A JOURNEY TO POSTTRAUMATIC STRESS DISORDER

Theoretical Approaches to mental

health and illnessSajia Afrin

LEARNING OUTCOMES: What is PSTD?

The leading factors and symptoms of PSTD.

Association of different theoretical approaches with PSTD.

Social perspective of PSTD.

Conclusion.

HOW CAN WE IDENTIFY?

Have you experienced flashback of any horror events make you more nervous, and increase fear in your mind?

Have you seen any person with headlight car crash may report headlights coming towards him all the time?

Have you ever felt troubling to remember all parts of any event?

How do you feel about this?

It is PSTD (Post-Traumatic Stress Disorder)

WHAT IS PSTD ??

It is an anxiety disorder.

People often experience when they exposed to any traumatic

events and recall and reexperience the horrible moments

repeatedly.

Development of PSTD associated with significant functional

impairment.

( Skelton et al, 2011)

(Yehuda, 2002)

WHAT CAN LEAD TO DEVELOP PSTD?

Any traumatic events……………………

• Vicious personal assaults

Child sexual attack

Sexual assault

Physical abuse or attack

• Terrorist attacks

•Serious accidents.

•Natural disasters.

• Combat or Military exposure.

• Massive loss and death in war.

WHO CAN BE SUSCEPTIBLE TO THIS DISEASE ?

Everybody !!!!

HOW SEVERE IT IS??????

Lifetime prevalence is 8 % ( among general population).

Risk of people who exposed with traumatic events are 75 %.

Rates as high as 58% in heavy combat

1-14% non combat

Torture ( 50-75%)

Natural Disaster victims 4-16%

Twice percent common in women than men

The conditional risk for PSTD ranges from 5 to 31% (Kulka et al,

1990)

WHEN DOES IT DEVELOP ????

Person may develop PTSD after a week or month after experiencing traumatic events.

It often develop adequately after 3 months of traumatic events.

For some people it develops after 6 months.

It continues with a longer period of time.

WHAT ARE THOSE SYMPTOMS????

Difficulty in concentration

Problem in forget things and events.

Re-experiencing traumatic events through flashback or nightmares.

Avoiding people, places or reminding the past trauma.

Feeling detached from others.

Feeling angry and unable to trust people.

Feeling numb, hopelessness and fearful .

Disturbance in sleeping.

WHAT CAUSES TO THIS DISEASES?

Genetic and PSTD:

PSTD is heritable!!!!!!!

People with first-degree relatives have twice more higher risk to develop

PSTD.

Monozygotic twins have 30% possibility to develop PSTD.

(Lyons et al, 1993)

Weakness of the genetic model:

No specific gene found.

No separation from environmental factors.

PTSD cannot be assessed in those individuals who are not exposed to trauma.

Result can’t be generalized.

NEUROBIOLOGY AND PSTD

Changes in HPA Axis Vulnerability to PSTD

I. Volume of the hippocampus is reduced.

II. Functional changes in Amygdala.

III. Decreased volume of frontal cortex.

IV. Alterations in functions of neurotransmitters (GABA, Serotonin)

(Christine et al, 2009)

Weakness of the model

No enough explanation of structural alterations of amygdala.

Dependent on medications to cure patients.

Medications are expensive and leave side effects.

NEUROBIOLOGY AND PSTD CONT……..

Psychodynamic model and PSTD

1. Cognitive- behavioral model and PSTD

2. Humanistic-existential model and PSTD

Strength of the model Deal with individual patients emotions and feelings.

Allow patients for free association.

Descriptive explanation available.

Reflects a broader meaning of this disease.

Psychodynamic and PSTD cont….

Weakness of the model :

Less scientific evidence.

Too complex and hard to understand.

Very subjective.

Though psychodynamic model have some weakness in representing the PSTD disease, but is it one the best model that covers and explains the hidden attributes of the post-

traumatic stress disorder.

SOCIAL PERSPECTIVES OF PSTD

People who develop PSTD often face social withdrawal that increase

the vulnerability more than preliminary stage.

TO SUM UP…Genetic model and PSTD : Heritability association of PSTD.

Neurobiological model and PSTD: Brain functions dysfunction.

Cognitive-behavior model and PSTD: Relationship of emotions and reactions.

Humanistic-existential model and PSTD : Psychological interaction of human with society and world.

Psychodynamic model is best

REFERENCES Ananda B. Amstadter, Nicole R. Nugent, and Karestan C. Koenen,. "Genetics of PTSD: Fear Conditioning as a Model for Future." NIH Public Access. 2009: 39(6): 358–367. Anke Ehlers, David M. Clark. "A cognitive model of posttraumatic stress disorder." Behaviour Research and Therapy. 1999: 27.

Christine Heim, Charles B., Nemeroff. "Neurobiology of Posttrumatic Stress Disorder." CNS Spectr .2009: 12.

Claes SJ. "Corticotropin-releasing hormone (CRH) in psychiatry: from stress to psychopathology”. Ann Med 2004: 36(1):50–61.

Corbett L., Milton M. "Existential Therapy, A useful Approach to Trauma?" Family therapy. 2000: 31.

Lyons MJ, Goldberg J, Eisen SA, True W, Tsuang MT, Meyer JM. “Do genes influence exposure to trauma? A twin study of combat. American Journal of Medical Genetics”. 1993: 48(1):22–27. Yehuda R. "Post-Traumatic Stress Disorder ." The New England Journal of Medicine. 2002:108-114: Vol. 346, No. 2. "Understanding Post-traumatic Stress Disorder." Post-traumatic Stress Disorder. 01 Nov. 2012. <http://www.mind.org.uk/help/diagnoses_and_conditions/post-traumatic_stress_disorder>.

Skelton, K., et al., PTSD and gene variants: New pathways and new thinking, Neuropharmacology (2011),doi:10.1016/j.neuropharm.2011.02.013

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