The term post-traumatic stress disorder first appeared in 1968 and it includes disorders that were previously described as the consequences of traumatic experiences – e.g. War neurosis, syndrome of concentration camps, rape syndrome, nervous shock, etc.
Posttraumatic Stress Disorder is classified from a medical and psychological point of view, under the group of anxiety disorders, or under group of reactions to severe stress and adjustment disorders belonging to neurotic disorders. Further we differentiate its forms as acute, chronic (lasting longer than three months) and with delayed appearance (occurring later than 6 months after experiencing a traumatic accident).
Posttraumatic Stress Disorder is an anxiety disorder that arose as a delayed response to the experience of stressful events or situations, unusually threatening or of catastrophic nature, which will probably cause powerful and pervasive distress for everybody.
Among such events belong war traumas, experienced torture, and trauma caused by people - rape, assault, natural disaster - destructive earthquakes, floods, fires, tsunamis, tornadoes, as well as traffic accidents and the like. For originating of a disorder is an essential factor an experienced trauma, but other factors also affect its eventual development. It is mainly the effect of the unpredictability of the situation and the inability to control the development of situations and events.
The diagnostic criteria of posttraumatic stress disorder
Certain changes in behaviour and feelings of man are normal after experiencing any trauma. The person might be for example anxious, edgy, badly falls asleep, and the like. These symptoms, they should not take too long and should not bother unduly concern affected person.
Diagnostic criteria for Posttraumatic Stress Disorder are as follows:
- To develop the disorder occurred within 6 months after experienced a traumatic event
- The event is repeatedly and insistently lived in the memories, in daily vivid imaginations and dreams
- Vegetative disorders may occur, mood disorders and abnormal behaviour
- A response of an individual to experienced traumatic event involved intense fear, helplessness, or horror (among children the answer on this stressful situation may be expressed by disorganized or agitated behaviour)
- Persistent avoidance of stimuli, which are associated with the trauma, and attenuation of general sensitivity. It is manifested with three or more of the following criteria:
a) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
b) Efforts to avoid activities, places, or people evoking memories of trauma
c) Inability to recall an important moment of trauma
d) Interest about important life activity is markedly reduced
e) Feelings of indifference or alienation in relation to other people
f) Narrowing range of emotive, e.g. an inability to feel love
g) Accompanying phenomena: about half of people develop some difficulties and failures, it is particularly addiction to alcohol and other drugs, personality changes (aggression, vulgarisation), depression and suicidal tendencies
h) The feelings of the limited possibilities for the future, e.g. loss of interest in career, marriage, children, or a loss of normal desire for a future life
i) Signs of increased excitability manifested (minimum two of above mentioned), sleep disorders, irritability, impaired concentration, excessive startle response, hyper-vigilance
Manifestations of people afflicted by post-traumatic stress disorder
- A traumatic event is experiencing repeatedly in the form of anxiety memories, thoughts, dreams, hallucinations, or illusions.
- After exposure of the impulsions, which somehow resemble the trauma, the affected people have considerable mental problems.
- A person suffers from post-traumatic stress disorder avoids suggestions, ideas, places or activities somehow connected with traumatic events.
- These people hardly recall some moments from time of the traumatic moment and they sometimes feel alienated from the society.
- There is increased irritability, which was not present before the trauma. It may be a restless sleep problems and difficulty falling asleep, increased startle activity and reactivity, difficulty with concentration, aggression with occasional outbursts of anger.
- All the above symptoms persist for more than a month.
- Problems affect family, social and work life of any person suffering with post-traumatic stress disorder. These people are losing their interest in their favourite activities and hobbies, there are disorders of self-esteem and emotional problems and emotional numbness.
- Post-traumatic stress syndrome may be associated with other psychiatric disorders (depression, phobias, panic disorder, etc.).
Remembering to trauma
People suffering from post-traumatic stress disorder often have obtrusive memories, which are bringing back to their mind in harassing way memories of the traumatic event they experienced. Although these memories are mostly fragmentary, they are uncomfortably vivid. These memories are then repeatedly causing bouts of anxiety, anger, helplessness, sadness, or feelings of alienation and futility. Sometimes there is a reliving of the trauma - the experience is so strong that suffering person has vivid feelings as if the traumatic event is repeated or as it is seen before his eyes.
A traumatic event can also occur in terrifying dreams. These nightmares cause intense anxiety to terror and panic. The affected person often wakes up sweating, with a strong heart palpitation, gasping for breath. The content of the dream is a traumatic event, sometimes as re-experiencing of traumatic event, sometimes with ominous and symbolic meaning. Sometimes there is a sudden reliving horrific emotional and vegetative symptoms, even without the presence of memories of a traumatic event. The affected person is surprised without any outer reason by the strong anxiety, fear, or sadness, crying, pounding heart, gasping for breath, pain, etc. These abrupt seizures occur repeatedly.
Negative emotional states and the loss of positive emotions
Sufferers may feel numbness, inability to experience pleasure or experience pleasurable feelings. They may experience constant feelings of disgust, boredom, apathy, or resentfulness. They are only monotonously performing routine activities and they avoid pleasant activities. They are missing enjoyment of life, they feeling as if they burned out and inner emotional cold.
People suffering from Post-Traumatic Stress Disorder are not able fully express strong emotions related to the trauma itself. They are trying for various reasons rather to suppress them. With the attempts to suppress these strong unpleasant emotions, are unfortunately suppressed emotions at all. From this suffers mostly positive emotions.
Secure and avoidance behaviour
People suffering from Post-Traumatic Stress Disorder are typically avoiding such situations and activities that in some way resemble traumatic experience. This happens because everything this experience reminds them subsequently leads to the development of discomfort. Often, they are avoiding touching the other person, especially if the human touch was part of trauma. In these cases, they very often do not tolerate even the touch of beloved ones and those who they respect.
Typical is avoiding talking about the trauma, films with a similar theme, books, and articles. Anxiety in affected people sometimes raises even the hint that someone could start talking about something similar.
Another typical way of avoiding traumatic reliving is called “Mental avoidance”. If it occurs spontaneously memory of the traumatic event, afflicted person is trying to suppress it as quickly as possible and this person is then trying to divert their attention elsewhere. Because memories tend to appear repeatedly, over and over again, it is often very debilitating struggle. Part of unintentional mental avoidance can sometimes be an inability to remember some important aspects of the traumatic event. There is a loss of some memories.
The avoidance includes the avoidance of close relationship. Sufferers avoid express warm emotions, they tend to fear to confide in and open up to another person. In relationships, they often give way mistrust. They are susceptible to the feeling that someone has betrayed them, even if it does not have any real reason. This distrust and difficulties with warmth in the relationship leads to feelings of alienation from the other people, and sometimes to isolation. Secondarily these people may even be afraid to speak with other people at all.
Other people, especially the victims of war violence or natural disasters are avoiding taking responsibility for others (e.g. for kids), because they have large misgiving that they cannot provide them enough security.
Increased mental and physical excitableness
Typical symptoms of post-traumatic stress disorder include increased mental and physical excitableness. It is related to automatically expectations that something bad can happen again. Constant anxiety and stress lead to irritation.
The constant waiting for threat can lead to the fact that all new or unexpected upsets and upsets sufferers. It can be just small stimuli, which would be at the time before a traumatic event unnoticed. Suffering people are forced to be in opposition, they often argue, look disgusted and annoyed. In front of strangers, they are usually trying to control themselves excessively, because they fear overreaction and rejection. They tend to have difficulty concentrating, getting to sleep, and their sleep is often interrupted. These people are very often hot-tempered, the impetuosity of the behaviour (impulsivity), and alertness. As if they were still in anticipation, that something threatening will happen again. Due to their edginess, they get easily into conflict with other people, both at home and at work, and they are quite quickly loosing friends. Difficulty with concentrating, then leads to worse productivity.
Excessive caution appears as a constant tension and these people are easily frightened. It looks as if they are constantly expecting something threatening would appear. Any sudden sound or noise is followed by a shock, overreaction may emerge, and intolerance to certain smells, sounds, lights etc.
These people also have increased physical excitableness. This manifests as a high readiness for alarm response of the body, which manifests as a variety of autonomic responses, such as the heartbeat, chest pain, sweating, trembling, shortness of breath and rapid breathing. Other symptoms may be tingling in the extremities, dizziness, nausea, abdominal pain, headaches, and many others.
Treatment options depend on the type of problems related to the case. If the disease is accompanied by depression and sleep disorders, then nursing doctor may prescribe antidepressants, possibly in combination with drugs that decrease anxiety.
Post-traumatic stress disorder is another anxiety disorder in which has an important part of treatment a cognitive behavioural therapy. For person suffering with this disorder may be big help strong social support, consolidation of family, friendship, and neighbourliness relationships. Treatment can bring rapid improvement but long time untreated disorder would take a long time to heal....
Post-traumatic stress syndrome is variable, also a variety of symptoms associated with it is different for each individual. Recent researches have also shown that different time periods can act in some way to heal better than others. It was found that depressive symptoms of traumatic events tend to disappear over time. Other symptoms of post-traumatic stress, however, did not improve even after several years. In many cases, moreover, has post-traumatic stress syndrome multiple triggers of anxiety memories, but palpable remembrance of traumatic events does not occur frequently.
One of the greatest tragedies of possible treated anxiety disorder of post-traumatic stress syndrome is a long time lag, before the patients seek for the help. The average delay of treatment lasts eight years.