Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is a condition that sometimes develops in the aftermath of a specific stressful, traumatic event. The disorder exceeds 1 month and involves re-occurring memories of the trauma. Other symptoms includes are emotional withdrawal, intrusive memories, emotional numbing, and increased physiological arousal. Examples of traumas include (but are not limited to) abductions, rapes, incest, and combat experiences. PTSD was first "discovered" and classified due to symptoms presented by Vietnam veterans. Similar patterns of symptoms were in the past called "shell shock". People with this disorder often become emotionally numb and try to avoid anything that will trigger unwanted memories. People with posttraumatic stress disorder often have difficulty sleeping, aggressive behavior, and anxiety attacks. The theoretical approaches used in this disorder are psycho education, cognitive-behavioral, and psychodynamic. Symptoms of PTSD may be chronic (lasting many years resulting from unresolved childhood trauma) or may be much shorter in duration. Rapid treatment after a traumatic incident has been shown to prevent the more chronic symptoms. Some believe that Borderline Personality Disorder is related to early childhood trauma. PTSD in childhood may result in character logical defenses that become engrained in the adult personality. Further, individuals with a history early trauma or disrupted attachment relationships may be more vulnerable to develop the maladaptive patterns of behavior associated with PTSD later in life. 

With PTSD, you will need to conduct an assessment and establish a working relationship with the patient. You also should reduce isolation and provide some measure of immediate symptom relief. This can often be done by education and supportive empathic listening. A thorough clinical history as well as a psychosocial will be needed. Family dynamics and emotional functioning are also very important to assess. A referral may be needed for a physician to see if there is a general medical condition (you will need to get a release). If your patient is in crisis then crisis intervention will be necessary. Finally, you will need to make an agreement with the patient in reference to treatment goals and refer to support groups as well as community resources.

Generally, exposure has been found to be the most effective treatment for PTSD. Exposure is repeated discussions of the traumatic situation. Validation of the individual's trauma and the damage done is crucial. Often, reappraisal of the traumatic situation will be useful. For patients that were traumatized as children, looking at the situation through adult eyes and using the "inner adult" to protect the child is helpful. For a patient that was sexually abused as a child, reenacting the incident with more adaptive responses can empower them and shift the patient to a new perspective. (One example would be to have the patient imagine that he or she had a baseball bat with them at the time of the abuse. The clinician can explore possible responses in this scenario.) However, incest victims often blame themselves for the abuse. The clinician should be cautious to not add to the belief that the patient should have done something different to prevent the abuse. EMDR is a new therapy that has promise in treating PTSD. However, it is too early to tell how effective it really is. Stress reduction techniques have been found to be very effective in-patients with this disorder. Since the patient has learned to avoid recollecting the traumatic events, caution should be used in proceeding with treatment. Symptoms may exacerbate as the patient explores the events. (Linton, 2008)