Traumatic Stress Disorder Post-Traumatic Stress Disorder (PTSD) is a disorder that has existed for many years but is just now beginning to be accepted by mainstream society and government bodies. In this brief paper, I will discuss the history of PTSD as a recognized disorder as well as the symptoms exhibited by someone suffering from the disorder. To conclude the paper, I will discuss some of the techniques that have proven useful in treating PTSD. History The history of PTSD is three-prong.
With the advent of the railroads and increased travel by rail, doctors began to see train wreck victims who presented with symptoms even though there was no physical cause. So common was this phenomenon that medical doctors began diagnosing it as “railway spine. ” Psychologists were more derisive however, labeling it “compensation neurosis,” believing that the victims were malingering in order to receive insurance benefits. Across the ocean, Sigmund Freud was working with young women when he began noticing symptoms of denial, repression, avoidance.
Ptsd Rape Essay Example
He believed these were due to childhood sexual abuse and labeled it “hysterical neurosis. ” His findings of widespread childhood sexual abuse were not well-received by polite Victorian society and he was forced to disavow his findings. However, it has been exposure to combat that has generated the greatest number of incidents. As early as the American Civil War, symptoms labeled “neurasthenia,” “soldier’s heart,” and “nostalgia” were reported. In World Wars I and II, the increase in aerial bombardment and artillery gave rise to the terms “shell shock” and “combat fatigue. Although doctors did not know how to treat it, PTSD (or the symptoms rather) were recognized as a psychological disturbance by the end of World War II and the Korean War years. It was the war in Vietnam and the sheer volume of affected returning soldiers that truly thrust PTSD in the spotlight. Although it was previously denied by policymakers, a coalition of grass-roots support groups forced politicians and health sciences officials to acknowledge the reality of the issue.
Research into rape and child and spousal abuse victims found that many of the symptoms being reported were the same as those afflicting soldiers. With the publication of the DSM-III, Vietnam Veterans syndrome, rape trauma syndrome, battered woman syndrome, and abused child syndrome were combined under the rubric Post-Traumatic Stress Disorder. Diagnosis Diagnosing PTSD is challenging. Frequently, the symptoms presented could be indicative of several different diagnoses and many times other diagnoses are comorbid such as alcohol abuse or depression.
According to the DSM-IV-TR, in order to be diagnosed with PTSD, the client must have been exposed to an event that involved actual or perceived death or serious injury or threatened the physical well-being of themselves or others. They must also persistently re-experience the event in at least one of the following ways: recurrent and intrusive recollections of the event, recurrent nightmares, flashbacks that cause the person to dissociate and act or feel as if the event were recurring, intense distress upon exposure to cues that resemble the event, or physiologic reactions upon exposure to cues that resemble the event.
The client must persistently avoid the stimuli in at least three ways: attempts to avoid thoughts, feelings, or dialogues associated with the event; avoids activities, people, or situations that arouse recollection of the event; unable to recall important aspects of the event; exhibits markedly diminished interest in significant activities; detached emotionally and socially from other people; numbed feelings resulting in restricted emotional affect; and general sense of foreshortened future.
Finally, persistent symptoms of increased nervous system arousal that was not present before the event must manifest, as indicated by at least two of the following symptoms: difficulty sleeping, irritability or outbursts of anger, difficulty concentrating, hypervigilance, or exaggerated startle response (APA, 2000). Children can also experience post-traumatic stress disorder. Children will often manifest symptoms by exhibiting agitated or disorganized behavior. They often experience nightmares, especially of monsters or rescuing others.
They may believe that they will not live to experience adulthood or that they can predict future traumatic events. Finally, physical symptoms such as headaches and stomachaches may develop (APA, 2000). A second form of PTSD, known as “complex PTSD” or “disorder of extreme stress not otherwise specified” (DESNOS), may develop after long-term exposure to traumatic events. This may present in soldiers who have been in long-term combat, victims of chronic childhood sexual abuse or domestic violence, or concentration camp survivors (James & Gilliland, 2013, p. 153).
This disorder manifests as three primary symptoms: somatization such as physical problems, pain, and limited functioning; separation of the personality into distinct components (dissociation); and affect dysregulation including alterations in impulse control, attention, and consciousness, perception of perpetrators, relationships with significant others, and systems of meaning (Courtois, Ford, & Cloitre, 2009, p. 85-86). Treatment Treating PTSD can be broken down into individualized treatment and group treatment. It can be further into the population being treated, whether it is an adult, child, or the family.
Due to page limitations of this paper, I will limit my discussion to that of adults. In individual adult treatment, there are five stages: the initial emergency or cry for help, numbing and denial, intrusive-repetitive, reflective-transition, and integration. In the first stage, the primary goal is to get the client stabilized. Meditation, relaxation, hypnosis, and biofeedback are all techniques that may be utilized (Evans, 2003; Kolb & Mutalipassi, 1982). After the client is relaxed, the therapist can provoke central nervous system arousal to elicit the traumatic memories.
Flooding, systematic desensitization, implosion, and Gestalt techniques are useful in this activity. The second stage of recovery is the denial and numbing stage. In this stage, the goal of the therapist is to bring into conscious awareness the traumatic event and hidden details and emotions the client may deny (Brende & Parson, 1985, pp. 191-192). Using reminiscence, the therapist breaks through the client’s defense mechanisms and exposes the event as it truly happened, rather than the fantasized version the client’s mind has created (James & Gilliland, 2013).
Using a psychodynamic approach, the therapist clarifies and interprets the information that the client has given. This marks the third stage of recovery, interpretation. The goal is to integrate the trauma of the past event with the healing of the present therapeutic moment (Lindy, 1996, p. 534). Because clients may lash out at the therapist for the pain they are experiencing, an effective therapist will expect this and remain as empathetic as possible (Lindy, 1996, p. 536).
In the fourth stage, reflection and transition, the goals for the client are to re-experience the emotions felt at the time of the event and examine the coping methods used to process it. The techniques of flooding, thought-stopping, and journaling are effective in this process. In flooding, the therapist continuously presents the fear-evoking stimuli while removing the reinforcement for the anxiety. The client discovers that their fear is unfounded and anxiety dissipates. In thought-stopping, the therapist progressively builds the fear-inducing scene to maximum arousal.
Once there, the therapist shifts the client from that scene back to a positive, affirming place. The final technique, journaling, is beneficial to both the therapist and the client. By writing his thoughts down and hearing it read aloud, the client can process the thoughts at a safe psychological distance and move from self-condemnation to animated guilt (James & Gilliland, 2013). The final stage of individual treatment, integration, is the act of bringing the traumatic event out of the client’s past and working it into the conscious awareness.
Techniques such as empty chair have been proven useful in helping clients deal with the “unfinished business” (Cohen, 2002, 2003; Scurfield, 1985). Group therapy is also effective in treating PTSD. First formed in New York City in 1970, grassroots support groups formed to assist veterans returning from Vietnam who could not receive help through government channels. Adapted to serve widely diverse populations, support groups help counter the social isolation and emotional estrangement that accompanies PTSD by giving the client a sense of community with people like them who are facing similar struggles.
Clients also gain knowledge from other clients facing similar issues. After the trauma of the event is resolved, clients move into the second stage of group treatment, the life adjustment group. The goal of this group is to integrate the events of the past with an attempt to move forward and adjust to society. Action and behavioral change is mandatory at this stage (James & Gilliland, 2013). This is extremely difficult for many clients and will cause many to drop out of the group. Work to reestablish healthy relationships within the family are vital to long-term continued success.
Coordination to or with a specialist in family therapy is recommended. Conclusion Recognizing and treating PTSD is important for several reasons. First, many disorders and crises may have their root in PTSD. Substance-abuse, child-abuse, domestic violence, and suicide may all be maladaptive coping mechanism from someone trying to cope with a traumatic event or the event that causes PTSD to emerge. Additionally, the aging of Vietnam veterans as well as the similarity of the Afghan and Iraqi wars to Vietnam ensure that PTSD will be a significant issue in mental health care for many years to come.
Finally, mental health workers who deal with PTSD regularly may begin to develop symptoms themselves (Halpern & Tramontin, 2007; Pearlman & Saakvitne, 1995). By recognizing the symptoms and seeking appropriate help early, mental health workers can resolve the issues quickly and return to the “front lines” sooner. References American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. Brende, J. O. , & Parson, E. R. (1985).
Vietnam veterans: The road to recovery. New York: Plenum Press. Cohen, A. (2002. Gestalt therapy and post-traumatic stress disorder: The potential and its (lack of) fulfillment. Gestalt! , 6(1), 21-28. Cohen, A. (2003). Gestalt therapy and post-traumatic stress disorder: The irony and the challenge. Gestalt Review, 7(1), 42-55. Courtois, C. A. , Ford, J. D. , & Cloitre, M. (2009). Best practices in psychotherapy for adults. In C. A. Courtois & J. D. Ford (Eds. ), Treating complex traumatic stress disorders: An evidence-based guide (pp. 82-101).
New York: Guilford Press. Evans, B. (2003). Hypnosis for post-traumatic stress disorders. Australian Journal of Clinical & Experiential Hypnosis, 31 (1), 54-73. Halpern, J. , & Tramontin, M. (2007). Disaster mental health: Theory and practice. Belmont, CA: Brooks/Cole. James, R. K. , & Gilliland, B. E. (2013). Crisis intervention strategies (7th ed). Belmont, CA: Brooks/Cole. Kolb, L. C. , & Mutalipassi, L. R. (1982). The conditioned emotional response: A subclass of the chronic and delayed stress disorder. Psychiatric Annals, 12, 969-987. Lindy, J.
D. (1996). Psychoanalytic psychotherapy of post-traumatic stress disorder: The nature of the therapeutic relationship. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds. ), Traumatic stress (pp525-536). New York: Guilford Press. Pearlman, L. A. , & Saakvitne, K. W. (1995). Trauma and the therapist. New York: Norton. Scurfield, R. M. (1985). Post-traumatic stress assessment and treatment: Overview and formulations. In C. R. Figley (Ed. ), Trauma and its wake: The study of posttraumatic stress disorder (pp. 219-256). New York: Brunner/Mazel.