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Block 2 Unit 3 Post Traumatic Stress Disorder

1) How many arousal symptoms must be present for diagnosis of Post Traumatic Stress disorder?

At least two of the following symptoms of excessive arousal must be present: difficulty falling or staying asleep, irritability, outburst of anger, problem in concentration, and exaggerated startle response.

2) What is the estimated life time prevalence of Post Traumatic Stress disorder?

The estimated lifetime prevalence of PTSD is about 9% of the general population.

3) What is survivor’s guilt?

Survivor's guilt is when a victim feels they did not play their role adequately during an emergency situation, and this results in self-blame for the loss of a loved one.

4) What is narcosynthesis?

Narcosynthesis is a treatment method where Sodium Pentathol (a "truth serum") is used to induce a drowsy state in a person with PTSD. This allows them to vividly recall and describe the traumatic event. Afterwards, a discussion of the events helps the patient understand the trauma is in the past and no longer a threat.

5) What is the usual coping style of persons with Post Traumatic Stress disorder?

The usual coping style of persons with PTSD is often emotion-focused rather than problem-focused. They often take personal responsibility for failures, resulting in survivor guilt.

6) Discuss the symptoms and clinical features of different types of Post Traumatic Stress Disorders with case examples.

• The core symptoms of PTSD include intrusive memories of the traumatic event, which may include recurrent recollections, distressing dreams, and intense distress when exposed to cues that resemble the traumatic event.
• Victims also display avoidance behaviors, which may involve trying to get rid of the thoughts, feelings, and activities related to the trauma, as well as detachment and a restricted range of emotions.
• Additionally, PTSD is characterised by symptoms of excessive arousal, such as difficulty sleeping, irritability, anger outbursts, concentration problems, and exaggerated startle responses.
• The source material mentions a case example of Mohan, an ex-serviceman with PTSD. He experiences depression and alcoholism. He is haunted by the memory of his friend dying in combat and feels guilty for surviving.

7) Discuss the aetiological factors of Post Traumatic Stress Disorder.

The aetiology of PTSD involves a combination of biological, psychological, and social factors.

• Biological factors may include temperamental factors and a vulnerable personality. Twin studies have shown that vulnerable personalities may run in families. Exposure to trauma may also activate the noradrenergic system, leading to elevated norepinephrine levels, which result in exaggerated startle responses and heightened emotional arousal.
• Psychological factors include a vulnerable personality and life events, including being female, early separation from parents, family history of psychiatric disorder, and pre-existing anxiety or mood disorders. Psychoanalytic theory suggests that PTSD is a result of the ego's struggle to assimilate the traumatic experience. Learning theory proposes PTSD results from classical conditioning and avoidance. Cognitive approaches suggest that faulty coping mechanisms, like an emotion-focused style and taking personal responsibility for failures, are a factor in PTSD.

• Social factors can also play a role; when traumatic events are multiplied the risk of PTSD is enhanced.

8) Discuss the prevention technique of Post Traumatic Stress Disorder.

The primary prevention technique described is stress inoculation training. This involves three stages:

• Providing information about the situation, potential stresses, and how to cope.
• Encouraging self-statements like "This pain is not going to last forever, don't panic".
• Exposing the person to simulated threatening situations for practice.

9) Discuss the treatment options of Post Traumatic Stress Disorder.

• Treatment options for PTSD include:
• Medications: Psychoactive drugs, particularly antidepressants and tranquilising medicines, including SSRIs, may be used to ease terror.
• Short-term crisis therapy, which involves proactive engagement, providing information, support, and clarification.
• Long-term therapy focused on integrating the traumatic experience into the person's daily life. Key aspects of this therapy include:
  • Gradually exposing the person to the memories of the trauma and teaching coping skills.
  • Education about the nature and symptoms of PTSD.
  • Psychoanalytically oriented approach which emphasises the interaction between pre-trauma personality and the therapeutic relationship.
  • Trauma-focused cognitive-behavioural therapy which encourages gradual exposure to trauma-related thoughts, feelings, and situations. It also uses exploration of core beliefs and automatic thoughts, replacing erroneous thoughts with more reality-oriented ones.
• Narcosynthesis which uses sodium pentathol (truth serum) to induce a drowsy state and allow emergence of traumatic memories which can then be integrated into the present.
• Eye Movement Desensitisation and Reprocessing (EMDR) which uses rhythmic, left-right stimulation to "unfreeze" stuck traumatic memories.
• Logotherapy which focuses on integrating the trauma into a broader framework of existential meaning.

10) What is a rap group?

Rap Group

• A rap group is a type of self-help group where individuals who have experienced similar traumatic events come together to share their experiences.
• In the context of PTSD, the source material provides the example of Robert Jay Lifton who formed rap groups with Vietnam War veterans. These groups provided a space for veterans to discuss their residual guilt and anger related to the war.
• The sharing of experiences within the rap group allows individuals to work through their trauma.

11) Distinguish between the usual clinical features of Post Traumatic Stress Disorder of children and adults.

Clinical Features of PTSD in Children vs. Adults

• Children often express PTSD responses differently than adults.
• Children may have greater difficulty verbally expressing their pain, particularly in cases involving physical or sexual abuse. They may lack the language to describe their experiences.
• Numbness may be observed in children who have experienced trauma, along with sleep disorders and nightmares.
• Some children may experience a loss of already acquired developmental skills, such as speech or toilet training.
• Changes in behaviour are common, with happy children becoming introverted or shy children becoming unduly aggressive.
• Victims of PTSD, especially children, remain prone to psychiatric disorders and physical health hazards for the rest of their lives, and may develop mood disorders, other anxiety disorders, and substance abuse disorders. They are also more likely to experience academic, career, and relationship problems, as well as cardiac problems later in life.
• Adults can experience symptoms of intrusive memories, avoidance behaviours, and excessive arousal.
• It further describes that biological, psychological and social factors may play a role in who succumbs to the symptoms.
• For a diagnosis of PTSD the symptoms should persist for at least a month.

In summary, while both children and adults can experience PTSD after a trauma, children may have more difficulty expressing their experiences verbally and might exhibit different symptoms such as regression in acquired skills. Rap groups offer a supportive environment for individuals to process trauma by sharing experiences with others who have faced similar situations. 

Important Points

• Intrusive thoughts characterise Post Traumatic Stress disorder.
• Children’s symptoms of Post Traumatic Stress disorder maybe different from that of adults.
• Post Traumatic Stress disorder may last one’s life time
• During stress cortical level increases.
• Francine Shapiro’s technique of dealing with Post Traumatic Stress disorder is known as EMDR. 
• Integration of trauma to present existence is the key of treating Post Traumatic Stress disorder.