Posttraumatic stress disorder (PTSD) comprises many functional impairments that influence behavior, neurological processes, and the psychological sphere of a person. It belongs to the group of trauma- and stressor-related disorders. This disorder can be conditioned by diverse factors or events including “wars, environmental disasters, rape, accidents, physical traumas, and near-death events” together with many others such as “bullying, childbirth, torture, heart failure, cancer survival” and others (Martin, Preedy, & Patel, 2016, p. ix).
Such manifestations as nightmares and sleep disorders, intrusive thoughts, recollections of traumatic events, and hypervigilance, determining meaningful social, occupational, and interpersonal dysfunction, are typical of PTSD (Sareen, 2017). It affects different categories of people, both adults, and children, while women have PTSD twice more often than men. Still, the disorder can be diagnosed and cured. This paper provides a description of the category of trauma- and stressor-related disorders and a detailed analysis of posttraumatic stress disorder, including its symptom criteria, prevalence, epidemiology, and treatment opportunities.
Brief Description of Trauma- and Stressor-Related Disorders
The category of trauma- and stressor-related disorders comprises disorders that include “exposure to a traumatic or stressful event” as a diagnostic criterion (Black & Grant, 2015, p. 265). Reactive attachment disorder, posttraumatic stress disorder, disinhibited social engagement disorder, acute stress disorder, and adjustment disorders belong to this category. Psychological distress that causes these disorders can develop as a result of diverse traumatic or stressful events.
Sometimes, the symptoms are related to anxiety and fear. Still, individuals who have experienced stressful or traumatic events frequently observe such symptoms as anhedonic and dysphoric, externalizing angry and aggressive, or dissociative (Black & Grant, 2015). Due to the diversity of clinical distress that follows catastrophic or aversive experience, these disorders were singled out into a separate category of trauma- and stressor-related disorders. Nevertheless, the clinical picture often comprises a combination of the mentioned symptoms.
Statement of Diagnosis
Posttraumatic stress disorder in adults, adolescents, and children over six years old has the following diagnostic criteria.
- “Exposure to actual or threatened death, serious injury, or sexual violence” (Black & Grant, 2015, p. 271). It can be a direct experience, witnessing the events happening to other people, learning that the traumatic events happened to close people, experience connected, or exposure to aversive details of the traumatic event. It should be mentioned that for this criterion, exposure should be personal, not through media (Black & Grant, 2015).
- “Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred” (Black & Grant, 2015, p. 271). These symptoms include repeated, uncontrolled, and intrusive distressing memories related to the traumatic events; repeated stress connected with the traumatic events; dissociative reactions related to the traumatic event; excessive or lasting psychological distress; definite physiological reactions to cues resembling some aspects of the traumatic events (Black & Grant, 2015).
- “Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred” (Black & Grant, 2015, p. 271). This diagnostic criterion is characterized by avoidance or attempts to avoid stressful thoughts, feelings, or memories related to the traumatic events and avoidance of different reminders of the traumatic events.
- “Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic events occurred” (Black & Grant, 2015, p. 271). This criterion is significant is it is supported by such manifestations as lack of ability to remember some details of the traumatic events (conditioned by dissociative amnesia); excessive and overstated negative attitudes to the surrounding people, oneself, or the world; misinterpretation of the reasons of traumatic events resulting in self-blame; constant negative emotional condition; low interest in important activities; feeling of disconnection; constant inability to express positive emotions (Black & Grant, 2015),
- “Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred” (Black & Grant, 2015, p. 272). It is revealed through irritable behavior and angriness, self-destructive actions, hypervigilance, overstated reactions of fear; poor concentration, and sleep problems.
- Duration of the disturbance that means that symptoms mentioned in criteria B-E are present for more than 1 month.
- The disturbance results in clinically proved stress, or the patient cannot properly function in social, personal, occupational, and other spheres.
- The experienced disturbance does not depend on the influence of substance use or other health-related reasons.
Diagnostic features of PTSD include the following. First of all, the symptoms typical of PTSD develop after one or more traumatic events. It should be mentioned that emotional reactions, such as fear, are not considered significant for diagnosing. In fact, the process of diagnosing is complicated due to the fact that clinical manifestations of PTSD are varied. Some patients demonstrate more evident fear-based emotional and behavioral symptoms, while others are more distressed by anhedonic or dysphoric mood conditions. Also, some people have typical arousal and reactive-externalizing symptoms, and others show more dissociative symptoms (Black & Grant, 2015). After all, some patients observe combinations of different symptoms.
The traumatic events that are experienced directly according to Criterion A include exposure to war as a combatant or civilian threatened or actual physical assault (e.g., physical attack, robbery, mugging, childhood physical abuse), threatened or actual sexual violence (e.g., forced sexual penetration, alcohol/drug-facilitated sexual penetration, abusive sexual contact, noncontact sexual abuse, sexual trafficking), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war, natural or human-made disasters, and severe motor vehicle accidents (Black & Grant, 2015, p. 274).
Some medical incidents, such as waking during surgery or anaphylactic shock, can also be considered traumatic events.
PTSD can also be caused by witnessed events, such as, for example, observation of a serious injury or violent death, different types of assault, road accidents, domestic violence, and others (Black & Grant, 2015). Negative reactions can become stronger due to re-experiencing the traumatic events. Thus, nightmares or other distressing dreams can be examples of re-experiencing. Moreover, brief intrusions, also known as flashbacks, are typical of PTSD. A characteristic feature of PTSD is the avoidance of stimuli related associated with the traumatic event. Usually, a person purposefully avoids feelings, thoughts, or memories related to trauma.
Also, avoidance of trauma-related activities, objects, situations, or people is common (Black & Grant, 2015). Frequently, individuals experience dissociative amnesia as a result of the traumatic events, and it is not connected with head injury or consumption of alcohol or drugs. Other typical diagnostic features include exaggerated negative expectations and self-blame. Moreover, individuals with PTSD frequently do not have an interest in daily activities or the affairs that were signed before the traumatic events. Finally, a lack of ability to experience positive emotions is a typical feature of PTSD.
As for PTSD prevalence, it differs depending on age. Thus, in the United States, the lifetime risk for PTSD at age 75 years is estimated at 8.7% (Black & Grant, 2015, p. 276). According to the National Institute of Mental Health (n.d.), the twelve-month prevalence of PTSD among the American adult population is 3.5%. In Europe and the majority of Asian, Latin American, and African countries, PTSD prevalence is lower, about 0.5%-1.0% (Black & Grant, 2015).
After all, it should be mentioned that PTSD can develop at any age. Still, the average age-of-onset is considered to be 23 (National Institute of Mental Health, n.d.). PTSD manifestations typically begin within a period of 3 months after the traumatic events. Still, the active manifestations can be delayed due to some peculiarities of the patient and begin after months or even years. The duration of the disorder can also differ. The average full recovery for about 50% of adult patients usually occurs within a period of three months. However, some patients can maintain PTSD symptoms for more than 12 months and even over 50 years (Black & Grant, 2015).
Some issues relevant to PTSD and influencing its occurrence among population include nationality, race, culture, and belonging to certain demographic groups. Thus, the research proves that citizens of lower-income countries are more exposed to trauma in comparison to high-income countries (Atwoli, Stein, Koenen, & McLaughlin, 2015). While there is no significant difference in PTSD prevalence rates globally, post-conflict areas demonstrate the highest rates of PTSD. It is conditioned by differences in trauma and PTSD risk factors distribution in lower-income and high-income countries. Moreover, in poorer countries or areas of conflicts, there is typically low access to mental health professionals, and PTSD treatment is a problem (Atwoli et al., 2015).
Different cultural groups also demonstrate different levels of PTSD risk. It can be explained by the type of traumatic exposure (e.g., genocide), the impact on disorder severity of the meaning attributed to the traumatic event (e.g., inability to perform funerary rites after a mass killing), the ongoing sociocultural context (e.g., residing among unpunished perpetrators in post-conflict settings), and other cultural factors (e.g., acculturative stress in immigrants)” (Black & Grant, 2015, p. 278).
Representatives of different cultures can demonstrate diverse clinical expression of the PTSD symptoms. Moreover, cultural syndromes and idioms of distress have an impact on the way PTSD and some comorbid disorders are expressed in different cultures. It is also related to certain behavioral and cognitive templates typical of this or that culture.
Gender has a significant impact on PTSD prevalence. Thus, the disorder is more typical of women than men despite the fact that women generally are less subject to traumatic events (Atwoli et al., 2015). Moreover, an average female observes PTSD symptoms longer than an average male (Black & Grant, 2015). It should also be mentioned that higher PTSD risk for females is mostly related to a greater probability of such traumatic events as rape or other forms of violence.
PTSD prevalence differs among diverse demographic groups. Thus, PTSD rates are usually higher among veterans and others categories of people whose occupation is related to high risk of trauma, such as firefighters, police officers, emergency medical personnel. Moreover, individuals who survived rape, military combat and captivity, are up to two times more exposed to PTSD compared to other people (Black & Grant, 2015). Age is also significant for PTSD.
Although it can affect individuals of any age, children and adolescents are at lower risk of PTSD. As for adult population, 6.3% of young adults aged 18-29 in the US have PTSD compared to 8.2% of people aged 30-44 and 9.2% in people of 45-59 (National Institute of Mental Health, n.d.). The lowest lifetime prevalence of PTSD is among the patients older than 60, only 2.5%. Speaking of race, in the US Latinos, African Americans, and American Indians demonstrated higher rates of PTSD compared to Asian Americans.
Pertinent Information Associated with Diagnosis
Historically, the issue of psychological trauma is connected with the establishment of PTSD as a syndrome (Martin et al., 2016). Already in ancient literature, troubling memories were related to previous exposure to certain stress or terror. After World War I the concept of psychological trauma moved to clinical setting and was developed both in in medical and psychiatric context (Martin et al., 2016). In fact, the development of the traumatic stress entity into scientific issue comprised three major stages, such as “(i) a scientific interest created by clinical anecdotes, (ii) the integration of a syndrome when the observable scientific facts can be reproduced using reliable criteria, and (iii) a pathogenic specificity corroborating the fundamentals of the clinical observation” (Martin et al., 2016, p. 4).
Although PTSD is curable, the treatment is not cheap. However, the majority of health insurance plans cover the treatment. Full or partial coverage depends on the treatment plan and the form of health insurance.
Beneficial Treatment Interventions
Treatment of PTSD can be provided in several ways. It depends on the clinical manifestations and the general condition of the patient. For acute treatment of PTSD, antidepressants are usually used and their efficiency is clinically proved (Baldwin et al., 2014). Long-term treatment is necessary for chronic course of PTSD. On the whole, treatment interventions for PTSD can be pharmacological, psychological, and combination. According to meta-analysis provided by Baldwin et al. (2014), “trauma-focused CBT and eye movement desensitization and reprocessing (EMDR) are both efficacious and superior to ‘stress management” (p. 422).
Some other studies compare the efficacy of psychological and pharmacological interventions, both in acute and long-term treatment of patients with PTSD and they prove certain advantages and more lasting effect of trauma-focused CBT compared to paroxetine (Baldwin et al., 2014).
Helpful Resources for Managing GAD
In addition to psychological and pharmacological treatment, PTSD can be better managed with the help of supplemental resources. They include PTSD Support Groups that function in different locations and unite people with similar problems. Thus, there are support groups for veterans, victims of violence, etc. Consequently, a person suffering from PTSD can find a group of people who have similar stressful and traumatic experience. Such interventions can be beneficial because the patients can not only compare experiences, but share the means of overcoming their condition. These groups can be community-based or work within organizations or clinical institutions.
On the whole, posttraumatic stress disorder demand careful and complex approach in diagnosing and treatment. Since it has similar manifestations with other trauma- and stress-related disorders, the symptoms should be checked before diagnosing. The treatment interventions should be selected with consideration of patient’s peculiarities and the causes of stress. Individual approach is significant for PTSD due to the diversity of stressful factors and traumas. Finally, there is a need for global interventions to reduce stress and thus contribute to shortening of PTSD prevalence.
Atwoli, L., Stein, D., Koenen, K., & McLaughlin, K. (2015). Epidemiology of posttraumatic stress disorder. Current Opinion in Psychiatry, 28(4), 307-311. Web.
Baldwin, D., Anderson, I., Nutt, D., Allgulander, C., Bandelow, B., den Boer, J. … Wittchen, H.-U. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439. Web.
Black, D.W., & Grant, J.E. (2015). DSM-5 guidebook. The essential companion to the diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Martin, C.R., Preedy, V.R., & Patel, V.B. (Eds.). (2016). Comprehensive guide to posttraumatic stress disorders. Cham, Switzerland: Springer International Publishing.
National Institute of Mental Health. (n.d.). Posttraumatic stress disorder among adults. Web.