PTSD

Definition

PTSD or Post Traumatic Stress Disorder is a disorder that develops in some people who have seen or lived through a shocking, scary, or dangerous event. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. A significant feature of PTSD is persistent symptoms of “increased arousal” of the autonomic nervous system- feeling very anxious, constantly alert for signs of danger or “hyper”. This can cause difficulty sleeping, outbursts of anger or irritability, and difficulty concentrating.

Signs and Symptoms

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

1. At least one re-experiencing symptom
   • Flashbacks- reliving the trauma over and over, including physical symptoms like a racing heart or sweating
   • Bad dreams
   • Frightening thoughts

   Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms

2. At least one avoidance symptom
• Staying away from places, events, or objects that are reminders of the traumatic experience
• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. At least two arousal and reactivity symptoms
• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping
• Having angry outbursts


Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

4. At least two cognition and mood symptoms
• Trouble remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Distorted feelings like guilt or blame
• Loss of interest in enjoyable activities

Cognition and mood symptoms can make the person feel alienated or detached from friends or family members.

The Treatment Process With Barbara

First a complete evaluation of the symptoms experienced , present coping and client history will need take place. It is important for the therapist to understand fully what symptoms are occurring and how the client is able to cope with the symptoms before EMDR processing or other therapy can proceed. The client may need help in developing capabilities of managing symptoms of trauma or “containing” the symptoms before EMDR Therapy can begin. This could take a few sessions to a few months. Each client is different. Moving too quickly into EMDR Therapy before the client is able to manage symptoms outside of the session needs to be avoided so that re-traumatization does not occur.
The client needs to be able to have “dual awareness”, the capability of being able to stay in the present moment while at the same time recognizing that the re-experiencing symptoms are ‘in the past” even though they might feel like they are in the present. Often, the therapy will need to begin by helping the client regain access to their innate ability to maintain dual awareness.
Successful treatment will bring the client to the point of being able to recall the traumatic event without having it “hijack” the nervous system to cause involuntary re-experiencing of the trauma. The memory might bring up feelings of sadness or other “negative” emotions, but it will be manageable and will not disrupt the daily functioning any longer.

DSM-5: PTSD Criteria
A. The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows:
1. Direct exposure
2. Witnessing, in person
3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies or pictures.
B. Intrusion symptoms (1/5 symptoms needed)
1. Recurrent, involuntary and intrusive recollections
2. Traumatic nightmares
3. Dissociative reactions (e.g. flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness
4. Intense or prolonged distress after exposure to traumatic reminders
5. Marked physiological reactivity after exposure to trauma-related stimuli
C. Persistent effortful avoidance of stimuli associated with the trauma (1/2 symptoms needed)
1. Trauma-related thoughts or feelings
2. Trauma-related external reminders (e.g. people, places, conversations, activities, objects or situations)
D. Negative alterations in cognitions and mood that are associated with the traumatic event (2/7 symptoms needed)
1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs)
2. Persistent (& often distorted) negative beliefs and expectations about oneself or the world (e.g. “I am bad,” “the world is completely dangerous”)
3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences
4. Persistent negative trauma-related emotions (e.g. fear, horror, anger, guilt, or shame)
5. Markedly diminished interest in (pre-traumatic) significant activities
6. Feeling alienated from others (e.g. detachment or estrangement)
7. Constricted affect: persistent inability to experience positive emotions
E. Alterations in Autonomic nervous system arousal and reactivity that are associated with the traumatic event
(2/6 symptoms needed)
1. Irritable or aggressive behavior
2. Self-destructive or reckless behavior
3. Hypervigilance
4. Exaggerated startle response
5. Problems in concentration
6. Sleep
F. Persistence of symptoms (in Criteria B, C, D and E) for more than one month
G. Significant symptom-related distress or functional impairment
H. Not due to medication, substance or illness