Synonyms
Post Traumatic Stress Disorder, PTSD, Trauma
Definition
The actual term post-traumatic stress disorder has its origins in the military. Soldiers who became unfit for service during the Vietnam War due to various war events, because they were exposed to the strongest physical or mental stress, received this diagnosis. In previous wars the disorder was given other names.
In World War I, for example, the very apt term “Shell Shock” was used. This refers to the shock of the innermost psychic core (shell). Nowadays the diagnosis is also used in civilian areas.
Whenever a person is exposed to an event of extraordinary physical or mental threat, there is a risk of developing PTSD. Women are usually affected significantly more often than men. Some studies assume a ratio of 2:1.
Possible reasons for this are, for example, the high probability of developing PTSD (post-traumatic stress disorder) after rape (probability approx. 50%), as well as the probability of approx. 20% for victims of violent crime.
The risk for women to become a rape victim once in their life is about 8% in Germany. Overall, the probability of suffering PTSD (post-traumatic stress disorder) once in a lifetime is between 10-12% for women and 5-6% for men. Other traumas with a high risk of PTSD are Fighting in war, child abuse, torture, captivity, but also car accidents, or being an eyewitness to an accident.
Diagnostics
Diagnostic criteria according to ICD-10SymptomaticSymptoms Symptoms typically occur within 6 months after the stressful event. A later onset may also be possible. The diagnosis should be made by a physician or psychologist experienced in psychotherapy.
2 instruments typically used in diagnostics are “Impact of Event Scale”- R (IES-R) Horowitz et al. 79, German version: Maercker 98 4 Factor Structure: The questionnaire is short and simple. Questionnaire on thoughts after traumatic experiences (PTCI) Foa, Ehlers 2000 self-disclosure instrument to identify problematic interpretations of the trauma and its consequences, seven-level Likert scale, 3 factors.
Causes for the development of post-traumatic stress disorder: Disorder concept according to Ehlers and Clark: Anxiety is a feeling that usually refers to a current or future situation. In PTSD (post-traumatic stress disorder), however, a massive feeling of fear with the above-mentioned symptoms arises because of a past event. In the Ehlers and Clark model of the disorder, it is now assumed that the trauma has been mishandled in the affected person in such a way that memories of the event are perceived as a current, present threat.
For perception in general it is assumed that two processes can be held responsible for a person perceiving past events as a current threat.
- Those affected were exposed to an event or occurrence of extraordinary threat or catastrophic proportions that would trigger almost any profound despair.
- Persistent memories or re-experience of the stress through intrusive reverberations (flash-backs), vivid memories, recurring dreams or through inner distress in situations similar to or related to the stress. (Possibly a kind of emotional dullness or apathy and indifference may also appear)
- Similar circumstances are actually or if possible avoided.This behavior did not exist before the event
- One of the points mentioned below: Inability to remember some important aspects of the trauma Persistent symptoms of increased psychological sensitivity and arousal (not before dreaming) with two of the following characteristics: difficulty falling asleep and staying asleep (sleep disorder) irritability or anger outbursts difficulty concentrating hypervigilance (state of heightened arousal) increased jitteriness
- Inability to remember some important aspects of the trauma
- Persistent symptoms of increased mental sensitivity and arousal (not before dreaming) with two of the following characteristics: difficulty in falling asleep and staying asleep (sleep disorder) irritability or outbursts of anger concentration difficulties hypervigilance (state of heightened excitement) increased jitteriness
- Insomnia (sleep disturbance)
- Irritability or outbursts of anger
- Concentration difficulties
- Hypervigilance (state of increased arousal)
- Increased jerkiness
- Inability to remember some important aspects of the trauma
- Persistent symptoms of increased mental sensitivity and arousal (not before dreaming) with two of the following characteristics: difficulty in falling asleep and staying asleep (sleep disorder) irritability or outbursts of anger concentration difficulties hypervigilance (state of heightened excitement) increased jitteriness
- Insomnia (sleep disturbance)
- Irritability or outbursts of anger
- Concentration difficulties
- Hypervigilance (state of increased arousal)
- Increased jerkiness
- Insomnia (sleep disturbance)
- Irritability or outbursts of anger
- Concentration difficulties
- Hypervigilance (state of increased arousal)
- Increased jerkiness
- “Intrusion” (reverberation memories)
- “avoidance”.
- “Overexcitation”
- “Numbing” (emotional numbness)
- Negative cognitions about yourself
- Negative cognitions about the world
- Self-accusation
- The individual interpretation (interpretation) of the event and its consequences: It is assumed that patients with PTSD cannot see the bad event as a time-limited event that will not necessarily have negative effects on their lives.
It is further assumed that patients with PTSD (post-traumatic stress disorder) so often evaluate and interpret the event and its consequences negatively that they perceive it as a very real threat.
- The so-called “trauma memory“: Patients with PTSD often have great difficulty in remembering the event completely on purpose. Often only fragmentary memories are formed. On the other hand, there are unwanted memories that force themselves upon the patient.
In these moments, the patient experiences them as if the event were happening again in the present moment. The trauma cannot be inserted into the actual structures of the memory. Normally we put memories in a temporal context (e.g. “That was 1999.
It was hard, but it’s over… “). This is not possible with PTSD. Due to relatively low stimuli, the feeling of being threatened can occur at any time (e.g. slamming a car door reminds us of the car accident, etc.
).
These stimuli remind patients of stimuli they perceived shortly before or during the trauma (sounds, smells, etc.). Stimulus and trauma are thus coupled, so to speak. Whenever the patient later perceives such or similar stimuli, the trauma can become present again in one fell swoop without the patient being able to explain it to himself.
In addition, patients with PTSD seem to be more aware of bad, i.e. trauma-specific stimuli (the so-called priming). (For example, a woman who has been attacked by a bearded man often sees men with beards immediately from a crowd. )As a consequence, such disturbances in perception usually result in a change of behavior and thoughts.
Patients very often tend to avoid situations that they think might cause disturbances. Also, any thoughts about the event are often suppressed. Unfortunately, this avoiding behavior has an opposite (paradoxical) effect, i.e. thoughts and feelings of threat are more frequent.
