Monday, June 17, 2013

POST TRAUMATIC STRESS DISORDER

1.0 Introduction Post Traumatic Stress Disorder is one of the disorders affecting human beings that have been clouded with great controversy particular in regard to its diagnosis. According to Saigh (1989, p. 75) a great number of researches and investigative studies have been carried out in order to determine the historical, social and political factors that influence the literature and knowledge affecting the acceptance of the difference factors believe to bring about post traumatic stress disorder. According to the American Psychiatric Association (1994) even more investigative studies are currently being carried out foe purposes of determining the impact that present day discoveries on the issue as a consequence of research on the initial knowledge that was formulated on Post Traumatic Stress Disorder. In recent days, particularly the last three decades there have been an increased clinical and scientific interest in Post Traumatic Stress Disorder after it was discovered that people experiencing traumatic experiences such as armed warfare or rape go through a number of complicated issue (David and Foa, 1993). This paper aims at describing Post Traumatic Stress disorder, current literature regarding the disorder and the manner in which current literature challenges the original or initial conceptualizations of the disorder. 2.0 Post Traumatic Stress Disorder (PTSD) American Academy of Child and Adolescent Psychiatry (AACAP) (1998) points out that Post Traumatic Stress Disorder refers to a continuous and incapacitating psychological condition that affects humans, and is brought about by witnessing or being involved in life occurrences of events that are very emotionally or psychologically disturbing. Bernat et al (1998, p. 646) purport that some of the symptoms that characterize Post Traumatic Stress Disorder include hyper arousal, disturbing flashbacks of the traumatizing ordeals and emotional numbing. Post Traumatic Stress Disorder is also defined as the development of a set of identified symptoms in a person that has witnessed or experienced serious injury, near death incidents or serious bodily harm. As indicated by Carlson (1997) unless the individuals that are engaged in such traumatizing life occurrences receive the necessary therapy and treatment Post Traumatic Stress Disorder may last for years and affect the different aspects of life that the affected individual engages in for instance social, occupational, emotional and physiological domains. 3.0 Early Literature on Post Traumatic Stress Disorder Foa and Rothbaum (1998) purport that stress reactions associated to witnessing or being involved in mentally or psychologically disturbing occurrences have been known to exist for as long as the human race has. The earliest literature on Post Traumatic Stress Disorder are to be found in the most conventional Greek literature particularly that regarding scientific medicine. From as early as 6AD it was a well known fact that there are a number of external factors that act as stressors and cause distress in the persons that they affect. Historically Post Traumatic Stress Disorder is commonly associated with warfare and other forms of armed confrontations (American Academy of Child and Adolescent Psychiatry (AACAP), 1998). The Post Traumatic Stress Disorder condition affecting humans was recognized and described in the modern times by the American Psychiatric Association Diagnostic and Statistical Manual in the year 1980. According to Ford et al (1996) there are a number of credible thinkers that have contributed significantly to the discussion regarding Post Traumatic Stress Disorder. One such thinker is Shell Shock. Shell Shock was given recognition in the year 1916 by the war Office which after he researched on a number of occurrences that affected soldier. An estimated 3007 soldiers have been killed for allegedly being “cowards”. 80% of the war veterans studied never took up active duties after war. By the year 1918 15,000 war veterans were till institutionalized. According to Foa et al (p. 155) the first investigative studies regarding Post Traumatic Stress Disorder were carried out in order to determine the mental and behavioral descriptions of the manner in which the Post Traumatic Stress Disorder condition is acquired and managed. In order to determine this, the Two-Stage theory by Mowrer was utilized in the study of rape victims and soldiers who were veterans in the Vietnam War. These investigative studies concluded that the conventional S-R models are a very effective in the description of the phenomena of fear and avoidance by persons that have witnessed or been part of traumatic experiences (Foa et al, 1989, p. 155). The theories were also discovered to be very effective in the description of simple phobias; in spite of this, the remaining symptoms associated with Post Traumatic Stress Disorder remained unexplained. As indicated by Carlson (1997) another important thinker that has contributed greatly to this debate on Post Traumatic Stress Disorder is Freud Sigmund. Freud came up with the Affect-Trauma model in the year 1985 as well as the concept of psychological determinism. In his investigative studies Freud analyzed the phenomena of hysteria and other unconscious processes that affect human beings. 4.0 Theories Of Post Traumatic Stress Disorder Meichenbaum (1994) claims that Post Traumatic Stress Disorder is believed to be caused by a number of factors that greatly impact upon the mental, psychological, emotional and physiological aspects of individuals. According to Brewin and Holmes (2003, p. 339), there are a number of theoretical frameworks such as cognitive, Anxious Apprehension, Stress Response, Emotional Processing and Dual Representation theories that have been formulated to explain Post Traumatic Stress Disorder. Brewin and Holmes (2003, p. 339) conduct a summary of the research and investigative studies that have been conducted currently regarding the psychological processes that are implicated in Post Traumatic Stress Disorder. As already indicated by Brewin and Holmes (2003, p. 339), most common theories described as regards Post traumatic stress Disorder include Social cognitive Theory, information processing and conditioning theories. 5.0 Causes, Victims and Types of Post Traumatic Stress Disorder As indicated by Carlson (1997) the most common causes of Post Traumatic Stress Disorder include witnessing disturbing occurrences or events, actual or threatened deaths and injuries, personal experiences that were traumatic as well as threats to an individual’s integrity. According to Briere (1997) any human being may be affected by Post Traumatic Stress Disorder as long as they have witnessed or gone through ordeals that are very impactful or disturbing. The seriousness of a person’s exposure to Post Traumatic Stress Disorder is determined by the duration of time, proximity and intensity of the traumatizing ordeals that they were exposed to. In addition to this, Brewin et al (2000, p. 500) claim that there are a number of factors that predispose individuals to development of the Post Traumatic Stress Disorder condition; these include traumatizing childhoods, pre-existing mental conditions and differences in personalities. Hereditary features such as depression may increase a person’s susceptibility to the disorder. More over, due to their tendency to be more emotional, women hare perceived as being twice as much vulnerable to Post Traumatic Stress Disorder than men (Harvey & Bryant, 1998). There are three main types of Post Traumatic Stress Disorder that are acknowledged in current literature regarding Post Traumatic Stress Disorder. Acute Post Traumatic Stress Disorder refers to the types of Post Traumatic Stress Disorder that usually fades away within short periods of time (three months and below). The second category of Post Traumatic Stress Disorder that is identified in current literature is chronic Post Traumatic Stress Disorder. According to Briere (1997) this refers to that which is characterized by symptoms that last for more than 3 months. The last type of Post Traumatic Stress Disorder is described as occurring with delayed onset; persons that are affected by this type of Post Traumatic Stress Disorder do not depict any symptoms until after half a year or longer spells of time (Jones & Barlow, 1990, p. 300). 6.0 Diagnosis and Treatment of Post Traumatic Stress Disorder Current literature on Post Traumatic Stress Disorder reveals that the symptoms of this condition may be grouped into three main groups: Intrusive features, avoidance characteristics and increased arousal. In order for a person affected by Post Traumatic Stress Disorder to be diagnosed of intrusion, they have to have recurrent dreams of the traumatizing event as well as recurrent and intrusive thoughts or memories of the event. More over such individuals also suffer from psychological distresses when exposed to events or happenings that are similar to the traumatizing events that they experienced. Avoidance features refer to symptoms in the persons affected by Post Traumatic Stress Disorder which cause them to feel isolated from the rest of the people around them, lack a sense of hope for the future and indicate a decline in the interest they portray in events that are significant to them. According to Briere (1997) such persons also assert great effort in order to avoid and if possible forget the events that traumatized them. Persistent symptoms of increased arousal are characterized by difficulties in sleeping, irritability, exaggerated responses when startled, anger outbursts, hyper vigilance and inattentiveness (Chemtob et al, 1988, p. 254). In order to treat the persons suffering from Post Traumatic Stress Disorder it is important for the concerned experts to measure the Post Traumatic Stress Disorder. Stamm (1006) claims that Post Traumatic Stress Disorder is usually measured by a number of instruments for instance the Impact of Events, Post Traumatic Stress Disorder Diagnostic and Impact of events Scales Gray & Lombardo, 2001). A Structural Clinical interview or Post- Traumatic Cognitions Inventory may also be used to measure Post Traumatic Stress Disorder (Stamm, 1996). There are a variety of treatment procedures that persons affected by Post Traumatic Stress Disorder may be exposed to. The first treatment method is cognitive behavior therapy. Persons affected by the Post Traumatic Stress Disorder may also be put on drugs (Wilson and Keane, 1996). Current research on Post Traumatic Stress Disorder has revealed that there are a number of biological characteristics that are associated with the disorder. As a matter of fact, Post Traumatic Stress Disorder is believed to be characterized by biological abnormalities and transformations (Ehlers & Clark, 2000, p. 320). Persons that are affected by Post Traumatic Stress Disorder have been recognized to have an atypical stress response; Rather than emitting an increased level of cortisol which is a hormone in the human body related to stress, the bodies of the affected persons tend to encounter a disruption of the hypothalamic pituitary axis mechanisms which serve to decrease the levels of cortisol. A number of individuals suffering from Post Traumatic Stress Disorder have also been reported to undergo a decline in the volume of brain or particular brain structures. 7.0 Conclusion As already indicated in this paper, Post Traumatic Stress Disorder is one of the most debated upon conditions affecting human beings. Post Traumatic Stress Disorder is believed to come about as a consequence of individuals being exposed to or witnessing ordeals or occurrences that are psychologically disturbing for instance death/injury or near death/ injury incidents, rapes, natural disasters or war. it is noteworthy that the severity or length of time that an individual may be affected by Post Traumatic Stress Disorder is determined by a number of factors for instance their family history, pre-existing mental conditions and variances in personality. It is important that Post Traumatic Stress Disorder in affected individuals be recognized early so that the individuals can be put on treatment. 8.0 References American Academy of Child and Adolescent Psychiatry (AACAP), (1998), “Practice Parameters for the Assessment and Treatment of Children and Adolescents with PTSD, Journal of American Academy of Child and Adolescent Psychiatry, 37, 4s-26s American Psychiatric Association (1994), “Diagnostic and Statistical Manual” (4th ed.), Washington, DC: Author Bernat, J. A., Ronfeldt, H. M., Calhoun, K. S., & Arias, I. (1998), “Prevalence of Traumatic Events And Peritraumatic Predictors Of Posttraumatic Stress Symptoms In A Nonclinical Sample of College Students”, Journal of Traumatic Stress, 11, 645–664 Brewin, C. R. and Holmes, E. A., (2003), “Psychological Theories of Post-Traumatic Stress Disorder”, Clinical Psychology Review, pp. 339-376 Brewin, C. R., Andrews, B., & Rose, S., (2000), “Fear, Helplessness, And Horror In Posttraumatic Stress Disorder: Investigating DSM-IV Criterion A2 In Victims Of Violent Crime”, Journal of Traumatic Stress, 13, 499–509 Briere, J., (1997), “Psychological Assessment of Adult Post Traumatic States”, Washington, DC: American Psychological Association Carlson, E. B., (1997), “Trauma Assessments: A Clinician’s Guide”, New York: Guilford Press Chemtob, C., Roitblat, H. L., Hamada, R. S., Carlson, J. G., & Twentyman, C. T., (1988), “A Cognitive-Action Theory Of Post-Traumatic Stress Disorder, Journal of Anxiety Disorders, 2, pp. 253–275 Davidson, J. R and Foa, E. (Eds), (1993), “Post Traumatic Stress Disorder: DSM-IV and Beyond”, Washington DC: American Psychiatric Press Ehlers, A., & Clark, D. M. (2000), “A Cognitive Model Of Posttraumatic Stress Disorder” , Behavior Research and Therapy, 38, 319–345 Foa, E. B, Steketee, G. and Rothbaum, B. O., (1989), “Behavioral/Cognitive Conceptualizations of Post-Traumatic Stress Disorder”, Behavior Therapy, Vol. 20, Issue 2, pp. 155-176 Foa, E.B. and Rothbaum, B.O., (1998) “Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD”, New York: Guilford Ford, J.D., Thomas, J.E., Rogers, K.C. et al., (1996), “Assessment of Children’s PTSD Following Abuse or Accidental Trauma”, Presented at the annual meeting of the International Society of Traumatic Stress Studies, San Francisco Gray, M. J., & Lombardo, T. W. (2001), “Complexity of Trauma Narratives As An Index Of Fragmented Memory in PTSD: A Critical Analysis”, Applied Cognitive Psychology, 15, 170–185 Harvey, A. G., & Bryant, R. A. (1998), “The Relationship Between Acute Stress Disorder And Posttraumatic Stress Disorder: A Prospective Evaluation Of Motor Vehicle Accident Survivors”, Journal of Consulting and Clinical Psychology, 66, 507–512 Jones, J. C., & Barlow, D. H. (1990), The etiology of Posttraumatic Stress Disorder, Clinical Psychology Review, 10, 299–328 Meichenbaum, D. (1994), “A clinical Handbook/Practical Therapist Manual For Assessing And Treating Adults with Post-Traumatic Stress Disorder (PTSD)”, Waterloo, Ontario, Canada: Institute Press Saigh, P., (1989), “The Development and Validation of the Children’s Post-traumatic Stress Disorder Inventory”, International Journal of Special Education, 4, pp. 75-84 Stamm, B.H. (Ed.), (1996), “Measurement of Stress, Trauma, and Adaptat’, Lutherville, MD: Sidran Press Wilson, J.P., and Keane, T.M. (Eds.), (1996), “Assessing Psychological Trauma and PTSD”, New York: Guilford Press