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Post
traumatic Stress Disorder (PTSD) is one of several
anxiety
disorders.
The diagnosis of PTSD is quite often incorrectly applied to accident
or injury victims. While PTSD does occur among accident and assault
victims, there are numerous other conditions that resemble
posttraumatic stress disorder. These include Anxiety Disorder Due to
a Medical Condition and Substance (Medication) Induced Anxiety
Disorder. Both involve anxiety but do not meet criteria for
diagnosis of PTSD itself.
Accident victims may have anxiety without having
PTSD itself. They may also be prescribed medications whose side
effects evoke anxiety symptoms. Additionally, there are a range of
phobias and other anxiety disorders that have some, but not all, of
the features of PTSD.
The treatment for anxiety obviously differs according
to the root cause. Thus, a thorough diagnostic evaluation is
critical prior to instituting a treatment plan.
Posttraumatic, and Acute Traumatic Stress (a briefer
form of PTSD) Disorders, differ from other anxiety disorders in that
they arise from exposure to an extreme traumatic stressor
involving direct personal experience of an event that involves
actual or threatened death , threat of serious injury or threat to
the physical integrity of another person.
They can also arise in response to
merely
learning of a violent death,
serious harm/threat of injury/death of a family member or close
friend.
PTSD does not arise in response to pain or prolonged recovery from
an accident.
PTSD does not arise as a response to common bodily injuries.
The Cause
The cornerstone of posttraumatic and acute traumatic
stress disorder is
an event which
is outside the range of normal daily experience.
The disorder may
also be intensified and prolonged when the event is of intentional
human design (Eg. rape, torture, abuse).
Events which most frequently cause posttraumatic or
acute traumatic stress disorder include violent personal assault,
amputation, mugging, torture, sexual assault, kidnapping, diagnosis
of a life threatening illness, severe motor vehicle accident,
military combat or natural disasters.
Posttraumatic stress disorder may be associated with
increased rates (i.e.“co-morbidity”) of other disorders such as
generalized anxiety, major depressive episode, and substance related
disorders. In very severe cases of posttraumatic stress disorder,
auditory and visual hallucinations can be reported.
The Symptoms
The patient with PTSD struggles to deal with anxiety
which may express itself in bodily complaints such as shortness of
breath, chest pain, or palpitations. Anxiety also presents
emotionally, as fear, aversion, apprehension, worry and dread. It
appears cognitively as worry and preoccupation.
In a futile attempt to reduce their level of anxiety,
true PTSD patients may develop behaviors which themselves then
become a new source of problems such as the social withdrawal of
those with phobias, the ritualistic or repetitive behavior of those
with obsessive thoughts, and the avoidant behavior of those with
panic disorder.
Symptoms of PTSD usually emerge in the first three
months following the precipitating event. There are also cases of
delayed onset PTSD where a triggering event reminds the individual
of the original trauma which may have been repressed or gone
untreated. Half of patients with PTSD will spontaneously recover
within 90
days of the onset of symptoms. There are data to
indicate that the individual’s family history, childhood
experiences, personality variables and pre-existing mental disorder
determine why one person develops PTSD and another, in experiencing
the same situation, does not.
The classic pattern of PTSD symptoms involves
a trauma within the last 90 days, symptoms for at least the past 30
days, and re-experiencing the event in thoughts/dreams with intense
emotional and physical symptoms when exposed to the original or
similar setting. The patient learns a pattern of avoidance (usually
detrimental to performing activities of daily living) and appears
numb in response to events around them. Problems with sleep, anger,
concentration, and signs of increased physical arousal may be
present.
The Treatment
If symptoms do not spontaneously remit, medication,
cognitive-behavioral psychotherapy and desensitization procedures
are effective means of intervention.
Complicating Factors
The course of recovery will be negatively influenced
by family, friends and others who unwittingly, or knowingly,
encourage the
patient’s symptoms by labeling the patient as disabled,
dysfunctional and fail to assist the patient in the rehabilitative
process.
The advantages of discussions of PTSD in the media is
that this serves to alert others to signs of the disorder. However,
such coverage also has the potential to alarm a post-injury/accident
patient by mislabeling a temporary emotional adjustment
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