a 501C3 Organization
Mission: Support, Education, and Advocacy on behalf of Survivors of Human Trauma
The Post Traumatic Stress Response is a biochemical reaction to traumatic stress.
| History | Symptoms | Prevalence | Biology | Factors | Treatment |
Psychological distress after trauma was reported in 1900 BC by an Egyptian physician who described hysterical reactions to trauma which lead to it being called, “hysteria” for many centuries. Abram Kardiner, a pupil of Freud was the first to describe the symptoms of this disorder. The condition was first labeled Post-Traumatic Stress Disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM) of 1980 in response to the needs of Vietnam War veterans for economic compensation of their symptoms. However, in the 1970’s it began to be recognized that the most common experiences of post traumatic stress occurred not in war but in civilian life such as rape. (Judith Herman, Trauma and Recovery,1992.) Today consumers know it as a Post Traumatic Stress Reaction or “PTSR” for this reaction is the psycho/physiological consequences of exposure to or confrontation with stressful experiences, which involve actual or threatened death, serious physical injury or a threat to physical integrity and which the person found highly traumatic.
In recent history the Indian Ocean Tsunami Disaster, which took place December 26, 2004, and took hundreds of thousands of lives and the September 11, 2001 attacks on the World Trade Center and the Pentagon may have caused PTSR in many survivors and rescue workers. Today relief workers from organizations such as the Red Cross and the Salvation Army provide counseling after major disasters as part of their standard procedures to curb severe cases of post traumatic stress.
Symptoms can include re-experiencing phenomena such as nightmares, dissociation, and flashbacks, avoidance of reminders and emotional detachment, numbness, extreme distress resulting from personal “triggers”, irritability and excessive startle reaction in connection with high sounds or fast motions, insomnia, and hyperarousal, a state of nervousness in preparation for “fight or flight”. Young children suffering from the post traumatic stress response will often enact aspects of the trauma through their play, and may often have nightmares that lack any recognizable content. Frequently other psychological conditions such as depression and anxiety accompany the post traumatic response. Experiences likely to induce the condition include rape, combat exposure, natural catastrophes, violent attacks, childbirth and perhaps its accompanying exhaustion, and childhood physical/emotional abuse. PTSR(PTSD) may also become a persistent condition but can improve with treatment or even spontaneously.
Dissociation is especially common in children who experience long term abuse and neglect without a support system. Dissociation is generally defined as a sense of "disconnect" in one's feelings toward self, others, or the environment. Many in the field of psychology consider this a "complex form" of PTSR. Some now view the effects of long term victimization and dissociation as contributing to "developmental" difficulties in the young child. (Putnam, F. "Dissociation in Children and Adolescents: A Developmental Perspective",1997.)
For most people, the emotional effects of traumatic events will tend to subside after several months. If they last longer than four months the individual is generally considered to be experiencing a persistent traumatic response. Most people who experience traumatic events will not develop persistent PTSR. PTSR may also have a delayed onset of years or even decades and may be triggered by a life event such as the death of someone close or the diagnosis of a serious medical condition. Once PTSR reaches the criteria for diagnosis the untreated course is generally for some worsening and then a leveling of symptomology over many years.
According to the National Center for Post-Traumatic Stress Disorder 60.7% of men and 51.2% of women reported at least one traumatic event in their life time. PTSR may be experienced following any traumatic experience or series of experiences which is life threatening, overwhelms the individual, and does not allow the victim to readily recuperate from the detrimental effects of the stressor. It is believed that of those exposed to traumatic conditions between 5% (for life threatening illnesses such as cancer) and 80% (for rape) will develop PTSR depending on the severity of the trauma and personal vulnerability. In peacetime, 30% of those that suffer will go on to develop a persistent condition; in wartime, the levels of PTSR are believed to be higher. (Based on studies by Breslau, 1991; Davidson, 1991; Kulka, 1990; Rothbaum, 1992.) 25% of the population suffers from PTSD (Kluft RP, Bloom SL, Kinzie JD Treating the Traumatized Patient and Victims of Violence, Psychiatric Aspects of Violence, Summer: 70-102, 2000), 10% experience some form of dissociation (Briere J, "Dissociative Symptoms and Trauma Exposure: Specificity, Affect Dysregulation, and Posttraumatic Stress", The Journal of Nervous and Mental Disease, 194(2):78-82, 2006), and 1% experience Dissociative Identity Disorder (formerly Multiple Personality Disorder) (The Sidran Foundation http://www.sidran.org/) More recent studies place DID at 3% of the population (Ross 1991, 1997).
Victims of long term violence are at greater risk of re-victimization than the general population. 1/4th of all Victims of Crime have had prior victimization. (The US Dept. of Justice.) 1/3 to 1/2 of battered women will be battered again. Women who are victims of Child Sexually Assault are 35 X more likely to experience Sexual Assault as an adult. (the Vera Justice Institute 2005). 66 % of Battered women had a history of childhood abuse. (Kemp, A., Rawlings, E.I. & Green, B.L., "Post-Traumatic Stress Disorder in Battered Women: A Shelter Sample", Journal of Traumatic Stress, 4: 137, 1991).
Activation of the amygdale (known to play a role in the body’s fear response) is thought to be responsible for the painful, disturbing memories, and the “flashback” common in PTSR. Brain wave activity as measured on an electroencephalogram (EEG) is abnormal in the post traumatic response which may be associated with sleep disturbances and a hyperactive startle reflex. The detachment and blunting of emotions seen in persons suffering from PTSR is thought to result from a continued secretion of endorphins, which are natural opiates produced by the brain and nerve endings in times of stress. Neurotransmitters such as Epinephrin (adrenaline) and Norepinephrin are elevated activating the sympathetic nervous system to directly increase heart rate, release energy from fat, and increase muscle readiness. Cortisol secretion from the adrenal cortex increases in response to any stress in the body, whether physical (such as illness, trauma, surgery, or temperature extremes) or psychological. It acts as an antagonist to insulin and promotes the breakdown of carbohydrates, fatty acids, and proteins to immediately increase the body’s energy levels in response to a life threat and ensures that the brain receives adequate energy sources. Cortisol concentrations change in proportion to the duration of stress. In early stages of adrenal stress, cortisol levels will be too high during the day and continue rising in the evening. This is called “hyperadrenia”. In the middle stages, cortisol may rise and fall unevenly as the body struggles to balance itself despite the disruptions of caffeine, carbs, and other factors, but levels are not normal and are typically too high at night. In advanced stages of prolonged stress, when the adrenals are exhausted from overwork, cortisol will never reach normal levels (“hypoadrenia” or “adrenal exhaustion” as it is more commonly known).
A study by Appel and Beebe, after the Second World War, concluded that even the strongest soldier would break down after 240 days of combat. There was “no getting use to it” they concluded. Factors contributing to the development of PTSR include, age of traumatization, duration of the trauma, the type of trauma (physical, mind control, sexual, verbal), having multiple types of trauma, how much support the victim had following the trauma, the relationship of the victim to the abuser, and whether the perpetrator was caught and punished. The most vulnerable populations are children, the disabled, and the elderly and those exposed to physical, sexual abuse, and mind control having the most persistent symptoms of PTSR.
Collaborative
treatment plans that include a team of combined services for victim service oriented
case managers, peer support, therapeutic event processing, and medication offers
the best prognosis for victims of prolonged life threatening stress.