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  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
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.
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
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
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.
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.
"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.
 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.
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.
- 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).
- 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).
- 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.
- 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).
- 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).
- 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).
- 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).
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:
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.
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.
Summary
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.
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.
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
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 site: click here
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.
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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.
10 die as storms hit Texas-Mexico border
By MICHELLE ROBERTS
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.
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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!
kathleen
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.
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."
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