What is Post Traumatic Stress Disorder?
Post Traumatic Stress Disorder (PTSD) is an intense, prolonged response to an extremely stressful event outside the range of everyday experience, which would be likely to cause distress in almost everyone. The person must have experienced, witnessed or been 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, and the person’s response must involve fear, helplessness or horror.
The term PTSD was introduced in 1980. It was not the first recognition of the psychiatric consequences of war or trauma, but it did represent new ideas on the causes of such conditions. Previously it has been thought that any such disorder should be short lived, and if not, then the war/trauma was not the cause. PTSD was the first recognition that trauma/war might cause long term disorder in people who had previously been healthy.
The essential features of PTSD are hyperarousal, re-experiencing of aspects of the stressful events and avoidance of reminders.
Examples of extreme stressful events that may cause PTSD include disasters such as floods, earthquakes, major fires, serious transport accidents, circumstances of war, rape or serious physical assault.
The onset is usually within six months of the event.
There has been a tendency over recent years for PTSD to be inappropriately diagnosed, for example in people subject to emotional rather than physical trauma, such as a spouse suddenly leaving home or a particularly distressing confrontation with a manager at work. It has also been diagnosed in people after relatively minor incidents in which there has been no real or perceived danger to life and limb, and in which adjustment disorders would be more appropriate.
The rates of PTSD after trauma or disaster show considerable variation. For example, rates are lower in professionally trained people such as soldiers as opposed to civilians. Rates are higher where the trauma is more severe, or where it has less meaning. It is also more common where people believe that they have carried out acts of commission or omission and blame themselves for the trauma, or where they believe others have “let the side down”, as in problems of Friendly Fire in the Armed Forces. Man made disasters are often associated with higher rates than natural disasters.
There continues to be controversy about the role of PTSD in other cultures – most people believe that there is considerable variation both within and between cultures.
There are several factors that predispose an individual to developing PTSD. These include gender, low IQ, family history and pre-existing anxiety or depression.
Delayed onset PTSD.
It is fairly common for people to delay for months or even a few years before seeking treatment for PTSD. However, true delayed onset is unusual, making up less than 10% of cases (and sometimes less). Evidence that a person was free from symptoms after the trauma, and continued to function at a reasonable level, but only later developed symptoms should raise concerns about alternative diagnoses before accepting a diagnosis of delayed PTSD. Delayed help seeking should always be distinguished from true delayed onset – the former is common, the latter is not.
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Amended June 2008