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Post Trauma Stress Disorder

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POST TRAUMA STRESS DISORDER
What is Post Trauma stress Disorder?

PTSD is a condition that is most commonly associated with veterans of war who have experienced front line battle. However, it can affect anyone who has had a major trauma in their lives. These can include but are not limited to auto accidents, rape, child and/or spousal abuse as well as other traumatic cases.

The Wounded Warriors Project is a service that offers assistance to those returning from war that have lost limbs, vision, and those with PTSD to accept what has caused them to be or act crazy when they see or hear certain sounds. One of these sounds that can affect the soldier is the sound of fireworks. However, watching movies about war can also trigger that feeling of being there fighting with them.

PTSD is categorized into four types: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions. The symptoms of PTSD can start as early as 1 day up to three months of the traumatic event. However, there are those who do not show signs of PTSD for many years. The symptoms may not appear until work or social situations cause the client to see the problem.

Intrusive memories are mainly unwanted recurrent memories. This can make the client relive or have flashbacks on what caused the trauma. With this in mind, many family members find themselves walking on egg shells to avoid triggering an episode. Many clients with PTSD begin to avoid talking about what happen to them. If a child was abused and did not report it, as an adult, they may find themselves avoiding anyone of the opposite sex because they are afraid that it might happen again. They may also avoid the place where the incident took place. Many clients also have negative feelings about themselves or other people. The client may be putting distrust in their way, and feeling negative emotions and thoughts about themselves or their loved ones.

The National Center for PTSD researches trauma to find the latest research on those exposed to trauma. They also have on their website (www.ptsd.va.gov) training resources for professionals. They also are helping survivors through this trying time in their lives and getting back on the normal side rather than the terrified side.

A detailed evaluation can help psychologist develop a treatment program for the client. The main program is that of psychotherapy or talk therapy. However, it takes more than this to help in most cases. Many patients are also on medications or on both types of therapy. What works for one client may not work for another. All trauma patients do not have the same reason for having PTSD. One of the biggest theories of cogitative behavior and PTSD is to remove the patient from the situation area. For instants an abused spouse that has developed PTSD symptoms. Education for the trauma survivors and their families and loved ones can help keep these victims headed in the right direction. Many PTSD survivors suffer due to memories so it is best to take the memory away.

Expert opinion

Dr. Frank Ochberg Ph.D. has stated that PTSD and PTSI are “an injury, not a disorder”. He also has stated that PTSD has been an acceptable diagnose since 1980. However, it is currently (2012) making controversial headlines. The advocates of veterans and other women’s groups are arguing that PTSD should be changed to PTSI (Post-Traumatic Stress Injury.

Retired General Peter Chiarelli, former Vice Chief of Staff of the U.S. Army, after reviewing the number of suicides from the military thought it was not a disorder at all, but an injury. This is due in part to the fact that it affects the brain as an injury since most of those suffering have physical injuries.

Dr. Jonathan Shay, MD. Ph.D. proposed that the DSM (Diagnostic and Statistical Manual) adopt PTSI rather than PTSD. He stated that “there is a crisis of suicide, stigma, and misunderstanding affecting young veterans”. He also brought it to the attention of the APA President John Oldham MD that civilians can also suffer from the condition. Those victims are former crime victims’, raped and abused women as well as others. Like veterans, these people have also suffered lingering wounds from home front battle scars as well.

However, the DSM-5 states that changing the name will not change the outcome. To veterans, it would mean, if the name was changed to PTSI, would make it easier for injured soldiers to get a purple heart.

DR. Matthew Friedman, M.D., Ph.D. states that “changing the name won’t eliminate stigma or make sufferers more likely to seek treatment.” He believes the name should be changed because the classification of post-traumatic stress is an Operational Stress Injury (OSI).

While the debate continues on, Dr. Edna Foa, Ph.D. states that “The epidemiological studies tell us that 60% of men and 50% of women in the US have been traumatized at least once in their lifetime.” Those types of trauma that are most likely to lead to PTSD (PTSI) are from combat and rape victims. However, on the other side of the spectrum, natural disasters and auto accidents have a low rate for PTSD. Combat has the highest rate at 60%. She suggests that asking the patient if they have experienced a traumatic event. If they have nightmares, intrusive thoughts or avoid things they use to do.

Medications such as paroxetine and sertraline help about 50% of the people. However, 30% have had a relapse after stopping one or both of the medications. However, those who received Cognitive Behavioral Therapy (CBT) did not relapse. (Foa 2015)

CASE STUDY
Brian is a young man who has suffered more than his share of trauma. Brian comes from an abusive home, and being bullied at school and on the playgrounds only to find himself in Iraq fighting for our freedom. Returning from the war, he had been injured and not only was he depressed and wanting commit suicide because of all the things he was going through.

Brian came to me today seeking help with his mother and father for help. Since his return, he has kept to himself, quit talking, and has been found by his mother trying to kill himself because of his missing limb.

After talking to the family, I had them wait in the lobby as I talked to Brian. During our conversation, Brian explained to me that he felt useless and felt he did the wrong thing. When I asked him why he felt that way, he simply said he let his friend die.

He then continued. “The sound of that bomb coming right at us rings in my head every day. I try to sleep and it is there, and I see him bleeding and dying in front of me.” Brian was crying now. He continued with “I wanted to carry him away, but I could not move. I was numb from the waist down. I did not even think I was wounded. But I found out differently as the battalion leader came to assess the damage done to our camp site. We were not prepared for the devastation that occurred.”

I listened as he explained all that happen. I asked him why he felt it was his fault. Then I told him that there was nothing that he could do about it. It was not his fault as they were camped out and sleeping when the attack happened.

I recommended that Brian continue to see me and also wrote a prescription for an anti-depressant and that he would need to see me weekly for at least the next three months. I also told him if he felt he could not go on, to call and I would talk to him, or have him come in.

I have diagnosed him with V71.01 – Adult Antisocial Behavior, V62.81 Relational Problems. These are the two major problems with Brian. He has always had AAB and is currently RP as he is alienating his parents and all his friends. I have signed him up for one of the 2 different group sessions for others with PTSD. I have also recommended him to take Melatonin to help calm him down so he can sleep better. I have also recommended that he join a yoga class to help calm him brain down and take the next level of recovery.

Bibliography
American Psychological Association. "Psychology's Impact." Psychology: Science in Action. Washington, DC: American Psychological Association, 2015.
Bauer, Russell M. "Evidence-based practice in psychology." UFL , n.d.
Bemak, F. "Applications in Social JUstice Counselor Training: Classroom without Walls." Journal of Humanistic Counseling. Questia, 2011, Vol. 50, No. 2.
Deep Dive Admin. "DSM-5 Codes." PsyWeb. May 15, 2013.
Foa, Edna. "Therapy for PTSD." Psych Central. Psych Central, July 12, 2015.
Goldberg, Joseph. "Anxiety Disorders." WebMd. 2014 WebMd, LLC, February 08, 2014.
Johnson, VanderStroep &. "Research Methods for everyday life: Blending qualitative and quantitative approaches." Research Methods. 2010. n/a. "What is involved in Psychiartric analysis." wiseGeek. wisegeek, n.d.
NYU. "Types of treatment." NYU Psychiatry. n.d.
Robinson, Patrice D. "Understanding reliability and validity in qualitative research." synomym. demand media, n.d.
Staff, Mayo Clinic. "PSTD-Causes." Mayo Clinic, n.d. . unknown. Journal of Clinical Psychology. DOI 10.1002/jclp, n.d. unknown. "what is the treatment for PTSD." Make The Connection, n.d.: section 3.
Washington, DC. "Diagnostic and statistical manual of mental disorders." U.S. Department of Veterans Affairs, 2014.
Washington, DC. "DSM-5 Criteria for PTSD." US department of veteran affairs, 2013.

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