Post-traumatic stress disorder (PTSD) is a psychological stress disorder that is caused by an individual’s exposure to trauma. According to Sareen (2014), PTSD was first listed in the Diagnostic and Statistical Manual of Mental disorders (DSM) in 1980 even though observations of the disorder were made long before that. The definition of a traumatic event about PTSD is the exposure to threatened death, death, threatened or actual serious injury, and threatened or actual sexual violence. PTSD has four core features: witnessing or experiencing a stressful event, having nightmares and flashbacks about the event, making efforts to avoid places, people, and situations that remind the individual about the event, and experiencing hyperarousal symptoms including concentration problems, irritability, and sleep disturbances. An additional criterion for the disease includes symptoms such as feelings of constricted affect and detachment, the persistent blame of self or other people, and persistent negative expectations and beliefs about oneself.
Since PTSD may be similar to other mental disorders, what makes PTSD different from the other disorders is the fact that PTSD is characterized by re-experiencing symptoms such as flashbacks and nightmares. Other symptoms of PTSD such as avoidance, hyperarousal, and numbing overlap with the symptoms of panic disorder, anxiety disorder, and depression. Therefore, it is essential to determine whether an individual has re-experiencing that are related to a stressful event they experienced. It is also essential to understand that some individuals who do not have PTSD symptoms may have a serious mental impairment that may need intervention. Studies indicate that individuals with sub-threshold PTSD have impairment levels that range between those with no symptoms and those with full PTSD.
Traumatic Events Associated with PTSD
Most people in the world have witnessed or experienced traumatic events that would be classified under the stressor criterion for suffering from PTSD. Among women, traumatic events include witnessing the death or injury of another person, experiencing natural disasters such as earthquakes, and being in accidents that may be life-threatening. For men, common traumatic events include witnessing another person’s death or another person being seriously injured, being threatened especially with lethal weapons, and being in a near-death accident. Injuries and combat exposure are the most studied traumatic events among men, while childhood sexual abuse, rape, and partner violence are the most studied among women.
Combat-related PTSD
PTSD among military personnel is usually related to combat trauma. According to Richardson, Frueh and Acierno (2010), PTSD has a prevalence rate of between 5% and 20% among US military personnel that were deployed to Afghanistan and Iraq in 2001. PTSD was associated with a 200% increase in military personnel hospitalizations between 2006 and 2012 and is the leading diagnosis in mental disorders in the medical settings of the Department of Veterans Affairs. These statistics, however, may underestimate the impacts of PTSD because many members of the military who need treatment for PTSD do not seek it. Moreover, the increase in PTSD rates after military deployment is attributed to delayed-onset PTSD, an issue that is currently a growing health concern and may affect PTSD statistics among military personnel.
PTSD has numerous negative effects on military personnel. Xue et al. (2015) explain that the effects of combat exposure on PTSD are currently a significant concern among military leaders, the general public, and policy makers. The mental disorder can be a debilitating effect of life-threatening or sever trauma. Furthermore, PTSD can result in a lot of distress that interferes with social and personal functioning leading to aggression, social withdrawal, and anger. Moreover, PTSD among military personnel has a pervasive effect on the readiness of the military and the ability to accomplish military goals set by a country.
Various risk factors are associated with the development of PTSD among military personnel. According to Müller, Ganeshamoorthy, and Myers (2017), young military personnel is more likely to suffer from PTSD that older ones. Older veterans experience symptoms that may be perceived to be different from normal PTSD symptoms. These include lower arousal, depression, or higher somatic complaints. Muller et al. add that young veteran with severe PTSD symptoms are more likely to die young than those with less severe symptoms. There is a link between the development of PTSD and substance abuse since the history of alcohol, and drug abuse is usually associated with PTSD. An explanation for this is that people who have PTSD often engage in drug and substance abuse as a way of improving the symptoms. Hines, Sundin, Rona, Wessely, and Fear (2014) add that alcohol and substance abuse decreases the level of a concentration and is associated with other symptoms such as anger, insomnia, aggression, and irritability. There is a high likelihood that substance abuse increases the re-experiencing of the symptoms related to PTSD and hyperarousal. Other factors such as the duration and severity of substance abuse may either accelerate or improve PTSD symptoms. Muller et al. further explains that there is a complex interaction between pain and PTSD symptoms among military personnel. Chest pain was proven by many studies to be a contributor to the development of PTSD symptoms. Chest pain may serve as an actual or symbolic reminder of the traumatic event and may contribute to re-experiencing symptoms. Chronic pain, as well as PTSD, are characterized by reduced disability. Moreover, the anxiety that PTSD patients experience may affect their perception of pain.
Common Limitations Caused by PTSD
The development of PTSD varies according to the level of trauma experienced by the PTSD patient. Armenta et al. (2018) state that persistent PTSD is associated with comorbidities and neurobiological changes that occur over a long period. These changes may affect the individual’s behavioral, psychosocial, and physical health, and decrease the quality of life of the individual. Additionally, PTSD may manifest in forms such as obesity, hypertension, cardiovascular diseases, mortality, and immune-related disorders. Moreover, PTSD co-occurs with substance abuse, depression, and anxiety, which are all factors that are associated with suicidal ideation.
The limitations of PTSD extend to negative effects on social interactions especially those involving intimate relationships. For instance, a married person with PTSD may experience difficulties in communicating with their partner or doing the things they used to do before. This often leads to decreased support for the patient and may worsen the PTSD symptoms. PTSD may also result in child-relational problems through social withdrawals and emotional numbing which disrupt parent-child relationships. Ongoing PTSD is associated with decreased levels of productivity, increased disability, and decreased fitness levels that may limit one’s ability to work. The longer the time which PTSD remains untreated, the greater the likelihood of developing health complications. Therefore, it is critical that all mechanisms associated with the persistence of PTSD be understood and treated to promote the wellbeing of PTSD patients (Armenta et al., 2018).
Patients who have PTSD may experience a decline in working memory. Honzel, Justus, and Swick (2013) explain that PTSD symptomatology is associated with cognitive dysfunctions particularly about memory performance and cognitive control. PTSD patients often experience a decline in both delayed and immediate recall. Deficits in working memory, impulsivity, and cognitive control are related to the poor functioning of networks in charge of mediating emotional control. The prefrontal cortex (PFC) is critical for the proper functioning of the brain’s executive control. Honzel et al. state that there is evidence to suggest that PTSD results in frontal dysfunction since the performance on specific tasks by PTSD patients is similar to the performance of frontal lobe injury patients.
PTSD patients are likely to experience functional impairment even after they heal from a mental disorder. Westphal et al. (2011) explain that functional impairments are highly experienced by patients who exhibit PTSD symptoms but do not meet the criteria for the diagnosis of PTSD. The possibility that individuals with past PTSD will continue to exhibit emotional and functional problems is dependent on the medical settings for their mental health intervention.
Remaining Functional Abilities Despite the Presence of PTSD
Although PTSD is usually associated with negative effects on physical, emotional, and mental health, various functional abilities remain or are sharpened by PTSD. About Ogińska-Bulik (2015), PTSD may lead to better coping skills since patients may experience a greater appreciation of life and higher levels of spiritual satisfaction. PTSD may also foster better relationships with other people, particularly if the people provided support for the PTSD patient when he or she needed them. PTSD may also enable an individual to acquire new habits such as reading that may improve their quality of life, or may push one to engage in activism against the traumatic events that happened to them.
Distress Caused by PTSD
PTSD causes anxiety and sadness as part of the negative effects of the traumatic event. Symptoms such as guilt are linked to PTSD development and maintenance of its symptomatology. A PTSD patient may blame himself or herself for the traumatic event, and this may, in turn, increase the intensity of the symptoms. Distress may also be caused by feelings of hopelessness and helplessness especially when PTSD affects the working life and personal relationship of the patient.
Impact of PTSD on Society
PTSD may affect businesses, hospitals, the military, and other workplaces that the PTSD patient works in. PTSD patients are likely to miss work days and to work less efficiently than before. PTSD may negatively impact familial and societal relationships, and this may lead to a trail of broken families and family members. Increased cases of PTSD are also likely to increase crime rates, especially among young people since PTSD patients may join gangs as a means of coping with the negative mental state. PTSD patients may also inflict physical or emotional harm on other people in the society, and at times, they may participate in homicides. Suicide cases associated with PTSD may further disintegrate family structures and societal relationships (Ogińska-Bulik, 2015).
Treatment and Prevention of PTSD
Psychological or Behavioral Interventions
Psychological debriefing
The psychological debriefing was used in the 1980s and the 1990s to prevent long-term symptoms of PTSD by promoting faster emotional processing of stressful events after trauma. The debriefing was offered to all survivors of events that could be traumatic without prior evaluation or diagnosis since exposure to trauma was regarded as a satisfactory risk indicator. The method involved one session that was conducted within a few days or hours after a traumatic event. Debriefing included educating the trauma victim on the effects of trauma exposure, validation, and sharing of the experiences of the individual, and preparing the victim for future encounters. However, some studies suggest that debriefing may negatively affect the recovery process, hence the method may not be valid (Qi, Gevonden, & Shalev, 2016).
Cognitive behavioral therapy
Exposure-based CBT is used to achieve and maintain a state of fear extinction by repeatedly exposing a trauma victim to trauma-related stimuli within a safe context. The victim can develop control over their reactions and reduce avoidance. Cognitive-based CBT aims at challenging the beliefs of the patient about the current implications and the meaning of trauma. This intervention aims to change the patient’s reactions to reminders that are related to traumatic exposure, to reduce feelings of guilt and blame, and to get rid of behavioral rules and restrictions that are derived from traumatic exposures (Qi et al., 2016).
Pharmacological Interventions
Various types of medications including agonists and antagonists are used in treating PTSD symptoms. Propranolol, for instance, is an antagonist that reduces the patient’s ability to recall traumatic events hence may reduce PTSD symptoms. Benzodiazepines are agonists used as sleep inducers and tranquilizers, and if administered in larger doses, they also interfere with memory acquisition. Morphine is another drug that was proved to be beneficial especially if it is administered 48 hours after exposure to a traumatic event to survivors who have physical pain. Morphine reduces the likelihood of developing PTSD (Qi et al., 2016).
PART B: PERSONAL REFLECTION
In my opinion, PTSD is a mental disorder that is more prevalent than people think mainly because some people who have PTSD do not seek medical help. Most people in society experience traumatic events at one point in their lives, and some of them are not even aware that they have a mental disorder and that they need help. Although many studies indicate that women are more likely to suffer from PTSD, I think that it is wrong to make this assumption because men also suffer from PTSD at levels almost as equal as that of women but try to hide it. Men, from a young age, are taught that displaying any sign of emotional weakness is not masculine hence they learn to bottle up their feelings even after they are exposed to traumatic events. Men are less likely to admit that they have a mental disorder, and to seek for professional help. Among women, sexual abuse is one of the most common causes of PTSD. I feel that men also experience PTSD from sexual abuse, but sexual abuse among the male gender is less investigated. Currently, suicide rates are very high among men in comparison to women, and I think that this can be investigated by considering the incidence of mental disorders among men.
I think that it is sad that most military personnel suffer from PTSD. It may be hard to eliminate PTSD cases among military veterans since the nature of their profession involves violence and exposure to death or near-death instances. High incidence of PTSD among military personnel can, however, be tackled by the use of preventive interventions before military deployment. Military personnel can be taught how to deal with traumatic experiences before they experience them to enable easy handling of trauma and reduce the risk of PTSD. Cognitive-behavioral therapy may be used as a prevention strategy for veterans.
Throughout my life, I have known people who exhibit PTSD symptoms such as intrusive memories, avoidance, and feelings of guilt, fear, and shame. My grandfather was a veteran in the Second World War, and he had PTSD until his death. I always thought that he was mad until I became older and began to understand what he had gone through. He was emotionally unstable at times for unknown reasons, and we were often told to stay away from him. As a child, the only memories I have of him involve drunkenness and high temper. When I was a teenager, he found me took some of his whisky, and he told me that alcohol was not good for anyone’s health. When I asked him why he took so much alcohol, he informed me that it was the only way he could forget about the atrocities he witnessed and committed during the war. He still saw and heard voices of his fellow veterans screaming in pain, and re-lived the murders he committed. After learning about his experiences, I began viewing him in a different light. I now regarded him as a hero and spent more time with him. However, his mental problems worsened, and this was revealed when he physically attacked his counsellor for advising him to take his PTSD medication. He later took an overdose of medication pills when we were on vacation, and his nurse found him dead in his room. I think that the interventions that were administered to my grandfather were not effective since he did not heal. Instead, his mental state became worse with time and led to suicide.
I have never experienced any traumatic event that may lead to PTSD. However, several of my age mates have, and it was difficult for me to watch them struggle through the pain. Her uncle sexually abused a childhood friend throughout her childhood, and her parents only noticed it when he began raping her. When we went for sleepovers, she often started screaming at night since she still dreamt about the things her uncle did to her. As an adolescent, she was scared of getting into any intimate relationship, and she would not let any male get close to her, or even touch her. She underwent a lot of therapy and is currently living a normal life.
My experiences on PTSD point to one thing; the importance of using appropriate intervention strategies to heal people who have PTSD. Although I was not aware of the intervention strategies that my grandfather went through, am sure that they did not work. He had PTSD since he was in his 30s and did no heal from it. My friend, on the other hand, was able to heal due to the therapy she underwent. PTSD interventions, in my opinion, have to consider the intensity of the trauma experienced by the patient. There is another possibility that my grandfather began therapy after PTSD had set in, and this may be the reason why he did not heal. Early intervention after the occurrence of PTSD may be important in determining patient outcomes.
In conclusion, PTSD is a mental disorder that might be experienced by anyone, as long as the individual goes through a traumatic event. According to Armenta et al. (2018), early intervention should be encouraged to reduce PTSD symptoms and to encourage healing. Moreover, PTSD patients should be taught coping skills that will enable them to easily deal with future trauma.