Post-Traumatic Stress Disorder (PTSD)

1. Post-Traumatic Stress Disorder(PTSD) By: Tayler Hughes, Egal Warsame, Xavier Strozewski, Melissa Ramirez, Alisha Mokwinski

2. What is it? • An Anxiety disorder • Characterized by intrusive memories of the traumatic event , emotional withdrawal, and heightened autonomic arousal. • May result in insomnia , hyper vigilance, loss of control over anger or aggression. • PTSD patients often experience a decreased interest in others and a sense of estrangement. • May also suffer anhedonia- the inability to feel positive emotions • http://www.youtube.com/watch?v=n4nxTIFI0xA&feature=related • http://www.youtube.com/watch?v=ZGWSSUNXn4A&feature=related

3. Symptoms of PTSD • Affective: Anhedonia; emotional numbing • Behavioral: hypervigilance; passivity; nightmares; flashbacks; exaggerated startle response • Cognitive: intrusive memories; inability to concentrate; hyperarousal • Somatic: lower back pain; headaches; stomach ache and digestion problems; insomnia; regression in some children; losing already acquired developmental skills, such as speech or toilet training. • http://www.youtube.com/watch?v=mZU2A2lsEB8

4. Relevant study • The case of Rwanda • Study of PTSD was done on survivors of the Rwandan genocide. • The study was done soon after the genocide had occurred. • A survey was conducted by UNICEF which looked at 3000 Rwandan children aged 8-19 years • They showed: • 95% had witnessed violence • 80% had suffered a death in their immediate family • 62% had been threatened with death • According to UNICEF: • 60% didn’t care if they grew up • Many were parentless and stilled lived in the place where the trauma occurred • This left many with repeating flashbacks and constant trauma of the genocide

5. Stressor • The person has been exposed to a traumatic event in which both of the following have been present: • The person has experienced, witnessed, or been confronted with an event that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others. • The person’s response involved intense fear, helplessness, or horror.

6. Intrusive Recollection • The traumatic event is persistently re-experienced in at least one of the following ways • Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. • Recurrent distressing dreams of the event. • Acting or feeling as if the traumatic event were recurring(includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). • Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. • Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

7. Avoidant/Numbing • Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following: • Efforts to avoid thoughts, feelings, or conversations associated with the trauma • Efforts to avoid activities, places or people that arouse recollections of the trauma • Inability to recall an important aspect of the trauma • Markedly diminished interest or participation in significant activities • Feeling of detachment or estrangement from others • Restricted range of affection • Sense of foreshortened future

8. Hyper-Arousal • Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following: • Difficulty falling or staying asleep • Irritability or outbursts of anger • Difficulty concentrating • Hyper-Vigilance • noun • state or quality of being vigilant; watchfulness • Vigilant: • adjective 1. keenly watchful to detect danger; wary: a vigilant sentry. 2. ever awake and alert; sleeplessly watchful.

9. Duration • Duration of the disturbance (symptoms) is more than one month • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning Functional Significance

10. Two Types • Acute: if duration of symptoms is less than three months • Chronic: if duration of symptoms is three months or more

11. Gender variation • A number of epidemiologic survey studies have shown that PTSD is twice as common in women as in men. In addition there are gender differences in… • The type of trauma exposure • Presentation of illness • Comorbidities • Some of these differences are clearly societal and non biologically based, it is also clear that biologic systems altered in PTSD may modulated by sex hormones.

12. Rachael Yehuda PhD of the Einstein Medical Center, Bronx, NY discussed the neuroanatomic, neuroendocrine and immune- related bases for various gender differences seen in PTSD . • There are also differences between men and women in the presentation of PTSD. • Women are more likely to have symptoms of numbing and avoidance and men are more likely to have the associated features of irritability and impulsiveness. • Men are more likely to have comorbid substance use disorders • Women are more likely to have comorbid mood and anxiety disorders, although many disorders comorbid with PTSD are commonly seen in both men and women. • Comorbid: pertaining to two diseases which occur together, such as ADHD and depression

13. Symptoms in Men vs. Women • Men: • Irritability • Impulsiveness • Substance Abuse Disorders • Women: • Numbing • Avoidance • Anxiety/Affective Disorders

14. Men vs. Women • Different types of traumas carry different risks for developing PTSD • This is one of the reasons why men and women differ in prevalence rates • Rape is experienced more often by women and carries one of the highest risks for PTSD • Other forms of sexual abuse and interpersonal violences are also more often followed by PTSD than natural disasters or other accidents • Socialization Differences: • Girls tend to internalize problems, boys externalize

15. Breslau et. Al (1991) • Did a longitudal study of 1007 young adults who had been exposed to community violence • Found a prevalence rate of 11.3% in women and 6% in men • Horowitz et. Al (1995) reviewed a number of studies and found that women have a risk up to five times greater than males to develop PTSD after violent or traumatic events.

16. Cognitive • There are differences in the way individuals cognitively process experiences and there may be a difference in attributional styles • PTSD patients tend to feel that they have a lack of control over their lives and the world is unpredictable • They often experience guilt regarding the trauma • Intrusive memories are memories that come to consciousness at random • Can be triggered by sounds, smells and/or sights • Ex. War Veterans having flashbacks • Alberto Rizzo developed a therapeutic tool using virtual reality. It is called virtual Iraq and has changeable variables to change the experience for the patient. This method is based off of flooding, or over-exposure, causing the patient to become accustomed to the trauma.

17. Cognitive • Development of PTSD is associated with a tendency to take personal responsibility for failures and to cope with stress by focusing on the emotion • Versus facing the problem • Sutker et. Al(1995) • Found that Gulf War Veterans who had a sense of purpose and commitment to the military had less chance of suffering from PTSD

18. Biological • Twin studies show possible genetic predisposition to PTSD • Focuses on the neurotransmitter noradrenalin • Noradrenalin controls emotional arousal. • High levels of noradrenalin cause people to express emotions more openly than others.

19. Sociocultural • Research suggests that experiences with racism and oppression are predisposing factors for PTSD.

20. Roysircar (2000) • Cites research that among Vietnam War veterans, 20.6% of black and 27.6% of Hispanic veterans met the criteria for a current diagnosis of PTSD, compared to the 13% in white veterans. • He takes it a step farther in researching Rwandan children, and argues that the threat of death was the factor evidencing the strongest influence on intrusive thoughts and avoidance of behaviour • This just means avoiding situations that can trigger anxiety and panic.

21. Research • Research in Bosnia supports this in 1998 when close to 73% of girls and 35% of boys suffered from PTSD • Kaminer et. Al (2000) stated that the higher rate in girls came from fear of rape • Social learning may play a role in PTSD • Children may develop PTSD by observing domestic violence

22. Culture • In many cultures, it is common for survivors to initiate treatment with someone due to Somatic Complaints • Those that have no medical explanation • Generally consist of gastrointestinal problems, constipation, heartburn, nausea, vomiting, colitis, migraines, headaches, back aches, and skin disorders • thought that these problems, although real to the sufferer, may be brought on by stress or emotional factors. Somatic complaints are difficult to treat because there are no underlying medical issues that are causing them • According to the DSM, somatic symptoms of PTSD are typical

23. Kleinman (1987) • It is irrational and ethnocentric to assume that non-western forms of this disorder are atypical • The form commonly seen in the West being assumed as the “norm” • Non-Western survivors exhibit Body Memory Symptoms: • Lllll • One example of this is dizziness experienced by a woman, found to be a body memory of her repeated experience of being forced to drink large amounts of alcohol and then being raped • Sexual abuse is a traumatic experience and that the memory of it can be stored in your physical body. This can be true even if you have no conscious recollection of the abuse.

24. Treatment • Psychotherapy (Talk Therapy) • Medications • People have different ways of overcoming PTSD and the treatment should always be done through the health care provider.

25. Psychotherapy • Also known as “talk therapy” • Occurs with a one-on-one conversation and lasts between 6 and 12 weeks. • During psychotherapy, the psychiatrist will use other therapy tactics to help the patient. • Different therapy options: • Exposure Therapy-It a tactic that involves the patient to face their fear and trauma in a safe way • Cognitive Restructuring- helps people make sense of bad memories by helping the patient look at the memory in a realistic way • Stress Inoculation Training- tries to reduce symptoms by teaching the person a way to reduce anxiety and helps look at their memories in a healthy way

27. Medication • Two medications were approved by the FDA • Sertraline(Zoloft) • Paroxetine(Paxil) • These drugs are antidepressants that help treat depression • It helps control symptoms such as sadness, worry, anger, the feel of emptiness • Side effects for these drugs include: • Headaches • Nausea • Sleeplessness or drowsiness • Agitation • Sexual problems

28. Sources • http://www.medscape.org/viewarticle/418733 • DSM • Book • http://answers.yahoo.com/question/index?qid=20080305151704AAs8BEu