by: Hanis Sophia
Posttraumatic stress disorder (PTSD) is a
psychiatric disorder that may occur in people who have experienced or
witnessed a traumatic event such as a natural disaster, a serious
accident, a terrorist act, war/combat, or rape or who have been
threatened with death, sexual violence or serious injury.
PTSD has been known by many names in the past, such as “shell shock”
during the years of World War I and “combat fatigue” after World War II,
but PTSD does not just happen to combat veterans. PTSD can occur in all
people, of any ethnicity, nationality or culture, and at any age. PTSD
affects approximately 3.5 percent of U.S. adults every year, and an
estimated one in 11 people will be diagnosed with PTSD in their
lifetime. Women are twice as likely as men to have PTSD. Three ethnic
groups – U.S. Latinos, African Americans, and American Indians – are
disproportionately affected and have higher rates of PTSD than
non-Latino whites.
People with PTSD have intense, disturbing thoughts and feelings
related to their experience that last long after the traumatic event has
ended. They may relive the event through flashbacks or nightmares; they
may feel sadness, fear or anger; and they may feel detached or
estranged from other people. People with PTSD may avoid situations or
people that remind them of the traumatic event, and they may have strong
negative reactions to something as ordinary as a loud noise or an
accidental touch.
A diagnosis of PTSD requires exposure to an upsetting traumatic
event. However, the exposure could be indirect rather than first hand.
For example, PTSD could occur in an individual learning about the
violent death of a close family or friend. It can also occur as a result
of repeated exposure to horrible details of trauma such as police
officers exposed to details of child abuse cases.
Symptoms And Diagnosis
Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.
- Intrusion: Intrusive thoughts such as repeated,
involuntary memories; distressing dreams; or flashbacks of the traumatic
event. Flashbacks may be so vivid that people feel they are re-living
the traumatic experience or seeing it before their eyes.
- Avoidance: Avoiding reminders of the traumatic
event may include avoiding people, places, activities, objects and
situations that may trigger distressing memories. People may try to
avoid remembering or thinking about the traumatic event. They may resist
talking about what happened or how they feel about it.
- Alterations in cognition and mood: Inability to
remember important aspects of the traumatic evet, negative thoughts and
feelings leading to ongoing and distorted beliefs about oneself or
others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts
about the cause or consequences of the event leading to wrongly blaming
self or other; ongoing fear, horror, anger, guilt or shame; much less
interest in activities previously enjoyed; feeling detached or estranged
from others; or being unable to exprience positive emotions (a void of
happiness or satisfation).
- Alterations in arousal and reactivity: Arousal and
reactive symptoms may include being irritable and having angry
outbursts; behaving recklessly or in a self-destructive way; being
overly watchful of one's surroundings in a suspecting way; being easily
startled; or having problems concentrating or sleeping.
Many people who are exposed to a traumatic event experience symptoms
similar to those described above in the days following the event. For a
person to be diagnosed with PTSD, however, symptoms must last for more
than a month and must cause significant distress or problems n the
ndividual's daily functioning. Many individuals develop symptoms within
three months of the trauma, but symptoms may appear later and often
persist for months and sometimes years. PTSD often occurs with other
related conditions, such as depression, substance use, memory problems
and other physical and mental health problems.
Related Conditions
Acute Stress Disorder
Acute stress disorder occurs in reaction to a traumatic event, just
as PTSD does, and the symptoms are similar. However, the symptoms occur
between three days and one month after the event. People with acute
stress disorder may relive the trauma, have flashbacks or nightmares and
may feel numb or detached from themselves. These symptoms cause major
distress and problems in their daily lives. About half of people with
acute stress disorder go on to have PTSD.
An estimated 13 to 21 percent of survivors of car accidents develop
acute stress disorder and between 20 and 50 percent of survivors of
assault, rape or mass shootings develop it.
Psychotherapy, including cognitive behavior therapy can help control
symptoms and help prevent them from getting worse and developing into
PTSD. Medication, such as SSRI antidepressants can help ease the
symptoms.
Adjustment disorder
Adjustment disorder occurs in response to a stressful life event (or
events). The emotional or behavioral symptoms a person experiences in
response to the stressor are generally more severe or more intense than
what would be reasonably expected for the type of event that occurred.
Symptoms can include feeling tense, sad or hopeless; withdrawing from
other people; acting defiantly or showing impulsive behavior; or
physical manifestations like tremors, palpitations, and headaches. The
symptoms cause significant distress or problems functioning in important
areas of someone’s life, for example, at work, school or in social
interactions. Symptoms of adjustment disorders begin within three months
of a stressful event and last no longer than six months after the
stressor or its consequences have ended.
The stressor may be a single event (such as a romantic breakup), or
there may be more than one event with a cumulative effect. Stressors may
be recurring or continuous (such as an ongoing painful illness with
increasing disability). Stressors may affect a single individual, an
entire family, or a larger group or community (for example, in the case
of a natural disaster).
An estimated 5% to 20% of individuals in outpatient mental health
treatment have a principal diagnosis of adjustment disorder. A recent
study found that more than 15% of adults with cancer had adjustment
disorder. It is typically treated with psychotherapy.
Disinhibited social engagement disorder
Disinhibited social engagement disorder occurs in children who have
experienced severe social neglect or deprivation before the age of 2.
Similar to reactive attachment disorder, it can occur when children lack
the basic emotional needs for comfort, stimulation and affection, or
when repeated changes in caregivers (such as frequent foster care
changes) prevent them from forming stable attachments.
Disinhibited social engagement disorder involves a child engaging in
overly familiar or culturally inappropriate behavior with unfamiliar
adults. For example, the child may be willing to go off with an
unfamiliar adult with minimal or no hesitation. These behaviors cause
problems in the child’s ability to relate to adults and peers. Moving
the child to a normal caregiving environment improves the symptoms.
However, even after placement in a positive environment, some children
continue to have symptoms through adolescence. Developmental delays,
especially cognitive and language delays, may co-occur along with the
disorder.
The prevalence of disinhibited social engagement disorder is unknown,
but it is thought to be rare. Most severely neglected children do not
develop the disorder. Treatment involves the child and family working
with a therapist to strengthen their relationship.
Reactive attachment disorder
Reactive attachment disorder occurs in children who have experienced
severe social neglect or deprivation during their first years of life.
It can occur when children lack the basic emotional needs for comfort,
stimulation and affection, or when repeated changes in caregivers (such
as frequent foster care changes) prevent them from forming stable
attachments.
Children with reactive attachment disorder are emotionally withdrawn
from their adult caregivers. They rarely turn to caregivers for comfort,
support or protection or do not respond to comforting when they are
distressed. During routine interactions with caregivers, they show
little positive emotion and may show unexplained fear or sadness. The
problems appear before age 5. Developmental delays, especially cognitive
and language delays, often occur along with the disorder.
Reactive attachment disorder is uncommon, even in severely neglected
children. Treatment involves the child and family working with a
therapist to strengthen their relationship.
References
- Bichitra Nanda Patra and Siddharth Sarkar. Adjustment Disorder:
Current Diagnostic Status. Indian J Psychol Med. 2013 Jan-Mar; 35(1):
4–9.
- National Library of Medicine: MedlinePlus. Adjustment Disorder.
- American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. (DSM-5)
- American Academy of Child and Adolescent Psychiatry. Facts for Families: Attachment Disorders.
