Post-traumatic stress disorder (PTSD)

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Post-traumatic stress disorder (PTSD)

Post by Trooper on Tue 12 Apr 2016, 06:25

"Tests and diagnosis"

Post-traumatic stress disorder is diagnosed based on signs and symptoms and a thorough psychological evaluation. Your health care provider will likely ask you to describe your signs and symptoms and the event that led up to them. You may also have a physical exam to check for medical problems.

To be diagnosed with PTSD, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM criteria for PTSD

Diagnosis of PTSD requires exposure to an event that involved or held the threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

You experienced the traumatic event
You witnessed, in person, the traumatic event
You learned someone close to you experienced or was threatened by the traumatic event
You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)
You experience one or more of the following signs or symptoms after the traumatic event:

You relive experiences of the traumatic event, such as having distressing images and memories.
You have upsetting dreams about the traumatic event.
You experience flashbacks as if you were experiencing the traumatic event again.
You experience ongoing or severe emotional distress or physical symptoms if something reminds you of the traumatic event.
In addition, for more than one month after the traumatic event you may:

Try to avoid situations or things that remind you of the traumatic event
Not remember important parts of the traumatic event
View yourself, others and the world in a negative way
Lose interest in activities you used to enjoy and feel detached from family and friends
Feel a sense of emotional numbness, feel irritable or have angry or violent outbursts
Engage in dangerous or self-destructive behavior
Feel as if you're constantly on guard or alert for signs of danger and startle easily
Have trouble sleeping or concentrating

Your symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks.

For children younger than 6 years old, signs and symptoms may include:

Reenacting the traumatic event or aspects of the traumatic event through play
Frightening dreams that may or may not include aspects of the traumatic event

"Treatments and drugs"

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but often includes medication. Combining these treatments can help improve your symptoms, teach you skills to address your symptoms, help you feel better about yourself and learn ways to cope if any symptoms arise again.

Psychotherapy and medications can also help you if you've developed other problems related to your traumatic experience, such as depression, anxiety, or misuse of alcohol or drugs. You don't have to try to handle the burden of PTSD on your own.

Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations. For PTSD, cognitive therapy often is used along with exposure therapy.
Exposure therapy. This behavioral therapy helps you safely face what you find frightening so that you can learn to cope with it effectively. One approach to exposure therapy uses "virtual reality" programs that allow you to re-enter the setting in which you experienced trauma.
Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to traumatic memories.
All these approaches can help you gain control of lasting fear after a traumatic event. You and your health care professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

"Medications"

Several types of medications can help improve symptoms of PTSD:

Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress for a short time to relieve severe anxiety and related problems. Because these medications have the potential for abuse, they are not usually taken long term.
Prazosin. If symptoms include insomnia or recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA-approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.
You and your doctor can work together to figure out the best treatment, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your health care professional about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

"Coping and support"

If stress and other problems caused by a traumatic event affect your life, see your health care professional. You also can take these actions as you continue with treatment for post-traumatic stress disorder:

Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan will help move you forward.
Learn about PTSD. This knowledge can help you understand what you're feeling, and then you can develop coping strategies to help you respond effectively.
Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
Talk to someone. Stay connected with supportive and caring people — family, friends, faith leaders or others. You don't have to talk about what happened if you don't want to. Just sharing time with loved ones can offer healing and comfort.
Consider a support group. Ask your health professional for help finding a support group, or contact veterans' organizations or your community's social services system. Or look for local support groups in an online directory or in your phone book.

"When someone you love has PTSD"

The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.

Hearing about the trauma that led to your loved one's PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can't fix your loved one or hurry up the process of healing.

Remember that you can't change someone. However, you can:

Learn about PTSD. This can help you understand what your loved one is going through.
Recognize that withdrawal is part of the disorder. If your loved one resists your help, allow space and let your loved one know that you're available when he or she is ready to accept your help.
Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
Be willing to listen. Let your loved one know you're willing to listen, but you understand if he or she doesn't want to talk.
Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your emotions.
Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.

"Prevention"

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what's happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.

Getting support can help you recover. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health provider for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. Support from others may also help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/coping-support/con-20022540
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DSM-5 Criteria for PTSD

Post by Trooper on Tue 12 Apr 2016, 06:40

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-

Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.
Two specifications are noted including delayed expression and a dissociative subtype of PTSD, the latter of which is new to DSM-5. In both specifications, the full diagnostic criteria for PTSD must be met for application to be warranted.

"Dissociative Subtype of PTSD"

The role of dissociation as the most direct defense against overwhelming traumatic experience was first documented in the seminal work of Pierre Janet. Recent research evaluating the relationship between Posttraumatic Stress Disorder (PTSD) and dissociation has suggested that there is a dissociative subtype of PTSD, defined primarily by symptoms of derealization (i.e., feeling as if the world is not real) and depersonalization (i.e., feeling as if oneself is not real). Confrontation with overwhelming experience from which actual escape is not possible, such as childhood abuse, torture, as well as war trauma challenges the individual to find an escape from the external environment as well as their internal distress and arousal when no escape is possible. States of depersonalization and derealization provide striking examples of how consciousness can be altered to accommodate overwhelming experience that allows the person to continue functioning under fierce conditions.
An ‘out-of-body’ or depersonalization experience during which individuals often see themselves observing their own body from above has the capacity to create the perception that ‘this is not happening to me’ and is typically accompanied by an attenuation of the emotional experience.
Similarly, states of derealization during which individuals experience that ‘things are not real; it is just a dream’ create the perception that ‘this is not really happening to me’ and are often associated with the experience of decreased emotional intensity.
The addition of a dissociative subtype to the PTSD diagnosis is expected to further advance research examining the etiology, epidemiology, neurobiology, and treatment response of this subtype and facilitate the search for biomarkers of PTSD.
Rationale

The recognition of a dissociative subtype of PTSD as part of the DSM-5 PTSD diagnosis was based on three converging lines of research: (1) symptom assessments, (2) treatment outcomes, and (3) psychobiological studies. Even though dissociative symptoms such as flashbacks and psychogenic amnesia are included as part of the core PTSD symptoms, evidence suggests that a subgroup of PTSD patients exhibits additional symptoms of dissociation, including depersonalization and derealization, thus warranting a subtype of PTSD specifically focusing on these two symptoms. Recognizing a dissociative subtype of PTSD has the potential to improve the assessment and treatment outcome of PTSD.
Evidence

The addition of a dissociative subtype of PTSD in the upcoming DSM-5 was based on three lines of evidence:
Several studies using latent class, taxometric, epidemiological, and confirmatory factor analyses conducted on PTSD symptom endorsements collected from Veteran and civilian PTSD samples indicated that a subgroup of individuals (roughly 15 - 30%) suffering from PTSD reported symptoms of depersonalization and derealization (1-3). Individuals with the dissociative subtype were more likely: to be male, have experienced repeated traumatization and early adverse experiences, have comorbid psychiatric disorders, and evidenced greater suicidality and functional impairment (4). The subtype also replicated cross-culturally.

Neurobiological evidence suggests depersonalization and derealization responses in PTSD are distinct from re-experiencing/hyperarousal reactivity. Individuals who re-experienced their traumatic memory and showed concomitant psychophysiological hyperarousal exhibited reduced activation in the medial prefrontal- and the rostral anterior cingulate cortex and increased amygdala reactivity. Reliving responses are, therefore, thought to be mediated by failure of prefrontal inhibition or top-down control of limbic regions. In contrast, the group who exhibited symptoms of depersonalization and derealization showed increased activation in the rostral anterior cingulate cortex and the medial prefrontal cortex. Depersonalization/derealization responses are suggested to be mediated by midline prefrontal inhibition of the limbic regions (5,6).
Early evidence suggests that symptoms of depersonalization and derealization in PTSD are relevant to treatment decisions in PTSD (reviewed in Lanius et al., 2012;5). Individuals with PTSD who exhibited symptoms of depersonalization and derealization tended to respond better to treatments that included cognitive restructuring and skills training in affective and interpersonal regulation in addition to exposure-based therapies (7,Cool. Additional research is needed to more fully evaluate the effects of depersonalization and derealization on treatment response.

Assessment

The Clinician-Administered PTSD Scale (CAPS) includes items assessing depersonalization ("Have there been times when you felt as if you were outside of your body, watching yourself as if you were another person?") and derealization ("Have there been times when things going on around you seemed unreal or very strange and unfamiliar?"). In addition, there are several self-report rating scales that assess dissociative symptomatology. These include the Dissociative Experiences Scale, the Multiscale Dissociation Inventory, the Traumatic Dissociation Scale, and the Stanford Acute Stress Reaction Questionnaire. Additional interviews and scales specific to the dissociative subtype are currently under development.
Associated features and risks of the dissociative subtype

As compared to individuals with PTSD alone, patients with a diagnosis of the dissociative subtype of PTSD showed:
Repeated traumatization and early adverse experience prior to onset of PTSD
Increased psychiatric comorbidity, in particular specific phobia and borderline and avoidant personality disorders among women, but not men
Increased functional impairment
Increased suicidality (including suicidal ideation, plans, and attempts)

Treatment concerns

Treatment studies specifically designed to examine clinical outcomes of psychological and pharmacological treatment of PTSD in those with versus without the dissociative subtype are needed. However, we do know that individuals with dissociative PTSD may require treatments designed to directly reduce depersonalization and derealization. For such individuals, exposure treatment can lead to further dissociation and inhibition of affective response, rather than the goal of cognitive behavioural/exposure therapy, which is desensitization and cognitive restructuring.
There is preliminary evidence that relative to exposure-based therapies alone, individuals with PTSD who exhibited symptoms of depersonalization and derealization responded better to treatments that also included cognitive restructuring and skills training in affective and interpersonal regulation (5,7,Cool.
Author Note: Dr. Ruth Lanius is a Professor of Psychiatry at Western University of Canada; Drs. Mark Miller and Erika Wolf are Psychologists at the National Center for PTSD at VA Boston Healthcare System; Dr. Bethany Brand is a Professor of Psychology at Towson University; Dr. Paul Frewen is an Assistant Professor of Psychiatry at Western University of Canada; Dr. Eric Vermetten is the Head of Research Military Mental Health, Department of Psychiatry, University Medical Center and Rudolf Magnus Institute of Neuroscience in Utrecht; Dr. David Spiegel is Professor of Psychiatry at Stanford University.

PTSD Criteria

Posttraumatic Stress Disorder (PTSD) will be included in a new chapter in DSM-5 on Trauma- and Stressor-Related
Disorders. This move from DSM-IV, which addressed PTSD as an anxiety disorder, is among
several changes approved for this condition that is increasingly at the center of public as well as professional
discussion.
The diagnostic criteria for the manual’s next edition identify the trigger to PTSD as exposure to actual or
threatened death, serious injury or sexual violation. The exposure must result from one or more of the
following scenarios, in which the individual:
• directly experiences the traumatic event;
• witnesses the traumatic event in person;
• learns that the traumatic event occurred to a close family member or close friend (with the actual
or threatened death being either violent or accidental); or
• experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not
through media, pictures, television or movies unless work-related).
The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the individual’s
social interactions, capacity to work or other important areas of functioning. It is not the physiological
result of another medical condition, medication, drugs or alcohol.
Changes in PTSD Criteria
Compared to DSM-IV, the diagnostic criteria for DSM-5 draw a clearer line when detailing what constitutes
a traumatic event. Sexual assault is specifically included, for example, as is a recurring exposure
that could apply to police officers or first responders. Language stipulating an individual’s response to
the event—intense fear, helplessness or horror, according to DSM-IV—has been deleted because that
criterion proved to have no utility in predicting the onset of PTSD.
DSM-5 pays more attention to the behavioral symptoms that accompany PTSD and proposes four
distinct diagnostic clusters instead of three. They are described as re-experiencing, avoidance, negative cognitions and mood, and arousal.
Re-experiencing covers spontaneous memories of the traumatic event, recurrent dreams related to it,
flashbacks or other intense or prolonged psychological distress. Avoidance refers to distressing memories,
thoughts, feelings or external reminders of the event.
Negative cognitions and mood represents myriad feelings, from a persistent and distorted sense of
blame of self or others, to estrangement from others or markedly diminished interest in activities, to an
inability to remember key aspects of the event.
Finally, arousal is marked by aggressive, reckless or self-destructive behavior, sleep disturbances, hypervigilance
or related problems. The current manual emphasizes the “flight” aspect associated with PTSD;
the criteria of DSM-5 also account for the “fight” reaction often seen.

The number of symptoms that must be identified depends on the cluster. DSM-5 would only require
that a disturbance continue for more than a month and would eliminate the distinction between acute
and chronic phases of PTSD.
PTSD Preschool Subtype and PTSD Dissociative Subtype
DSM-5 will include the addition of two subtypes: PTSD in children younger than 6 years and PTSD with
prominent dissociative symptoms (either experiences of feeling detached from one’s own mind or
body, or experiences in which the world seems unreal, dreamlike or distorted).
PTSD Debate within the Military
Certain military leaders, both active and retired, believe the word “disorder” makes many soldiers who
are experiencing PTSD symptoms reluctant to ask for help. They have urged a change to rename the
disorder posttraumatic stress injury, a description that they say is more in line with the language of
troops and would reduce stigma.
But others believe it is the military environment that needs to change, not the name of the disorder, so
that mental health care is more accessible and soldiers are encouraged to seek it in a timely fashion.
Some attendees at the 2012 APA Annual Meeting, where this was discussed in a session, also questioned
whether injury is too imprecise a word for a medical diagnosis.
In DSM-5, PTSD will continue to be identified as a disorder.

http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp
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Re: Post-traumatic stress disorder (PTSD)

Post by Dannypaj on Tue 12 Apr 2016, 06:58

I am so sorry I caught the PTSD or whatever it is called (Post Traumatic "CF" Service Disorder), it is like a bad cold you can't shake.
Now and again there is clarity and then darkness and then the rerunning of shit through you head and the sleepless nights, soaking the bed in night sweets, added to mornings of being pissed off at the system for the complete abandonment and dysfunction coming straight from the top.
Years and years on repeat of the same shit!
It has been near over 19 years of living like this and waiting for help.
I had know idea what was really happening since masking it with alcohol was the easiest thing to do.
Two years sober and I read over all my paperwork sober and holy frictty frack, no wonder! NO WONDER!
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Re: Post-traumatic stress disorder (PTSD)

Post by Dannypaj on Tue 12 Apr 2016, 07:06

I am that private that is going to come back and bite the GOC in the ass, document everything, keep all your documents! Thanks to the people I served with side by side (unlike the Ottawa folks who decides your faith), they didn't lie to me and told me straight up to CYA.
CYA I wondered as a Private, now I know. Now you Know.
Keep all your paperwork because VRAB will through in every monkey wrench into their outcome of your appeal.
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Moved Post to PTSD

Post by Rags on Tue 12 Apr 2016, 08:30

Nav read what I said at no time did i say less or more important not sure where you got that idea from I just said they are different. They need to be detailed that way not that one deserves more support or more money. so dont confuse my comments with better worse more or less they are just what they are. All I said was detail them as they are. The key issue that rubs everyone the wrong way here is that I feel that DVA should deal with one and Private insurance should deal with the other. It is shit simple. So dont cast false views on me that I think or say one is better or worse or more deserving then another.

And now back to the Sean thing.

Thanks.

Rags

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Post-traumatic stress disorder (PTSD)

Post by Dannypaj on Wed 13 Apr 2016, 06:01

This post has been moved to a new thread under Comments.


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