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Diagnosis, Treatment, Research, & Resources Part 2

Jul 02, 2021

Post-Traumatic Stress Disorder (PTSD) can occur after you've been through a traumatic event. A traumatic event is something terrible and frightening that you see or that happens to you. During this type of event, you think that your life or the life of others is in danger. You may be scared or feel like you have no control over what is happening.

Anyone who has had a life-threatening event can develop PTSD. But people don't always have to see a traumatic event or it happens to them that they get PTSD. Sometimes PTSD can arise from learning that a traumatic event has happened to a loved one.

These events can be:
- Life-threatening diseases.
- Sexual violence, such as sexual assault (rape).
- Living in or near a conflict-affected area, such as war.
- Physical violence.
- Serious injuries, such as a car accident.
- Natural disasters such as fire, tornado, flood or earthquake.
- Fight or be sent to a combat zone.

After the event, you may find yourself thinking a lot about what happened, avoiding memories of the event, and thinking negative thoughts about yourself and the world.

How is PTSD developing?
All people with PTSD have personally - or through others - experienced a traumatic event in which they fear for their lives, see terrible things and feel helpless. Strong emotions caused by the event lead to changes in the brain that can lead to PTSD.

Many people who go through a traumatic event do not get PTSD. It's not clear why some people develop PTSD and others don't. The likelihood of developing PTSD depends on many factors. These include:

- How intense the trauma was.
- When you have lost a loved one or been injured.
- How close you were to the event.
- How strong your reaction was.
- How much control you had over events.
- How much help and support you received after the event.

A history of mental illness, substance use disorders, or childhood trauma can also increase the risk of PTSD.

According to Dr. Ananya Mandal, MD (https://tinyurl.com/y2tpuaca), symptoms of Post-Traumatic Stress Disorder (PTSD) can develop within a month from when a traumatic event was experienced to up to months or years afterward. Oftentimes, people with PTSD do not seek medical help until the condition has started to seriously affect their daily lives.

Based on the Diagnostic and Statistical Manual for Mental Disorders, a diagnosis of PTSD must have the following characteristics or symptoms:

A. A history of being exposed to a traumatic event:
a. Experience, witness, or confrontation with actual or threatened death or bodily harm to yourself or others
b. Experienced intense fear, horror, or helplessness

B. The event is re-experienced in one or more of the following ways:
a. Remembering the event with thoughts, images, or perceptions
b. Have nightmares or vivid dreams about the event
c. Reliving the event through hallucinations, illusions, or flashbacks, including those experienced upon waking or intoxicated
d. Intense stress in response to triggers reminding of the event
e. Physical reactions such as sweating, palpitations, anxiety, dizziness, or headache in response to cues that trigger memories of the event

C. Avoidance of cues related to the traumatic event and numbing emotional responses to cues by:
a. Avoiding thoughts, feelings, or talking about the event.
b. Avoiding places, people, and activities that bring back memories of the event.
c. Failure to clearly remember an important aspect of the event.
d. Loss of interest in activities.
e. Feeling detached and isolated from others.
f. Impaired ability to feel affection.
G. The feeling that the lifetime is being shortened prematurely and that there are no milestones such as marriage, children or career.

D. Overexcitation condition indicated by at least two of the following:
a. Insomnia or difficulty staying through or falling asleep.
b. Irritability or outbursts of anger.
c. Difficulty concentrating.
d. Excessive vigilance.
e. Easily frightened.

E. Symptoms listed in Sections B, C, and D must have persisted for more than 1 month.

F. Symptoms must cause significant distress or impaired function.

How is PTSD treated?

Post-Traumatic Stress Disorder (PTSD) is also a treatable disease (https://tinyurl.com/3cyfe5hx). However, treatment may take some time, with periods of symptom remission followed by periods of exacerbation of symptoms. The condition can develop within days, weeks, months, or even years after the traumatic event.

A team of medical professionals and other specialists are often involved in helping a PTSD patient recover. This team usually consists of a mental health specialist, psychologist, psychiatrist, psychiatric nurse, and / or social worker.

Below is an overview of how to treat PTSD:
- For people with mild symptoms who persist less than four weeks after a traumatic event, watchful waiting may be used, where the person is closely monitored to see if the symptoms worsen. If vigilant waiting is required, a follow-up appointment is usually made after a month.

- Psychotherapy is one of the main approaches to treating PTSD. Psychotherapy can be carried out as individual therapy or as group therapy. Psychotherapeutic treatment for PTSD can last 6 to 12 weeks or more.

- Cognitive-behavioral therapy (CBT) is a form of psychotherapy that helps a patient change the negative effects that disrupted thought patterns or attitudes have on their behavior. This is achieved by individually opening up the problems that arise in everyday life and analyzing and changing the negative thoughts that can trigger them. Patients usually attend 90-minute CBT sessions once or twice a week for 8 to 12 weeks, although less may be required if therapy is started within a month of the patient's first traumatic event.

- Desensitizing and reprocessing eye movements is a relatively new approach to treating PTSD, in which the patient moves their eyes from side to side while remembering the traumatic event. This technique helps the hippocampus in the brain process unpleasant memories and flashbacks in such a way as to lessen their effects on the mind.

- Medications that can be used to treat PTSD include the antidepressant paroxetine, selective serotonin reuptake inhibitors, and mirtazapine, a noradrenergic and specific serotonergic antidepressant. These drugs are generally used in severe cases that have not responded to psychotherapy or CBT alone. Sedatives such as benzodiazepines and antipsychotics may also be prescribed for some people.

Treatment can help you be more in control of your emotions, have fewer symptoms, and start enjoying life again.