Post-traumatic stress disorder

What is post-traumatic stress disorder?

Post Traumatic Stress Disorder (PTSD), may arise as a result of a traumatic event involving direct personal experience of an event that causes or may result in death or serious injury or other threats to physical integrity; or the presence at an event that results in death, injury or other threats to the physical integrity of another person; or knowledge of violent or unexpected death, serious harm or threat of death or injury endured by a family member or other person with whom one is in close relationship (DSM-5).

The first studies on the characteristics and treatment of this disorder concerned war veterans, but the signs and symptoms outlined can be detected as a consequence of any serious experience, especially if it is perceived as unpredictable and uncontrollable.

Events that can cause PTSD include: war, rape, natural disasters, kidnapping, physical assault, medical procedures (especially in children), the sudden death of a loved one, car or plane accidents, sexual or psychological abuse.

PTSD is a normal response of people to one or more abnormal situations. The traumatic event that triggers the disorder is so intolerable and frightening that it would upset most people. When our sense of security is shattered, it is normal to have the impression of losing one's mind, of feeling disconnected from reality, as if enveloped in a funereal cloud. The only difference between those who develop PTSD and those who do not is how they react to the trauma. The factors that condition the response to trauma are:

• the age at which one undergoes it
• duration over time (repeated series of events over time, prolonged nature of the trauma)
• the interpersonal nature
• individual psychological characteristics
• the victim's inability to end or avoid the trauma
• the context in which it takes place (in the family)

After a traumatic experience, the mind and body are in shock. The memory of what happened and the feelings associated with it are disconnected. To be able to move on, it is important to deal with and manage memories and emotions.

Symptoms of post-traumatic stress disorder

The symptoms of post-traumatic stress disorder may occur immediately, gradually, or come and go over time. Sometimes they arise unexpectedly, other times some external stimulus, such as a noise, a picture, words or a smell, reminds one of the traumatic event.

While each individual experiences symptoms differently, categories that those suffering from PTSD have in common include:

Reliving the traumatic event: intrusive and painful memories of the event; flashbacks (acting out or having the feeling that the event is happening again); nightmares.

Avoid anything that may remind you of the trauma: avoidance of activities, places, thoughts or emotions reminiscent of the trauma; inability to recall important aspects of the trauma; loss of interest in activities and life in general; difficulty concentrating; substance or alcohol abuse.

Increased anxiety and physiological activation: feeling of intense stress associated with the memory of the trauma; intense physical reactions when faced with the memory of the event; difficulty falling asleep and waking up at night; hypervigilance.

Difficulties in interpersonal relationships: lack of assertiveness; outbursts of anger; victimisation or re-victimisation; feelings of alienation and loneliness.

Difficulties in managing emotions: feeling of detachment from reality; limited sense of the future; irritability; depression; suicidal thoughts; emotional inhibition; guilt, shame.

The in-depth study of the nature of trauma and its consequences has led to the definition of a further category of symptoms and signs called complex post-traumatic disorder.

The complex trauma

Complex trauma is for the time being not included in the DSM 5 (Diagnostic Statistical Manual of Mental Disorders), but finds a place in the ICD 11 (Eleventh Revision of the International Classification of Diseases), which defines it as "... a disorder that may develop as a result of exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which it is difficult or impossible to escape (e.g., genocidal campaigns, prolonged domestic violence, repeated sexual or physical abuse in childhood). , campaigns of genocide, prolonged domestic violence, repeated sexual or physical abuse in childhood). All diagnostic requirements for post-traumatic stress disorder are met. Complex trauma is, in addition, characterised by:

• severe and persistent problems in the regulation of affections;
• negative beliefs about oneself (feeling inferior, bad, worthless) accompanied by feelings of shame, guilt or failure related to the traumatic event; and
• difficulties in maintaining relationships and feeling close to others."

Given the numerous overlaps of the effects of complex trauma with features of diagnoses such as personality disorders, dissociative disorders and psychotic disorders, it is important to emphasise the importance of early intervention and proper case assessment in determining a favourable prognosis.

 

How can we help you?

Trauma-focused Cognitive Behavioural Therapy

People with PTSD often try to avoid anything that reminds them of trauma. This may help them feel better in the short term, but not in the long term. In particular, avoiding feelings, situations or objects actually prevents and hinders recovery.

The approaches that have been most exhaustively studied and recognised as most effective in the treatment of trauma are:

Exposure-based therapies (ET). They include techniques of in-vivo, imaginative and narrative (oral or written) exposition, but also generally include elements of cognitive restructuring (e.g., evaluation of beliefs related to the perception of danger, etc.) as well as relaxation techniques and self-monitoring of anxiety.

Cognitive processing therapy (CT). They include cognitive restructuring (challenging automatic or acquired thoughts following the traumatic event such as beliefs about safety and confidence) but also include relaxation techniques and discussion/narration of the trauma both verbally and in writing.

Stress Inoculation Training (SIT). The most studied specific treatment for anxiety management in the literature on post-traumatic disorder places great emphasis on breathing training and muscle relaxation, but also includes cognitive elements (internal dialogue, awareness of dysfunctional patterns, etc.) and exposure techniques (in-vivo or narrative of the traumatic event).

Desensitisation and reprocessing through eye movements (EMDR). It closely resembles other cognitive-behavioural modalities in that it uses exposure elements (e.g., talking about the traumatic event and/or recalling traumatic memories without verbalising them) in combination with cognitive components (e.g., identifying negative thoughts, identifying an alternative thought and assessing the validity of a thought) and relaxation and self-monitoring techniques (e.g., breathing, body scan). Alternating eye movements and bilateral body stimulation are characteristic elements of the EMDR technique.

The STAIR method - Affective and interpersonal regulation skills training. The STAIR method, training in affective and interpersonal regulation skills, has proven to be the treatment of choice for people with post-traumatic disorder, including chronic and complex forms and in comorbidity with other problems. The objective of the training is to transfer emotional and interpersonal management skills to the subjects. It includes techniques of narrative exposition (oral or written) useful for the re-elaboration of traumatic memories.