Post-traumatic stress: Definition.
Post-traumatic stress is called a series of symptoms related to anxiety, which appear after exposure to a very stressful and traumatic event, which entails physical harm or a catastrophic threat to the subject.
Chronic post-traumatic stress.
The symptoms of post-traumatic stress do not usually appear immediately after the traumatic event, but some time later. One of the characteristics of this symptomatology is its persistence over time, with a clear tendency to become chronic .
When anxiety symptoms, which appear after an experience of great impact for the subject, become chronic and meet a series of specific criteria, we speak of Post-Traumatic Stress Disorder or PTSD.
Post Traumatic Stress Disorder (PTSD)
“Post-traumatic stress disorder (PTSD) appears after exposure to intense traumatic factors of various kinds.”
What is Post Traumatic Stress Disorder (PTSD)?
The posttraumatic stress disorder ( PTSD) is characterized by a variety of specific symptoms, which appear some time after a highly stressful event for the subject. The nature of this event entails exposure to a very threatening and traumatic situation, with possible physical harm or a catastrophic threat to the subject.
Post-traumatic stress disorder (PTSD) is included in anxiety disorders along with other conditions such as generalized anxiety disorder (GAD), Anxiety attacks (with or without agoraphobia ), obsessive compulsive disorder (OCD), phobias simple , the social phobia , anxiety disorders and substance use disorder acute stress.
PTSD appears some time after the subject has experienced a traumatic event such as the pain of war experiences, torture, sexual harassment or imminent death threats, earthquakes or natural disasters.
Post Traumatic Stress Disorder: Symptoms.
The symptoms in PTSD are grouped into four categories: reliving the traumatic situation again, avoiding acts, situations or places that recall the tragic event, physical symptoms derived from anxiety and adrenergic hyperactivity, and finally, psychic symptoms such as intense mental discomfort.
Repetition of the traumatic situation.
The individual may begin to present a set of symptoms where the stressful situation experienced is relived again . This repetition can appear in the form of dreams or nightmares , or as unpleasant and recurring memories ( Flashback ).
These flashbacks are repetitive and intrusive series of images, feelings or thoughts. They appear without prior notice, against the will of the subject and the subject has the feeling that the traumatic event is happening again today.
The flashback can be of such intensity that it causes a psychic dissociation in the subject, that when reliving the act, he feels, acts and behaves in the same way that he did in the past, getting to lose the references of where he is at the moment Present.
The individual tries at all costs to avoid the memories, thoughts, or feelings associated with the traumatic event. At the same time avoid places, situations or acts that can bring back painful memories of what happened in the past.
There is presence of physical symptoms caused by excitement and adrenergic hyperactivity associated with the repetition of the traumatic event: sweating, palpitations, tachycardia, shortness of breath, etc.
Among the psychic symptoms we can highlight: disorientation, lack of concentration, insomnia, irritability, persecutory manias, hypervigilance, attacks of uncontrolled rage, negativism, feelings of loneliness, guilt or sadness.
Although the symptoms in PTSD can sometimes appear immediately after the traumatic event, it is normal for them to appear after a variable time that can range from weeks to months and even years.
PTSD can appear at any age, even in children. It is especially prevalent in war veterans.
How does post-traumatic stress disorder occur?
As we have already pointed out, the appearance of SEPT in an individual is conditioned by a very severe emotional reaction to extreme psychological trauma. This trauma must be of sufficient importance to cause the subject’s defense mechanisms to collapse. This collapse will depend on the intensity and abruptness or unpredictability of the traumatic event.
Defense mechanisms of the self.
To understand PTSD, we must understand how humans react to painful or stressful events. Every human being has a series of defense mechanisms of the self. These mechanisms are unconscious psychic attitudes or behaviors, aimed at supporting the adversities of daily life.
Let’s look at some of these mechanisms:
- Regression: It is a behavior typical of a previous age (An adult who reacts with a tantrum like a small child).
- Denial: The individual does not accept reality and denies a painful event (A husband who has lost his wife, unconsciously denies this death, and acts as if he is still alive).
- Displacement: It is about displacing a feeling, generally a violent attitude, towards another person or object (The worker who comes home angry with his boss and takes his anger out on his wife for no reason).
- Repression: The subject cancels certain thoughts or desires from consciousness and lives as if they did not exist (A homosexual subject can unconsciously repress his desires and live ignoring his sexual nature).
- Projection: The subject attributes his own thoughts or feelings to others (A very deceitful person may believe that another person is deceiving him, for no reason. There is a saying that says: “The thief thinks that everyone is of his condition”.
- Rationalization: Different and explanatory reasons for an event are sought, so as not to have to accept the real reason that is painful.
- Other mechanisms are reactive formation, condensation, isolation, and sublimation.
Pathophysiology of post-traumatic stress.
In order to survive, humans use these defense mechanisms to minimize damage or pain. The more abrupt and unexpected an event is, the less likely the individual is to use his defense mechanisms.
In post-traumatic stress the psychological blow is so terrible that it blocks the reaction capacity of the subject. The individual is paralyzed, reacts by awe. He is unable to understand or assimilate the magnitude of the event.
If a stressful event is of sufficient intensity and occurs in a sudden and unforeseen way, it causes such a great psychic arousal that the person cannot absorb or process the tremendous energy. The individual is left without escape routes due to the magnitude of the event. Their defense mechanisms are blocked and all the emotional tension remains accumulated and causes the appearance of pathological symptoms.
If the individual knows in advance what is going to happen, he can use all the resources of his personality to adapt to the impact of the trauma. If the event occurs unexpectedly, he is unable to react and becomes psychically blocked and collapsed.
We can affirm that the appearance of a post-traumatic stress disorder in an individual who lives a highly stressful situation will depend on:
- Intensity and duration of the event. The greater the intensity and duration, the greater the probability of suffering it.
- The unexpectedness of the event. The greater the anticipation of what may happen, the less likely it is to suffer from PTSD.
- The nature of the act. Natural tragedies are better accepted than human barbarism.
- The sensitivity or vulnerability of the individual.
Nature of stressful situations.
The nature of the traumatic event can be very varied:
– Floods . In the summer of 1931 a terrible flood killed more than two million people in central China.
– Earthquakes . The largest known earthquake occurred in May 1960. It happened in Valdivia (Chile), although the deadliest happened in Sumatra (Indonesia) in 2004 and ended with almost 250,000 deaths.
– Tsunamis : In 1958 there was an earthquake in Alaska and a subsequent tsunami, which caused a wave of 530 meters in height.
– Fires . Some fires have destroyed entire cities, such as Chicago (1871) or London (1666).
– The Black Death in the 14th century killed about 200 million people.
– The Spanish flu in 1918 killed 5% of the world’s population, with about 75 million deaths.
– AIDS has claimed the lives of more than 30 million human beings.
– Wars. In World War II, more than 80 million people died.
– Genocides. In addition to the genocide of the Jews in World War II, there have been brutal genocides, such as the one in Rwanda (1994) where 800,000 Tutsis were killed by the Hutus. In Cambodia, Pol Pot and the Khmer Rouge killed nearly 2 million people in 1975.
– Terrorist attacks. We still have recent images of the attack on the two twin towers of New York in 2001, with 3,000 dead and 6,000 injured.
– Torture: It is hard to come to believe in what human beings are capable of doing to their fellow men. Dogs devouring the belly of pregnant prisoners. Prisoners forced to play soccer using the decapitated heads of their parents as a ball.
– Mass rapes: In the Bosnian war (1992) it is estimated that more than 40,000 women were raped by Serbs.
– Sexual abuse in childhood.
– Physical and psychological abuse of children and women.
Accidents and illnesses.
– Accidents of means of locomotion (plane, train, boat, car), explosions, fires, sudden or violent deaths of a family member, etc.
It should be noted that children who have suffered sexual abuse, even if they have not suffered physical violence, are candidates for developing PTSD. Some of the groups considered at high risk for PTSD are soldiers who have participated in wars and prostitutes.
The fact of having experienced a traumatic situation, such as those described above, does not necessarily imply that the individual will suffer from PTSD, since the appearance of the symptoms is conditioned by other factors, which are not yet well known today, such as genetic load, family environment or previous emotional situation.
Post Traumatic Stress Disorder Diagnosis.
The diagnostic criteria used for the diagnosis of PTSD in adults and children over six years of age are included in the fifth edition of the DSM and are as follows:
- Exposure to death, serious injury, or sexual violence , whether actual or threatened, in any of these ways:
- Traumatic events experienced directly.
- Events that occurred to other people and witnessed directly.
- Knowledge of violent or accidental traumatic events that occurred to a close family member or close friend.
- Traumatic events with repulsive details experienced repeatedly or with great intensity (for example, first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
- Presence of any of the following symptoms associated with the traumatic episode and that begin after it has occurred:
- Recurrent, involuntary, and intrusive distressing memories of traumatic events.
- Recurring distressing dreams related to traumatic events.
- Dissociation reactions (eg flashbacks) in which the individual does not act as if they were re-experiencing the traumatic events.
- Intense or prolonged psychological discomfort in the face of factors similar to traumatic events.
- Intense physiological reactions to factors similar to traumatic events.
- Constant avoidance of stimuli associated with traumatic events:
- Efforts to avoid distressing memories, thoughts, or feelings associated with traumatic events.
- Efforts to avoid external reminders (people, places, conversations, situations) that arouse distressing memories, thoughts, or feelings associated with traumatic events.
Other symptoms necessary for diagnosis.
- At least two of the following negative cognitive and mood disturbances associated with traumatic events:
- Inability to remember an important aspect of traumatic events.
- Persistent and exaggerated negative beliefs about oneself or others (“I feel very bad”, “I don’t trust anyone”, “The world is very dangerous”).
- Persistent distortion of the cause of traumatic events that causes the individual to blame himself or others.
- Persistent negative emotional state: Fear, terror, anger, guilt or shame.
- Significant decrease in interest and participation in significant activities.
- Feeling of detachment from others.
- Persistent inability to experience positive emotions such as happiness, satisfaction, or loving feelings.
- At least two of the following characteristics related to a significant alteration in reactivity associated with traumatic events:
- Irritable behavior and outbursts of rage.
- Reckless or self-destructive behavior.
- Excessive vigilance.
- Exaggerated startle responses.
- Lack of concentration.
- Sleep disturbances
- Symptoms last longer than a month.
- The disturbance causes clinically significant distress or impairment of social, work, or family life.
8. The alteration cannot be attributed to the physiological effects of a substance (such as medications, alcohol or drugs) or to another medical condition.
Treatment of post-traumatic stress disorder.
The treatment of Post Traumatic Stress Disorder seeks to alleviate the symptoms, avoid their chronification and rehabilitate the subject socially and occupationally.
As in other anxiety disorders, the approach to PTSD has two aspects: drugs and psychotherapy.
Depending on the symptoms, antidepressants and / or anxiolytics can be used .
The insomnia is one of the most common symptoms can be treated with Benzodiazepines short – lived, as the lormetazepam (Loramet, Noctamid).
The depressive symptoms are common in these patients they can be treated with antidepressants, highlighting in this group related to the metabolism of serotonin (SSRIs) such as fluoxetine (Prozac), paroxetine (SEROXAT), sertraline (Aremis) or escitalopram ( CIPRALEX).
The symptoms of anxiety are common to almost any patients. They can be treated with the aforementioned antidepressants, or or with anxiolytics, for short periods of time to avoid dependence. Alprazolam (TRANKIMAZIN), lorazepam (ORFIDAL), or bromazepan (LEXATIN) can be used.
The most used psychotherapy treatments in the treatment of PTSD are:
- Exposure treatment.
- Training in stress inoculation.
- Eye movement desensitization and reprocessing (EMDR).
- Cognitive-behavioral therapy focused on trauma.
- Dynamic psychotherapies to bring out repressed unconscious memories. These techniques allow the patient to verbally recall and objectify the traumatic event, thus freeing him from excessive affection, achieving an improvement in the symptoms.
- Techniques for the management of anxiety such as TFE (Therapy focused on emotions)
Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.