1. Post-Traumatic Stress Disorder Rose Marie Lichtenfels MSW, MA, LCSW 1

2. Definition Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. This threat could have happened to themselves or they could have witnessed it happened to someone else. 2

3. Examples Military combat Kidnapping Physical Assault Sexually Assault Severe or fatal car accident Witness to a severe crime Earthquakes Tornadoes Life threatening illness Refugee from war zone Death of a child 3

4. Facts about PTSD An estimated 5.2 million American adults ages 18 to 54 or approximately 3.6 people in this age group in a given year have PTSD About 30% of Vietnam veterans developed PTSD at some point after the war. The disorder has also been detected among veterans of the Persian Gulf War at about 8%. More than twice as many women as men experience PTSD following exposure to trauma. 4

5. PTSD Facts Continue Depression, alcohol or other substance abuse, or other anxiety disorders frequently co-occur with PTSD. The likelihood of treatment success is increased when these other conditions are appropriately diagnosed and treated as well. 5

6. What Happens The event propels the individual into a traumatic state that last as long as the mind needs to reorganize, classify and make sense of the traumatic event. For some people that may take anywhere from a few hours or up to a month to occur or for some even years. 6

7. Some of the things that will determine how a person relates to a traumatic event is their basic assumptions about their belief in the world as a meaningful and comprehensible place, their own person invulnerability, and their view of themselves in a positive light. 7

8. Different types of Trauma There is a marked distinction between natural and human made catastrophes. Natural disasters create far fewer victims of PTSD than do human made ones. Human made acts of trauma create even more victims of PTSD when the trauma directly affects the social support system of the family. 8

9. Reactions Following a traumatic event, people typically describe feeling things like relief to be alive, followed by stress, fear, and anger. They also often find they are unable to stop thinking about what happened. These feelings are normal and will slowly decrease over time. 9

10. Reactions Continue Feeling hopeless about the future & detached or unconcerned about others. Having trouble concentrating, indecisiveness Jumpy & startle easily at sudden noises On guard and constantly alert Having disturbing dreams/memories or flashbacks Work or school problems 10

11. Physical Reactions Stomach upset and trouble eating Trouble sleeping and exhaustion Pounding heart, rapid breathing, edginess Severe headache if thinking of the event and sweating Failure to engage in exercise, diet, safe sex, regular health care Excessive smoking, alcohol, drugs and food 11

12. Emotional Reactions Feeling nervous, helpless, fearful, sad Feeling shock, numb, unable to experience love or joy Avoiding people, places, and things related to the event Being irritable or outbursts of anger Becoming easily upset or agitated 12

13. Emotional Reactions Con’t Self blame or negative views of oneself or the world Distrust of others, conflict, being over controlling Withdrawal, feeling rejected or abandoned Loss of intimacy or feeling detached 13

14. First The person’s response to the trauma was intense, fear, helplessness or horror. As a result, he or she has persistent symptoms of anxiety or arousal that were not evident before the traumatic event. 14

15. Second The person persistently re-experiences the traumatic event in at least one of the following ways: Recurrent and intrusive distressing recollections of the event Intense psychological distress on exposure to internal or external cues that symbolize or resemble an aspect of the event. 15

16. Second continue Flashback episodes including those that occur on awaking or when intoxicated that may include all types of sensory hallucinations or illusions that cause the individual to dissociate from the present reality and act or feel as if the event were recurring. 16

17. Second Continue Physiological reactivity on exposure to events that symbolize or resemble some aspects of the trauma, such as a person who was in a tornado starting to shake violently at every approaching storm. 17

18. Third The person persistently avoids such stimuli in at least three of the following ways. Attempts to avoid thoughts, dialogues, or feelings associated with the trauma. Tries to avoid activities, people, or situations that arouse recollections of the trauma 18

19. Third Continued Has an inability to recall important aspects of the trauma. Has markedly diminished interest in significant activities Feels detached and emotionally removed from others. 19

20. Third Continued Has a restricted range of affect by a numbing feeling Has a sense of foreshortened future such as no career, marriage, children or a normal life span. 20

21. Fourth The person has persistent symptoms of increased nervous system arousal that were not present before the trauma, as indicated by at least two of the following: Difficulty falling or staying asleep Irritability or outbursts of anger 21

22. Fourth continued Difficulty concentrating on tasks Constantly being on watch for real or imagined threats that have no basis in reality (hyper vigilance) Exaggerated startle reactions to minimal or non-threatening stimuli 22

23. Fifth The disturbance causes clinically significant distress or impairment in social, occupation, or critical areas of living. 23