Post-traumatic stress disorder

It occurs because of reactivation of traumatic events that were experienced earlier in life. Christenson et al. shows how a recent event may “trigger” past traumas and result in serious adjustment problems:
“Mr.A. a 55-year-old divorced man, was admitted with severe anxiety; multiple somatic complaints; feelings of hopelessness; somatovegetative signs of depression; and suicidal ideations. He had required psychiatric hospitalization for “nerves” shortly after his discharge from the service at the end of World War II. He subsequently had a good adjustment and a stable marriage and work history. Three years before this admission Mr. A. Abruptly left his job as an emergency room technician and began drinking heavily. Eventually his wife left him, and the actual signing of divorce papers precipitated the symptoms that led to his admission.

It was only after another patient on the ward began talking of his difficulties during World War II that Mr. A. revealed the following history. He had been stationed in the South Pacific and had survived  two battles in which his ship had been destroyed and many people around him violently killed. Shortly after these events his unit was instructed that island children were being wired as human bombs, and an order was issued to shoot all children approaching the camp. When Mr. A. was on duty, he had been forced to shoot a 10-year-old boy. After this incident Mr.A. began having nightmares of exploding shells, violent scenes of people being killed, and scenes of himself killing the boy. These cleared over a period of a few years. Mr. A.’s recent deterioration (3 years ago) came after an episode at work in the emergency room where he was told to clean up a child in one of the rooms. He was unaware that the child (a 9-year-old boy) was already dead when he was brought to the emergency room. When Mr. A. discovered that the boy was dead, he was horrified, left work, and never returned. His nightmares resumed, but he felt unable to discuss these war episodes with his wife. At times, he would wake up screaming and throw his wife to the floor to “cover” her from exploding shells. It was this unexplained behaviour that forced their separation.

During his hospital stay Mr.A. was able to talk about these war episodes for the first time in 35 years. He actively participated in a small therapy group of World War II veterans that focused on the veterans ventilating their feelings about traumatic war experiences. Mr.A. was also treated with 150mg. h.s. of doxepin.

Gradually Mr.A.’s depression cleared and he claimed he was less anxious than any time since the war. He was sleeping through the night without nightmares. Mr.A. made appropriate arrangements to resume his most recent job and had a optimistic view of the future. He identified the opportunity to openly discuss his war experiences as the most important factor in his recovery.”

Acute posttraumatic stress. Trauma typically involves the shock stage, the suggestible stage, and the recovery stage. Acute posttraumatic stress disorder may develop in third stage. The stages are stated below:

1.Shock stage, the individual is stunned, dazed, and apathetic. In extreme cases, the individual may be stuporous, disoriented, and amnesic for the traumatic event.

2.Suggestible stage, in this stage the individual tends to be passive, suggestible, and willing to take directions from others. One expresses extreme concern for others too.

3.Recovery stage, the individual may be tense and apprehensive and shows generalized anxiety, but gradually regains psychological equilibrium. One may repetitively tell about the catastrophic event.

In some instances, the clinical picture may be complicated by intense feelings of grief and depression. It is further complicated by strong feelings of guilt developed because of personal inadequacy contributed to the loss of loved ones.

Chronic or delayed posttraumatic stress. In the event of terrifying  experiences a reaction pattern may persist for weeks, months, or even years. The posttraumatic stress reaction would be diagnosed as chronic if it continues for longer than six months; if it does not begin until six months after the traumatic event, it would be diagnosed as delayed. It includes the following symptoms: (a) anxiety-mild apprehension to episodes of acute anxiety associated with the traumatic experience; (b) chronic tension and irritability-accompanied fatigability , insomnia, and the inability to tolerate noise, and restlessness; (c) repetitive nightmares; (d) complaints of impaired concentration and memory; and (e) feelings of depression. In some instances, the  individual may withdraw from social contact, excitation, and needs “peace and quiet at any price.”

Causal factors in trauma reactions. The secure and safe world suddenly becomes a terrifying place. Psychological decompensation associated with the traumatic event paves the way for symptoms of being stunned, dazed, and “numbed” in part and these also appear in part to be defense mechanisms protecting the individuals. The inability to deal with the situation alone gives rise to the stage of suggestibility. It may be a regression to a passive-dependent position. Narration repeatedly and nightmares appear to be mechanisms for reducing anxiety and desensitizing the individual to the traumatic experience in recovery stage. Residual effects of the shock reaction may cause tension, apprehensiveness, and hypersensitivity, besides, reflection of a terrifying world. Precipitating and predisposing factors determine who develops traumatic reactions and who does not, and why some recover much more rapidly than others. Personal and external resources influence the severity of the traumatic reaction. In all cases of postraumatic stress conditioned fear appears to be a key causal factor.

As Horowitz has concluded from his own experimental findings and an early review of available literature,”A traumatic perceptual experience remains in some special form of memory storage until it is mastered. Before mastery, vivid sensory images of the experiences tend to intrude into consciousness and may evoke unpleasant emotions. Through such repetitions the images, ideas, and associated affects may be worked through progressively. Thereafter, the images lose their intensity and the tendency toward repetition of the experience loses its motive force.”

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