Almost threatening or catastrophic which would be likely to

Almost 10% of the United States population suffers from PTSD, both chronic and acute (DAV). However, when the topic of PTSD comes forward in conversation, many people picture a wounded American soldier returning home, but unable to sleep or function normally. While this image is not technically incorrect, PTSD (Post-Traumatic Stress Disorder) affects many more people than just those who have served. The DSM-IV, by the American Psychiatric Association describes a traumatic event as  “an experienced or witnessed event that carries the threat of death or injury and evokes feelings of terror, horror or helplessness” (APA). Another source, the ICD-10 written by the World Health Organization, defines trauma itself as “having an exceptionally threatening or catastrophic which would be likely to cause pervasive distress” (WHO). The most common sources of trauma are often combat related or due to sexual assault, sexual abuse, torture, and any accident that results in bodily harm. In certain cases, even natural disasters can lead to a diagnosis of PTSD. The symptoms of PTSD can be crippling or subtle, depending on the person, but there are a wide variety of treatments available for those suffering from the disorder.After enduring trauma, there are a number of not just psychological but physical symptoms that manifest either immediately after the event or surface months or years afterwards. Posttraumatic Stress Disorder, as described in DSM-IV, is a set of symptoms that begins after a trauma and persists for at least one month after the trauma has occurred. According to the National Library of Medicine, PTSD symptoms fall into three clusters. Firstly, the person experiences “reliving” the traumatic event either through nightmares, intrusive thoughts or flashbacks. Secondly, the individual must have some form of avoidance such as the shunning of any thoughts or emotions about the trauma, amnesia or repression of the events or emotional numbing and detachment from those around them. Finally, according to the NCBI, the person must experience at least two of the following: “sleep disturbances, difficulty concentrating and studying, irritability or an exaggerated startle response” (NCBI). To be diagnosed with PTSD, these symptoms must cause a noticeable disability in daily functioning and relationships. While the NCBI’s list of diagnostic criteria provide a decent overview of all symptoms in usual cases, symptoms can vary widely depending on the trauma endured, duration of the trauma and the age at which the trauma occurred which in turn makes the NCBI’s definition inadequate. On the other hand, the ICD-10 defines PTSD simply as,  “Symptoms include disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, continue for more than a month after the occurrence of a traumatic event” (WHO). The major difference between the diagnostic criteria for these two sources is that the NCBI has specified a minimal number of symptoms that must be present for the individual to receive a diagnosis of PTSD. On the other hand, the ICD-10 is more vague and allows for those who fall into the gray areas of medicine to receive treatment as the coding itself leaves more room for doctoral judgement. Meaning that if a patient has been through a traumatic event and requires treatment but does not meet the criteria for an official diagnosis as described by the NCBI, the still psychiatrist has the freedom to diagnose them. This is thanks to the more lax definition written in the ICD-10.Patients may also be affected by more than just their PTSD symptoms. Those with PTSD are more prone to depression, anxiety, dissociation, substance abuse and addiction, as well as physical health issues. The rate of drug abuse, including nicotine and caffeine, in traumatized individuals is much higher than those in the general population. This is thought to be explained by the need to cope through substance abuse, but also that substance abuse increases the risk of experiencing a traumatic event. Depression and anxiety are also common. According to the DSM-10, symptoms of depression include “sadness, fatigue diminished interest in activities, sleeplessness, and eating disturbances such as Anorexia Nervosa and Binge Eating Disorder” (DSM-10). According to the US National Library of Medicine, “The rate of anxiety is especially elevated in people with PTSD. Panic disorder in Vietnam veterans with PTSD was 21% in females and 8% in males, compared to just 1.5-3.5% in the general population. OCD was found in 13% of female veterans and 10% in males, as compared to 2.5% of the general population” (NLM). It is important to note that while the symptoms of these two disorders overlap in some aspects, the disorders are completely separate entities and must be treated in the clinical setting as such. In addition to higher rates of psychological disturbances, PTSD increases the frequency of physical health problems, especially in chronic PTSD. Trauma victims are likely to have higher rates of gastrointestinal disorders, heart disease, immunologic disorders, abdominal pain and problems with hormone function. The exact cause of PTSD development after trauma is thought to be due to extended exposure to stress hormones. This conclusion was reached after a study conducted by Van der Kolk, McFarlane & Weisaeth found that those exposed to extreme stress or trauma had an increased rate of physical and psychological disease. The conductors of this study concluded that upon exposure to a stressor, hormones such as epinephrine and norepinephrine, serotonin, cortisol and oxytocin are released. Epinephrine, cortisol and norepinephrine are both released when the body is under extreme stress, as they help to prepare the body for fight or flight. Whereas, according to the APA, serotonin and oxytocin regulate mood, social bonding and other important aspects of the body. Normally, the response to stress is intense and rapid, but then quickly dissipates after the stressor is removed. However, after prolonged exposure to trauma or stress, the responses to the stimulus become unregulated and levels remain elevated even after the stressor is removed. The symptoms may overflow and also cause reactions to everyday events, even if they are not deemed threatening. Because of this, it is believed that PTSD reflects a failure to regulate those autonomic functions when confronted with a reminder or “trigger” of the trauma. Besides hormonal and neurological problems, those with PTSD have been found to carry very specific brain abnormalities. This is especially the case in the limbic system which functions in memory and emotional reactions to stimuli. A portion of the limbic system, the hippocampus is known for recording experiences in memory. According to a study by Dr. Mark W. Gilbertson, trauma victims with PTSD have been found to have a decreased hippocampal volume compared to those without PTSD (Gilbertson). The reasoning has been interpreted to be that high cortisol levels causes shrinkage to the hippocampus, reducing its ability to form short term memories. Additionally, many trauma victims experience a decrease in neural pathways between the left (the more rational and logical) and right (emotional and raw) hemispheres. According to Dr. Onder Kavakci, his process of communication between hemispheres is called “Adaptive Information Processing” and helps the mind weed out which stimuli are threats and which are not (Kavakci). When these neurological pathways are severed by trauma, the right brain cannot rationalize that the trauma is over and the person is no longer in danger. This produces the anxiety and PTSD symptoms in victims after the trauma has ceased. Often, the longer the person is traumatized, the longer it will take for the brain to realize it is no longer in danger. According to a clinical study by Dr. EB Foa, there are many treatments to reduce the impact of PTSD on a person. This can include counseling (either individually or in groups), psychotherapy, pharmacotherapy, and CBT (cognitive behavioral therapy). Of all types of CBT therapy, Cognitive Processing Therapy and EMDR are the two most common used in the treatment of PTSD. Cognitive Processing Therapy (CPT) is described in Resick and Schnicke’s 1992 book. The therapy involves cognitive restructuring through writing, speaking and creating art about the trauma. On average, victims report a 40% symptom reduction making it one of the most effective treatments for PTSD. The second most common treatment for PTSD is described by Shapiro as “Eye Movement Desensitization and Reprocessing” (Shapiro). The therapy is similar to CPT as it places emphasis on cognitive re-processing accompanied by guided eye movements or other forms of rhythmic bilateral stimulation, such as vibrations, tones or taps. While experiencing bilateral stimulation, the patient recalls and focuses on a traumatic memory (Bartson). The goal of this therapy is regrow the neural pathways between the right and left hemispheres of the brain that are destroyed by trauma so that they may communicate and ease the symptoms of PTSD. Both forms of therapy may be occupied by medications such as SSRIs (the most common for treating PTSD being Sertraline) or even anticonvulsants usually given to treat seizure activity or muscle twitches. Despite the common notion that PTSD only affects veterans, the disorder can affect anyone at any age. PTSD itself is caused by severe exposure to trauma that disrupts the regulation of stress hormones in the brain. This in turn causes paranoia, anxiety, hallucinations and flashbacks. Those with PTSD are more vulnerable to repeated trauma, substance abuse and other mental disorders such as anxiety and depression. A shrunken hippocampus caused by chronic exposure to cortisol results in poor short term memory and difficulty with concentration. There are, however, many different treatments that can be utilized to heal the brain after trauma or alleviate the symptoms. Treatments range from medications such as SSRIs or anticonvulsants to psychotherapy such as cognitive processing therapy and EMDR. As more procedures, therapies and medications hit the market for the treatment of PTSD, our understanding of the disorder grows and our ability to treat it expands. Traumatic events will always occur as they are unavoidable facts of life, but if something can be done to help four year old rap survivors, refugees suffering nightmares, and the military veterans turned alcoholics; then society should do everything in their power to help those individuals find relief.