Post Traumatic

Stress Disorder
(PTSD)
Lecture by: M.K. Sastry
Head Of the Department (UNIT 2)
Department of Integrative Functional &
Resortive Medicine, Nobel Institute Of
Neurosciences, Nobel Medical College
Teaching Hospital, Nepal
 PTSD Symptoms
 PTSD can be related to are depression,
substance abuse, problems of member and
cognition, and other physical and mental
disorders. This is why diagnoses of PTSD can
be hard.
 PTSD Symptoms
 PTSD is associated with a persons inability to
function in daily life from family life such as
divorce, parenting difficulties, and job
problems
 PTSD Symptoms
 Some other common symptoms include:
Affective: Anhedonia- loss of the ability of
feel pleasure, emotional numbering
 PTSD Symptoms
 Some other common symptoms include:
Hyper vigilance- enhanced sensibility to the
senses, Passivity, Nightmares, Flashbacks,
Exaggerated startle response (behavioral)
 PTSD Symptoms
 Some other common symptoms include:
Intrusive memories, inability to
concentrate, hyper arousal- nervous system
is in constant state of alert (cognitive).
 PTSD Symptoms
 Some other common symptoms include:
Lower back pain, headaches, stomach ache
and digestion problems, regression in some
children- maturity, insomnia, losing skills
the person already has- speech and toilet
training (Somatic).
 Biological Etiologies
 (Etiologies- the cause or the origin of the
disease. )
 Twin Research has shown a possible genetic
predisposition for PTSD (Hauff and Vaglum
1994)
 Biological Etiologies
 It is shown in studies that people who have
developed PTSD have an increased level of
noradrenaline.
 Noradrenaline is a neurotransmitter that
plays a role in emotional arousal.
 Biological Etiologies
 The high level of noradrenaline causes a
person to express more emotions on a
certain situation or topic more than a normal
person, this was found by Geracioti(2001).
 Biological Etiologies
 The high levels of Noradrenaline often lead to
people having flash back and panic attacks.
 Biological Etiologies
 Bremner 1998
 There is evidence for increased sensitivity
of noradrenaline receptors in patients with
PTSD
 Cognitive Etiology

 Researchers took a look into how the person

perceives the traumatic situation. If the
person tries to blame themselves and takes
responsibility for the situation then they will
suffer significantly.
 Cognitive Etiology

 When the person feels this way they also

beginning to feel they have a lack of control
over their surroundings and the world.
 Cognitive Etiology

 Development of PTSD is associated with a

tendency to take personal responsibility for
failures and to cope with stress by focusing on
the emotion, rather than the problem.
 Cognitive Etiology

 People who have been diagnosed with PTSD

often develop something called intrusive
memories. These memories come to mind
randomly and are triggered by sounds, sight,
and smells that the person associates with the
event.
 Cognitive Continued

 Sutker et al. (1995)

 Found that Gulf War veterans who had a
sense of purpose and commitment to the
military had less of a chance of suffering
from PTSD than other veterans.
 Cognitive Continued

 Sutker et al. (1995)

 Cognitive theorists have also found that
victims of child abuse who are able to
see that the abuse was not their fault,
but a problem with the perpetrator, are
able to overcome the symptoms of PTSD.
 Cognitive Continued
 Links to schema processing and attribution.
Suedfeld (2003)
 Examined attributional patterns in Holocaust survivors.
Suedfeld found that the attributional style of Holocaust
survivors tends to be much more external (Fate, God,
Luck, etc.) When asked why someone survived the
Holocaust, survivors were more likely than a Jewish control
group to mention help from others- including help from
Gentiles. Although help from others was prominent in the
study, survivors nevertheless have low trust in others and
demonstrate a skeptical view of the world.
 Cognitive Continued
 Links to schema processing and attribution.
Suedfeld (2003)
This study shows that a specific attribution may
be linked to Holocaust survivors. However, it is
relevant to ask if this attributional style was the
result of the Holocaust or particular to the
Jewish community, which could perhaps be
more about sociocultural factors than cognitive
ones.
 Socio-cultrual Etiology
 The majority of research on PTSD focuses on
socio-cultural explanations. Research
suggests that experiences with racism and
oppression are predisposing factors for PTSD.
 Socio-cultrual Etiology
 Dyregrov
 Research on PTSD in Rwandan children.
 Socio-cultrual Etiology
 Dyregrov
 Argued that death was the factor
evidencing the strongest influence on
intrusive thoughts and avoidance of
behavior, which simply means avoiding
situations can trigger anxiety and panic.
 Socio-cultrual Etiology
 Dyregrov
 This appears to have support in Bosnia,
where in 1998 close to 73 % of girls and
35% of boys in Sarajevo suffered from
symptoms of PTSD.
 Gender

 Research has found that there is a significant

gender difference in the prevalence of PTSD
 Gender

 Breslau et al. (1991) did a longitudinal study of

1007 young adults who had been exposed to
community violence and found a prevalence
rate of 11.3% in woman and 6% in men.
 Gender

 Horowitz et al. (1995) reviewed a number of

studies and found that woman have a risk up
to 5 times greater than males to develop PTSD
after a violent or traumatic event.
 Culture
 According to DSM, somatic symptoms of PTSD
are atypical.

 Kleinmen (1987) argues that it is irrational and

ethnocentric to assume that non-western
forms of this disorder are atypical- the form
commonly seen in the West being assumed to
be the norm.
 Culture
 Non-western survivors exhibit what is called body
memory symptoms
 Ex. The dizziness experienced by a woman which
was found to be a body memory of her repeated
experience of being forced to drink large amounts
of alcohol and then being raped (Hanscom 2001)
 Treatment
 Pros of Treatment
 Educating people with PTSD about the
disorder may help them cope with
having the disorder.
 Treatment
 Pros of Treatment
 Exposure therapy can work at helping
the survivor of a traumatic experience
get over their anxiety developed from
it.
 Treatment
 Pros of Treatment
 Giving a per suffering from PTSD the
correct medicines may help cure them.
(e.g. Antipsychotics, Antidepressants
or Anti-anxiety medications)
 Treatment
 Pros of Treatment
 Individual treatment can allow the
doctor to gain one on one personal
relationships with the patient allowing
them to be more open to sharing what
they are thinking.
 Treatment
 Cons of Treatment

 Some people may deny they have the

disorder and resist treatment more.
 Treatment
 Cons of Treatment

 Using exposure on a person suffering

from PTSD may cause them to freak
out and forget about the coping
mechanisms they learned, do to panic.
 Treatment
 Cons of Treatment

 If a person suffering from PTSD is

prescribed too many different
medicines they may become addicted
or dependent on the drugs.
 Treatment
 Cons of Treatment

 You may not know how well the

treatment worked until how the
patient reacts around more than one
person.
Examine biomedical, individual and group
treatment

 Contemporary abnormal psychology adopts

a number of different approaches to
treatment depending on the disorder (such
as biomedical, individual and group
therapy).
Examine biomedical, individual and group
treatment

 It’s believed that multifaceted treatment is

the best treatment and this is called the
biopsychosocial approach to treatment.
 This may include drug treatment, individual
therapy and group therapy as well as handling
risk factors in the environment.
Examine biomedical, individual and group
treatment
 People who suffer from PTSD often take
antidepressants and tranquillizers to help
cope with their disorder.
 Valium and Xanax are tranquillizers that
modulate the neurotransmitter GABA in
order to regulate anxiety levels.
Examine biomedical, individual and group
treatment
 Antidepressants are often prescribed
because most people who suffer from
PTSD have depression; those will
improve with depression also will
improve with PTSD (Marshall, 1994).
 Examine biomedical, individual and group
treatment
 At a traumatic event psychiatrists come to help
survivors / witnesses and try to prevent them from
having PTSD. Mayou et. el (2000) claims that crisis
intervention may do more harm than good. The
argument is that psychiatrists lay down more
concrete memories of the event and make it more
difficult to forget.
 Examine biomedical, individual and group
treatment
 Foa (1986) treats individuals suffering from PTSD by
having them talk about their experience. The four
goals of treating a person suffering from PTSD are:
1. Create a safe environment.

2. Show that remembering is not equivalent to

experiencing the event again.
 Examine biomedical, individual and group
treatment
 Foa (1986) treats individuals suffering from PTSD by
having them talk about their experience. The four
goals of treating a person suffering from PTSD are:
1. Show anxiety is alleviated over time.

2. Acknowledge that experiencing PTSD symptoms

does not lead to loss of control.
Examine biomedical, individual and group
treatment

 Friedman and Schnurr (1996) looked at the

role of group therapy on Vietnam War
veterans. They had a total of 325 war
veterans as participants.
Examine biomedical, individual and group
treatment
 There was a group that held trauma-
focused therapy which had three
components: exposure to traumatic
memories, cognitive restructuring, and
coping skills development. Compared to a
controlled group who only talked about
current life issues, the group that had
trauma-focused therapy had a better
improvement rate.
Examine biomedical, individual and group
treatment
 However, the trauma-focused group had
a very high attrition rate (participants
dropping out).Attrition rate was 27
percent compared to 17 percent
 Eclectic Approaches

 Antipsychotics. Are
prescribed to relieve severe
anxiety and/or related
problems.
Ex. difficulty sleeping or
emotional outbursts.
 Eclectic Approaches
 Antidepressants. Can be used to help symptoms of
both depression and anxiety. They can help improve
sleeping issues and improve concentration.
 Eclectic Approaches
 Medication related: selective serotonin reuptake
inhibitor (SSRI) medications sertraline (Zoloft) and
paroxetine (Paxil)
 Eclectic Approaches
 Anti-anxiety medications. Can improve feelings of
anxiety and stress.
 Eclectic Approaches
 Prazosin(Minipress) . For symptoms that include
insomnia or recurring nightmares. It is also used for
the treatment of hypertension and blocks the brain's
response to adrenaline-like brain chemical called
norepinephrine
 Psychotherapy
 Cognitive therapy.
Vocal therapy lets the person
recognize ways of thinking or
cognitive patterns that keep
the patient stuck. This
method can be used along
with behavioral therapy also
known as exposure therapy.
Ex. negative or inaccurate ways
of perceiving normal situations.
 Psychotherapy
 Exposure therapy.
Behavioral therapy safely lets the
patient face the very thing that is
found frightening, and helps them
learn to cope with it effectively.
Another way of doing this is by
using "virtual reality" programs
that allow you to re-enter the
setting in which you experienced
trauma
-Ex. a "Virtual Iraq" program.
 Psychotherapy
 Eye movement desensitization and reprocessing
(EMDR).
 This combines exposure therapy with a series of
guided eye movements that can help process
traumatic memories.
 Relationship between etiology and
therapeutic approach in relation to one
disorder.
 Etiology: to find out why people suffer from
a disorder; this way is more difficult to
establish for a psychological disorder, than
for physical illness in general.
 Relationship between etiology and
therapeutic approach in relation to one
disorder.
 Therapeutic: treating or curing of the
disease.
 Therapy

 Therapy is the most effective approach to try

to cure PTSD.
 Therapy will help one have a good
relationship between the person suffering
from PTSD and the therapist.
 Therapy

 The goal of therapy is to provide a

nonjudgmental environment that allows the
person suffering from PTSD and the therapist
to work together to achieve certain goals.
 Therapy

 The sooner one addresses the symptoms of

PTSD, the less likely that person will become
worse with their PTSD and will increase the
risk of depression.
 Therapy

 Symptoms can vary depending on the sex

of the patient. Most men develop
aggression, become irritable, and violent
while women are more prone to anxiety,
avoidance of social situations, and
depression
 Therapy (Cont.)

 During therapy, the therapist and the patient

work on the triggers that make the PTSD
more difficult.
 The patient and therapist develop
techniques to help relieve the triggers that
can cause an onset of PTSD responses.
 Therapy (Cont.)

 The therapeutic approach and the

relationship with etiology become more
clear once the patient can identify the
triggers sooner and implement the
techniques to help relieve the symptoms of
PTSD.
 Therapy (Cont.)
 Some therapists recommend that the PTSD patient
work with a dog that is trained to know when the
patient is starting to feel the symptoms of PTSD.
 The patient can use the techniques developed
faster when they have a dog to help identify that
symptoms are starting.
 Etiology
 The patient usually suffers a traumatic experience
that leads the patient to suffer from PTSD.
 Some traumatic experiences include: fighting in
a war and having to kill someone, being
involved in a car accident, being raped, etc.
 Etiology
 Patients that suffer from PTSD learn with help
from a therapist what can trigger the symptoms
of PTSD.
 Some triggers can include: a gun shot or a
firecracker going off, a person following too
closely, or acting aggressively towards a raped
victim, etc.
 Etiology
 Patients that suffer from PTSD learn with help
from a therapist what can trigger the symptoms
of PTSD.
 Another trigger is having nightmares about the
traumatic experience and feeling like the
patient is reliving the experience over and over
again.
 Achenbach (1991)

 Research for PTSD shows that gender plays

a role in symptoms.
 Males are more likely to experience
externalization symptoms such as
aggression and delinquency.
 Achenbach (1991)

 Females are more likely to experience

symptoms internally such as anxiety and
depression.
 Diagnostic criteria for Posttraumatic
Stress Disorder
 Criteria A: The person has been exposed to a
traumatic event in which both of the following
were present:
 The person experience, witnessed, or was
confronted with an event of events that
involved actual or threatened death or
serious injury, or a threat to the physical
integrity of self or others
 Diagnostic criteria for Posttraumatic
Stress Disorder

 Criteria A: The person has been exposed to a

traumatic event in which both of the following
were present:
 The person’s response involved intense fear,
helplessness, or horror. NOTE: In children, this
may be expressed instead by disorganized or
agitated behavior.
 Criteria Cont.
 Criteria B: The traumatic event is persistently
reexperienced in one (or more) of the following
ways:
 Recurrent and intrusive distressing
recollections of the event, including images,
thought, or perceptions. NOTE: In young
children, repetitive play may occur.
 Criteria Cont.
 Criteria B: The traumatic event is persistently re-
experienced in one (or more) of the following
ways:
 Recurrent distressing dreams of the event.
NOTE: In children. There may be frightening
dreams without recognizable content.
 Criteria B Cont.

 Acting or feeling as if the traumatic event were

recurring (includes a sense of reliving the

experience, illusions, hallucination, and

associative flashback episodes, including those

that occur on wakening or when intoxicated.

 Criteria B Cont.

 Intense psychological distress at exposure to

internal or external cues that symbolize or

resemble an aspect of the traumatic event.

 Criteria B Cont.

 Physiological reactivity on exposure to internal or

external cues that symbolize or resemble an

aspect of the traumatic event.

 Criteria C
 Persistent avoidance of stimuli associated with
the trauma and numbering of general
responsiveness (not present before the trauma),
as indicated by three (or more) of the following:
 Efforts to avoid thoughts, feelings or
conversations associated with the trauma
 Criteria C
 Efforts to avoid activities, places, or people that
arouse recollections of the trauma

 Inability to recall an important aspect of the

trauma
 Criteria C
 Markedly diminished interest or participation
in significant activities

 Feeling of detachment of estrangement from

others
 Criteria C
 Restricted range of affect (e.g., does not expect
to have a career, marriage, children, or a
normal life span)
 Criteria D
 Persistent symptoms of increased arousal
(not present before the trauma), as
indicated by two (or more) of the following:
 Difficulty falling or staying asleep
 Irritability or outbursts of anger
 Criteria D
 Persistent symptoms of increased arousal
(not present before the trauma), as
indicated by two (or more) of the following:
 Difficulty concentrating
 Hyper vigilance

 Exaggerated startle response

 Criteria E

 Duration of the disturbance (symptoms in

Criteria B, C, and D) is more than 1 month.
 Criteria F

 The disturbance causes clinically significant

distress or impairment in social,
occupational, or other important areas of
functioning.
 Statistics of PTSD
 In the US, PTSD has a prevalence rate of 1-3
percent and an estimated lifetime prevalence of 5
percent in men and 10 percent in women.
 Studies by Davidson (2007) and Breslau (1998)
estimate that PTSD affects 15-24 percent of
individuals who are exposed to traumatic
events.
 Research (When?)
 Careful research and documentation of PTSD
began after the Vietnam War. The National
Vietnam Veterans Readjustment Study estimated
in 1988 that the prevalence of PTSD among
veterans was 15.2 percent at that time, and that
30 percent had experienced the disorder at some
point since returning from Vietnam
 Rwanda Genocide (PTSD Study)

 Study of the Survivors of the Rwandan

Genocide. (Occurred soon after the
genocide).
 Rwanda Genocide (PTSD Study)

 1995 UNICEF conducted a survey of 3000

Rwandan children, aged 8—19 years of
these:
 95 percent had witnessed violence

 80 percent had suffered a death in their

immediate family
 Rwanda Genocide (PTSD Study)

 1995 UNICEF conducted a survey of 3000

Rwandan children, aged 8—19 years of
these:
 62 percent had been threatened with
death.
 Study Cont.

 Des Forges (1999) argued that eliminating

Tutsi children was seen as a critical
dimension in eliminated the Tutsi presence
in Rwanda.
 Study Cont.

 According to a UNICEF survey (1999), 60

percent of children surveyed did not care if
they grew up.
 Study Cont.
• Dyregrov (2000) argues that the extent of loss and
trauma which affected all levels of society
throughout Rwanda may have rendered the
traditional coping mechanisms and collective
support less viable, and the whole adult
community less receptive to children’s needs, as
adults coped with their own traumas and grief.
 Study Cont.
 According UNICEF, in 1997 there were 650,000
families headed by children aged 12 years or
younger.
 Over 300,000 children were growing up in
households without adults.
 Study Cont.

 The children lived in the community in

which the atrocities occurred. This
community has a higher opportunity of
intrusive memories.
 Biological factors in PTSD

 Twin research has shown a possible genetic

predisposition for PTSD (Hauff and Vaglum 1994),
but most biological research focal point is on the
role of noradrenaline.
 Noradrenaline- is a neurotransmitter which plays
an important part in emotional arousal
 Biological factors in PTSD

 When people express emotions more openly than

normal is because they have higher levels of
noradrenaline.
 Geracioti (2001) found that PTSD patients have
higher levels of this neurotransmitter than a
common person has.
 Biological factors in PTSD

 In 70 percent of patients, stimulating the adrenal

system in PTSD patients causes a panic attack, and
flashbacks in 40 percent of patients. These
symptoms are not experience by any of the
control group members.
 Biological factors in PTSD

 Bremner (1989), there is no proof found for

increased sensitivity of noradrenaline receptors in
patients.
 Cognitive factors in PTSD
 Can an individuals cognitions make a difference to
people who develop PTSD.
 There may be differences in the way an individuals
cognitive process experiences and the other may be
a difference in attributional styles.
 Cognitive factors in PTSD
 What cognitive therapists often note is that PTSD
patients tend to feel that that have very little control
over their lives and that the world is unpredictable.
 Example: A survivor of a car accident or a victim of rape
often experience guilt regarding this trauma.
 Cognitive factors in PTSD
 These intrusive memories that seem to come to
consciousness at random are often triggered by sight,
sounds, and smells related to the traumatic event.
 Example: Flashbacks may be experience while watching a
fireworks display to a war veteran.
 Cognitive factors in PTSD
 These intrusive memories that seem to come to
consciousness at random are often triggered by sight,
sounds, and smells related to the traumatic event.
 Example: Flashbacks may be experience while watching a
fireworks display to a war veteran.
 Cognitive factors in PTSD
 Brewin (1996) These flashbacks occur as a result of
cue- dependent memory, where stimuli similar to the
original even may activate sensory and emotional
aspects of the memory, thus causing extreme fright.
 Cognitive factors in PTSD Cont.
 Albert Rizzo professor at the University in
Southern California.
 Rizzo was trying to develop a tool to treat PTSD
patients by using virtual reality.
 Cognitive factors in PTSD Cont.
 In Virtual Iraq these traumatized soldiers can re-
experience these horrors of the war while
therapist manipulated variables that would be
appropriate to each individual.
 Cognitive factors in PTSD Cont.
 This was based on the concept of flooding. An
example of this is over- exposure to stressful
events. When the stress reaction finally fades is
due to what is called habituation.
 Cognitive factors in PTSD Cont.
 Rather than focusing on the problem,
development of PTSD is associated with a
tendency to cope with stress by focusing on the
emotion and to take personal responsibility for
failures
 Cognitive factors in PTSD Cont.
 Sutker (1995) found that Gulf War veterans had a
less chance of suffering from PTSD than other
veterans.
 Cognitive Theorists have found that victims of
child abuse that see that the abuse was not their
fault, tend to overcome the symptoms of PTSD
 Sociocultural factors in PTSD
 A large amount of the research on PTSD focuses on
sociocultural explanations.
 Some predisposing factors for PTSD are
experiences with racism and oppression.
 Sociocultural factors in PTSD
 Roysircar (2000) researched Vietnam War veterans.
His results were that 20.6 percent of black and 27.6
percent of Hispanic veterans met the criteria for a
diagnosis on PTSD and only 13 percent of white
veterans met this criteria.
 Sociocultural factors in PTSD
 Dyregrov goes a step further, when it came to
Rwandan children, arguing that threat of death was
the strongest influence on intrusive thoughts and
avoidance of behavior.
 Sociocultural factors in PTSD
 Research in Bosnia seemed to support this,
because in 1998 close to 73 percent of girls and 35
percent of boys in Sarajevo suffered from
symptoms of PTSD.
 Sociocultural factors in PTSD
 Kaminer (2000) was credited to have the highest
rate of PTSD in fear of rape in girls.

 A role in PTSD is social learning. Silvia (2000)

studies indicated that children may develop PTSD
by observing domestic violence.
Thank You