Colloquially, the term "stress" to refer to emotional discomfort, stress and worry, and also to overload and problems that give rise to these feelings, either in relation to work to personal relationships or the economy is used, family, among others.
We experience different forms of stress or emotional distress such as sadness, anger, boredom, embarrassment or fear of course. In situations of danger, it is perfectly normal and adaptive afraid and emotionally upset when something bad happens.
In the case of Disorder Post-Traumatic Stress Disorder (PTSD), emotional stress is linked to the experience of extreme fear. PTSD is the response to an extremely stressful or traumatic situation, ie representing a danger to life or physical integrity and can begin at any age, even during childhood. This affects mental disorder at some point in their life, between 2% and 8% of the general population.
Posttraumatic stress or inability to overcome a disgrace
The post-traumatic stress occurs due to the inability to overcome a traumatic event, meaning traumatic, of threatening or catastrophic, can cause severe discomfort and prolonged nature anyone.
After a traumatic experience is normal that the person suffers post - traumatic stress symptoms during the first month or so. Somehow, it is a protective reaction; the mind starts mechanisms to better withstand the situation as symptoms that help the person to move on and understand the experience that happened. This is what we call an "acute stress reaction". After a few weeks, most people are assuming gradually what happened, and stress symptoms begin to disappear. However, about one-third of those symptoms continue and fail to assume what has happened. Symptoms of post-traumatic stress really become an issue or disorder when they continue beyond the month after the traumatic event.
Types of post traumatic stress disorder
PTSD symptoms do not always appear immediately, usually appear within the first six months after the traumatic event. Depending on the time these symptoms appear, three types are distinguished:
- Acute, it manifested during the first month and before 3 months after the trauma.
- Chronic, lasting greater than or equal to them six months.
- Delayed Onset, when symptoms appear after six months after the trauma.
Causes of PTSD
Some extreme stress or anxiety can overcome our psycho-biological and mental ability to manage emotions too intense and implement defensive mental strategies while allowing prevent further damage, involve the appearance of symptoms after a while.
For example, dissociation is an involuntary mental process that allows to separate the emotion from the rest of the situation. Thus, the person lives or recalls the traumatic event as if it were not with her, as if remembering a movie that does not cause any significant emotion. The problem is that this split between the experience and its emotional component prevents the progressive decrease in emotional intensity that accompanies the experience.
Other mental and behavioral process that can complicate the course of symptoms is the systematic avoidance of places, memories, conversations or other stimuli associated with the traumatic event. This can severely limit the daily life of the person and also significantly hinder the process of development and cessation, ie the gradual decrease in the intensity of emotional reaction.
As for the neurobiological processes in the development of PTSD, adrenaline levels are not properly recover after its elevation during the stressful event; it seems that the vivid memories of the trauma keep adrenaline levels high. This makes the person tense, irritable and unable to relax or sleep well. This rise in the concentration of adrenaline and other stress hormones alter the normal functioning of the hippocampus (part of the brain that processes memory). So the flashbacks and nightmares continue. If the stress goes away and adrenaline levels return to normal, the brain can repair the damage itself, like other natural healing processes of the body. So disturbing memories can be processed and the flashbacks and nightmares will slowly disappear.
The most common traumatic events are related to accidents, natural disasters, unexpected death of a loved one, including spontaneous abortions, being a victim of physical assault or rape, physical or sexual abuse, torture, kidnapping or witnessing death or serious injury, for example in combat tasks or rescue (mainly soldiers, firefighters, police and emergency services).
The most traumatic events are those that are sudden and unexpected, lasting a long time, when one is trapped and can not escape, if they are caused by man, when causing many deaths, if they cause mayhem and loss of arms or legs and when there children involved.
Symptoms of PTSD
As in other disorders, symptoms may vary from one person to another depending on the characteristics and previous personality. In the case of PTSD, many people feel heartbroken, depressed, guilty, anxious and angry after a traumatic experience. In addition to these understandable emotional reactions, there are three main types of symptoms:
- Flashbacks and nightmares: Re-experiencing the traumatic event as vivid intrusive memories or nightmares, or feeling that the event is happening again or disproportionate emotional reactions to stimuli that can remember the traumatic experience.
- Avoidance and numbing: Persistent avoidance of stimuli associated with the trauma: efforts to avoid thoughts, feelings or conversations associated with the trauma, to avoid activities, places or people that arouse recollections of the trauma or inability to recall an important aspect of the trauma. Also it involves markedly diminished interest or participation in significant activities; detachment or estrangement from others; restriction of emotional life and feeling of a bleak future.
- Hypervigilance: Persistent symptoms of increased nervous activation: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, exaggerated startle response.
It should be noted that a significant number of people with PTSD also have other secondary disorders, the most frequent alcohol abuse, depression, behavior disorders, simple phobia, social phobia or agoraphobia.
Diagnosis of PTSD
In order to make a proper diagnosis clinical psychologist or psychiatrist should verify that the person experienced, witnessed , or was confronted characterized by deaths or threats to their physical integrity events or that of others, and has responded with a fear, a helplessness , or horror intense, and finally, that these alterations cause clinically significant distress or impairment in social, occupational or other important areas of activity of the individual. In the diagnosis should also specify the duration of symptoms and time of onset.
However, there are several reasons why many people with this disorder do not receive adequate diagnosis. On the one hand, because nobody likes to talk about events and feelings as dramatic. Others do not want to admit they have these symptoms, for fear of being considered weak or mentally unstable. Also, because some doctors and psychologists may also feel uncomfortable, if we try to talk about horrible or horrifying events. And especially because often people with PTSD find it easier to talk about the symptoms that accompany PTSD such as headaches, sleep problems, family problems or work, that the origin and the main symptoms of the disorder.
Treatment of PTSD
The guide NICE (National Institute of Clinical Evidence, which promotes treatments that have been scientifically proven effective) suggests that psychological trauma focused therapies should be offered before starting medication, whenever possible.
Psychological Treatment of PTSD
The problems associated with PTSD on the psychological therapy will focus its efforts are intrusive thoughts, flashbacks, fears associated with the trauma, panic and avoidances, affective blunting / detachment from others / loss of interest, guilt / self humiliation, irritability / anger, general anxiety (hyperreactivity, hypervigilance, agitation, alarm), sleep disturbances and difficulty concentrating. To address these problems, the most useful psychotherapeutic techniques are exposure therapy, cognitive therapy techniques and anxiety management.
The evolution of therapy depends on the existence of a prior psychopathological disorder, perception of control over negative events, the intensity and severity of stressors, the early presence of dissociative symptoms and psychological and social received support during and after trauma.
Pharmacological treatment of PTSD
Antidepressants reuptake inhibitors serotonin decrease the intensity of PTSD symptoms and relieve depression may also be present. They must be prescribed by a doctor.
This type of medication can have side effects in some people. They can also produce unpleasant symptoms if discontinued too fast, so the dose should be gradually reduced. If they are effective, they should continue to take about 12 months. Tricyclic antidepressants may also be helpful.
Sometimes, if someone is so distressed that you can not sleep or think clearly, anti - anxiety medication may be necessary.
Regardless of the particular treatment that the person has followed (psychological or combined with psychotropic drugs), it is considered that the disorder is exceeded when you can think about it without fret not feel constantly threatened and not think about it at inappropriate times.
The complex post - traumatic stress disorder
Suffer people who have experienced serious neglect or abuse both adult and child repeatedly, or repeated serious violence or abuse in adulthood, such as torture or kidnapping. This is called Stress Disorder Post-Traumatic complex. You can start weeks or months after the traumatic events, but it can take years to be recognized.
Trauma affects the psycho - emotional development of children, the earlier the trauma, most damage. Some children face getting defensive or aggressive. Others are isolated from their environment and grow up with a sense of shame and guilt rather than feel safe and good about themselves. Adults who have been abused or tortured over a period of time develop a sense of separation from others and loss of confidence in the world and the environment.
In the case of PTSD it complex the absence of a proper diagnosis is made even more obvious, especially when the abuser is a parent, a person's family background or other trusted authority, as in these cases, besides the aggressor, it is important lack of protection by the other adults. In general, the child feel that somehow deserve what happens to them and also fear that if they tell, cause serious conflicts in the family or between parents and the abuser.
We might get to ask ourselves if most mental disorders are not actually posttraumatic stress disorder delayed start in which the affected person tries to avoid at all costs the feelings he experienced.