Post-traumatic stress disorder

Post-traumatic stress disorder consists of the development of anxiety after being exposed to a traumatic situation, such as the death of a loved one or a situation in which there has been a fear of dying or being hurt (abuse, a situation of domestic violence, a war, a natural disaster, etc.).

The reaction can occur immediately after the traumatic situation, which is called acute stress disorder, or recurring time later (usually months but sometimes years), which is called post-traumatic stress disorder. In both circumstances, patients develop associative symptoms of indifference or detachment and lack of emotional response.

Patients usually:

• Mentally relive traumatic events. It can be in the form of returning images from the past, nightmares, hallucinations, etc.
• Avoid anything that reminds them of the trauma. Both situations, places, people, or objects. This fact leads them to move away and isolate themselves from people and places they once loved and to lose interest in previously pleasurable activities.
• State of permanent agitation that makes it difficult for them to relate to others and show them affection. This state favors insomnia, irritability, the appearance of episodes of rage or fury, and difficulty concentrating.

Post-traumatic stress disorder is a serious illness. These patients are at risk of developing other illnesses related to anxiety, mood, or alcohol or drug abuse.

Between 5 and 10 percent of the population will develop a post-traumatic stress disorder at some point in their lives, more frequently women. The risk factors for its development are the previous presence of psychiatric illnesses and certain personality characteristics, such as being extroverted or having neurotic traits.

Causes of Post-Traumatic Stress Disorder

The causes of post-traumatic stress disorder are unknown, although there are genetic factors involved since the disease occurs more frequently in family members. Not everyone who attends a traumatic event develops the disease.

What are your symptoms and diagnostic criteria for post-traumatic stress disorder?

The symptoms and diagnostic criteria vary depending on the type of post-traumatic stress. 

Criteria for the diagnosis of acute stress disorder

A.    The person has been exposed to a traumatic event in which both of the following circumstances have existed:

1. The person has experienced, witnessed, or has explained to him, one (or more) events characterized by deaths or threats to his physical integrity or that of people close to him.
2. The person has responded with intense fear, hopelessness, or horror.

B.     During or after the traumatic event, the individual has three (or more) of the following dissociative symptoms:

1. Subjective sensation (felt by the patient himself) of dullness, detachment, or lack of emotional reactivity.
2. Reduced awareness of your surroundings (for example, being dazed).
3. Derealization (this is an alteration of perception in which the world is seen as strange or unreal).
4. Depersonalization (he believes that the things that happen around him have nothing to do with him, he sees the world as if it were a movie).
5. Dissociative amnesia (for example, inability to remember an important aspect of the trauma).

C.    The traumatic event is persistently re-experienced in at least one of these ways: repetitive images, thoughts, dreams, illusions, flashback episodes or a feeling of reliving the experience, and discomfort when exposed to objects or situations that remind you of the traumatic event.

D.    Marked avoidance of trauma-reminiscent stimuli (thoughts, feelings, conversations, activities, places, people).

E.     Pronounced symptoms of anxiety (sleep difficulties, irritability, poor concentration, hypervigilance, exaggerated startle responses, motor restlessness).

F. These disturbances cause clinically significant distress or impairment in the individual’s social, occupational, or other important areas of activity, or markedly interfere with the individual’s ability to perform essential tasks. For example, getting the necessary help or human resources by explaining the traumatic event to your family members.

G. These changes last a minimum of 2 days and a maximum of 4 weeks, and appear in the first month after the traumatic event.

H. These disturbances are not due to the direct physiological effects of a substance (drugs, pharmaceuticals) or a general medical condition, and are not better explained by the presence of a Brief Psychotic Disorder.

Diagnostic criteria for post-traumatic stress disorder

A.    The person has been exposed to a traumatic event in which both of the following circumstances have existed:

1. The person has experienced, witnessed, or has explained to him one (or more) events characterized by deaths or threats to his physical integrity or that of people close to him.
2. The person has responded with intense fear, hopelessness, or horror. In children, these responses can be expressed as unstructured or agitated behaviors.

B.     The traumatic event is persistently re-experienced through one (or more) of the following ways:

1. Recurring and intrusive memories of the event that cause discomfort include images, thoughts, or perceptions. In young children, this can be expressed in repetitive games where characteristic themes or aspects of the trauma appear.
2. Recurring dreams about the event, which cause discomfort. In children, there may be terrifying dreams of unrecognizable content.
3. The individual acts out or has a feeling that the traumatic event is occurring (includes feelings of reliving the experience, delusions, hallucinations, and dissociative flashback episodes, including those occurring upon awakening or intoxication). Young children may re-enact the specific traumatic event.
4. Intense psychological distress when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event.
5. Physiological responses when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event.

C.    Persistent avoidance of stimuli associated with the trauma and blunting of the individual’s general reactivity (absent before the trauma), as indicated by three (or more) of the following symptoms:

1. Efforts to avoid thoughts, feelings, or conversations about the traumatic event.
2. Efforts to avoid activities, places, or people that trigger memories of the trauma.
3. Inability to remember an important aspect of the trauma.
4. Marked reduction in interest or participation in activities.
5. The feeling of detachment or alienation from others.
6. Restriction of affective life (for example, inability to have feelings of love).
7. Feeling of a bleak future (does not expect to get a job, get married, start a family, or, ultimately, lead a normal life).

D.    Persistent symptoms of increased hyperactivity that were not present before the trauma, as indicated by two (or more) of the following symptoms:

1. Difficulty falling or staying asleep.
2. Irritability or fits of anger.
3. Difficulty concentrating.
4. hypervigilance
5. Exaggerated startle responses.

E.     These disturbances (symptoms in Criteria B, C, and D) last longer than 1 month.

F.     These alterations cause significant clinical discomfort or deterioration in social, occupational, or other important areas of the individual’s activity.

Can it be prevented?

Some studies have shown that treatment with beta-blockers and/or opioids at the time of acute trauma, which could later trigger the chronic phase of PTSD, reduces the chance of entering the chronic phase.

Forecast

The prognosis of post-traumatic stress disorder is variable. In general, the disease does not disappear but the symptoms can be satisfactorily controlled with the prescribed treatment.

Post-traumatic stress disorder treatment

Acute stress disorders are self-limited and usually do not require any treatment. Sometimes they require the temporary administration of benzodiazepines or supportive psychotherapy.

Post-traumatic stress syndrome requires a more complex and prolonged treatment that includes:

• Pharmacotherapy. Some types of antidepressants are often used, and drugs against epilepsy or neuroleptics have also been used occasionally.
• Psychotherapy. It consists of helping the patient develop coping strategies for symptoms and memories. Multiple types of psychotherapy are used in these patients.