PTSD Notes

PTSD is a mental health problem that can develop after experiencing or witnessing a life-threatening event.
- Examples: combat, natural disaster, accidents/fires, physical or sexual assault.
In children, PTSD can arise from:
- Physical/sexual abuse.
- Violence to self or others.
- Exposure to suicidal acts.
- Serious or life-threatening illness (e.g., cancer, severe burns).
Symptoms include upsetting memories, and are normal for a few weeks or months after the event.
PTSD may be the cause if symptoms continue and interfere with relationships or work.
Symptoms can start much later or come and go over time.
Recovery can occur within 6 months, but PTSD can also become chronic for some individuals.

To be diagnosed with PTSD (adults), the following symptom clusters must be present for at least one month:
- At least one re-experiencing symptom.
- At least one avoidance symptom.
- At least two arousal and reactivity symptoms.
- At least two cognition and mood symptoms.
The DSM V classifies PTSD under "Trauma and Stressor Related Disorders."

Flashbacks:
- Reliving the trauma repeatedly, including physical symptoms like a racing heart or sweating.
Nightmares:
- Recurring distressing dreams of the event.
Recurrent and intrusive distressing recollections of the event.
Triggers:
- Triggers can be internal (feelings, thoughts) or external (words, objects, situations that are reminders of the trauma).

Staying away from:
- Places or events that are reminders of the traumatic experience.
Avoiding:
- Thoughts, feelings, or conversations related to the trauma.
Feelings of detachment and estrangement from others.
Sense of a foreshortened future:
- A belief that one doesn’t expect to have a future, marriage, children, or a normal lifespan.
Changes in personal routine, potentially leading to isolation.

Being easily startled.
Feeling tense or on edge.
Having difficulty sleeping.
Having angry outbursts.
Hypervigilance.
These symptoms are often constant and not necessarily trigger-related.
They can cause stress and anger, making daily tasks (sleeping, eating, concentrating) difficult.

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.
These symptoms can begin or worsen after the trauma, but not due to injury or substance use.
Can lead to feelings of alienation or detachment from friends and family.

Symptoms may vary from adults.
Very young children (<6) may exhibit:
- Wetting the bed after toilet training.
- Forgetting how to or being unable to talk.
- Acting out the scary event during playtime.
- Being unusually clingy with a parent or trusted adult.
Teens may develop:
- Disruptive, disrespectful, or destructive behaviors.
- Guilt for not preventing injury or deaths.
- Thoughts of revenge.

According to the National Center for PTSD (VA.gov), approximately 7-8 out of 100 people will experience PTSD in their lives.
Women are slightly more likely to develop PTSD than men.
Genetic factors play a role.
Previous trauma as a child increases risk.
Little or no social support after a traumatic event.
Additional stress after a traumatic event (e.g., loss of a loved one, loss of a job).
History of substance abuse or mental illness.

Seeking out social support from family and friends.
Finding support groups after a traumatic event.
Having a positive coping strategy or a way of getting through the event and learning from it.
Being able to act and respond effectively despite feeling fear.

Veterans with PTSD are at a higher risk for suicidal behavior.
Reasons for this may include:
- Survivor guilt.
- Being an agent of killing.
- Intensity of sustaining a combat injury.
- Co-morbidity with traumatic brain injury is common.

Psychological:
- Trauma-focused cognitive behavioral therapy is the most effective.
  - Revisits distressing elements of the traumatic event, addressing avoidance and cognitive distortions.
- Exposure therapy.
Pharmacologic:
- Anti-depressive agents:
  - Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs).
    - Examples:
      - Sertraline (Zoloft).
      - Paroxetine (Paxil).
      - Fluoxetine (Prozac).
      - Venlafaxine (Effexor).
  - Benzodiazepines are NOT recommended due to:
    - High risk of dependency.
    - Interference with exposure therapy.
    - Increased risk of substance use.

Hyperarousal:
- Feeling extremely anxious, angry, or out of control.
- Unfamiliar or threatening feelings overwhelm you, leading to fight-or-flight responses.
Dysregulation (Agitated):
- Feeling agitated, anxious, revved up, or angry.
- Not feeling out of control, but also not comfortable.
Window of Tolerance:
- A state where things feel just right.
- You are best able to cope with life's challenges; you're calm but not tired, alert but not anxious.
Dysregulation (Shutting Down):
- Feeling like you're shutting down; spacy, losing track of time, or feeling sluggish.
- Not feeling out of control, but also not comfortable.
Hypoarousal:
- Feeling extremely zoned out and numb, both emotionally and physically.
- Time can go missing; it might feel like you're completely frozen.
Stress and trauma can shrink your window of tolerance.
Working with a practitioner can help to enlarge your window of tolerance.
- They can help you stay calm, focused, and alert even when something happens that would usually throw you off balance.

Effective treatment remains a challenge.
Non-response rates are high across various treatment approaches.
Many patients experience a reduction of symptoms but without complete remission.
Many off-label medications are used, potentially leading to overmedication.
Overall high-priority goals:
- Stabilize lives.
- Reduce self-destructive behaviors.
- Address social isolation and despair.