Post-traumatic Stress Disorder

What is a psychological trauma?

What is meant by psychological trauma is an event significant enough to inflict emotional damage on anyone who is exposed to it. We can list some of the traumas created by men as follows: war, physical or sexual assault, serious accidents, being a witness to harm inflicted to oneself or someone else. Some traumatic events are caused by nature, like fires, earthquakes, storms and floods.

In its essence, there is a fairly personal aspect to trauma. An event that inflicts deep damage on one person may carry far less importance for another. It is the personality, the person’s beliefs, personal values and previous life experience that is responsible for this difference. However, for an event to be accepted as a trauma the event of a threatening nature has to be met with excessive fear, hopelessness and horror right from the start of the event. The event causes a series of psychiatric complaints both during the initial period and months and years later. This is the aspect which we will investigate in this article.

History of post traumatic stress disorder

During the American Civil War the condition of heart complaints like palpitation were named “soldier’s heart” as they were frequently seen in soldiers. During the 1st and 2nd World Wars this was followed by psychiatric complaints experienced by both soldiers and people who stayed in concentration camps. Medical circles became interested in the subject when similar complaints were seen in American soldiers who had fought in the Vietnam war. At first it was thought that these complaints were only related to wars, however later on it was recognised that they can also occur in people who survived an earthquake, a serious accident or a physical/sexual assault. The condition was named “post-traumatic stress disorder”. Post-traumatic stress disorder is still a current psychiatric problem that is being researched with regards to its stages of development and possible treatment options.

What is Post-traumatic Stress Disorder?

Post-traumatic stress disorder is a psychiatric illness which develops after a major traumatic event. It can develop at any age. Most people pull themselves together fairly quickly in the months that follow a major trauma, however a group of people will develop post-traumatic stress disorder which then becomes a major problem throughout the remainder of their lives. In post-traumatic stress disorder problems are experienced in three different areas:

The first of these is, that memories, images, scents, noises and emotions related to the incident are relived time and time again. These individuals can be involved in their own past experience to such an extent that they are unable to focus on daily events in the present. The person will greatly suffer from such repetitive experiences. During sleep he may have various nightmares related to the event. During such “re-experiencing” of the original trauma during sleep the person may show signs of sweating, palpitations, muscle strain and other such conditions.

Secondly we see, that in order to avoid the “re-experiencing” mentioned above and the associated worries and anguish, these individuals try to avoid any situation that may remind them of the traumatic event. This results in the person finding himself cut off from family members, friends and social circles. In this way he tries to avoid painful memories. However, with a desensitization towards what is happening around him a state of isolation sets in, and with a loss of motivation and an inability to experience daily feelings like love and joy, the person finds himself cut off from many activities and preferences he used to have previously. The family usually responds with thoughts like “he is not the person he used to be”, or “his whole personality has changed”.

A third characteristic seen in these persons is that they are alert and hyper-vigilant at all times. Due to this they may become excessively nervous. In their bouts of anger they may harm themselves or other people. Difficulty in concentrating, inability to sleep and being startled quickly are some of the symptoms they display. Alcohol and substance abuse as well as thoughts of suicide are frequent in such persons.

How is the disorder diagnosed?

A diagnosis of post-traumatic stress disorder should be made by a psychiatrist. The aim during the diagnostic phase is to distinguish the symptoms from physical and other psychological problems. A detailed physical examination, various blood tests and imaging are required and, if necessary, consultations with doctors from other branches may be requested.

Who develops post-traumatic stress disorder?

Post-traumatic stress disorders develops after a serious psychological trauma. What is interesting is that not all but only some of the individuals who live through a traumatic event develop this disorder. This means that unless there is a predisposition, a traumatic event does not directly lead to the illness. Therefore it is not so much the seriousness of the stressor but more the response the individual that is important. It is claimed that people who before and after a disaster don’t have access to a sufficient social support system, are more prone to develop the disorder. On the other hand, brain research revealed that many neurotransmitters (brain stimulating molecules) play a role in the development of the disorder. Some researchers have focused on the similarities between post-traumatic stress disorder and the other two psychiatric disorders, namely panic disorder and depression.

Methods of treatment

Drug therapy and psychotherapy are some of the methods used in treatment. Using both methods of treatment increases the chances of recovery. One of the main rules is for the clinician to approach his patient in a supportive manner. The patient is encouraged to talk about the traumatic event, and together with relaxation techniques this approach strengthens the patient’s coping mechanisms. Participation of the patient’s family also contributes to the treatment process.

Medication

The medication used consists primarily of antidepressants, but drugs which are used in other psychiatric illnesses, can also be used.

What we need to know about antidepressants

1. Antidepressants should only be used under the supervision of a doctor.

2. It takes 2-4 weeks before the patient experiences the full effect of the medication. These drugs do not have an immediate beneficial effect. In fact, in the early stages some complaints may be exacerbated by the medication.

3. Your doctor should decide whether the drug is sufficient for the patient’s needs, whether or not to change it, or if additional medication is required in order to strengthen the effect.

4. After a certain level of improvement is achieved, you should continue with the treatment for at least 6-9 months. The decision to stop the medication at the end of the treatment should be discussed with your doctor and you should follow his recommendation.

5. Contrary to what is commonly believed, antidepressants do not act by tranquillizing the patient. Your ability to think and decide will not be affected during use of antidepressants.

6. Antidepressants do not cause a drug dependency.

7. Side effects associated with antidepressants are usually mild and short-lived. They usually occur during the first week. The patient may experience nausea, vomiting, headaches or a feeling of confusion. Longer term side effects may be a lack of sexual drive, difficulties in erection and ejaculation. Weight gain is only associated with a certain group of this medication and does not reach extreme levels. Do not refrain from sharing such side effects with your doctor, he will welcome it. If any unexpected side effects occur during treatment you must contact your doctor immediately.

Psychotherapy

In all types of psychotherapy the primary aim is provide close support to the patient during a crisis. Involvement of family members in the treatment process plays an important role. Treatment can be individual or in the form of group therapy with other persons who developed post-traumatic stress disorder as a result of similar experiences. Whatever the treatment, the main aim is for the patient to face – in stages – the imagination of the event or circumstances which remind him of the event, and in this manner to desensitize the patient towards these. Hypnosis is another method that can be used.

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