Post Traumatic Stress Disorder (PTSD) is something many of us are aware of but can we say we know everything about PTSD?

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PTSD is a growing problem. Particularly for services sector personnel.

Here we answer some questions for you.

Post-traumatic stress disorder (PTSD) is a complex psychiatric disorder with somatic, cognitive, affective and behavioural effects, secondary to psychological trauma. In other words, PTSD can elicit disturbing memories, flashbacks, sleep disturbances, hypervigilance, etc. in people who have undergone considerable psychological strain. PTSD is no different from anxiety, depression, and other psychiatric conditions; therefore, its treatment should be paid attention to, rather than believing that ‘time heals all wounds’

PTSD had many alternate names, including “shell shock” and “combat fatigue” during World War I and after World War II, respectively. Though it is more often seen in military personnel, veterans, firefighters, people in the service sector, or those with combat exposure. This does not mean however that PTSD is restricted to this group of people only. It can occur in civilians too, in fact, in anyone at all! [1]

How common a problem it is?

According to a national survey [2] conducted on the general population in the U.S., the prevalence of PTSD was found to be between 6.8 to 9.2%, more in women and older adults than men and younger individuals. People in the service sector have an even higher prevalence rate, relatively proportional to the severity of the injury; Those with combat-exposure but no injuries, have a prevalence rate of 8% whereas it is 33% prevalent in those with a combination of injuries. Moreover, 70% of such patients, had concurrent mental health problems such as depression. [2]

Here in the UK:

  • One in 13 children will be affected by the age of 18. 
  • One in five police officers has PTSD. In fact news headlines today – Kent Police have reached a five year high with currently 147 officers off with stress-related issues.  How many more will follow?
  • Given that traumatic exposure is common among firefighters, it is not surprising that high rates of PTSD have been found. Studies have found that anywhere between approximately 7 percent and 37 percent of firefighters meet the criteria for a current diagnosis of PTSD.
  • Among all emergency service workers, paramedics have the highest rate of PTSD, with an estimated prevalence of 14.6%. While all emergency service personnel face catastrophic and stressful eventsparamedics are exposed to these events on a daily basis.
  • Ex-serving military personnel deployed in a combat role were found to have higher rates of PTSD at 17.1%, compared with 5.7% of those who had been in a support role such as medical, logistics, signals and aircrew.
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What psychological trauma can cause PTSD?

As the word, PTSD itself states ‘Post-traumatic’, so any event that is traumatic for the mind of a person can lead to PTSD. From interpersonal violence, organized violence or to life-threatening events.  Any event eliciting extreme fear can have a psychological impact. Some of the examples of such traumatic events and their contribution to the pool of PTSD are mentioned below: [3]

  • 33% due to Abusive sexual relationship- sexual child abuse, marital abuse, rape.
  • 30% due to interpersonal trauma- life-threatening health condition, unanticipated death of a loved one, etc.
  • 14% due to organized violence- war zone refugee or civilian, combat exposure, discovering dead bodies on crime or war zone, abduction, etc.
  • 12% due to physical violence- physical assault, childhood physical abuse, a threat to oneself
  • 12% due to life-threatening events- natural catastrophe, fatal road traffic accident, dangerous chemical exposure.

Clinical manifestations:

Symptoms can be summarised into four:

  • Reliving: Reliving includes flashbacks of the events, intrusive memories, recurrent distressing dreams, intense and vigilant reactions when exposed to anything that even remotely resembles the traumatic experience.
  • Avoidance: Efforts directed toward avoiding distressing thoughts. Absolute avoidance of the discussion of the trauma and of anything or anyone that can be a potent reminder of the event.
  • Mood and cognitive symptoms: Such symptoms include forgetting a critical aspect of the traumatic experience, persistent pessimism towards oneself: blaming oneself for the strain, marked disinterest in activities, disproportional anger, guilt, fear and horror
  • Reactive symptoms: Such as exaggerated startle response, hypervigilance, undue verbal or physical aggression, self-destructive behaviours, inability to concentrate and focus, sleep disturbances, etc.

Diagnostic criteria:

To differentiate PTSD from acute stress disorder, it is worthy of mentioning here that to diagnose PTSD the above symptoms should be present for at least one month. Table 1 Diagnostic criteria of PTSD according to DSM V Source: MDedge ©

Why some of the trauma victims have PTSD while others don’t?

There are several factors in a community that increases or decreases the probability of having PTSD after a traumatic experience. Not only that, but the physical condition, mental health, and other risk factors prior to the trauma also contribute massively towards PTSD. Age, gender, comorbid physical and psychological diseases, socioeconomic status, marital status, childhood history of abuse/adversities, family history, etc. all are contributing determinants of the outcome. The extent to which the traumatic event was unpredicted, unmanageable, irrepressible, and inevitable also acts as a protagonist.

Factors that help against the development of PTSD are called ‘Resilience factors’, which include

[4]:

  • Friends and family support
  • Post-traumatic support group/counseling sessions
  • Positive coping approach
  • Sanity in the moment of fear enabling a person to react effectively

Impact of PTSD on general health: [5]

Several studies have been conducted to find a causative link between PTSD and other medical conditions. This is owing to the fact that PTSD patients are more likely to report certain diseases when compared with the unaffected general population. A link between inflammation and PTSD is being studied. PTSD is often found to be coexistent with chronic pain, cardiovascular, gastrointestinal, pulmonary, autoimmune, musculoskeletal disorders.

A study [5] conducted in New York City showed that four times increased probability of heart attack and emphysema, and twice the likelihood of having hypercholesterolemia, insulin resistance, and angina in the participants who had PTSD than those without PTSD. Besides these medical conditions, depression, drug, and substance abuse have been found to be highly associated with PTSD patients.

What are the management options?

PTSD is treated with an amalgam of psychological therapies and pharmacological. [6] Four weeks’ watchful waiting is recommended for those with milder symptoms with instructions of one month follow up.

  • Psychological therapies are directed towards modifying the emotional state of the victims, i.e. efforts to replace the sense of shame, guilt, and fear with optimistic sentiments. Such treatments include Trauma-focused cognitive behavioural therapy (CBT), eye movement desensitization, exposure therapy and reprocessing and group therapy.
  • Pharmacological management: Antidepressants such as paroxetine, sertraline amitriptyline, mirtazapine, etc. should be given for at least 12 months if it is imparting beneficial effects, followed by a gradual decrease over a period of 4 weeks before discontinuing.

The cornerstone of the management of PTSD is to recognize and seek help to be able to break out from the cage within.

Before you give up!

As with all stress, overwhelm or trauma, what is not recognized fully is that the tension is drawn into the body and stored in the muscle memory.  The adrenalin and cortisol have no release and so more and more the symptoms worsen.  Tension is drawn deep – and in fact from the day we are born, into the Psoas Muscle.  Most are not aware of it and not surprising.  It sits deep in the back body.  Holds us together but most importantly our fight/flight center.  It is where we hold our fears and emotions and can impact breathing.  Animals release after a traumatic event by tremoring.  Then they can carry on with their day.  We as humans have suppressed that natural response to stress release.  Getting back in touch with what we are meant to do brings profound healing as the body has the ability to heal itself.

Get in touch to find out more about the Total Release Experience ® .  For if you think you have tried everything you haven’t and what do you have to lose!

“Pain is inevitable. Suffering is optional.”

Haruki Murakami

References:

Ranna Parekh, M. M. (2017, January). PTSD- Posttraumatic stress disorder. Retrieved from American Psychiatric Association: https://www.psychiatry.org/patients-families/ptsd/what-is- ptsd

  • Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder; Board on the Health of Select Populations; Institute of Medicine. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. Washington (D.C.): National Academies Press (U.S.); 2014 Jun 17. 2, Diagnosis, Course, and Prevalence of PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224874/
  • Jitender Sareen, M. F. (2020, Jan 10). Posttraumatic stress disorder in adults. Retrieved from UpToDate:

https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology- pathophysiology-clinical-manifestations-course-assessment-and diagnosis?search=ptsd&source=search_result&selectedTitle=2~150&usage_type=default&displ ay_rank=2#H1