Post-Traumatic Stress Disorder

By: Bhavya Appannagaari

Photo Credit: www.depositphotos.com

What is PTSD?

Post-traumatic stress disorder is a mental disorder that occurs due to witnessing or experiencing traumatizing events or circumstances. Some examples of these traumatizing events are natural disasters, accidents, terrorists, war, rape, or bullying. This disorder can affect you mentally, socially, or physically (Psychiatry.org, 2022). PTSD occurs in direct response to a stressful event. Some symptoms of PTSD can include nightmares and severe anxiety. People with these symptoms can sometimes recover. However, If these symptoms last longer, get worse, or interfere with your day significantly, it is likely that you have PTSD (Mayo Clinic, 2022).

What is required for the DSM V to be diagnosed with PTSD?

Here are the diagnostic criteria that need to be met in order to be diagnosed with PTSD:

The first criteria is stressor, which means a person is exposed to death, injury, or sexual violence in at least one of the following ways:

● Directly experiencing it

● Witnessing it in person

● Indirectly experiencing it

● Close relative friend was exposed to it

The second criteria is intrusion, and it means the traumatic event was relieved in at least one of the following ways:

● Unwanted memories

● Flashbacks

● Nightmares

● Emotional distress after said event

● Physical activity after said event

The third criteria is avoidance, and it means avoiding what triggered the PTSD in at least one of the following ways:

● Trauma-related thoughts/feelings

● Reminders of the trauma

The fourth criteria is negative alterations in cognition and mood, which means negative feelings which worsened or started after the trauma and must be experienced in at least two of the following ways:

● Memory problems of the traumatic event

● Overly negative thoughts/assumptions

● Exaggerated blame for who/what caused the trauma

● Negative emotions

● Loss of interest in hedonic activities

● Feeling isolated

● Not experiencing positive emotions

The fifth criteria is alterations in arousal and reactivity. This means trauma-related symptoms worsened after the trauma and must be experienced:

● Aggression/irritability

● Destructive behavior

● Exaggerated reactions

● Concentration problems

● Hard time falling asleep

The sixth criteria is duration, which means that the symptoms must last for at least one month.

The seventh criteria is functional significance, which means PTSD causes significant impairment, which can be social, or job-related.

The eighth criteria is exclusion, which means that the disorder is not due to other illnesses such as medication or substance abuse.

There are also two specifications that need to be met in order to diagnose PTSD.

The first is a dissociative specification and it has two parts; depersonalization and derealization. Depersonalization means you have the experience of being detached from yourself and derealization means you are experiencing unreality or distortion.

The second specialization is delayed specification. It means that the diagnostic criteria are not met until at least six months after the trauma occurred.

(BrainLine, 2023)

How is PTSD diagnosed?

In order to diagnose PTSD, a medical professional must initiate an assessment; this involves asking questions about thoughts, feelings, and behaviors through a PTSD screen. If you suspect having PTSD, you could approach a doctor about the event which triggered it and then be given a PTSD screen. The results do not determine if you have PTSD, but can initiate a further assessment. If you screen positive, you will be asked for a more thorough assessment which can last 10 -15 minutes, or 1-2 houses depending on the patient. If you incorporate information with legal reasons for disability claims, sometimes PTSD assessments can go on for a longer time. The doctor will ask you about the event which may have triggered PTSD; you may be asked about difficulties or impairments which you have had since the traumatic event. You can complete surveys for more information about the diagnosis, as well as talk to family members about problems. You could also be screened for physical health problems that could be caused by the trauma (Veteran Affairs, 2018).

How can PTSD affect someone with epilepsy?

Epilepsy is a neurological disorder that generates seizures, as well as cognitive, social, and psychological setbacks. It is present for about one percent of the population. Psychotic disorders have been identified for about 25 – 50 percent of patients with epilepsy. The relationship between epilepsy and negative life events is a multi-directional relationship. Early life stress could cause the brain to be vulnerable to epilepsy. People with PTSD have a higher risk of developing epilepsy in the future. Acute stress due to traumatic events could trigger epileptic seizures. People who reside in war zones/disaster-prone countries are more likely to experience a seizure (Mariotti et al, 2021).

Having an abnormally large amount of stress can contribute to PTSD symptoms and have adverse impacts on mental and physical health. (Maeng et al, 2017). Such stress can make it easier to contract epileptic seizures during periods of high stress. This is more common if stress happens over a long period of time. Sometimes, having stress can contribute to a patient developing epilepsy, in the first place. Especially, if the stress is severe, lasts a long time, or has affected you in the critical period. Stress can affect the development of the brain, which could contribute to the onset of epilepsy (Epilepsy Action, 2023).

What are the symptoms of PTSD?

There are many common symptoms of PTSD. The first is revealing what happened through flashbacks and memories/nightmares. The next symptom is alertness, which involves panicking when reminded of the trauma, feeling irritable, extremely alert, and finding it hard to concentrate. Another symptom of PTSD is avoiding feelings or memories. This involves wanting to keep busy, avoiding what triggered the trauma, memory loss of the trauma event, feeling numb, and being unable to express affection. The last symptom of PTSD is difficult feelings, which means you cannot trust anymore, that nowhere is safe, like nobody understands you, and you keep blaming yourself for what happened (Mind, n.d.).

What are the treatment options for PTSD?

The major type of treatment for PTSD is cognitive behavioral therapy. Cognitive behavioral therapy has three subsets, cognitive processing therapy, cognitive therapy, and prolonged exposure. Cognitive behavior therapy basically means focusing on thoughts and feelings, targeting problems and symptoms that lead to difficulty in functioning. Cognitive processing is a subset of cognitive behavioral therapy, which involves challenging unhelpful beliefs related to trauma. Cognitive therapy modifies trauma memories to interrupt unwanted thought patterns interfering with life. Prolonged exposure means facing what caused the traumatic event, and learning that being exposed to that trigger is not actually harmful, thereby does not need to be avoided or is dangerous (American Psychological Association, 2020).

What are the risk factors of having PTSD?

There are many factors that cause you to develop PTSD, especially after a traumatic event. There are the following:

● Experiencing long-lasting trauma

● Experiencing early life trauma, such as child abuse

● Having a job that increases exposure to traumatic events, like being in the military

● Having other mental health problems

● Substance abuse

● No good support system of family/friends

● Close family has anxiety/depression

(Mayo Clinic, 2022)

Conclusion

Post-traumatic stress disorder is a mental disorder caused by experiencing a distressing or traumatic event. Some examples of such events are child abuse, accidents, bullying, or war. This disorder can impact you in many different ways, such as socially or physically. There are many criteria that need to be met to diagnose PTSD through DSM 5, such as stressor, intrusion, or avoidance. PTSD can be diagnosed through a PTSD screening, which asks you questions about thoughts and feelings that could have triggered your PTSD. Some symptoms of PTSD are flashbacks or nightmares. PTSD and epilepsy have a strong correlation as those with PTSD are more likely to contract epileptic seizures, as well as increased vulnerability to epilepsy itself. Cognitive behavioral therapy, the study of thoughts and feelings to help deal with PTSD is the dominant form of treatment. Some risk factors of PTSD are child abuse, substance abuse, or close family that has anxiety or depression.

References:

American Psychological Association. (2020). Treatments for PTSD. American Psychological Association. https://www.apa.org/ptsd-guideline/treatments DSM-5 criteria for PTSD. BrainLine. (2023, March 22).https://www.brainline.org/article/dsm-5-criteria-ptsd

Maeng, L. Y., & Milad, M. R. (2017, June 27). Post-traumatic stress disorder: The relationship between the fear response and chronic stress. Chronic stress (Thousand Oaks, Calif.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219872/

Mariotti, S., Valentin, D., Ertan, D., Maillard, L., Tarrada, A., Chrusciel, J., Sanchez, S., Schwan, R., Vignal, J.-P., Tyvaert, L., El-Hage, W., & Hingray, C. (2021, July 8). Past trauma is associated with a higher risk of experiencing an epileptic seizure as traumatic in patients with pharmacoresistant focal epilepsy. Frontiers in neurology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296979/

Mayo Foundation for Medical Education and Research. (2022, December 13). Post-traumatic stress disorder (PTSD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms causes/syc-20355967

Mayo Foundation for Medical Education and Research. (2022, December 13). Post-traumatic stress disorder (PTSD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms causes/syc-20355967

Stress and epilepsy. Epilepsy Action. (2023, March 15). https://www.epilepsy.org.uk/living/health/stress-and-epilepsy

Symptoms of PTSD. Mind. (n.d.). https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-trauma tic-stress-disorder-ptsd-and-complex-ptsd/symptoms/

Va.gov: Veterans Affairs. How Is PTSD Assessed? (2018, September 18). https://www.ptsd.va.gov/understand/isitptsd/measured_how.asp

What is posttraumatic stress disorder (PTSD)? Psychiatry.org – What is Posttraumatic Stress Disorder (PTSD)? (2022). https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

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