Monday, April 10, 2017

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder, or PTSD, is an anxiety disorder that develops after a person experiences a very stressful, frightening or distressing event.

PTSD symptoms include reliving the event in flashbacks and nightmares. A person with PTSD may also feel guilt, isolation, problems concentrating and sleep problems.

Symptoms may be seen shortly after the event or may emerge some time later.

Not everyone who goes through a traumatic event will experience PTSD.

What are the symptoms of PTSD?

Symptoms of PTSD often are grouped into three main categories, including:
  • Re-living: People with PTSD repeatedly re-live the ordeal through thoughts and memories of the trauma. These may include flashbacks, hallucinations, and nightmares. They also may feel great distress when certain things remind them of the trauma, such as the anniversary date of the event.
  • Avoiding: The person may avoid people, places, thoughts, or situations that may remind him or her of the trauma. This can lead to feelings of detachment and isolation from family and friends, as well as a loss of interest in activities that the person once enjoyed.

  • Increased arousal: These include excessive emotions; problems relating to others, including feeling or showing affection; difficulty falling or staying asleep; irritability; hypervigilence; outbursts of anger; difficulty concentrating; and being "jumpy" or easily startled The person may also suffer physical symptoms, such as increased blood pressure and heart rate, rapid breathing, muscle tension, nausea and diarrhoea.
Young children with PTSD may suffer from delayed development in areas such as toilet training, motor skills, and language.

Who gets PTSD?

Everyone reacts to traumatic events differently. Each person is unique in his or her ability to manage fear and stress, and to cope with the threat posed by a traumatic event or situation. For that reason, not everyone who experiences or witnesses a trauma will develop PTSD. The type of help and support a person receives from friends, family members and professionals following the trauma may influence the development of PTSD or the severity of symptoms.

PTSD was first brought to the attention of the medical community by war veterans, hence the names shell shock and battle fatigue syndrome. However, PTSD can occur in anyone who has experienced a traumatic event. People who have been abused as children or who have been repeatedly exposed to life-threatening situations are at greater risk of developing PTSD. Victims of trauma related to physical and sexual assault face the greatest risk of PTSD.

How common is PTSD?

PTSD affects around 1 in 3 people after a traumatic event. PTSD can occur at any age, including childhood.

Around 40% of people with PTSD will have suffered a sudden bereavement of someone close to them.

Women are more likely to develop PTSD than are men. This may be due to the fact that women are more likely to be victims of domestic violence, abuse and rape.

How is PTSD diagnosed?

The GP can refer patients with possible PTSD to mental health specialists, like counsellors, community psychiatric nurses, psychologists or psychiatrists.

A diagnose of PTSD can be made by discussing symptoms, talking about feelings, looking at the person’s medical history and overall health. Doctors may use a special questionnaire to help with the diagnosis.

How is PTSD treated?

The goal of the treatment is to reduce the emotional and physical symptoms associated with PTSD, to improve daily functioning and to help the person better cope with the event that triggered the disorder. Treatment for PTSD may involve psychotherapy (a type of counselling), medication, or both.

Doctors may prescribe antidepressant medications to treat PTSD and to control the feelings of anxiety and its associated symptoms, including selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, and others such as amitriptyline.

Psychotherapy for PTSD involves helping the person learn skills to manage symptoms and develop ways of coping. Therapy also aims to teach the person and his or her family about the disorder, and help the person work through the fears associated with the traumatic event. A variety of psychotherapy approaches are used to treat people with PTSD, including:
  • Cognitive-behaviour therapy, which involves learning to recognise and change thought patterns that lead to troublesome emotions, feelings, and behaviour.
  • Exposure therapy, a type of cognitive-behaviour therapy that involves having the person re-live the traumatic experience, or exposing the person to objects or situations that cause anxiety. This is done in a well-controlled and safe environment. Exposure therapy helps the person confront the fear and gradually become more comfortable with situations that are frightening and cause anxiety. This has been very successful at treating PTSD.
  • Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event.
  • Family therapy may be useful because the behaviour of the person with PTSD can have an affect on other family members.
  • Group therapy may be helpful by allowing the person to share thoughts, fears, and feelings with other people who have experienced traumatic events.
  • Eye Movement Desensitisation and Reprocessing (EMDR) is a complex form of psychotherapy that was initially designed to alleviate distress associated with traumatic memories but is now also used to treat phobias.

What is the outlook for people with PTSD?

Recovery from PTSD is a gradual and ongoing process. Symptoms of PTSD seldom disappear completely, but treatment can help sufferers learn to cope more effectively. Treatment can lead to fewer and less intense symptoms, as well as a greater ability to cope by managing feelings related to the trauma.
Research is ongoing into the factors that lead to PTSD and into finding new treatments.

Can PTSD be prevented?

Some studies suggest that early intervention with people who have suffered a trauma may reduce some of the symptoms of PTSD or prevent it all together.

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