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PTSD Explained

PTSD researcher Dr. Paula Schnurr received the Ladies Home Journal "Health Breakthrough Award" for her work with PTSD and women veterans this year. She provided needed data that revealed benefits of prolonged exposure therapy. Now you may have thought all therapies were equal, but they are not. In fact, an assessment conducted by the American Psychological Association found a deficiency of research on PTSD, which is of growing concern in today’s complex global war and terrorism climate.

If you're wondering about PTSD because you've heard about it in the news or you know someone who suffers from it, or if you are battling it yourself, here's a little information about the history of PTSD along with some information about recent treatments.

First known as “Shell Shock” among WWI veterans, PTSD (Post-traumatic Stress Disorder) is a debilitating condition brought on from witnessing or experiencing a traumatic event (see below for criteria). It affects about 5.2 million Americans aged 18-54. Traditionally, PTSD treatments have included a mixture of psychotherapy (talk therapy), pharmacotherapy (medication), Eye Movement Desensitization (EMDR) and Cognitive Behavioral Therapy (CBT). In addition, newer research about Exposure Therapy has demonstrated some promising results. Exposure Therapy involves slowly and carefully re-exposing the person to images of the trauma until the images and memories no longer evoke an anxiety response. Please note that researchers are continuing to investigate even better treatments.

Because no one treatment fits all, researchers are also recognizing those who suffer from Complex Grief. Complex Grief can be experienced by those who have PTSD (similar to Survivor’s Grief—the guilt and grief one experiences when surviving a war or tragedy). It can also affect family members of lost soldiers in war. Part of the grieving and healing process involves finding meaning in the loss. The complexity comes about when meaning can’t be found. In addition, researchers are discovering that the former “move on” approach isn’t working. Rather, it’s about honoring and remembering.

DSM-IV Criteria for PTSD

A. The person has been exposed to a traumatic event in which both of the following have been present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways: (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. (2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur. (4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. (5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma (2) efforts to avoid activities, places, or people that arouse recollections of the trauma (3) inability to recall an important aspect of the trauma (4) markedly diminished interest or participation in significant activities (5) feeling of detachment or estrangement from others (6) restricted range of affect (e.g., unable to have loving feelings) (7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (1) difficulty falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating (4) hypervigilance (5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


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