Traumatology – Posttraumatic Stress Disorder Paper

Traumatology – Posttraumatic Stress Disorder Paper

(PTSD)

Trauma has an impact on the physical as well as emotional or mental health of its victims. Posttraumatic stress disorder is a psychiatric disorder that follows traumatic events such as violence, war, actual death, threatened death, and injury. The exact definition is still controversial as the ICD-10 and the DSM-V view the psychological manifestations slightly differently. Witnessing a traumatic event or experiencing a traumatic event can risk the development of PTSD. Trauma can provoke helplessness and fear in individuals many months or years after a life-threatening or horrifying event. The diagnosis of PTSD is clinical and more often does not require laboratory workups. This presentation paper describes PTSD in various dimensions including epidemiology, presentation, morbidity, diagnosis, treatment, and spiritual aspects of this condition.

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Epidemiology of PTSD

Posttraumatic stress disorder is common in females than males and occurs in about 5% to 10 % of the population after trauma (Mann & Marwaha, 2021). It is also common in those with preexisting mental illnesses, individuals with traumatic childhood experiences, and individuals with certain neurobiological derangements. Other risks factors include low socioeconomic status and education. According to the Centers for Disease Control and Prevention, the prevalence of PTSD in the general population was 36.8% among public health workers during the COVID-19 period (Bryant-Genevier et al., 2021). This was related to workload-related stress, workplace incivility, and being diagnosed with COVID-19. In the post-traumatic period, the risk factors for developing trauma include the development of acute stress disorder, inadequate or absent social support, and other problems such as financial problems. Interpersonal violence, the severity of the trauma, and the nature of the trauma also play important roles in placing the victims at risk of developing PTSD (Lewis et al., 2019 Traumatology – Posttraumatic Stress Disorder Paper). Therefore, the epidemiology of this condition varies in different parts of the world due to the heterogeneous nature of trauma and its unequal distribution.

Victims of PTSD

Post-traumatic stress disorder can affect any age group. However, the presentation might vary with age. The baseline factor remains the presence of identifiable exposure to trauma through witnessing or experiencing traumatic events. Children with PTSD manifest symptoms in their play, while teenagers and adolescents may show it in their impulsivity (U.S. Department of Veterans Affairs, 2020 Traumatology – Posttraumatic Stress Disorder Paper). Most of the time, teenagers and adults show the same symptomatic characteristics. Children younger than six years may show regressive symptoms with anxiety presentation. Fear of separation from their parents or the urge to repeat episodes of trauma may signify the reaction to reencounter with the trauma

Harm or Danger Involved in PTSD

Severe PTSD carries significant morbidity and mortality when left untreated. Mild PTSD, on the other hand, may resolve on its own after a few months (Kessler et al., 2017). Various risks of harm are associated with posttraumatic stress disorder. Whether in adults or children the harm may arise from the presentation and may include harm to self. Hyperarousal of the brain in chronic untreated PTSD has various consequences on the individual’s behavior and thinking. As aforementioned, PTSD in teenagers is associated with impulsivity (Mann & Marwaha, 2021). This impulsivity can lead to substance use, aggression, and violence. Sometimes, self-destructive behaviors or suicidal ideations intentions, and actions can be witnessed.

In children, reencounter or thought of reencounter with the same traumatic agents can cause counter-protective behavior whereby they may attempt to redo the traumatic experiences to attempt to prevent the recurrence. This is different from an adult who may exhibit outbursts and anxiety. Hypervigilance and paranoia may also place the individual at risk of harm to themselves or other people. Chronic hyperarousal states can lead to permanent brain damage that has intellectual, behavioral, and cognitive consequences.

Symptoms of PTSD

Symptoms of PTSD include four major groups of common presentation. Intrusive thoughts, hyperarousal or hyperactivity, avoidance of triggers, and cognitive and mood negative alterations are the major symptoms of PTSD. Intrusive thoughts are involuntary, recurrent, and are associated with the memory of the traumatic event. Intrusion in children leads to repetition to replay the event to make the symptoms recede. However, the symptoms do not go away and the vicious cycle continues (Gore & Bienenfeld, 2018). Intrusion symptoms also include nightmares and dissociations leading to psychological and emotional reactions to the triggers.

Avoidance symptoms are also present in PTSD. In PTSD, avoidance is triggered by the trauma reminders through memory or occurrence of the traumatic event or similar events.  In response, individuals will try or show attempts to avoid the people, places, or items that trigger reminders about the trauma. Other items that might act as trauma reminders such as conversions and activities are also avoided because they trigger memories about the trauma (Mann & Marwaha, 2021). The individuals may even avoid thinking about these triggers so that they may escape the outcomes related to the trauma.

Negative alterations in mood and cognition make the patients perceive the word differently. The partial loss of memory about the event should not be attributed to alcoholism or head injury. These individuals view the world or themselves as bad and undeserving. This negative emotional state is always persistent and is characterized by guilt, sadness, and sometimes horror. The victims may blame themselves for the trauma and develop persistent negative beliefs or expectations about themselves. The guilts, despair, and mood alterations may cause the victims to detach themselves from other people and lose interest in participating in social activities.

The fourth major presentation in PTSD is hyperarousal or hyperactivity. As aforementioned, this presentation places these individuals at the greatest risk of harm or danger. Hyperarousal causes lack of sleep and nightmares (American Psychiatric Association, 2013). These individuals have difficulties initiating sleep or staying asleep due to hyperarousal. They are also hypervigilant and get anger outbursts or aggression at the least provocation. The alterations in reactivity can also present with self-destructive behavior, recklessness, or poor concentration. The symptoms of hyperarousal usually begin or are worsened after the trauma

Diagnosis and Assessment of PTSD

The diagnosis of PTSD involves history taking and mental state examination. Physical examination may be required to rule out other organic causes of similar presentation. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the criteria for the diagnosis of PTSD in all age groups (American Psychiatric Association, 2013). DSM-5 outlines eight criteria to diagnose PTSD: at least two intrusion symptoms; at least two symptoms of hyperarousal and hyperreactivity; evidence of avoidance; and two symptoms of alteration in mood and cognition. These symptoms should have lasted for more than one month. The patient should have been exposed to threatened death, severe injury, or witnessed death. There should be no physiological attributable etiologies to these symptoms. Finally, the symptoms should have caused significant impairment in any dimensions of functioning.

PTSD can coexist with other psychiatric diagnoses. The above criteria recognize the coexistence with dissociation thus the diagnosis must specify if dissociation is present or not (American Psychiatric Association, 2013). Screening for PTSD by healthcare providers involves using various tools some of which include Trauma Symptom Checklist – 40 (TSC-40) and PTSD Checklist for DSM-5 (PCL-5). Routine laboratory workups may be required to rule out medical reasons for the presentations. Thyroid function tests, full blood count, vitamin B12 assays, and urine tests are some of the possible tests. Disorders that may present similarly with PTSD include acute stress disorder, depressive disorders, other anxiety disorders, and adjustment disorders. Therefore careful, evaluation and assessment of the mental state are required to corroborate with the thorough history taking.

Treatment of PTSD

The management of PTSD can involve pharmacotherapy and non-pharmacotherapeutic strategies. The first line of pharmacotherapy management includes selective serotonin and selective norepinephrine reuptake inhibitors. Symptomatic management may require the use of specific medications such as clonidine for nightmares and trazodone for insomnia. Among adults, the Food and Drug Administration (FDA) approves the use of sertraline and paroxetine. As earlier mentioned in the presentation of PTSD, there are alterations in thinking and behavior. Two main psychotherapies, trauma-focused Cognitive Behavioral Therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR), have then been widely used (Bryant, 2019). Other psychotherapies have included imaginal exposure and cognitive processing therapy.

Spirituality and Biblical Integration

Spirituality plays an important role in recovery from sequelae of trauma in adaptive and maladaptive ways. The spiritual context of the trauma and association of the symptoms plays a part in the coping and treatment outcomes. Religion serves a resourceful role in the empowerment of patients and health-seeking behavior. Therefore, religion and spirituality can complicate or impede care in the setting of PTSD (Koenig et al., 2020). Association of the presentations with spiritual etiologies of religious teaching serves as a potential source of treatment success or failure (Starnino et al., 2019 Traumatology – Posttraumatic Stress Disorder Paper). Religious practices such as Sufism among Muslims have been implicated in the success of religious treatments of trauma-related mental health complications.

Biblical contexts provide the Christian believers with hope and spiritual contentment during traumatic events and aftermath. Biblical teachings have helped individuals with symptoms of PTSD cope well with their symptoms such as nightmares, fears, and intrusive thoughts. Understanding that the recovery from their symptoms might take time is influenced by teaching from the bible. A relatable biblical integration is Paul’s ‘thorn in the flesh’ analogical to the suffering experienced by the victims of PTSD (Got Questions, 2021 Traumatology – Posttraumatic Stress Disorder Paper). Paul’s second letter to the Corinthians comforted them and urged them to seek comfort from God. He further explained to them that the suffering abounds them to the suffering that Jesus had experienced to save everyone.

Conclusion

Posttraumatic stress disorder is entirely a mental health illness but has presentations similar in some aspects to other mental disorders such as acute stress disorders, mood disorders, and traumatic brain injury. DSM-5 provides a set of criteria to be used in the diagnosis of PTSD and delineates it from other mental presentations. Major groups of presentations include intrusion symptoms; avoidance of the triggers; hyperarousal, hypervigilance, or hyperreactivity; and negative alterations in mood. Diagnosis of PTSD requires symptom duration of at least one month and absence of medical etiologies for the presentations. Hyperarousal has been associated with the risk of harm to the victims. Management involves psychotherapy and medications. However, spirituality offers new dimensions to the outcome of management.

References for Traumatology – Posttraumatic Stress Disorder Paper

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