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This section of the website will provide an overview of Traumatic Stress-Related Disorders. Since disorders of this nature are diagnostically broken down into several categories, the following will focus on a single sub-category, Post Traumatic Stress Disorder (PTSD), outlining the basic information that is pertinent to this specific classification. Discussion will include a general summary of trauma or stress-related conditions, followed by a brief overview of the diagnostic criteria for PTSD, its symptoms, and finally treatment methods.
Trauma and Stress Disorders
Psychological, stress-related traumas cause a variety of conditions that result from experiencing an event that is disturbing, terrifying, or perceived as life-threatening. The stressor might be a single moment, such as a rape, or one in a series of repeated events, such as cycles of abuse or repeated molestations. In the aftermath of the occurrence, the victim is left overwhelmed and without the means of integrating the event(s) into their life. The sense of being out of control or overwhelmed can be delayed, the onset not occurring for weeks, days, or, in some cases, years. This is especially true where the event in question has lain buried, such as when an adult recalls being molested as a child.
It should be noted that in general, stress is a normal response to certain stressors and is not itself destructive. The process of trying to normalize stressful events is basic to our make-ups; and is not only natural but necessary to our survival. The fight-or-flight response developed as a survival instinct to situations in which the life of the individual was put in jeopardy. Typically, the causes of this form of psychological trauma are reserved for specific varieties of violence: sexual abuse, physical abuse, or severe and prolonged emotional abuse (additionally, exposure to natural disasters such as earthquakes, floods, or fires, or surviving catastrophic events such as genocide, will also play a part in generating stress-related disorders). However, exposure to certain stressors, whether prolonged or for a short duration, have the potential to develop into debilitating conditions that in time can adversely affect virtually all aspects of an individual’s life.
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a variety of Anxiety Disorder that occurs after a person has experienced a particularly disturbing event or events. The events in question are referred to as triggering events, and can be either one specific incident – e.g., witnessing a violent crime or surviving a car accident – or a series of incidents – e.g., enduring repeated sexual or physical abuse. What follows the triggering event is a type of psychological trauma, which can manifest as both emotional and somatic disturbances. Triggering events cover a fairly broad spectrum of occurrences, and are defined more by the havoc they reap than the nature of events itself. Events can include exposure to life and death situations, the death of a friend or loved-one; witnessing the death of a stranger , experiencing physical harm or surviving some form of abuse such as incest. Diagnostically, symptoms must meet very specific criteria to be considered PTSD. These criteria include symptomology that lasts more than a month and that causes demonstrable and significant social impairment, occupational impairment, or impairment in other areas of one’s life, such as with family or associates.
As stated previously, fear responses are not necessarily negative; they are an instinctual reflex that cuts across cultural and linguistic differences, and evolved to ensure our survival. However, when this reflex goes unchecked and has taken hold to the extent it has in PTSD sufferers, debilitation occurs that effect every aspect of normal functioning. For example, one of the distinctive features of PTSD is a trait called Avoidance, which causes the sufferer to become preoccupied with avoiding any stimuli they fear might trigger a stress-response. Although relatively well-adjusted individuals will also strive to avoid situations they fear might engender negative or unpleasant feelings, they do not do so to the point where their emotional, psychological, or physical well-being is compromised.
Symptoms of PTSD
Generally, symptoms of PTSD fall into one of three categories. These categories include reliving the event, performing avoidance behaviors, and experiencing arousal. To meet a diagnosis of PTSD these symptoms will invariably effect or impact all aspects of daily functioning. Symptoms include:
- Pronounced and reactions to scenarios that bring to mind the triggering event, and that deeply disturb the individual, often causing physiological reactions such as palpitations, racing heart, sweating or shaking.
- Recurring nightmares of the event.
- What are referred to as flashback-episodes, during which the event seems to be happening over and over.
- Repeated and intrusive memories of the event that cause physiological duress.
- Feeling detached or removed from reality.
- Emotional numbing or feeling disconnected from things one would be expected to care for.
- Depressed moods or retarded affect.
- The conviction that one has no future.
- Experiencing blackout periods, during which one is unable to remember certain features of the trauma.
- Experiencing anhedonia and a lack of interest in daily activities.
- Avoiding places, people, or thoughts that remind you of the event.
Arousal symptoms include:
- Experiencing difficulty concentrating or thinking in a linear fashion.
- Experiencing sleep disturbances, e.g., having trouble falling asleep or staying asleep.
- Having a sense of hyper-awareness of situations; what is referred to as hyper-vigilance.
- Being on edge and startling easily.
- Having difficulty relaxing.
- Demonstrating an exaggerated response startling events.
- Suffering continual bouts of irritability or having outbursts of anger.
In addition to these symptoms it is common for people to experience feelings of guilt in the aftermath of the triggering event; what is referred to as survivor’s guilt, especially with regards to situations where a person has survived some sort of natural or man-made disaster. The incidence of co-occurring disorders such as Anxiety Disorders or Depression is extremely high in this population.
Treatment for PTSD
Treatment of PTSD requires the use of several therapeutic modalities, in addition to employing certain medications designed to alleviate physiological symptoms. The therapeutic styles utilized to treat PTSD differ from one another with regards to style and the fundamental assumptions they make about the individual and their condition. Psychotherapy might take the form of Psycho-Education, Cognitive Behavioral Therapy, Exposure Therapy, Group Therapy, or Supportive Therapy.
Cognitive Behavioral Therapy (CBT) – this modality is currently one of the most widely used therapeutic styles. In addition to helping people manage Stress-Related Disorders it has also proved beneficial to individuals suffering from a wide range of conditions, including Anxiety Disorders and Substance Abuse Disorders. With regards to Trauma-Related conditions, the focus is on altering the dysfunctional thinking that has developed as a response to the trauma, and requires the client to adopt modified behaviors in situations where exposure to a stressor is present. One of the primary advantages of Cognitive Behavioral Therapy is its tendency to alleviate stress-symptoms while simultaneously curtailing the condition itself. The central premise is to help the client develop new coping strategies in the face of impending or inevitable arousal.
Different modes of CBT include:
- Exposure Therapy – by exposing individuals to the trauma they experienced, this therapy seeks to diminish stress responses by providing a safe, clinical environment in which they can process their feelings. Often therapists using this style will employ mental imagery, writing, or even supervised visits to the place where the event occurred.
- Cognitive Restructuring – helps people make sense of the negative memories that are generated by the triggering event, in addition to identifying points where their emotional reactions take precedence over their intellectual capabilities. Frequently people remember events in a way that reinforces the stress-response, which keeps them locked in a deleterious cycle, and which does not correspond to the actual event(s) in question.
- Stress Inoculation Training – tries to reduce stressful symptoms by teaching a person how to reduce anxiety. Like Cognitive Restructuring, this mode of CBT strives to assist people to orient themselves to painful memories in a healthier manner.
Other modalities used to treat Stress-Related Disorder include:
Psycho-Educational Therapy (PET) – this is an off-shoot of Cognitive Behavioral Therapy, and its guiding features rest on the idea that over time the person is capable of recreating themselves (their self-image) with regards to their condition. PET employs a combination of strategies, including what is known as cognitive restructuring and the development of management skills to help navigate symptoms as they occur. The management skills are cultivated in conjunction with controlled exposure to specific stressors.
Psychological Debriefing – Psychological Debriefing uses an informational format to achieve results. By using the clinical dynamic as a means to convey information, the client will acquire a deeper understanding of their condition and its hidden springs, and thus be better able to manage their symptoms. This takes the form of the therapist providing information about the nature of symptoms and the condition, while also providing a forum in which the client can express their feelings with regards to episodes and symptoms. To date there is very little supportive data showing its efficacy.
Supportive Therapies – Supportive Therapies include group and family counseling. One of the distinctive features of both group therapy and family therapy is its ability to utilize a communal experience to achieve therapeutic growth. Because of its intangible nature, these aspects of therapy are sometimes overlooked or underplayed. However, the positive therapeutic nature of healthy group experiences has been shown to consistently assist individuals manage both their condition and their symptoms, in addition to providing invaluable support for family members, friends, and significant others who have also been impacted by the disorder.
Medications for PTSD
Data suggests that medications can be used to assist treating symptoms of Stress-Related Disorder. What is known as serotonergic dysregulation can be addressed with the use of a class of medications called SSRIs (selective serotonin reuptake inhibitors). Although these medications are designed to treat the symptoms of depression, they have also proved beneficial treating stress-related disorders. The SSRIs most commonly prescribed include:
In addition to the SSRIs a class of medications known as Benzodiazepines, or minor tranquilizers, might also be employed to off-set anxiety-symptoms.
A Special Note Regarding Benzodiazepines, PTSD, and Dual Diagnosis:
Dual Diagnosis refers to a condition in which an individual’s addiction occurs simultaneously with another mental health problem, each aggravating the other and both contributing to the problems of the individual. In situations where a dual diagnosis has been made – especially where some form of Stress-Related trauma has been diagnosed in tandem with an addiction – the use of benzodiazepines is usually discouraged. Unlike the anti-depressants that are prescribed for stress-related disorders, benzodiazepines have a euphoric component and abuse potential that generally makes them inappropriate for treating a population with histories of addiction.
Because of these complications, most physicians specializing in treating dual diagnosed clients will only prescribe benzodiazepines in a very restrictive way, for the shortest duration possible. Given these considerations, dual diagnosed individuals have a better chance of receiving comprehensive care from treatment teams that are specifically trained to deal with individuals who suffer from co-occurring disorders.
The benzodiazepines most commonly prescribed for short-term treatment are:
- Alprazolam (Xanax)
- Diazepam (Valium)
- Clonazepam (Klonopin)
- Lorazepam (Ativan)
- Chlordiazepoxide (Librium)
Ultimately the prime objective of Stress-related Disorder treatment is to help the client return to the levels of functioning they enjoyed prior to the triggering event. This means simultaneously decreasing the severity of symptoms while improving management of symptoms. This might include successfully utilizing family and friends as support networks, and slowly re-immersing one’s self back into work, school, or social activities.
Generally speaking, treatment of Stress-Related conditions attempts to achieve the following:
- Provide education about trauma and its symptoms.
- Teach sufferers relaxation and anger control skills.
- Help sufferers identify and deal with various emotional reactions to the presence of symptoms, which include guilt, shame, and feelings of inadequacy pertaining to the event.
- Helping identify strategies and skills to help change how people react to their condition and its symptoms.
Like other mental health disorders, no known cure exists for any of these conditions. However, with vigilance and maintenance it is possible to manage the conditions and allow for considerably better quality of life.
The topic of Stress-Related Disorders is large and not easily summed up in one article. Education and awareness are the first steps to acquiring help. Please visit the various sections of ARC’s website to acquire detailed information regarding each specific Stress-Related diagnosis. Take the time necessary to keep yourself informed about latest practices and current treatment options. Hopefully this article will assist giving you a foundation of knowledge that will make selecting the correct course of treatment easier to determine.
Call to Learn More about the Authentic Recovery Center Today
Many people who abuse drugs and alcohol have PTSD. Unfortunately, most treatment centers do not truly offer dual diagnosis services to attend to this type of issue. The Authentic Recovery Center offers one of the most sought after post-traumatic stress disorder treatment programs in the United States. If you would like to learn more about our services call 1 877 415 4673 now.