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Post Traumatic Stress Disorder

dr. Rohmania Setiarini

Definition
Posttraumatic stress disorder (PTSD) is a condition marked by the development of symptoms after exposure to traumatic life events

Epidemiology
According to the 2005 National Comorbidity Survey-Replication study, PTSD affects about 7.7 million American adults in a given year, though the disorder can develop at any age, including childhood

8% of men and 20% of women go on to develop PTSD 30% of these individuals develop a chronic form that persists throughout their lifetimes.

What Causes PTSD


The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

clinical features
principal clinical features of PTSD are painful reexperiencing of the event a pattern of avoidance and emotional numbing fairly constant hyperarousal

Symptoms of PTSD
intrusions, such as flashbacks or nightmares, avoidance, where the person tries to reduce exposure to people or things that might bring on their intrusive symptoms, hyperarousal,

Symptoms
Recurring nightmares about the event, including possibly intrusive memory flashbacks. Difficulty sleeping or changes in appetite. Feelings of anxiety and fear, especially when exposed to events or situations reminiscent of the trauma.

Symptoms
Edginess, exaggerated startle reflex, or becoming overly alert. Depression, sadness, and lack of energy. Spontaneous crying. Sense of despair and hopelessness. Memory problems, including difficulty in remembering aspects of the trauma.

Predisposing Vulnerability Factors in Posttraumatic Stress Disorder


Presence of childhood trauma Borderline, paranoid, dependent, or antisocial personality disorder traits Inadequate family or peer support system Being female Genetic vulnerability to psychiatric illness Recent stressful life changes Perception of an external locus of control (natural cause) rather than an internal one (human cause) Recent excessive alcohol intake

DSM-IV-TR Diagnostic Criteria for Posttraumatic Stress Disorder


A. The person has been exposed to a traumatic event in which both of the following were present: the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

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B. The traumatic event is persistently reexperienced in one (or more) of the following ways: recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children,
repetitive play may occur in which themes or aspects of the trauma are expressed.

recurrent distressing dreams of the event. Note: In children, there may


be frightening dreams without recognizable content.

acting or feeling as if the traumatic event were recurring. Note: In


young children, trauma-specific reenactment may occur.

intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

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C. Persistent

avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: efforts to avoid thoughts, feelings, or conversations associated with the trauma efforts to avoid activities, places, or people that arouse recollections of the trauma inability to recall an important aspect of the trauma markedly diminished interest or participation in significant activities feeling of detachment or estrangement from others restricted range of affect (e.g., unable to have loving feelings) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

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D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: difficulty falling or staying asleep irritability or outbursts of anger difficulty concentrating hypervigilance exaggerated startle response E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What Happens to Your Body with PTSD


altered brainwave activity, decreased volume of the hippocampus, abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response.

Hormone Changes
Thyroid function also seems to be enhanced in people with PTSD. Some studies have shown that cortisol levels in those with PTSD are lower than normal Epinephrine and norepinephrine levels are higher than normal.

Other Psychiatric Problems along with PTSD


PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. In a large-scale study, 88 % of men and 79 % of women with PTSD met criteria for another psychiatric disorder. The co-occurring disorders most prevalent for men with PTSD were alcohol abuse or dependence (51.9 percent), major depressive episodes (47.9 percent), conduct disorders (43.3 percent), and drug abuse and dependence (34.5 percent). The disorders most frequently comorbid with PTSD among women were major depressive disorders (48.5 percent), simple phobias (29 percent), social phobias (28.4 percent), and alcohol abuse/dependence (27.9 percent).

Treatment
Pharmacotherapy
SSRIs are considered first-line treatments for PTSD

Psychotherapy
behavior therapy cognitive therapy hypnosis

two major psychotherapeutic approaches


exposure therapy, in which the patient reexperiences the traumatic event through imaging techniques or in vivo exposure. The exposures can be intense, as in implosive therapy, or graded, as in systematic desensitization. teach the patient methods of stress management, including relaxation techniques and cognitive approaches to coping with stress

eye movement desensitization and reprocessing (EMDR), in which the patient focuses on the lateral movement of the clinician's finger while maintaining a mental image of the trauma experience. The general belief is that symptoms can be relieved as patients work through the traumatic event while in a state of deep relaxation

group therapy and family therapy

Course and Prognosis


Untreated, about 30 percent of patients recover completely, 40 percent continue to have mild symptoms, 20 percent continue to have moderate symptoms, and 10 percent remain unchanged or become worse. After 1 year, about 50 percent of patients will recover.

A good prognosis is predicted rapid onset of the symptoms short duration of the symptoms (less than 6 months) good premorbid functioning strong social supports the absence of other psychiatric, medical, or substance-related disorders or other risk factors

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