What is PTSD? (TEP)

He Posttraumatic stress disorder (PET) is characterized by an emotional disorder following a traumatic event or trauma.

This event can be of several types:

• Deaths of loved ones.
• Natural disasters.
• Accidents of cars.
• Physical aggressions.
• Wars.
• Be threatened with guns.

Many other traumatic events can also lead to PTS, such as robberies, robberies, plane crashes, torture, kidnappings, terrorist attacks and other extreme or life-threatening events.

In order to develop this disorder, exposure to a traumatic event during which fear, pain, or helplessness is experienced.

Subsequently, the victim again experiences that event through nightmares or memories and avoids any situation or thing that reminds him of the traumatic event.

As a consequence of the trauma, the victim may be unable to remember some aspects of the event or unconsciously avoid experiencing the emotion.

As a consequence of the trauma, the victim can easily become frightened, chronic over-activated, easily angered, or chronically overacted.

Traumatic events that lead to PTSD are usually so strong and feared that they would provoke emotional reactions in anyone.

When the sense of security is destroyed, it is normal to feel disconnected or paralyzed, it is common to have nightmares, fear or not be able to stop thinking about what happened.

However, for most people, these symptoms are short-term. They can last several days or weeks, but gradually decrease.

In PTE, these symptoms do not subside and the victim does not begin to feel better; In fact, it begins to feel worse.

Children are less likely to develop PTSD than adults, especially if they are under 10 years of age.

Symptoms of posttraumatic stress disorder

Symptoms of PTS may begin three weeks after the traumatic event, although they sometimes appear after several years.

Generally, the symptoms are grouped into four types (detailed in the section"diagnosis"):

• Intrusive memories.
• Avoidance.
• Negative changes in thinking and mood.
• Changes in emotional reactions.

The symptoms of PE vary in intensity over time. You can have more when the stress level is high or when there are reminders of the trauma.

Causes

The etiology of PE is clear: a person experiences trauma and develops the disorder.

However, a person's development depends on biological, psychological and social factors.

Intensity of trauma

In general, the more intense the trauma, the more likely there is to develop TEP.

A 1984 survey found that in Vietnam veterans, 67% developed TEP.

Biological factors

There is a greater chance of developing PE if there is a history of anxiety disorders in the victim's family. In fact, research has found that panic disorder and generalized anxiety Share 60% of the genetic variance with PTE.

There is evidence that susceptibility to PTE is inheritable. Approximately 30% of the variance is due to genetic factors.

There is also evidence that people with a smaller hippocampus are more likely to develop PE after a traumatic event.

Psychological Factors

When the intensity of the event is high, PET is much more likely to develop and there is no relationship to psychological factors.

However, when the intensity of the event is medium or low, factors such as family instability may increase the chances of developing it.

On the other hand, being prepared for events or having experience act as protective factors.

Social and cultural factors

People with strong social support are less likely to develop PTE after trauma.

Diagnosis

Diagnostic criteria according to DSM-IV

A) The person has been exposed to a traumatic event in which there have been 1 and 2:

The person has experienced, witnessed or explained one (or more) event (s) characterized by deaths or threats to his or her physical integrity or that of others.

The person has responded with a fear, a despair or an intense horror. Note: In children these responses can be expressed in unstructured or agitated behavior.

B) The traumatic event is persistently reexperienced through one (or more) of the following forms:

1. Recurring and intrusive memories of the event that cause discomfort and which include images, thoughts or perceptions. Note: in young children this can be expressed in repetitive games where themes or characteristic aspects of the trauma appear.
2. Recurring dreams about the event, which cause discomfort. Note: in children there may be terrifying dreams of unrecognizable content.
3. The individual acts as if, or has the feeling that, the traumatic event is occurring. It includes the feeling of being reliving the experience, illusions, hallucinations and dissociative episodes of flashback, even those that appear when waking up or intoxicated. Note: Young children can re-enact the specific traumatic event.
4. Severe psychological distress when exposed to intense or external stimuli that symbolize or remember an aspect of the traumatic event.
5. Physiological reactivity when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event.

C) Persistent avoidance of stimuli associated with trauma and blunting of the individual's general reactivity (absent before trauma), as indicated by three (or more) of the following symptoms:

1. Efforts to avoid thoughts, feelings or conversations about the traumatic event.
2. Efforts to avoid activities, places or people that motivate memories of the trauma.
3. Inability to remember an important aspect of trauma.
4. Sharp reduction of interest or participation in significant activities.
5. Feeling of detachment or estrangement from others.
6. Restriction of affective life.
7. Feeling of a bleak future.

D) Persistent symptoms of increased activation (absent before trauma), as indicated by two (or more) of the following symptoms:

1. Difficulties to reconcile or maintain sleep.
2. Irritability or fits.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle responses.

E) These alterations (symptoms of criteria B, C and D) are longer than one month.

F) These alterations cause significant clinical malaise or social, labor or other important areas of the individual's activity.

Specify if:

Acute: Symptoms last more than 3 months.

Chronic: Symptoms last 3 months or longer.

Specify if:

Moderate onset: between the traumatic event and the onset of symptoms at least 6 months have passed.

ICD-10 Diagnosis (World Health Organization)

The diagnostic criteria for PTS, stipulated by the World Health Organization are summarized as follows:

• Exposure to an event or situation (of short or long duration) of exceptional threat or catastrophic nature, which is likely to cause widespread malaise in almost all the world.
• Persistent recall or reliving the circumstances associated with the stressor (not present prior to exposure).
• Avoidance of circumstances that are similar to or associated with the stressor (not present prior to exposure).

1. Inability to remember, partially or completely, some of the important aspects of the period of exposure to the stressor.
2. Persistent symptoms of increased psychological sensitivity and arousal shown by two of the following:

• Difficulty sleeping or maintaining sleep.
• Irritability or fits.
• Difficult to focus.
• Hypervigilance.
• Exaggerated startle response.

Risk factor's

People considered at risk may include:

• Have a job that increases the risk of exposure to traumatic events: military personnel, emergency medical care.
• Victims of natural disasters.
• Having suffered abuse in childhood.
• Concentration camp survivors.
• Having other disorders such as anxiety disorders .
• Have little social support.
• Victims of violent crimes.
• Witness any of the above events.
• It can be developed by children or adults who Have suffered bullying .

Treatment

From the psychological point of view, it is important for the victim to cope with the trauma, to develop coping strategies that work and to overcome the effects of the disorder.

Cognitive-behavioral therapy

The Cognitive-behavioral therapy Seeks to change the way the victim perceives the trauma and works by changing the thought patterns and behavior responsible for negative emotions.

One goal of this treatment is for the victim to learn to identify the thoughts that make him feel scared or upset and replace them with non-threatening thoughts.

One of the most commonly used techniques is exposure, which requires the victim to re-experience the traumatic event to facilitate the habituation and emotional processing of the trauma.

This technique includes both confrontation in imagination and exposure in real life to stimuli that remind the event.

Re-exposure to trauma is best if done gradually. Although experiencing the memories again can provoke fear, it is therapeutic is done properly.

Desensitization and reprocessing by eye movements

Desensitization and reprocessing by eye movements is a form of psychotherapy developed and studied by Francine Shapiro. She discovered that when she was thinking about traumatic memories, her eyes moved rapidly. When he controlled eye movements, his thoughts were less stressful.

This technique is supported by the theory that eye movements can be used to facilitate the emotional processing of memories.

The therapist initiates rapid eye movements while the person focuses on memories, feelings or thoughts about a particular trauma.

Although beneficial effects of this therapy have been shown, more research is needed to clarify its effects.

The authors of a 2013 meta-analysis confirmed: We found that people treated with ocular movement therapy had a greater improvement in their PTE symptoms than those treated without ocular movement therapy. Second, we found that in laboratory studies the evidence concluded that thinking of unpleasant memories and simultaneously doing a task that facilitates eye movement, reduced the discomfort associated with unpleasant memories."

Medication

The Fluoxetine or Paroxetine May decrease symptoms in small amount. Most medications do not have enough evidence to support their use. With many drugs, residual symptoms following treatment are the rule rather than the exception.

Side effects in drugs such as paroxetine are headache, nausea, lack of sleep, and sexual problems.

• The first line of treatment with drugs are SSRIs (selective serotonin reuptake inhibitors): citalopram, Escitalopram , Fluoxetine, fluvoxamine, paroxetine.
• Benzodiazepines : Are not recommended to treat PE due to lack of evidence.
• Glucocorticoids: could be used in the short term to protect neurodegeneration caused by stress, but may promote long-term neurodegeneration.

Others

Physical activity can have an impact on the psychological and physical well-being of people. It is advisable to practice 3-5 times a week, at least 30 minutes a day to distract from disturbing emotions, Improve self-esteem And increase the feeling of control.

In the case of war veterans, programs that assist in the creation of social support, readjustment to civilian life and improve communication skills, especially with family members, are recommended.

Treatment in disasters

Sometimes a large number of people are affected by the same traumatic event, as in natural catastrophes, wars or terrorist attacks.

Most people have some PTS symptoms in the first few weeks after the event, which is a normal response to trauma, and for most people the symptoms decrease over time.

The basic support is:

• Go to a safe place.
• See a doctor in case of injury.
• Get food and water.
• Contact family.
• Know what has happened and what is the procedure of help.

However, sometimes people who have experienced a major traumatic event do not recover on their own.

In that case, brief cognitive-coding therapies may be used in the first few weeks.

Epidemiology

In a WHO study (21.8 per cent) or had suffered interpersonal violence (18.8 per cent), accidents (17.7 per cent), exposure To warlike conflicts (16.2%) or traumatic events related to loved ones (12.5%).

It is estimated in the study that 3.6% of the world population has suffered a post-traumatic stress disorder (PTSD) in the last year.

Complications

Post-traumatic stress disorder can have negative consequences in several areas of life: work, relationships, health and quality of life in general.

Having PTE can increase the risk of developing other mental disorders such as:

• Depression and anxiety.
• Drug and alcohol abuse.
• Eating Disorders.
• Suicidal thoughts and actions.

When to visit a professional

It is advisable to visit a professional psychologist or psychiatrist if you have thoughts or feelings about the traumatic event for more than a month, if the symptoms are severe and if you have problems leading a normal life.

References

1. "International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2007". World Health Organization (UN). 2007. Retrieved October 3, 2011.
2. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Pp. 271-280. ISBN 978-0-89042-555-8.
3. Zoladz, Phillip (June 2013). "Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature". Neuroscience and Biobehavioral Reviews 37 (5): 860-895. Doi: 10.1016 / j.neubiorev.2013.03.024.
4. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. ISBN 0-89042-061-0. [Page needed]; on-line.
5. Breslau N, Kessler RC (2001). "The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation". Biol. Psychiatry 50 (9): 699-704. Doi: 101016 / S0006-3223 (01) 01167-2. PMID 11704077.
6. Mayo Clinic staff. "Post-traumatic stress disorder (PTSD)." Mayo Foundation for Medical Education and Research. Retrieved 12-12-2011.
7. "The ICD-10 Classification of Mental and Behavioral Disorders"(PDF). World Health Organization. Pp. 120-121. Retrieved 2014-01-29.
8. "Mortality and Burden of Disease Estimates for WHO Member States in 2004". World Health Organization.
9. Image source.