Introduction to posttraumatic stress disorder
Introduction to posttraumatic stress disorder
Book Crisis Intervention Strategies
Author:
Richard K. James; Burl E. Gilliland
Introduction to posttraumatic stress disorder (PTSD).
Part II’s discussion of the more common types of cri- ses that you, as a mental health worker or consumer of mental health care, are likely to encounter opens with posttraumatic stress disorder (PTSD). The reason for beginning here is that many other crises reviewed in this book may be rooted in PTSD. For ex- ample, suicide (Chu, 1999; Kramer et al., 1994) and substance abuse (Ouimette, Read, & Brown, 2005; Read, Bollinger, & Sharansky, 2003) may be the end products of attempting to cope with trauma. In contrast, rape, sexual abuse, battering, loss, physical violence, hostage situations, and large-scale natural and human-made disasters may precipitate the dis- order (Ackerman et al., 1998; Bigot & Ferrand, 1998; Darves-Bornoz et al., 1998; Davis et al., 2003; Elklit & Brink, 2004; King et al., 2003; Lang et al., 2004; Melhem et al., 2004; North, 2004; Pivar & Field, 2004). Going one-on-one with PTSD is tough enough, but to make matters worse, lots of times PTSD turns into a gang war with a host of other comorbid (occurring along with it) problems that make it even harder to deal with as individuals bounce in and out of trans- crisis (Masino & Norman, 2015). Finally, PTSD-like symptoms may appear in the very people who attempt to alleviate the mental and physical suffering of peo- ple in crisis (Figley, 2002; Halpern & Tramontin, 2007; Pearlman & Saakvitne, 1995) and have become known as compassion fatigue (Figley, 2002) and vicar- ious traumatization (Pearlman & Saakvitne, 1995). We know this is a long chapter and you might need to take a nap or a snack break to get through it. Try as we might to prune it down, we felt that “all this stuff” was critical to giving you the background for understanding not only what PTSD is about, but what occurs in treating the other crisis and transcri- sis topics in this book. What we knew about PTSD in the first edition of this book in 1987 and what we know about it now—particularly the neurobiology and just how complex that is in manifesting the various traumatic responses that occur in humans— is like the difference between writing with a goose quill, inkwell, and papyrus scroll and word process- ing with an Apple Thunderbolt, OSX Lion operating system, and high-speed printer/scanner/fax. So bear with us! If you nail this chapter down, the other chapters will make a whole lot more sense as to how “all this stuff” goes together. In summary, PTSD has moved from the psychological backwaters of the Vietnam War to now being so central to treatment issues in mental health that there is the National Center for PTSD (http://www.ptsd.va.gov) and the National Child Traumatic Stress Network (NCTSN) www.nctsn.org.
Background
Psychic trauma is a process initiated by an event that confronts an individual with an acute, overwhelming threat (Freud, 1917/1963). When the event occurs, the inner agency of the mind loses its ability to control the disorganizing effects of the experience, and disequilibrium occurs. The trauma tears up the individual’s psychological anchors, which are fixed in a secure sense of what has been in the past and what should be in the present (Erikson, 1968). When a traumatic event occurs that represents noth- ing like the person’s experience of past events, and the individual’s mind is unable to effectively answer basic questions of how and why it occurred and what it means, a crisis ensues. The traumatic wake of a crisis event typically includes immediate and vivid reexperi- encing, hyperarousal, and avoidance reactions, which are all common to PTSD. The event propels the indi- vidual into a traumatic state that lasts as long as the mind needs to reorganize, classify, and make sense of the traumatic event. Then, and only then, does psy- chic equilibrium return (Furst, 1978).
The typical kinds of responses that occur imme- diately after the crisis may give rise to what are called peritraumatic (around, or like, trauma) symptoms. These are common responses as the mind attempts to reorganize itself and cope with a horrific event. For many people, these responses will slowly disappear af- ter a few days. Most people are amazingly resilient in the aftermath of a traumatic crisis and quickly return to mental and physical homeostasis, but if the symp- toms continue for a minimum of 2 days and a max- imum of 4 weeks and occur within 1 month of the traumatic event, then those time frames will meet the criteria of acute stress disorder (ASD) (American Psychiatric Association, 2013). Acute stress disorder diagnostic criteria are similar to the criteria for PTSD, which you will soon meet, except that the diagnosis can only be given in the first month after a traumatic event. ASD is somewhat different than PTSD be- cause dissociative symptoms such as memory loss, a sense of detachment from the world, belief that things and people are unreal, a blurred sense of iden- tity, and a general disconnect from reality are present (International Society for the Study of Trauma and Dissociation, 2015). As we will see, it is important to tackle ASD symptoms immediately and head on, be- cause they tend to be valid predictors for “catching” PTSD. Percentage rates for ASD vary a great deal de- pending on trauma type from vehicle accidents that range in the teens, to victims of robbery in the twen- ties, and to rape which skyrockets to the nineties (Gibson, 2015).
