Post traumatic stress disorder (PTSD) and its treatment.

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A girl who was sexually abused by her uncle gets very afraid upon seeing any middle aged man with beard. She avoids gathering involving men. She startles as soon as a scene of sexual assault appears on TV, has intense anxiety with tremor, sweating and  emotional numbness. She has been having night mares and have never been able to sleep well for last one month. If you have seen or heard of someone i described before, he/she might be having PTSD.

PTSD is an anxiety disorder following a stressful and traumatic event of an exceptionally threatening nature. It is mainly caused by tragic man made events happening to oneself or seeing it happen to others . Events such as witnessing violent death, being victim of sexual assault, rape,torture,terrorism or wars are by itself so dreadful to anyone but to some individuals, it can have protracted mental disturbances. It can be also caused by natural disaster such as flood or earthquake. It usually occur after 6 months following the traumatic event but might occur later as well. When it occurs, if the symptoms lasts for a month, you might consider seeing a psychiatrist. 

Studies have found that Females have double the risk of getting PTSD than man. And having experienced several stressful events unequivocally predisposes someone to get PTSD. Personality plays a vital role in deciding its incidence. Low self esteemed people are at higher risk. There is a propensity for section of society with low educational background. 

The symptoms of PTSD are as follows :

    1."Flashbacks" - its a recall of the traumatic event. Reconstruction of traumatic memories may be triggered by reminder of the trauma or it may simply be intrusive. 

    2.Avoidance of activities or events the reminisce the trauma. For example a soldier with PTSD might not like to go back to barracks after witnessing torturous death of his comrade. A driver with PTSD might not like to see vehicle of any sort after a road traffic accident. 

    3.Hypervigilence is manifested in then form of unnecessary alertness, exaggerated startle response, irritability and reduced concentration. 

    4.Insomnia due to recurrent nightmares.

It will have huge impact individually and socially. Avoidance of any event or activity which perilously used to excite him/her. Avoidance will deter relationship. Absenteeism from the regular duties is common. Anxiety attack at the workplace brings social stigma. This affects the so much so that some even resort to deliberate self harm. 

How to treat PTSD?

There is no pharmacological treatment but there are psychotherapies which can be arranged after consultation with the psychiatrist. One must visit a psychiatrist if the symptoms mentioned above have been persistent for a month. 

    1. Physchoeducation. The psychiatrist will educate him/her about the disease and counsel how to proceed with the treatment. One might be too protective about the victim and as a preventive measure, might feel the need for psychological reassurance right after any traumatic event. But psychological debriefing immediately after the trauma, is not advised. It's thought to be harmful instead. After all not all traumatic episodes will cause PTSD. More than 80% of people are immune. 

    2.Trauma focused Cognitive Behavioural Therapy (CBT). The therapist will manipulate his/her thoughts about the incident and improve the way he/she behave through counselling, advice and assurance. 

    3.Graded exposure to the avoided situation. The therapist will start with least fearful trigger and gradually increase to the most dreaded one. But the end of the therapy, the patient would have developed resistance to the same trigger which would elicit anxiety before. 

    4.Eye movement desensitization and reprocessing (EMDR) 

EMDR therapy is an eight-phase treatment.  Eye movements (or other bilateral stimulation) are used during one part of the session.  After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.  For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.”  Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes.  The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them.  Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.(from emdr.com)

The anxiety and sleep disorders can be managed with medicines because they are different psychiatric illness which can be managed by pharmaceutical therapy.

 50% have been found to recover with in a year but 30% will have a chronic course. Good social support and prevention of such traumatic events further has proved to yield better and faster outcomes.