POST-TRAUMATIC STRESS DISORDER (PTSD)

Introduction

PTSD was developed by studying soldiers from the war, and it was originally called "shell shock syndrome" in the United States. 60% of men and 50% of women experience a traumatic event during their lifetime. A terrifying experience in which serious physical harm occurred or was threatened can cause Post Traumatic Stress Disorder. PTSD is a problem in which the brain continues to react with nervousness after one had a horrific trauma even though the original trauma is over. Our brains can react by staying in "overdrive" and being hyper-alert to the next possible trauma. Diagnostic symptoms for PTSD include re-experiencing the original trauma through "flashbacks" or nightmares, avoidance of stimuli associated with the trauma, and increased arousal-such as difficulty feeling or staying asleep, depression and feeling of anger or irritability. Sometime one might continue to remember the trauma by having a flashback about the event of nightmares event though trauma is in the past. Survivors of rape, child abuse, war or a natural disaster may develop post-traumatic stress disorder. Professionals who are exposed to trauma in their daily work and witnessing someone being badly hurt or killed can also develop PTSD.

The DSM-IV-TR (the professional's diagnostic manual) classifies PTSD as an anxiety disorder. After a trauma in which one see someone die, or become seriously injured and s/he feels intense far, helplessness, or horror, it is very common to become distressed and anxious.

S/he may have trouble sleeping, have nightmares, think about the trauma a lot, try to avoid the site of the trauma, and or try to avoid feelings at all and become number. This situation is called "acute stress disorder". For most people, this distressing period passes within about four weeks. To be diagnosed as PTSD, the symptoms should last more than one month cause significant impairment in social, occupational, or other important areas of functioning (a/o both DSM-IV-TR and ICD-10). People who develop PTSD do not get over their trauma so quickly.

There are three main symptoms:

1.   Re-experiencing: The trauma, such as flashbacks, nightmares, intrusive thought etc.

2.   Avoidance: trying to avoid thoughts, feelings, situations or people who might remind you of the trauma.

3.   Hyperarousal: always being on alert, trouble sleeping, irritability, difficulty concentrating, exaggerated startle response.

The associated symptoms of PTSD:

Panic attack: Feeling of intense fear, which can be accompanied by shortness of breath, dizziness, sweating, nausea and a racing heart.

Physical symptoms: Chronic pain, headaches, stomach pain, diarrhoea, tightness or burning in the chest, muscle cramps of low back pain.

Feeling of mistrust: Losing trust in others and thinking the world is a dangerous place.

Problems in daily living: Having problem functioning in your job, at school, or in social situations.

Substance abuse: Using drugs or school to cope with the emotional pain.

Relationship problem: Having problems with intimacy or feeling detached from your family and friends.

Depression: persistent sad, anxious or empty mood, loss of interest in once-enjoyed activities, feelings of guilt and shame, or hopelessness about the future. Other symptoms of depression may also develop.

Suicidal Ideation: Thought about taking one's own life.

Objective

The objective is to find out the severity of PTSD symptoms of subjects.

Materials used

PTSD Checklist Civilian version, paper, pen and pencil

Information about the subjects

Subject A	Subject B
Name: Idress Ahmad Age: 43 Sex: Male Address: Pakistan Education: NA Marital Status: Married Occupation: NA Socio-economic status: NA Place: Office Mental and physical health: Normal Time: 10:00 AM Date: 21 Oct 2013	Name: Bina Gurung Age: 39 Sex: Female Address: Balaju Education: +2 Marital Status: Married Occupation: Housewife Socio-economic status: NA Place: Home Mental and physical health: Normal Time: 10:00 AM Date: 25 Oct 2013

Test description

PTSD Checklist Civilian version are the 17 items standardized self-report rating scale of the 17 DSM-IV symptoms. The PCL-C (civilian) can be applied with any population to any stressful.

The PCL is self-report measure is the list of statements that can give ideas about the subject's mental status, whether s/he is suffering from PTSD or just distress. It can be completed by subjects within 5-10 minutes. Interpretation of the PCL should be completed by an export.

Scoring:

A total symptom severity score (range=17.85) can be obtained by summing the scores from each of the 17 items.

A diagnosis can be made by determining whether an individual meets DSM-IV symptom criteria, i.e., at least I B item (questions 1-5), 3 C items (questions 6-12), and at least 2 D items (questions 13-17). Symptoms rated as "Moderate" or above (responses 3 through 5) are counted as present.

Scoring scale:

·         1-1.5=Not at all

·         1.6-2.5 = A little

·         2.6-3.5 = Moderate

·         3.6-4.5 = Quite a bit

·         4.6-5.00 = Extremely

Procedure

Test administration: First I made a call to them and told them about PTSD testing and its purpose. Then I took appointment from them. As the appointment, we met and I explained about my purpose. I explained about the materials carried by myself.

Instruction: Here is the list of 17 problems that people might experience after unpleasant or stressful events in life. Please try to recall the most painful event you have experienced which still bothering you and making difficult to carry on daily activities normally these days. Read all the statements carefully then circle the one option given in right that close to your feelings.

Introspective report of subjects

Subject-A: He seemed excited to fill out the test and want to know his status

Subject-B: It's difficult to recall the most unpleasant event that still bothering me. But try to complete this sincerely.

Result:

Subject-A: 2.70, moderate-2.6-3.5

Subject-B: 2.2, a little-1.6-2.5

Impression:

Subject A: He has gone through a bit of traumatic experience, felt like crying a kind of gilt and love towards his country and his separated family. He remembers his properties (Vehicle, job), relatives over his country.

Subject B: Though she was little a bit unhappy at the starting of testing, she found normal according to her scored scaling.

Result and discussion:

Subject-A: Idrees Ahmad is a Pakistani guy. He has been staying here in Nepal for since four years as a refugee. As a refugee, he is not allowed to work. There is a very poor financial condition in his family. There are his wife and two daughters in his family. According to him, he had been tutored physically and mentally while he was in Pakistan. Frequently death threatening was coming in Pakistan and he had to flee from his own country. He shared that he has experienced so many traumatic events i.e. detained in jail by armed forces, very bitter experiences while travelling from his country. Nightmare, headache, pain in the leg muscle, fear and worry about life were found to him. According to the score he got, his PTSD level falls under a moderate level. That can be decreased or control by counselling and it will help to do some relaxation i.e. Progressive muscle relaxation, safe imaginary guidance etc.

Subject-B: There was a misunderstanding between subject B and her husband. They have one tiny girl baby. Husband tortured her by accusing her by saying she has extra-marital relationship. She cries most of the time. She has sleeping disturbance, headache, and worry about life and relationship problem with husband. Based on her test obtained she falls in normal however she needs psychosocial counselling. Couple counselling is most for her. She can also apply counting, deep breathing, diary maintaining exercises to reduce her stress.

References:

Coleman, James C, (1996). Abnormal Psychology and Modern Life. D.B. Taraparevala Sons and Co. Private Limited.

PTSD checklist Civilian version.