Which of the following is a common characteristic of posttraumatic stress disorder?

Introduction

Posttraumatic stress disorder (PTSD) is an event-related disorder occasioned by exposure to a significant traumatic event, and followed by the development of characteristic symptoms in the aftermath of the event. Examples of such traumatic events include disasters, criminal violence, combat, motor vehicle accidents, and sexual assault. As defined by DSM-V, PTSD symptoms include intrusive memories, avoidance of reminders, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity. These symptoms generally occur shortly after the traumatic experience, but sometimes develop much later. The majority of individuals exposed to a given traumatic event are resilient and will recover from transient psychological symptoms without intervention. When considering the possibility of PTSD after a given trauma, important risk factors include the intensity of the threat, the duration of the threat, personal history of trauma, and the nature of the traumatic experience.

Our knowledge of PTSD continues to evolve as evidenced by the 2013 change to the diagnostic criteria with DSM-V. Although changing, the fundamental characteristics of PTSD have been recognized for centuries. In many ways, PTSD is a “forgetting disorder” in which “forgetting” is impaired. Or alternatively PTSD can be seen as a “cuing disorder” in which reminders of traumatic events have become overgeneralized. Historically, terms such as shell shock and battle fatigue are a few of the many constructs that have been offered by those attempting to describe the experience of PTSD. Despite the long history of knowing that trauma negatively impacts the human psyche, it is only in recent times that we have begun to understand how trauma and its repercussions impact the brain and human biology. Given the vast array of advances in our understanding of PTSD, this chapter covers the neurobiology of stress, animal models of PTSD, biomarkers of PTSD, the relationship between PTSD and cardiovascular disease (CVD), neuroimaging to discover the structural and functional basis of PTSD, and possible therapies for PTSD based on insights from the field of neuroscience.

Introduction

Posttraumatic stress disorder (PTSD) is currently conceptualized in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) as an anxiety disorder.1 However, unlike other disorders, it is one of only two diagnoses within the current classification system that is clearly linked to a specific prior incident or traumatic event. Although symptoms resulting from traumatic stress were first described over 5,000 years ago,2 it was not until the 18th century that posttraumatic stress syndromes came to be more specifically delineated and treated.3 In the 1900s, a number of conceptualizations of traumatic stress and related syndromes were formulated and this eventually led to the acceptance of PTSD as a distinct diagnosis in 1980.4

Since its introduction in the DSM-III, there has been a plethora of research studies investigating PTSD. Much of the early research on trauma and PTSD focused on male combat veterans.5,6 Subsequent investigation into women’s experiences of sexual assault identified a syndrome that was similar to that experienced by combat-exposed men.7 This gave rise to an increased focus of research attention on women’s experiences of various types of traumatic events and their association with PTSD.8 Since then, much has been learned about trauma and PTSD in women. This chapter aims to give an overview of recent findings and provide some recommendations for further work in this area.

Abstract

Posttraumatic stress disorder (PTSD) can develop following exposure to severe, often life-threatening stressors (e.g., combat, rape, and natural disasters). Although many survivors experience intrusive thoughts, nightmares, difficulty sleeping, and other symptoms in the immediate wake of trauma, PTSD is only diagnosable when symptoms persist longer than 1 month and produce clinically significant distress or impairment in everyday life. This article covers description of the four clusters of symptoms constitutive of PTSD, the historical evolution of the diagnosis, consideration of what distinguishes traumatic from other stressors, sex ratio, epidemiology, course of the disorder, risk factors for PTSD, comorbidity, cognitive research, biological research, and treatments for PTSD.

Abstract

Posttraumatic stress disorder (PTSD) is a psychological condition that results from exposure to one or more traumatic events. The disorder is characterized by symptoms that involve reexperiencing the traumatic event, avoidance, changes in beliefs, and emotions, and heightened physiological arousal and related difficulties following the event. The lifetime prevalence of PTSD is approximately 8%; female adults and adolescents are more likely than males to be diagnosed. Risk for PTSD is related to preexisting genetic factors, biological factors, aspects of the event including the severity, frequency, and duration of the traumatic experience, and individual factors such as cognitive appraisals and behavioral avoidance.

6.22.1 Introduction

Posttraumatic stress disorder (PTSD) is a common and disabling condition that can arise following severely threatening events such as sexual or physical assaults, combat, torture, terrorist attacks, serious accidents, disaster, or life-threatening illness. Descriptions of PTSD can be found in literature throughout history, from Homer's Iliad to Tolkein's Lord of the Rings, and in medical texts thousands of years old. Different terms have been used over the years, such as “soldier's heart”, “railway spine” and “shell shock”, often conceptualizing PTSD as a physical illness. Indeed, although modern conceptualizations of PTSD focus on psychological processes such as memory, emotion, cognition and behavior, the manifestations of PTSD symptoms are often physical including enhanced startle responses, physiological reactions to reminders of trauma and powerful physical re-experiencing of trauma memories.

Living with chronic PTSD can have a devastating impact on an individual's quality of life (Rapaport et al., 2005). PTSD is associated with poorer physical health, including a greater risk for cardiovascular diseases and cancer (Kubzansky et al., 2007; Pacella et al., 2013; Perkonigg et al., 2009; Sareen et al., 2007; Wild et al., 2016a) and functional impairments across a range of domains including lower work productivity (and increased economic burden; Ferry et al., 2015), marital and family functioning (Koenen et al., 2003), parenting (Cohen et al., 2011) and friendships (Laffaye et al., 2008). PTSD is also associated with an increased risk of suicide (Krysinska and Lester, 2010), as well as a range of comorbid conditions, including depression and substance misuse (Brady et al., 2000).

Research over recent decades into the psychological processes underlying PTSD has led to the development of several highly effective treatments for the disorder. In this chapter, we will summarize the epidemiology, diagnosis, main current psychological theories of PTSD and evidence, as well as a range of evidence-based treatments which have been developed and found to be effective in empirical evaluations. Preventative interventions and future developments in the field are also considered.

Abstract

Posttraumatic stress disorder (PTSD) arises following trauma experiences or chronic distress. The disorder was most common among individuals who experienced repeated stressors, or with a history of psychological disturbances. The disorder has been attributed to the failure of recovery systems, the inability to distinguish danger from safety, disturbed memory, impaired fear extinction, and sensitized neurochemical responses. PTSD is accompanied by morphological changes of the hippocampus, amygdala, and cortical regions, possibly reflecting preexistent vulnerability factors, or consequences of the disorder. Numerous neurochemical processes are associated with PTSD, possibly varying as the disorder plays out over time. Many behavioral and pharmacological treatments have been attempted, including their administration shortly after trauma or during memory reconsolidation, but their effectiveness has typically been moderate. Inflammatory immune alterations and microbiota variations have been linked to PTSD, but it is uncertain whether these are etiologically related to the disorder, or a consequence of the illness itself.

Basic Information

Epidemiology

The prevalence of post traumatic stress disorder (PTSD) is estimated at 8% of the general population Kessler et al (1995). Women are more likely than men to be exposed to high impact traumas or traumas associated with a high probability of developing PTSD, such as rape, sexual molestation, childhood neglect, and physical abuse. Men, on the other hand, are more likely to be involved in physical attacks, combat, and being kidnapped and held captive. Most patients with PTSD also have a lifetime prevalence of at least one other psychiatric illness Horwath and Weissman (2000).

General Description

As its name implies, posttraumatic stress disorder (PTSD) is unique among the mental disorders in that it is a reaction to a clear precipitating event – a traumatic experience. Although it is to be expected that people will experience distress after a serious trauma, individuals with PTSD continue to be bothered by the traumatic event long after it has passed. They often are distressed at or avoid thoughts or situations that remind them of the trauma. Features of PTSD include prominent symptoms of fear, anxiety, avoidance, and arousal, which are consistent with its classification as an anxiety disorder. However, it also includes depressive symptoms, numbing of feelings, and flashbacks.

Reintegration: Homecoming after Combat

As service members return home, their mission and the stressors they encounter change drastically. While this eagerly anticipated time is generally positive and marked by a reduction in risk, difficulties associated with transition back into noncombat roles are common. Many frequently report stress redefining their role within the family.21 While the service member is deployed, family members adapt and expand roles to fill the voids created by the person’s absence. Many returning service members describe feeling unneeded and out of place. Veterans with persisting physical or psychological wounds may not be able to reengage with previous activities or fulfill former obligations. They and their families often strive to accommodate changes in attitudes, emotions, and behaviors altered by military experiences. Similarly, veterans frequently report believing civilians cannot understand their sacrifices or combat experiences, resulting in feeling disconnected from their family, civilian peers, and their larger community.22 This can be particularly alienating in contrast with the closeness felt with the comrades with whom they served.

Employment can be a significant source of stress during the reintegration period and unemployment is disproportionately high in veteran populations.23 After returning from deployments involving leadership roles, making life-and-death decisions, or managing valuable equipment, civilian jobs may seem mundane. Cultivated talents may go unrecognized and underutilized, and as a result, they may struggle to find work, accept positions in which they are underemployed, and feel discouraged and devalued.