MVA victims with PTSD from those with subsyndromal PTSD & non-PTSD.

The initial psychophysiological assessment results predicted 1-year follow-up clinical status for the majority of individuals who initially met criteria for PTSD.

Wickramasekera (1998) defines 3 risk factors associated with PTSD symptom intensity. These are high hypnotic ability (high dissociation), low hypnotic ability (low dissociation) & a high Marlowe-Crowne score (Crowne & Marlowe, 1960).
The latter measures culturally acceptable statements that are probably untrue of most people & undesirable statements. These measures may produce incongruent responses between psychological measures (e.g. no perception or memory of negative emotions) & physiological (e.g. sympathetic activation, high skin conductance, high heart rate, high blood pressure) measures of threat perception.
These risk factors reduce or block negative emotions from conscious awareness but not from behavior (e.g. violence, avoidance, substance abuse) or physiology (e.g. migraines, autonomic nervous system dysregulation, musculoskeletal pain).
From the above, the usefulness of psychophysiological measures may be adduced as a valuable supplement to PTSD assessment.

Dissociation & Hypnosis

Dissociation is described as "a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic" (DSM IV, 1994).
Posttraumatic Stress Disorder (PTSD) may be conceptualized as part of a dissociative spectrum in which recall / re-experiencing of the trauma (flashbacks) alternates with numbing (detachment or dissociation) & avoidance (Turkus, 1992; also see Briere, Evan, Runtz, & Wall, 1988; Carlson & Rosser-Hogan, 1991; Goodwin & Reynolds, 1987; Jaschke & Spiegel, 1992; Kuch & Cox, 1992; Mellman, Randolph, Brawman-Mintzer, Flores, & Milanes,1992; Roszell, McFall, & Malas, 1991; Shalev, Schreiber, & Galai, 1993; Southwick, Yehuda, & Giller, 1993).

As Wickramasekera (1998) addressed hypnotizability, Spiegel, Hunt & Dondershine (1988) examined this trait in veterans with PTSD contrasted with a normal control group & 4 patient samples.
The results demonstrated that PTSD patients show significantly higher hypnotizability scores than patients with schizophrenia, major depression, bipolar disorder-depressed, dysthymic disorder, generalized anxiety disorder & the controls.
This supports the hypothesis that dissociation effects may are used as defenses during & after traumatic experiences.

Bremner & Brett (1997) examined dissociation in premilitary, combat-related & postmilitary traumas & the presence of long-term psychopathology in Vietnam combat veterans with & without PTSD.
Most interesting was the finding that PTSD patients reported higher levels of dissociative states at the time of combat-related traumatic events than non-PTSD patients.
These higher levels of dissociative states persisted in PTSD patients as higher levels of dissociation in response to postmilitary traumatic events.
The dissociative responses to combat trauma were linked with higher, long-term dissociative symptoms as measured by the Dissociative Experience Scale & an increased number of "flashbacks" since the time of the war.
The findings are congruent with earlier concepts that traumatic dissociation may be a sign of long-term psychopathology.

post traumatic stress disorder...

Treatment Implications

Contrary to the symptom-specific expectations of insurance reviewers, current research demands flexibility in the diagnoses & treatment of PTSD.
In some instances (see Foa, Hearst-Ikeda, & Perry, 1995), brief cognitive - behavioral program undertaken shortly after assault reduce the re-experiencing of severe arousal symptoms as well as depression.
However, a history of physical abuse in childhood has been strongly correlated with dissociative symptoms later in life as well as combat experiences in veterans (Spiegel, &. Cardena, 1990). As dissociative symptoms during & soon after traumatic experience predict later PTSD, brief, symptom-focused treatment may not always be applicable.

Hypnotic procedures may be helpful because the population has been shown to be highly hypnotizable. Hypnosis provides regulated access to painful memories that may otherwise be blocked from awareness.
In treating PTSD victims, dissociated traumatic memories are connected with a positive restructuring of involved memories, a cognitive reorientation. Accordingly, patients are helped to confront & manage traumatic experiences by inserting them into a new context meaning or "worldview."
Feelings of helplessness are endorsed while experiences are interlaced with restructured memories, emphasizing positive efforts at self-protection, affection with the living & those who may have died, or the capacity to control events & the environment at other times.

Although medication use shows a modest, clinically meaningful effect on PTSD, in their literature review on the effectiveness of PTSD treatments, Solomon, Gerrity & Muff (1992) found more robust effects for behavioral techniques involving direct therapeutic exposure in reducing PTSD intrusive symptoms. There's a caveat, however, in that complications were reported from the use of these techniques in patients with collateral psychiatric disorders. Cognitive therapy, psychodynamic therapy & hypnosis may also hold promise, but further research is needed.

Psychodynamic psychotherapy focuses on helping the patient examine their reactions to the physical or emotional personal violations of the traumatic event(s).
The goal is to increase awareness of intrapersonal conflicts & their resolution. The patient is guided towards developing increased self-esteem, self-control & a regenerated sense of personal integrity & self-confidence.
Group therapy may help PTSD patients develop a reference group and a sense of community, reacquiring the capacity to relate to others in a controlled, health-inducing manner and setting.

Most PTSD treatment is outpatient. When symptoms make it impossible to function or lead to other symptoms (e.g., alcohol or drug problems) inpatient treatment may become necessary.

post traumatic stress disorder...


PTSD is a diagnostically complex phenomenon requiring a multidimensional evaluation including clinical interviewing, background history, adequate testing and test interpretation and psychophysiological assessment.
These are imperative for diagnosis, treatment and competent testimony (Levit, 1986). In my practice, interviewing, psychometric testing, malingering / exaggerating measures and physiological responses to positive, negative and neutral stimuli are blended, similar to Scrignar’s (1988) biopsychosocial model of PTSD, to include Environment, Encephalic Events and Endogenous Events.

Effective psychological and pharmacological treatments are available for PTSD. Medications may be used as a complement to psychotherapy to help sleeplessness and hyperarousal. Psychotherapy restores the patient’s necessary sense of control while decreasing the impact of past events over present experience.
The sooner a patient is diagnosed and treated, the more likely s/he is to recover from trauma. A sense of safety and control in the patients’ lives must be re-established to help them feel effective and secure enough to embrace the feared reality of the events that transpired.

Social and familial support may be critical. Time must be permitted for grief and mourning, while communicating about events and receiving support for feelings of guilt, anger, self-blame and depression.
A treatment plan must be developed with the patient to help establish what's needed to restore a sense of confidence, control and predictability to life.

Forensic proof of the existence of PTSD requires that many of the needs and conditions cited here are met. Even when presented with solid, empirical evidence of PTSD, adversaries will often attempt to deny its existence or, as I've seen lately, attempt to transport responsibility for present distress onto earlier events or injuries.
As forensic specialists, our primary, professional responsibilities are to the patient. However, in serving the patient, we may also meet the needs of the legal system through responsible, detailed & thorough documentation of diagnosis and treatment supported by research.
source: @health

what causes post traumatic stress?
ptsd.. it's a little bit of everything ....

Action Points
  • Explain to interested patients that a first traumatic experience in childhood is common but does not usually cause posttraumatic stress symptoms or other psychiatric disorders.
  • Tell patients who ask, that the risk of posttraumatic stress symptoms increases with subsequent exposure to traumatic events.
Posttraumatic Stress Doesn't Shadow Trauma in Childhood
By Judith Groch, Senior Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine
May 08, 2007

DURHAM, N.C., May 8 -Children often get past traumatic events without subsequently encountering posttraumatic stress disorder, researchers here found.

More than two-thirds of the children studied reported one or more traumatic events by age 16, William E. Copeland, Ph.D., of Duke reported in the May issue of the Archives of General Psychiatry.

After a first childhood trauma, the prognosis is generally favorable, said Dr. Copeland and colleagues. However, they added, this is not true for children experiencing multiple traumatic events or for those with a history of anxiety.

The children in western North Carolina came from the Great Smoky Mountain Study, a longitudinal study of psychopathology and use of medical services in childhood.

From 1993 to 2000, a representative sample of one parent and 1,420 children, ages nine, 11, and 13 at the start, were followed up annually through age 16.

Of the children 790 were boys and 639 were girls. When weighted to population probability, 89.5% were white, 6.9 % were African American, and 3.6% % were American Indian.

Traumatic events were grouped into broad categories, including: violence (violent death of a loved one, war, terrorism, victim of physical violence, physical abuse by a relative, captivity); sexual trauma (rape, sexual abuse, coercion); other injury or trauma (diagnosis of physical illness, serious accident, natural disaster, fire); witness to trauma, and learning about trauma (so called "vicarious" events).

Violence & sexual trauma were associated with the highest rates of symptoms, the researchers reported.

Of the children, 68.2% reported at least one traumatic event by age 16, with 13.4% of those children developing some posttraumatic stress (PTS) symptoms.

However, full-blown post-traumatic stress disorder (PTSD) was rare in middle childhood and adolescence. Less than 0.5% of the children met the criteria for PTSD, the researchers reported.

Higher levels of trauma exposure were related to higher levels of most types of psychopathology, particularly anxiety and depressive disorders, as well as other impairments, the researchers said.

Adolescence was a strong predictor of both painful recall and subclinical PTSD, after controlling for other variables, the researchers said. Painful recall in these teenagers was linked to exposure to an earlier trauma, being previously diagnosed as having an anxiety disorder, and coming from a difficult family environment.

Risk factors significantly predicting a first traumatic exposure were previous environmental adversity, previous parenting problems, and a history of a depressive disorder.

In response to a first trauma experience, overall, 8.2% of the individuals studied reported painful recall of events and 1.4% reported subclinical PTSD.

Children exposed to trauma had almost twice the rate of psychiatric disorders compared with those not exposed, the researchers said.

For example, in a comparison of individuals reporting posttraumatic stress symptoms after a first trauma and those with no symptoms immediately after trauma, rates of psychiatric disorders were higher in the painful-recall group than among those without painful recall (31.1% versus 14.5%). However, a year after the traumatic event, psychopathology rates in the two groups were the same.

The rate of PTSD after exposure to a traumatic event was lower than that reported in studies of adults, the researchers wrote. At the same time, the results of this study suggest that these children experienced posttraumatic stress symptoms, higher rates of psychopathology, and additional impairments.

One explanation for this finding has to do with the DSM-IV criteria for PTSD, which were developed from the adult literature and may not fully reflect response to trauma in children, the researchers said. The results of the current study suggest that either the current criteria for PTSD when applied to children may not be developmentally sensitive, or that childhood PTSD is rare.

Among potential sources of bias in the study, the researchers wrote, is that estimates of traumatic events may have been inflated, and this would likely be reflected in similarly elevated psychopathology rates. However, psychiatric prevalence rates were consistent with those obtained in other studies, the researchers said.

Also, they wrote, there was no independent verification of the traumatic event reported, although it is probably unavoidable in a community-based study of an event that does not follow a specific event, such as a hurricane or flood.

Severe events, such as sexual abuse, may have been under-reported, they said. It is not uncommon for an event reported at one time to be followed by a false-negative report. However, in their study, the researchers said, severe events were assessed at multiple time points to attempt to offset this limitation.

Studies of childhood trauma that use convenience samples of children exposed to specific events and undergo assessments for PTS symptoms provide only incomplete answers to how common trauma is in childhood and how children typically respond to these events, Dr. Copeland said.

This study suggests that the effects of trauma are not symptom-specific. Few children exposed to trauma develop PTSD, and the few who display lesser PTS symptoms can be identified through information about their age, trauma history, anxiety history, other impairments, and family environment, Dr. Copeland concluded.

source: Medpage

ptsd.. it's a little bit of everything ....
what causes post traumatic stress?

Exposure therapy may help prevent post-traumatic stress disorder

Published: Tuesday, June 3, 2008 - 09:28 in Health & Medicine

Exposure-based therapy, in which recent trauma survivors are instructed to relive the troubling event, may be effective in preventing the progression from acute stress disorder to post-traumatic stress disorder, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Individuals who develop acute stress disorder during or soon after a traumatic event are likely to subsequently develop post-traumatic stress disorder (PTSD), according to background information in the article. PTSD is associated with other mental and physical illnesses, a reduced quality of life and increased health care costs. Both exposure therapy and cognitive restructuring, which focuses on changing maladaptive thoughts and responses to a traumatic event, have been used as early interventions to prevent PTSD in those with acute stress disorder. However, there is evidence that some clinicians do not use exposure therapy because it causes distress for recent trauma survivors.

Richard A. Bryant, Ph.D., of the University of New South Wales, Sydney, Australia, and colleagues conducted a randomized controlled trial involving 90 patients who developed acute stress disorder following a non-sexual assault or motor vehicle crash between March 2002 and June 2006. Thirty participants each were randomly assigned to five weekly 90-minute sessions of exposure therapy or cognitive restructuring, while the remaining 30 were put on a waitlist for treatment. All the patients were assessed at the beginning of the study, after six weeks and six months following treatment.

Sixty-three participants completed the study. After completing treatment, fewer patients in the exposure therapy group (10, or 33 percent) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63 percent) or the wait-list group (23, or 77 percent). At the six-month follow-up, fewer patients in the exposure therapy group (11, or 37 percent) met criteria for PTSD than patients in the cognitive restructuring group (19, or 63 percent), and 14 patients (47 percent) in the exposure group vs. four patients (13 percent) in the cognitive restructuring group achieved full remission.

"Despite some concerns that patients may not be able to manage the distress elicited by prolonged exposure, there was no difference in drop-out rates for the prolonged exposure and cognitive restructuring groups (17 percent vs. 23 percent)," the authors write. In addition, distress ratings were more significantly reduced in the exposure therapy group than the cognitive restructuring group after three sessions.

Exposure therapy may be more effective than cognitive restructuring because it eases the anxiety associated with the traumatic memory and corrects the belief that the memory must be avoided, in addition to encouraging self-control by managing the exposure exercise, the authors note. "The current findings suggest that direct activation of trauma memories is particularly useful for prevention of PTSD symptoms in patients with acute stress disorder," they conclude. "Exposure should be used in early intervention for people who are at high risk for developing PTSD."

Source: JAMA and Archives Journals 

source site: click here

ptsd.. it's a little bit of everything ....
what causes post traumatic stress?

Researchers investigate impact of stress on police officers' physical and mental health

Published: Friday, September 26, 2008 - 09:50 in Psychology & Sociology

Policing is dangerous work, and the danger lurks not on the streets alone. The pressures of law enforcement put officers at risk for high blood pressure, insomnia, increased levels of destructive stress hormones, heart problems, post-traumatic stress disorder (PTSD) and suicide, University at Buffalo researchers have found through a decade of studies of police officers.

UB researchers now are carrying out one of the first large-scale investigations on how the stress of police work affects an officer's physical and mental health, funded by a $1.75 million grant from the National Institute of Occupational Safety and Health (NIOSH).

The National Institute of Justice added $750,000 to the study to measure police officer fatigue and the impact of shift work on health and performance.

John M. Violanti, Ph.D., research associate professor in UB's Department of Social and Preventive Medicine in the School of Public Health and Health Professions, is principal researcher of the study, called the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study.

More than 400 police officers have participated in the study to date, with the researchers aiming for 500. The clinical examination involves questionnaires on lifestyle and psychological factors such as depression and PTSD, in addition to measures of bone density and body composition, ultrasounds of brachial and carotid arteries, salivary cortisol samples and blood samples. The officers also wear a small electronic device to measure the quantity and quality of sleep throughout a typical police shift cycle.

Results from Violanti's pilot studies have shown, among other findings, that officers over age 40 had a higher 10-year risk of a coronary event compared to average national standards; 72% of female officers and 43% of male officers, had higher-than-recommended cholesterol levels; and police officers as a group had higher-than-average pulse rates and diastolic blood pressure.

"Policing is a psychologically stressful work environment filled with danger, high demands, ambiguity in work encounters, human misery and exposure to death," said Violanti, a 23-year veteran of the New York State Police. "We anticipate that data from this research will lead to police-department-centered interventions to reduce the risk of disease in this stressful occupation."

Violanti and colleagues are using measures of cortisol, known as the "stress hormone," to determine if stress is associated with physiological risk factors that can lead to serious health problems such as diabetes and cardiovascular disease.

"When cortisol becomes dysregulated due to chronic stress, it opens a person to disease," said Violanti. "The body becomes physiologically unbalanced, organs are attacked, and the immune system is compromised as well. It's unfortunate, but that's what stress does to us."

The investigation's two most recent studies report on the effect of shift work on stress and suicide risk in police officers, and on male/female differences in stress and possible signs of cardiovascular disease.

Results of the shift work pilot study, involving 115 randomly selected officers, showed that suicidal thoughts were higher in women working the day shift, and in men working the afternoon/night shifts. The findings appear online in the October issue of the American Journal of Industrial Medicine.

Data showed that 23% of male and 25% of female officers reported more suicidal thoughts than the general population (13.5%). In a previous study, suicide rates were 3 times higher in police than in other municipal workers, Violanti found.

The findings, that in women officers working day shifts were more likely to be related to depression and suicide ideation, while in men working the afternoon or night shift was related to PTSD and depression, were surprising, said Violanti. "We thought both men and women officers would be negatively affected by midnight shifts."

"It's possible women may feel more uneasy and stressed in a daytime shift, where there can be more opportunity for conflict and a negative environment," he said. "On the other hand, higher suicide ideation reported by males on the midnight shift may be accounted for in part by a stronger need to be part of the social cohesiveness associated with peers in the police organization. Working alone at night without the support of immediate backup can be stressful," he said.

Source: University at Buffalo

Identifying PTSD from Childhood Abuse-3 Steps to Healing
by Bettina "Sparkles" Obernuefemann
I’ve learned during the past 20 years that almost all of us on planet earth have experienced some kind of trauma or loss, now more commonly recognized as POST TRAUMATIC STRESS DISORDER (PTSD). We become trauma victims when we experience natural disasters, murder, suicide, gang fights, robbery, car accidents, rapes, riots, terrorism, war and yes, child abuse!

No matter what the cause, the symptoms are similar; and, the sooner we receive treatment the sooner we have a chance to once again lead a happier life. Here in the USA, the general public has become aware of PTSD because it is so prevalent among our Iraq Vets, who have been offered more mental care than any other military men in history.

My specialty is mental, emotional, physical and spiritual (not sexual) childhood PTSD recovery. I’ve looked closely at the effects of my upbringing on my adult life. Not only did I grow up in the darkness of Germany’s WWII war but also, I was abused physically with wooden spoons, closeted and much more. Ironically, I was able to put on a happy face and hold a 38 year Flight Attendant career because I didn’t recall the details of my childhood abuse until 1990 when I was 50 years old.

Once it was pointed out to me, I started an interesting healing process and it continues to this day. Adults who are victims of early childhood abuse are called Adult Children. I am a Recovering Adult Child, an adult with a little girl inside who was kept from a normal healthy development. Recovery to me was like putting together pieces of a puzzle.

Has it ever changed my life! The “old” Bettina suffered from chronic depression, hyper vigilance, high anxiety, explosive anger, unworthiness, hopelessness and fear in general. The new “Sparkles” is leading quite a content life with only occasional short lived PTSD symptoms. When this occurs I immediately apply appropriate tools I’ve learned and get back on track.

Unfortunately, childhood trauma victims are overlooked in our society. My guess is that only 10% of our mental health care system even considers childhood abuses to be PTSD cases. The reason may be that most childhood PTSD victims are unaware of their abuse. Their wounds are hidden deep inside and fester for a long time, even an entire life time, causing very troubled lives. In my case it manifested in destructive relationships and alcohol addiction.

Those whose interest has been stirred by this article so far, might be wondering, “How do I know if I was abused?”

I suggest you ask yourself the following questions:

“Is my life working? Am I happy?
Do I like me when I look at myself in the mirror?”

If you answer, “No,” you may have a dispirited child inside of you who is trying to get your attention!”
You might be blaming everyone else. I had the same false belief, “That’s just the way life is! There’s nothing I can do about it” I thought to myself.

That is not true! There’s hope for adults who have been severely abused or traumatized in their early childhood. Help is available and it’s never too late for healing one’s old severely wounded spirit.
Right here and right now, I proclaim that there is a way out of the darkness into the light, a better way of living. Here’s how:

1. We must be willing to take a very close look at ourselves and our lives.
2. We must strongly desire to make changes in our lives. (I call this, “I’m putting on my own oxygen mask first, before assisting others!”)
3. Good news! We don’t have to do it alone; help is available.

When I said, “I can’t stand this anymore. I’ve had enough,” I suddenly noticed all kinds of help coming my way in form of books, people, tapes, and even angels.

Now, it is my mission to get the word out on childhood PTSD. Therefore, I’m sharing my personal story in a trilogy memoir. I’ve always wanted to be a teacher but instead I became a Flight Attendant (stewardess) from 1965-2003. I use the metaphor of flying with God because it is a fact; and, we are here to extend His Love here on earth.

In 2006 I produced first book: “FLYING WITH GOD, Putting on a Happy Face.” It’s about growing up during the WWII in Germany, moving to America and starting my flying career. I include interviews, training, along with the interesting episodes and photos. More about childhood PTSD and excerpts from my book are available at bettinasparkles.com.

Perhaps “FLYING WITH GOD” will inspire you. I pray for that!

Author's Bio
Bettina “Sparkles” Obernuefemann was born 1940 in Germany and presently lives in north central Arkansas, in the beautiful Ozark Mountains, with her husband Michael. July 31, 2003 she retired after a thirty-eight year flying career. She’s devoting her new ‘free’ time to writing, a creative effort blending her love for flying with her dedication to recovery and spirituality. Presently, Sparkles is enjoying writing her second book.
source site: click here

10 die as storms hit Texas-Mexico border
EAGLE PASS, Texas - Search teams worked their way thru wreckage-strewn neighborhoods in this border town Wednesday after a tornado killed at least 10 people & destroyed 2 schools & more than 20 homes. 

At least of 3 of the victims died just across the border from Eagle Pass in Piedras Negras, Mexico, said Oscar Murillo, the city's civil protection director.

On the U.S. side, 5 of the dead were in a mobile home when the storm slammed it against a school building, said Maverick County Judge Jose Aranda. A young girl between 4 & 6 years old, her parents & two other adult relatives were inside, he said.

Wednesday morning, several mobile homes from the community of about 26,000 residents were missing, officials said. More than 70 people were reported injured in Eagle Pass.

The huge weather system that caused the destruction was plowing through the Midwest on Wednesday after spinning off tornadoes in Oklahoma & Colorado, causing flooding in Iowa & Nebraska & piling snow more than a foot deep in the Rockies.

The tornado that struck the rural Rosita Valley area outside Eagle Pass destroyed 2 schools, City Councilman Ramsey English Cantu said Wednesday in an interview with AP Radio. Nobody was in the schools, officials said.

"There was one elementary that was destroyed," he said. "We have behind that a literacy academy for younger individuals that's like a preschool. That's not even standing, just completely leveled."

Teams were still assessing the damage Wednesday morning in the border area about 150 miles south of San Antonio. National Guard units attached to the Border Patrol were assisting local agencies in their door-to-door search & rescue efforts, Fire Chief Rogelio de la Cruz said.

"It's the worst I've seen," said Ricardo Tijerina, 38, who rode out the storm in a house near the school with his 6 children. He said he watched the storm destroy a mobile home across the street, but all of that home's residents survived.

More than 350 people were in shelters Wednesday morning, Cantu said. "Of course, some also may be staying with relatives. It's just a very, very catastrophic event that has come into this community."

Officials said 76 people were taken to Fort Duncan Med. Ctr., the city's only hospital. 4 were transferred to hospitals in San Antonio and Del Rio in critical condition.

"The hospital in the early stages was being overrun, but they had called in additional doctors & were able to take care of business," Eagle Pass Mayor Chad Foster said.

Severe thunderstorms also battered other parts of Texas with high wind, flooding rain & hail.

Streets were flooded & roofs peeled off homes in North Texas as the first thunderstorms moved thru Tuesday afternoon, followed by another line of severe storms about 6 hours later. Television footage showed drivers & residents being rescued from flooded cars & suburban neighborhoods.

American Airlines canceled about 200 flights in Dallas, spokesman Billy Sanez said. The airline also diverted about 80 flights bound for Dallas-Fort Worth International Airport to other airports, including San Antonio.

Elsewhere, as much as 3.5 inches of rain fell Tuesday on western & central Iowa, washing out roads, flooding basements & causing at least one landslide that buried part of Interstate 29 in Sioux City in trees & mud. No vehicles were driving thru the spot when the mudslide happened, officials said.

More than 5 inches of rain fell at Holdrege & Kearney, Neb. "We've got full ditches, water over the roads in some cities, urban areas," said meteorologist Cindy Fay at the National Weather Service in Hastings.

In Colorado, 6 buses carrying at least 60 children were stranded when the storm dropped more than a foot of snow in about 2 hours, said Rob Finley, assistant fire marshal for El Paso County. The children were taken to shelters in the county about 80 miles south of Denver.

Crews used Sno-Cats to rescue dozens of motorists from snow-covered roads on the plains east of Colorado Springs, said Lt. Clif Northam of the El Paso County sheriff's office. Evergreen, Colo., in the foothills west of Denver, reported 16 inches of snow,

A tornado damaged several buildings near the small town of Wild Horse about 110 miles southeast of Denver, but no injuries were reported, the Cheyenne County Sheriff's Department said. Another twister touched down in north-central Oklahoma but no damages or injuries were reported.

Associated Press writers Matt Joyce and Terry Wallace in Dallas contributed to this report.

...might want to get this book!
Invisible Heroes: Survivors of Trauma and How They Heal
by Belleruth Naparstek
My new book draws on over thirty years of clinical experience, the most recent, cutting edge research, and powerful new discoveries in neurophysiology, biochemistry and brain imaging, to synthesize a new understanding of trauma, and why imagery is truly the key to its healing.
Filled with the voices of scores of actual survivors and therapists, it offers a spate of imagery know-how, a step-by-step program with more than 20 imagery scripts, tailored to the three stages of recovery, and a practical guide to the best of the new imagery-based therapies, such as EMDR, Prolonged Exposure, Trauma Incident Reduction and Somatic Experiencing.
"To put it plainly, we didn't used to be able to help people with traumatic stress, at least not in any consistent way. Now we can..."

Survivors of Natural Disasters & Mass Violence

A National Center for PTSD Fact Sheet by Bruce H. Young, LCSW, Julian D. Ford, PhD, and Patricia J. Watson, PhD
Every year, millions of people are affected by both mass violence & natural disasters, such as earthquakes, floods, hurricanes, tornados & wildfires.
Survivors face the danger of death or physical injury & the possible loss of their homes, possessions & communities. Such stressors place survivors at risk for behavioral & emotional readjustment problems.

This fact sheet considers 3 questions often asked by survivors:
What psychological problems might one experience as a result of surviving a disaster?
What factors increase the risk of readjustment problems?
What can survivors do to reduce the risk of negative psychological consequences & to best recover from disaster stress?
What psychological problems might one experience as a result of surviving a disaster?
Most child & adult survivors experience one or more of these normal stress reactions for several days:
  • Emotional reactions: temporary (i.e., for several days or a couple of weeks) feelings of shock, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, or emotional numbness (difficulty feeling love & intimacy or difficulty taking interest & pleasure in day-to-day activities)

  • Cognitive reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, self-blame

  • Physical reactions: tension, fatigue, edginess, difficulty sleeping, bodily aches or pain, startling easily, racing heartbeat, nausea, change in appetite, change in sex drive

  • Interpersonal reactions in relationships at school, work, in friendships, in marriage, or as a parent: distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling

Most disaster survivors only experience mild, normal stress reactions. Disaster experiences may even promote personal growth & strengthen relationships.
However, as many as 1 out of every 3 disaster survivors experience some or all of the following severe stress symptoms, which may lead to lasting Posttraumatic Stress Disorder (PTSD), anxiety disorders, or depression:

  • Dissociation (feeling completely unreal or outside yourself, like in a dream; having "blank" periods of time you can't remember)

  • Intrusive reexperiencing (terrifying memories, nightmares, or flashbacks)

  • Extreme attempts to avoid disturbing memories (such as through substance use)

  • Extreme emotional numbing (completely unable to feel emotion, as if empty)

  • Hyper-arousal (panic attacks, rage, extreme irritability, intense agitation)

  • Severe anxiety (paralyzing worry, extreme helplessness, compulsions or obsessions)

  • Severe depression (complete loss of hope, self-worth, motivation, or purpose in life)


What factors increase the risk of readjustment problems?

Survivors are at greatest risk for severe stress symptoms & lasting readjustment problems if any of the following are either directly experienced or witnessed during or after the disaster:

  • Loss of loved ones or friends

  • Life threatening danger or physical harm (especially to children)

  • Exposure to gruesome death, bodily injury, or dead or maimed bodies

  • Extreme environmental or human violence or destruction

  • Loss of home, valued possessions, neighborhood, or community

  • Loss of communication with or support from close relations

  • Intense emotional demands (e.g., rescue personnel & caregivers searching for possibly dying survivors or interacting with bereaved family members)

  • Extreme fatigue, weather exposure, hunger, or sleep deprivation

  • Extended exposure to danger, loss, emotional/physical strain

  • Exposure to toxic contamination (such as gas or fumes, chemicals, radioactivity)

Some individuals have a higher than typical risk for severe stress symptoms & lasting PTSD, including those with a history of:

  • Exposure to other traumas (such as severe accidents, abuse, assault, combat, rescue work)

  • Chronic medical illness or psychological disorders

  • Chronic poverty, homelessness, unemployment, or discrimination

  • Recent or subsequent major life stressors or emotional strain (such as single parenting)

Disaster stress may revive memories of prior trauma & may intensify preexisting social, economic, spiritual, psychological, or medical problems.

What can survivors do to reduce the risk of negative psychological consequences & to best recover from disaster stress?

Researchers are beginning to conduct studies to answer this question. Observations by disaster mental-health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms & to promote postdisaster readjustment.*

Protect: Find a safe haven that provides shelter; food & liquids; sanitation; privacy & chances to sit quietly, relax & sleep at least briefly.

Direct: Begin setting & working on immediate personal & family priorities to enable you & your significant others to preserve or regain a sense of hope, purpose & self-esteem.

Connect: Maintain or reestablish communication with family, peers, & counselors in order to talk about your experiences. Take dvantage of opportunities to "tell your story" & to be a listener to others as they tell theirs, so that you & they can release the stress a little bit at a time.

Select: Identify key resources, such as FEMA (Federal Emergency Management Agency), the Red Cross, the Salvation Army, or the local & state health departments, for clean-up, health, housing & basic emergency assistance.

Taking each day one at a time is essential in disaster's wake. Each day is a new opportunity to FILL-UP:

  • Focus Inwardly on what's most important to you & your family today;

  • Look & Listen to learn what you & your significant others are experiencing, so you'll remember what's important & let go of what's not;

  • Understand Personally what these experiences mean to you, so that you'll feel able to go on with your life & even grow personally.

* The construct "Protect, Direct, Connect, Select" was developed by Diane Myers, unpublished manuscript.
source: @health

my prayers are with their loved ones & friends

No one's death comes to pass without making some impression, and those close to the deceased inherit part of the liberated soul and become richer in their humanness.
Hermann Broch

Virginia Tech...
Some thoughts....
I don't feel a need to present an article here to establish how post traumatic stress could be developed through the traumatic events that took place on the campus of Virginia Tech this past month. It's horrible & it's terrifying.
Experiencing an event with the magnitude such as the Virginia Tech incident can contribute to acute stress syndrome & post traumatic stress disorder. Especially students who witnessed the shooting, bodies of their peers who had been shot, injured & those who died. Events such as this are indescribably painful. There are no words to express the level of pain, heartache, sorrow, grief & fear that the students, parents and loved ones have endured.
These incidents are the ones that post traumatic stress disorder is all about. While people have different personalities, different temperments, life experiences and diverse thresholds for pain & heartache, you can't predict who will end up experiencing acute stress or post traumatic stress. You just never know which straw will break the camel's back & when it will happen.
Personally, I know about this because I have been diagnosed with post traumatic stress disorder. In my case, it was an escalation of different traumas with no resolution that induced my disorders. Continual abuse, depression, an eating disorder, panic attacks, sleeplessness, alcoholism, dissociation, nightmares, hyperarousal or hypervigilence or both, and many more symptoms have plagued me throughout my life beginning in childhood.
With the students at Virginia Tech there's an opportunity for them to see counselors, their families are aware of the trauma & can be mindful of the symptoms that may present themselves & I believe that there is a huge support system within the student body that can work miracles. There are those that will be predisposed to post traumatic stress that could be in extreme pain without knowing how to cope with it.
Already those across the country and the world for that fact, who have been victims already in school violence who may have had problems with acute stress or post traumatic stress disorder because of their own trauma; may be severely triggered in light of this event. Those who are experiencing anxiety disorders & depression who experienced different types of crisis or traumas can also be triggered by an event of this magnitude which will present feelings that are painful, the possibility of reliving their own trauma, and any number of symptoms that belong to these mental illnesses.
It's important that we, Americans, and all the people of the world, see that these mental illnesses are real, not a figment of anyone's imagination; real medical illnesses that present significant distress and an interruption of ones' life, disturbing normal daily responsibilities.
It's more pervasive than anyone can understand that hasn't experienced a mental illness before. More people have mental illness than they believe would be possible. Because of the stigma from times when mental illness was considered a disability or infirmness of mind instead of a real medical illness, people refuse to admit, even to themselves that mental illness is everywhere.
Education can help. Take on the responsibility of educating yourself should you come into contact with someone who needs your understanding and compassion. It'll make the social injustices that remain concerning mental illness a thing of the past sooner than later!

This memory brightens o'er the past; as when the sun, concealed; behind some cloud that near us hangs; shines on a distant field.
Henry Wadsworth Longfellow

Vulnerability to post-traumatic stress disorder runs in families, study shows 

Published: Friday, December 19, 2008 - 17:42 in Psychology & Sociology

Earthquakes have aftershocks - not just the geological kind but the mental kind as well. Just like veterans of war, earthquake survivors can experience post-traumatic stress disorder, depression and anxiety. In 1988, a massive earthquake in Armenia killed 17,000 people and destroyed nearly half the town of Gumri. Now, in the first multigenerational study of its kind, UCLA researchers studying survivors of that catastrophe have discovered that vulnerability to PTSD, anxiety and depression runs in families.

Armen Goenjian, a research psychiatrist in the UCLA Department of Psychiatry and Biobehavioral Sciences, and colleagues studied 200 participants from 12 multi-generational families exposed to the earthquake. Participants suffered from varying degrees of the disorders. The researchers found that 41% of the variation of PTSD symptoms was due to genetic factors and that 61% of the variation of depressive symptoms and 66% of anxiety symptoms were attributable to genetics. Further, they found that a large proportion of the genetic liabilities for the disorders were shared.

The research appears in the December issue of the journal Psychiatric Genetics.

"This was a study of multi-generational family members - parents and offspring, grandparents and grandchildren, siblings, and so on - and we found that the genetic makeup of some of these individuals renders them more vulnerable to develop PTSD, anxiety and depressive symptoms," said Goenjian, a member of the UCLA -Duke University National Center for Child Traumatic Stress and lead author of the study.

In addition, Goenjian noted, the study suggests that a large percentage of genes are shared between the disorders.

"That tracks with clinical experience," he said. "For example, in clinical practice, the therapist will often discover that patients who come in for treatment of depression have coexisting anxiety. Our findings show that a substantial portion of the coexistence can be explained on the basis of shared genes and not just environmental factors such as upbringing."

The researchers used statistical methods to assess heritabilities. One method was used to determine the genetic component of a disorder such as PTSD. Then, a separate analysis was used to see if different phenotypes shared genes. The results showed that a significant amount of genes are shared between PTSD and depression, PTSD and anxiety, and finally depression and anxiety.

Until now, Goenjian said, the only studies that have suggested such a heritability of PTSD have been twin studies.

"It's very hard to do family studies on PTSD because typically only single individuals, not whole families, are exposed to a particular trauma," he said. "In our study, we were able to avert this problem since all the subjects were exposed to the same severe trauma at the same time."

In fact, he said, the 200 participants all saw destroyed buildings throughout Gumri, 90% witnessed dead bodies left lying in the streets and 92% witnessed severely injured people.

The findings are promising for the next step in understanding the underlying biology of these disorders, which is locating the specific genes involved, Goenjian said.

Source: University of California - Los Angeles

PTSD endures over time in family members of ICU patients

Published: Monday, September 22, 2008 - 11:15 in Health & Medicine

Family members may experience post-traumatic stress as many as 6 months after a loved one's stay in the intensive care unit (ICU), according to a study by researchers at the University of Pittsburgh School of Medicine and University of California, San Francisco.

The study, published online in the Journal of General Internal Medicine, found that symptoms of anxiety and depression in family members of ICU patients diminished over time, but high rates of post-traumatic stress and complicated grief remained.

"Our findings suggest that family members of patients in the intensive care unit are at risk for serious psychological disorders that may require treatment," said Cindy L. Bryce, Ph.D., associate professor of medicine and health policy and management at the University of Pittsburgh School of Medicine.

"Unfortunately, it may be difficult to identify these family members while their loved one is in the hospital because the symptoms that we can observe and measure early – anxiety and depression – do not seem to be associated with the longer term outcomes like post-traumatic stress disorder and complicated grief. This tells us that screening family members after hospitalization is crucial."

The study included 50 family members of patients who were admitted to the ICU. Researchers measured family members' level of anxiety and depression in the ICU and at one- and six-month follow-up. They also measured symptoms of post-traumatic stress disorder and complicated grief during the six-month follow-up interview.

42% of family members exhibited symptoms of anxiety in the ICU. This percentage dropped to 15% at six-month follow-up. Likewise, 16% of family members displayed depression in the ICU that dropped to 6% at six months.

At six-month follow-up, 35% of all family members had post-traumatic stress while 46% of family members of patients who died had complicated grief. Surprisingly, post-traumatic stress was not more common in bereaved than non-bereaved family members.

"As doctors, we tend to think only of the patient in an intensive care situation," said Wendy Anderson, M.D., lead author and assistant professor, Division of Hospital Medicine, University of California, San Francisco. "Our results show that family members can be greatly influenced by a patient's ICU stay, and that this impact persists after the patient leaves the ICU."

Source: University of Pittsburgh Schools of the Health Sciences

you've been visiting anxieties 102...
please have a great day & take a few minutes to explore some of the other sites in the emotional feelings network of sites! explore the unresolved emotions & feelings that may be the cause of some of your pain & hurt... be curious & open to new possibilities! thanks again for visiting at anxieties 102!
emotional feelings - emotional feelings, 2 - emotional feelings, 3 - emotional feelings 4 - feeling emotional - feeling emotional, too - feeling emotional, 3 - feeling emotional, 4 - sorry to report that extremely emotional no longer exists! it was a sad surprise for me, believe it! now there is feeling emotional five! It's a work in progress, but you're welcome to visit when you have the chance!- your unemotional side - your unemotional side 2 - the layer down under - more layers down under - the layer down under that - the self pages - night eating - teenscene - angels & princesses - changes 101 - more changes - different religions - parental alienation - life skills 101 (not published yet) - physical you 101 abuse 101 - children 101 - try recovering 101
anxieties 101 - click here!
anxieties 102 - you are here!
almost 30 sites, all designed, editted & maintained by kathleen!
until next time: consider yourself hugged by a friend today!
til' next time! kathleen
thank you for visiting anxieties 102!