PTSD: Not all wounds are visible
Articles / Blog
05-28-14 Category: Mental Health

PTSD Awareness Month

Since 2010, June 27 has been designated by the United States Congress as Post-Traumatic Stress Disorder (PTSD) Awareness Day, in recognition of the fact that this phenomenon is a serious behavioral health issue. In addition, June has become PTSD Awareness Month in order to make people more aware of this disorder and the availability of treatment. Although most people think of PTSD as something that affects military personnel, it also occurs in civilians who have experienced serious trauma.  Not all people who experience a traumatic event, or stressor, go on to develop PTSD. However, almost 50 percent of adults in the U.S. will experience at least one traumatic event in their lifetimes that could lead to PTSD.

The federal Department of Veterans’ Affairs National Center for PTSD estimates that there are more than 5 million people in the U.S. who have PTSD. Then-secretary of the Department of Human Services Kathleen Sibelius said in 2012 that PTSD affects one in 29 Americans, including those who served in the military, law enforcement and first responders. It can also affect abused children and survivors of rape or domestic violence. Other people at risk of PTSD include survivors or witnesses of serious motor vehicle accidents, aircraft crashes, or natural disasters such as earthquakes, hurricanes, tornadoes, floods or fires. It also occurs in people who have endured civic conflict in other parts of the world and then come to the U.S.

It is estimated that 25-30 percent of victims of significant trauma will develop PTSD, according to the Addiction Technology Transfer Center (ATTC) network and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Approximately 80 percent of those diagnosed with PTSD have a dual diagnosis of at least one other co-occurring mental health such as depression or anxiety, or a substance abuse disorder. That is one reason that public awareness campaigns often use the phrase “not all wounds are visible.”

Sovereign Health Group, headquartered in San Clemente, California, is dually licensed as a mental health and substance abuse treatment facility, accredited by the Joint Commission. As such, we are uniquely qualified to treat the invisible wounds of PTSD and co-occurring disorders. For information about our Dual Diagnosis program, call Admissions at 866-264-9778.

Healing PTSD

Acute PTSD symptoms last for less than three months, but chronic PTSD symptoms persist, sometimes for 10 years or more, particularly without treatment. Counseling and therapy are important elements of treatment, and may be supplemented by medication (two drugs, sertraline and paroxetine – Zoloft and Paxil – are approved by the Food and Drug Administration for the treatment of adults with PTSD). The success of treatment varies, depending on the person, the nature and severity of the trauma, and the age of the person when he or she experienced the traumatic event.

Cognitive behavioral therapy (CBT) has been shown to be an effective method of reducing the severity of PTSD symptoms and is the most common approach. Specific types of CBT (such as cognitive restructuring and exposure therapy) that focus on ways to help patients confront their fears and develop anxiety management tools are often used. Although there is less evidence to support their use, some therapists use other approaches, including group therapy, eye movement desensitization and reprocessing therapy.

History of PTSD as a diagnosis

The DSM defines PTSD as something that “always follows a traumatic event which causes intense fear and/or helplessness in an individual. Typically the symptoms develop shortly after the event, but may take years.”

The symptoms of PTSD have been described in combat veterans going back thousands of years. Shakespeare’s description of King Henry IV suggests that the English king met many, if not all, of the criteria used to diagnose PTSD today, according to the federal Department of Veterans Affairs’ National Center for PTSD

PTSD was not included in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) until 1980, although the symptoms of acute stress reaction in combat veterans were well-known. In 2013 when the latest version of the DSM (DSM-5) was released, and the criteria were adjusted for children and adolescents, and separate criteria were created for children six years of age or younger. The status of PTSD as an anxiety disorder was changed, and the condition was moved to a newly-created diagnostic category, Trauma- and Stressor-Related Disorders.

The number of groups or clusters of PTSD symptoms also expanded from three to four. Symtoms related to avoidance and “numbing” were split into two groups instead of being lumped together:

  • Re-experiencing (this includes flashbacks, where a person feels as though he or she is reliving the traumatic experience, as well as nightmares);
  • Arousal/hyperarousal (aggressive or self-destructive behaviors, sleep disturbances, and physiological “fight-or-flight” reactions that are over-responses to the potential threat).
  • Avoidance (involving intrusive memories , thoughts and feelings about the event);
  • Negative cognitions and mood (persistent and distorted blaming of self or others, isolation and estrangement from others);

Research shows that different kinds of trauma result in different rates of PTSD, which can change the biochemistry of the brain. The most severe the trauma, the more likely it is that PTSD may occur, subject to other factors including genetics, personality, and levels of hormones, particularly cortisol (which is known as the stress hormone because it is released when the body goes into the fight-or-flight mode) when the trauma occurs. Research suggests that cortisol levels are lower than normal in infants born to women who develop PTSD while pregnant.

Symptoms of PTSD

Once a person develops PTSD, he or she is prone to over-react to cues in the environment that might indicate danger, triggering the flight-or-fight response. The most common symptoms of PTSD include flashbacks, nightmares, avoidance of situations and things that remind a person of the original stressful event, aggressive behavior and outburst of anger, and sleeplessness. Certain things – words, sounds, smells or even just a tone of voice – can trigger a flashback, where a person with PTSD actually relives or re-experiences the original traumatic event. These triggers may be a news report on television, or a loud noise like a car backfiring, As a result, people with PTSD may consciously or unconsciously avoid situations or people that may trigger a flashback or memories. For example, someone who was in a serious motor vehicle accident or was injured while in a military convoy may avoid driving.

Many people with PTSD avoid seeking help, partly because of the potential stigma but mainly because they want to avoid talking or thinking about their problem. Other common symptoms include:

  • Bad dreams or nightmares
  • Difficulty sleeping (often related to fear of nightmares)
  • Scary, uncontrollable thoughts
  • Feelings of loneliness and isolation
  • Constantly feeling on edge
  • Outbursts of rage
  • Thought of self-harm or hurting others

Anywhere from 15-43 percent of children will experience a severe traumatic event, and while most do not develop PTSD, some will do so. There is research to suggest that children are at greater risk of developing PTSD than adults, because they have not developed strong coping mechanisms for dealing with severe stress. Symptoms of PTSD specific to children include:

  • Reverting to behavior that they displayed at a younger age
  • An inability to talk
  • Complaints of physical ailments such as stomach aches or headaches
  • Refusing to go certain places or play with others

PTSD and veterans

Many people think of PTSD as something new that has developed in people due to their military experience. Although the term is recent, description of the symptoms occur in ancient Egyptian, Greek and Roman literature. More recently, it was a phenomenon encountered in the Civil War, WW I, WW II, the Korean War, the Vietnam War, and the more recent conflicts in Iraq and Afghanistan. Da Costa’s syndrome (also known as “soldier’s heart” or “exhausted heart” ) was often diagnosed during the Civil War to describe heart palpitations caused by stress or anxiety. In WW I, the term “shell shock” was used to explain psychological problems that were attributed to concussion caused by artillery explosions. In WW II, the terms “combat fatigue” and “battle stress” emerged.

Although it was not known as PTSD, the condition became a social issue as military personnel returned from the Vietnam War. Estimates put the number of Vietnam veterans who had symptoms related to traumatic stress that would meet current criteria for PTSD at 30-50 percent. Despite decades of unsuccessful advocacy, many of them still cannot get treatment for PTSD, prompting several individuals and three veterans’ organizations to bring a recent lawsuit against the Army, Navy and Air Force to adjust their PTSD-related discharges under other-than-honorable conditions, making them ineligible for VA benefits.

The number of veterans with both PTSD and substance abuse disorders increased from roughly 80,000 in 2008 to 120,000 in 2011, a 50 percent jump. Between 2001 and 2012, more than 2.2 million members of the U.S. military served in either Iraq or Afghanistan. SAMHSA research indicates that 18.5 percent of service members returning from Iraq or Afghanistan have PTSD or depression,. Approximately 27 percent of those veterans who use the services of the VA have been diagnosed with PTSD, and 22 percent of those diagnosed with PTSD also have a substance abuse disorder. One study found that veterans with PTSD were more than four times as likely to report having suicidal thoughts – which are a strong predictor of a suicide attempt – than veterans without PTSD.

PTSD and civilians

Military, law enforcement and firefighter personnel are at greater risk of developing PTSD than the general population because they routinely experience traumatic events as part of their professional  lives. For example, it is estimated that anywhere from 7-37 percent of firefighters reportedly meet criteria for a current diagnosis of PTSD.

About seven percent or more of the civilian population will likely develop PTSD at some point due to a traumatic experience such as sexual assault, shooting, mugging, a serious motor vehicle accident or a natural disaster such as a fire, tornado, hurricane, flood or earthquake. During such an experience, it is common for a person to feel helpless and unable to control the outcome, and at the same time – and frequently accurately – that his or her life is in danger. Increasingly, people in urban inner cities have been diagnosed with PTSD because of their exposure to drug- and gang-related violence.

Such experiences shatter assumptions about what constitutes a “normal” life, and create insecurity and fear of a new unexpected threat. While the anxiety of such acute PTSD subsides most of the time, some people cannot return to a normal pre-traumati9c psychological state, and develop chronic PTSD, exhibiting the same symptoms as combat veterans, such as flashbacks, nightmares, chronic hyperarousal, and other difficulties.

Sovereign Health Group Treats PTSD and Dual Diagnosis

Sovereign Health Group provides comprehensive treatment for PTSD and concurrent dual diagnoses of other mental health or substance abuse disorders. Our experienced staff od health care professionals will conduct a thorough assessment and develop a comprehensive, individualized treatment plan for each patient. For more information about our programs or to speak with our Admissions team, call 866-264-9778.

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