Post Traumatic Stress Disorder

1. Post Traumatic Stress Disorder Laura Gazdich How to recognize the symptoms and help people diagnosed with Post Traumatic Stress Disorder

2. Learner Objectives • Participants will learn how to define PTSD • Participants will be able to state the symptoms of PTSD • Participants will be able to identify some of the physical, mental, and emotional issues that occur when a person is suffering from PTSD • Participants will learn how to help a person with PTSD

3. Definition Post traumatic stress disorder (PTSD) is a complex health condition that can develop in response to a traumatic experience such as a life-threatening or extremely distressing situation that causes a person to feel intense fear, horror or a sense of helplessness. PTSD can cause physical, mental, and emotional problems for a person. The National Institute of Mental Health (NIMH), http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

4. Definition PTSD is often comorbid with other illnesses such as depression, panic disorders, obsessive-compulsive behaviors, specific phobias or fears, or substance abuse. • Depression-is an illness that affects the body, mood, and thoughts. Some symptoms include persistent sad or anxious mood, feelings of hopelessness or helplessness, and lost interest in activities. • Panic disorder- is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. The National Institute of Mental Health (NIMH), http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

5. Definition • Obsessive-compulsive Disorder-is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Ex. Someone is worried about germs. They obsess over it so much that they are constantly washing their hands. • Specific phobias/fears- specific phobia is an intense fear of something posing little or no actual danger. Common specific phobias are closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and blood. The National Institute of Mental Health (NIMH), http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

6. Prevalence PTSD can affect anyone regardless of the person’s age, sex, religion, culture or ethnicity 5.2 millions Americans have Post Traumatic Stress Disorder per year. 70% of adults have experienced at least one major trauma in their lives, and many of them develop PTSD It is estimated that 5% of the population currently have PTSD and that 8% have had PTSD at some point in their lives. One out of 10 women will suffer from PTSD at some time in their lives. Women are about twice as likely as men to develop PTSD. This may be due to the fact that women tend to experience interpersonal violence (such as domestic violence, rape or abuse) more often Almost 17 percent of men and 13 percent of women have experienced more than three traumatic events in their lives. http://www.depression-guide.com/post-traumatic-stress-disorder.htm

7. Prevalence in Children • A few studies of the general population have been conducted that examine rates of exposure and PTSD in children and adolescents . Results from these studies indicate that 15 to 43% of girls and 14 to 43% of boys have experienced at least one traumatic event in their lifetime. Of those children and adolescents who have experienced a trauma, 3 to 15% of girls and 1 to 6% of boys could be diagnosed with PTSD. • Rates of PTSD are much higher in children and adolescents recruited from at-risk samples. The rates of PTSD in these at-risk children and adolescents vary from 3 to 100%. For example, studies have shown that as many as 100% of children who witness a parental homicide or sexual assault develop PTSD. Similarly, 90% of sexually abused children, 77% of children exposed to a school shooting, and 35% of urban youth exposed to community violence develop PTSD. http://www.ncptsd.va.gov/ncmain/information

8. Identification and Symptoms PTSD is caused when a person is exposed to a traumatic event. The traumatic experience can cause: -intense feelings of fear -helplessness -horror for the person’s life The experience involved threatened or actual danger of physical harm or death. The event can happen to the person Someone they love Even a complete stranger.

9. Identification and Symptoms PTSD usually occurs within a couple months after the traumatic event but can even develop years after the event. PTSD is diagnosed when the event causes the person to relive the experience and interferes with the person’s daily life. Three factors increase a child’s chance of developing PTSD. -severity of the trauma -parental reaction to it -physical proximity of the child to the event.

10. Traumatic Events The following events are some examples of a traumatic experience that can lead to the development of PTSD • A violent crime • A war • Sexual abuse or rape • Natural disasters such as a hurricane, tornado, fire, or flooding • Physical abuse • An experience where a person thought they would be harmed or killed • A car wreck or airplane crash

11. Common Symptoms of PTSD The DSM-IV-TR defines the symptoms in the subsequent ways: The symptoms should occur for more than a month and they cause significant distress or impairment in social, occupational, or other important areas of functioning. The traumatic event is persistently re-experienced in the following ways: • Reliving the experience though reoccurring memories, including images, thoughts, or perceptions. • Reoccurring stressful dreams of the event • Believing the event happening over and over again though reliving the experience, illusions, hallucinations, and dissociative flashback episodes • Becoming upset (both mentally and physically) when exposed to anything that reminds the person of the event Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition

12. Common Symptoms of PTSD Consistently avoiding anything that is associated with the trauma and becoming unresponsive to the following: • avoiding thoughts, feelings, or conversations related to the trauma • avoiding activities, places, or people that remind the person of the trauma • forgetting important details of the trauma • losing interest activities that the person once enjoyed • unable to form or maintain current close relationships with other people and difficulty feeling strong emotions • losing hope for the future Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition

13. Common Symptoms of PTSD Ongoing symptoms of amplified stimulation as indicated by two of the following: • trouble falling or staying asleep • emotional instability such as being angry for no reason or easily irritated. • inability to concentrate • hyper vigilance • exaggerated startle response Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition

14. Biological factors Women are more likely to suffer from PTSD than men. A person’s temperament may play a role in the development of PTSD too. A person may have a more difficult time dealing with trauma due to their temperament. A person with a difficult temperament is more likely to develop PTSD. This may be because they have little or no coping skills. Experts believe that people suffering from PTSD can develop changes in brain chemistry which will result in the development of some of the symptoms. http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_hoperecovery_gpv.html?opm=1&rr=rr1545&srt=d&echorr=true

15. Family Factors Genetics are a factor in the development of PTSD. Research has found that a person is more likely to suffer from PTSD when faced with a traumatic experience if a family member has previously suffered from PTSD Families that live in high risk areas are more likely to have a family member develop PTSD. Some high risk areas include violent neighborhoods, low socioeconomic areas, and areas with a lot of drug activities. Here, research shows that individuals in high risk areas are more likely to observe or be involved in a traumatic event. http://www.ncptsd.va.gov/ncmain/information/

16. Family Factors • Family support and parental coping have also been shown to affect PTSD symptoms in children. Studies show that children and adolescents with greater family support and less parental distress have lower levels of PTSD symptoms. • A parent’s parenting style may increase a child’s risk for developing PTSD. For example if a parent is anxious and avoids dealing with issues that parent will teach those traits to their child. Anxiety and avoidance are key symptoms of a person with PTSD. If a trauma would happen to that child; the child would not have the appropriate coping skills needed to deal with the trauma. http://www.ncptsd.va.gov/ncmain/information/

17. School Factors The following indicators are signs that a student may be suffering from PTSD: Dropping grades Lack of concentration Late or missing homework Easily irritated Avoidance of peers Aggression/violence More issues with discipline

18. School Factors Students that are diagnosed with PTSD have a difficult time in the school setting. The students have issues with: -emotional regulation -developing problem solving skills -conflict resolution skills -social skills -poor decision making skills. -developing close and trusting relationships with peers or authority figures Students suffering from PTSD can misinterpret their peer’s words or actions as threatening This causes the student with PTSD to become defensive and further alienate themselves from their peers. The above problems make it even harder for a student with PTSD to function in appropriate ways in school.

19. How to Help • Family and friends should reassure the person with PTSD that they did not cause the traumatic event • It is important to listen to the person when they are ready to talk. • Remind them that they are loved and important and you are there to help them • Let them know that their feelings are important and it is ok to feel them • Closely monitor the person for any signs that he or she is suffering from any of the symptoms associated with PTSD

20. How Teachers Can Help • Teachers and parents should communicate regularly about the student’s progress in school • Teachers should keep the classroom rules and routines as consistent as possible. If the rules or routines need to change the teacher should prepare the student in advance. • Teachers should be aware that the student could become upset by something the reminds him or her of the trauma; therefore the student should be removed from the room. The student should be taken to a quiet room where they can calm down and be away from whatever triggered the response. • Teachers should show support to students with PTSD and be available if the student would like to discuss the trauma but never force the person to talk. This could cause the person to become even more upset.

21. Psychological Treatments • The person may require the help of a psychologist to recover from the trauma. A psychologist will determine what treatment will work best for the person. Some types of treatments • Cognitive Behavioral Therapy (CBT) This therapy changes the way a person thinks and feels about the traumatic event. • Exposure therapy This is used to teach people to have less fear about the memories • Eye movement desensitization and reprocessing (EMDR) While talking about your memories, you'll focus on distractions like eye movements, hand taps, and sounds • Medication Medication can be used to help control the symptoms such as antidepressants or anit-anxiety Prozac, Paxil, Zoloft, or Xanax

22. Avoid the following when helping a person with PTSD • Never force the person to talk about the traumatic event. If the person is not ready to talk forcing them may make the situation worse. • Never ask the person for personal details if they do not offer to tell them to you. • Never use words that minimize the person’s experience or feelings. For example: Everything is ok or at least you survived • Never blame the person for the traumatic event by telling them they caused or could have prevented the event • Never make promises you cannot keep. For Example: nothing bad will ever happen to you again.

23. Parent Information See Brochure Hand Out Things to think about Has my child shown any of the symptoms mentioned in the brochure? What should I do if I notice any symptoms? Does this mean my child is suffering from PTSD? Where do I get help from?

24. Helpful Resources National Institute of Mental Health (NIMH)6001 Executive Boulevard, Room 8184, MSC 9663Bethesda, MD 20892-9663 E-mail Address nimhinfo@nih.gov Phone Number 1-866-615-6464 Web site: http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

25. Helpful Resources National Center for Posttraumatic Stress Disorder EMAIL - ncptsd@va.gov Web site: http://www.ncptsd.va.gov/ncmain/index.jsp THE PTSD Information Line at (802) 296-6300 Mailing Address Books: When Something Feels Wrong: A Survival Guide About Abuse for Young People by Deanna S. Pledge The Anxiety Cure for Kids: A Guide for Parents by Elizabeth DuPont Spencer, Robert L. DuPont, Caroline M. DuPont

26. Case Study The following link is of a video on PTSD from the National Center for Posttraumatic Stress Disorder web site. This video shows a couple different people suffering from PTSD. http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_hoperecovery_gpv.html?opm=1&rr=rr1545&srt=d&echorr=true

27. Case Study Reflection Questions: The video begins by showing several people talk about different feeling. Why are the feeling they mention significant to PTSD? What were some of the feelings? How would you help these people? The video mentions a man named Rudy. He is able to work but has issues at home. Why do you think his family has suffered but not his job? How would you help Rudy and his family? The women named Tracy who was abused when she was younger says, “It’s not a character flaw to have been abused” Why do you think she said that?

28. Glossary Cognitive Behavioral Therapy (CBT) - is a type of psychotherapy based on changing thoughts, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions Comorbid - to two illnesses that occur at the same time Depression - a condition of general emotional unhappiness and withdrawal; sadness greater and more extended than necessary given the reason Dissociative flashback episodes - This is when a person with PTSD experiences the trauma like it was happening all over again. This is usually caused by a trigger that reminds the person of the original trauma. DSM-IV-TR - handbook for mental health professionals that lists different categories of mental disorder and the criteria for diagnosing them Exaggerated startle response - is the response of mind and body to a sudden unexpected stimulus such as being easily frightened by a noise Exposure therapy - is used to teach people to have less fear about their memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.

29. Glossary Eye movement desensitization and reprocessing (EMDR) - this therapy is used to help change how people react to memories of the trauma. Hyper vigilance - is an enhanced state of sensory sensitivity accompanied by an inflated intensity of behaviors whose purpose is to detect threats. For example a person suffering from PTSD will constantly monitoring their environment looking for danger. Obsessive-compulsive behaviors - is an anxiety disorder most commonly characterized by the person’s obsessive, distressing, intrusive thoughts and related compulsions (tasks or "rituals") which attempt to counteract the obsessions Panic disorders - is a condition characterized by persistent panic attacks in combination with considerable changes in behavior or at least a month of ongoing worry about concern about having other attacks Specific phobias or fears - is a type of anxiety disorder that causes people to feel an unreasonable or irrational fear related to exposure to specific objects or situations

30. References American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition. American Psychiatric Publishing, Inc. Depression-guide.com (n.d.) Depression Types : Post Traumatic Stress Disorder.Retrieved October 20, 2007, from http://www.depression-guide.com/post-traumatic-stress-disorder.htm MayoClinic.com (n.d.). Mental Health: Post-Traumatic Stress Disorder (PTSD). Retrieved October 20, 2007, from http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=1 National Institute of Mental health (n.d.). Post-Traumatic Stress Disorder (PTSD). Retrieved October 20 , 2007, from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml PTSD Alliance (Producer). (2000). Hope for recovery: understanding PTSD [Motion Picture]. (Available from the United States Department of Veteran Affairs website. http://www.ncptsd.va.gov/ncmain/ncdocs/videos/emv_hoperecovery_gpv.html?opm=1&rr=rr1545&srt=d&echorr=true United States Department of Veteran Affairs (n.d.). National Center for Post-Traumatic Stress Disorder. Retrieved October 20 , 2007, from http://www.ncptsd.va.gov/ncmain/information/

31. Contact Information Laura Gazdich E-mail: llg14@pitt.edu gaz11@hotmail.com