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Research article offering an in depth look at PTSD.
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PTSD: In-Depth Overview
Running Head: PTSD RESEARCH PAPER 1
PTSD Research Paper
Geries Shaheen
Lindenwood University
Author Note
PTSD is a condition that affects many individuals. While this research paper may focus
on a few select examples of PTSD, it is to be known PTSD may occur in any terrifying ordeal
that involves physical harm or the threat of physical harm.
PTSD: In-Depth Overview
PTSD: In-Depth Overview
PTSD 2
Abstract
This is a research paper on the topic of PTSD. The information found in this research paper has
been extracted from various reliable sources both online and offline. This research paper covers
the definition of PTSD as well as its criteria, symptoms, affects on family and depression, goals,
and treatment.
Keywords: PTSD, Causes, Depression, Criteria, Symptoms, Treatment
PTSD: In-Depth OverviewPTSD 3
PTSD Research Paper
When people feel they are in danger, the body responds naturally and prepares to make
many split second decisions. The body prepares to defend against the danger or to avoid it.
This healthy response is called a “fight-or-flight” reaction (Barlow, D. & Durand, 2012). With
people that have post-traumatic stress disorder (PTSD), this reaction is altered. People with
PTSD may feel stressed or frightened even when the danger does not exist. PTSD occurs when
someone is involved with physical harm or the threat of physical harm. That person may have
been the one who was harmed, the harm may have happened to a loved one, or the person may
have witnessed a harmful event that happened to loved ones or even strangers (Post-traumatic, n.
d.).
PTSD is a physical condition that affects the whole body. It's a collection of reactions
that can be both normal or abnormal depending on the situation. These reactions come about
after exposure to actual or threatened death, serious injury, or sexual violence (Hoge, 2010).
How It Works
PTSD begins with a traumatic event. The medial prefrontal cortex in the brain begins to
shut down when there is trauma or stress from combat or other similar events. This causes the
limbic system to kick in. The limbic system is primarily responsible for our emotional life, and
has a great deal to do with the formation of memories. Limbic system memories are the
memories that bring on PTSD. A light reflection from a window or passing car, the smell of
diesel fuel, the sound of helicopters or airplanes, someone's name, the news, a calendar date,
trash on the side of the road, traffic, kids yelling, raw meat, going into a porta - potty. These
experiences are stored as limbic memories, considering they are correlated to a traumatic event
that initially triggered the limbic part of the brain (Hoge, 2010).
PTSD: In-Depth OverviewPTSD 4
The following is an example of a limbic memory as quoted by a Senior NCO who is
diagnosed with PTSD.
"All we do is roll on missions and hope we don't get blown up, and then when we get hit
there is nothing we can do but watch my dead friends get pulled out in pieces. "
-Senior NCO Iraq (Hoge, 2010).
Causes
PTSD was first brought to public attention in relation to war veterans, but it can result
from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held
captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters
such as floods or earthquakes. The DSM 5 points to a few factors that lead to the onset and or
severity of PTSD.
Pre-traumatic factors include temperamental, environmental beginnings. They also
include genetic and physiological roots. Temperamental states that the client may have had
emotional problems. By the age of six the child may have been exposed to a traumatic event at
a young age or developed a mental disorder. Environmental states that the client may have
experienced effects of having a low socioeconomic status, poor education, or family dysfunction.
Lastly, certain genotypes may have an increased risk of PTSD (American Psychiatric
Association, & American Psychiatric
Association, 2013).
Peritraumatic factors express that the cause of PTSD is linked to the severity of the
traumatic event or events. Posttraumatic factors express that PTSD is seen through in
appropriate coping strategies, stress disorders, adverse life events negative appraisals, repeated
reminders of trauma. Currently, scientists are studying genes responsible for creating fear
PTSD: In-Depth OverviewPTSD 5
memories. PTSD researchers have found genes that make Stathmin, a protein required in the
formation of fear memories. In a study on mice that did not make stathmin shows they were less
likely than normal mice to “freeze,” after being exposed to a fearful experience. They also
showed less innate fear by exploring open spaces more willingly than normal mice. GRP
(gastrin-releasing peptide). is a signaling chemical in the brain that is released during emotional
events. In mice, GRP seems to help control the fear response, and lack of GRP may lead to the
creation of greater and more lasting memories of fear (post-traumatic-stress-disorder, n. d.).
Researchers have also found a version of the 5-HTTLPR gene, which controls levels of
serotonin. This brain chemical is related to mood and appears to fuel the fear response.
Different parts of the brain are involved in dealing with fear and stress. Understanding these
parts helps researchers focus on new possible causes of PTSD. For instance the amygdala is
known for its role in emotion, learning, and memory. It appears to be active in fear acquisition,
or learning to fear an event (such as touching a hot stove). , as well as in the early stages of fear
extinction, or learning not to fear (post-traumatic-stress-disorder, n. d.).
The prefrontal cortex, as stated earlier, plays a role in fear as well. Storing extinction
memories and dampening the original fear response appears to involve the prefrontal cortex.
Certain areas of the prefrontal cortex are responsible for different roles (Hoge, 2010). For
instance, when a source of stress is controllable, the medial prefrontal cortex suppresses the
amygdala and controls the stress response. The ventromedial prefrontal cortex then helps
sustain long-term extinction of the fearful memories. Any shift or differences in these genes or
brain areas could set the stage for PTSD without even causing symptoms.
Environmental factors stated earlier, such as childhood trauma, head injury, or a history
of mental illness, may increase a person's risk by affecting the early growth of the brain.
PTSD: In-Depth OverviewPTSD 6
Personality and cognitive factors, such as optimism and the ability to see challenges in a positive
or negative light, and social factors, such as the availability / use of social support, influence how
people adjust to trauma (post-traumatic-stress-disorder, n. d.).
Criteria and Symptoms
"War fucked me up mentally. I have bad dreams and I see all kinds of mad ill shit. I
see dead people. I sometimes get angry and pissed off and just want to kill somebody. "
-Junior enlisted solider post Afghanistan (Hoge, 2010).
The above quote express a few symptoms of PTSD.C.W. Hoge, the author of "Once a
Warrior, Always a Warrior, makes an emphasis that what medical professionals deem as
symptoms are also combat survival skills. The author explains that PTSD isn't just a problem,
but a condition that impacts individuals in a holistic manner. When someone is experiencing
PTSD they are affected physically, emotionally, psychologically and behaviorally.
Throughout the book, the author makes a point to express his ideas with underlying
notions. For example, he never eludes that there is anything "broken" with individuals
experiencing PTSD, but rather they have not been able to learn how to successfully dial up or
dial down their warrior skills / responses. They simply have not effectively adapted to their new
environment (Hoge, 2010).
PTSD brings with it many symptoms. These symptoms can be grouped into three
categories; Re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms.
Re-experiencing symptoms include having flashbacks, having bad dreams, and experiencing
frightening thoughts. Flashbacks are described as reliving the trauma over and over, and include
physical symptoms such as a racing heart or sweating (American Psychiatric Association, &
American Psychiatric Association, 2013).
PTSD: In-Depth OverviewPTSD 7
Re-experiencing symptoms may cause problems in a person’s everyday routine. They
can start from the person’s own thoughts and feelings. Words, objects, or situations that are
reminders of the event can also trigger re-experiencing.
Avoidance symptoms are seen when individuals begin staying away from places, events,
or objects that are reminders of the experience. They begin Feeling emotionally numb. They
feel strong guilt, depression, and worry. These individuals begin to lose interest in activities that
were enjoyable in the past. They also begin having trouble remembering the dangerous event
they initially experienced. Things that remind a person of the traumatic event can trigger
avoidance symptoms. These symptoms may cause a person to change his or her personal
routine. For example, after a bad car accident, a person who usually drives may avoid driving or
riding in a car (Hoge, 2010).
Lastly, Hyperarousal symptoms exist with PTSD. Individuals may be easily
startled, Feel tense or “on edge”, and have difficulty sleeping. Individuals with Hyperarousal
symptoms may also experience angry outbursts. Hyperarousal symptoms are usually constant,
instead of being triggered by things that remind one of the traumatic events. They can make the
person stressed and angry. These symptoms make it hard for the individual to accomplish daily
tasks, such as sleeping, eating, or concentrating (post-traumatic-stress-disorder, n. d.).
These symptoms are natural after a dangerous event. Sometimes people experience
serious symptoms that go away after a few weeks. This is called acute stress disorder. When
the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD.
Some people with PTSD don’t show any symptoms for weeks or months. Children and teens
can have extreme reactions to trauma, but their symptoms may not be the same as adults. Very
young children may begin bed-wetting, or forget how to talk. They may act out the scary event
PTSD: In-Depth OverviewPTSD 8
or become extremely clingy with parents. Older children and teens usually show symptoms
more like those seen in adults. They may develop disruptive behaviors. Older children and
teens might feel guilty for not preventing injury or deaths. They may also have thoughts of
revenge (post-traumatic-stress-disorder, n. d.).
DSM-5 Criteria
The DSM 5 offers criteria and symptoms of PTSD. PTSD is considered a trauma/
stressor related disorder, and is labeled with the following codes 309. 81 (F43. 10) for diagnosis.
The DSM 5 states that PTSD as the exposure to actual or threatened death, serious
injury, or sexual violence through Directly experiencing the traumatic event, witnessing, in
person, the event as it occurred to others, and Learning that the traumatic event occurred to close
and remember to close friend (American Psychiatric Association, & American Psychiatric
Association, 2013).
The DSM 5 addresses symptoms that exist at different times of the process. There is a
presence of one or more of the following intrusion symptoms associated with the
traumatic event, beginning after the traumatic event occurred. Recurrent, involuntary, and
intrusive distressing memories of the traumatic event occur. Recurrent distressing dreams in
which the content and or affect of the dream are related to the traumatic event occur as well.
Dissociative reactions such as flashbacks are attributed to PTSD, as described in the
DSM5. These flashbacks make the individual feel or act as if the traumatic event were
recurring. Intense prolonged psychological distress also occurs. This happens when the
individual is exposed to internal or external cues that symbolize or resemble an aspect of the
traumatic event. Marked physiological reactions to internal or external cues that symbolize
or resemble an aspect of the traumatic event also occur (American Psychiatric Association, &
PTSD: In-Depth OverviewPTSD 9
American Psychiatric Association, 2013).
The DSM5 states that the individual can develop persistent avoidance of stimuli
associated with the traumatic event, beginning after the traumatic event occurred. This is
evidenced by the intentional avoidance, or putting effort to avoid, distressing memories,
thoughts, or feelings about the traumatic event. The individual may also avoid, or put effort to
avoid, external reminders that arouse distressing memories, thoughts, or feelings about or closely
associated with the traumatic event.
Negative alterations, cognitions, and mood associated with the traumatic event that begin
or worsen after the dramatic event occurred are symptoms of PTSD. In this symptom, an
individual become unable to remember important aspects of the traumatic event. They may
show persistence and exaggerated negative beliefs or expectations about themselves, others, or
the world. They may have Persistent, distorted cognitions about the causal consequences of the
traumatic event that led the individual to blame him or herself or others. The individual may be
in a persistent negative emotional state and feel detached or estranged from others. They may
also display persistent inability to experience positive emotions (American Psychiatric
Association, & American Psychiatric Association, 2013).
Marked alterations in arousal and reactivity associated with the traumatic event may
begin or worsen after the traumatic event occurred. The individual may experience this
symptom through displaying irritable behavior and angry outbursts usually expressed as verbal
or physical aggression toward people or objects (Barlow & Durand, 2012). The individual may
exhibit Recklessness or even self-destructive behavior. Hypervigilance is a criterion for this
symptom. The individual may have an exaggerated startle response, and show problems with
concentration. Sleep disturbances often occur as a symptom as well (American Psychiatric
PTSD: In-Depth OverviewPTSD 10
Association, & American Psychiatric Association, 2013).
The DSM5 indicates specific criteria for these symptoms. The duration of the
disturbance must be more than one month. The disturbances must cause clinically significant
distress, or impairment, in social, occupational, or other important areas of the
individual's functioning. The disturbance must not be attributable to the physiological effects
of a substance or another medical condition (American Psychiatric Association, & American
Psychiatric Association, 2013).
While observing the symptoms, the DSM5 also expects specifications of
depersonalization, derealization, or delayed expression within the individual. It must be noted if
the individual feels detached, as if an observer looking into his world. It must be noted if the
individual experiences his world in a dreamlike fashion, feeling distant from reality.
Lastly, it must be noted if the individual experiences the symptoms immediately or
months later (American Psychiatric Association, & American Psychiatric
Association, 2013).
PTSD and Family
"Whenever there are crowds I start feeling like I'm in Iraq and have to get out of there
fast. "
-Junior enlisted soldier post Iraq (Hoge, 2010).
PTSD creates challenges for the diagnosed individual as well as their families. It may be
difficult for families to accept the changes PTSD can bring to life. However, family is an
important element of recovery. Families rely on one another for support. It is important to
know that family members may not always know how to respond when they see symptoms of
PTSD. They may be scared, sad, guilty, or even angry about the condition. Talking through
PTSD: In-Depth OverviewPTSD 11
PTSD with families helps with coping strategies. It is important to talk about symptoms and
what triggers them. Discussing different treatments and how they can help in recover allows
families to open up. Family therapy is also a means of accomplishing these discussions (PTSD
and Your Family, 2011).
When talking with children about PTSD it is crucial to be honest and listen to what they
think. Offering a safe environment for them to ask questions creates progress. Promising that
the PTSD will go away does not create progress. Inform the child about PTSD. Explain how it
was acquired, and the recovery process (PTSD-Recovery, 2011).
Triggers are sudden reminders of the traumatic event (Barlow & Durand, 2012). They
bring about flashbacks and stressful feelings. It is common for individuals with PTSD to avoid
their specific triggers. In doing so, it places a hardship on the rest of the family. The family
will find itself not engaging in social activities enjoyed previously. It is important for families
to know what the triggers entail. Being aware of the triggers may help the individual and the
family members cope. These triggers may include attending a bonfire, being at a reunion, or the
anniversary of the event itself (PTSD-Recovery, 2011).
Major holidays can be painful for families navigating PTSD. Large family gatherings
may now seem stressful. Holidays may now become reminders of life before PTSD. Large
family groups may now be tiring and overwhelming. The individual may feel they must act
happy, or feel pressured to join activities in which they do not wish to engage. There may even
be relatives or people that will ask about life and specifically the PTSD. These experiences may
also be lived out by the individual's family (PTSD and Your Family, 2011).
To cope with holidays, families can focus on a few strategies. Families can set limits of
time spent participating in activities. Taking breaks and going on walks aids in becoming
PTSD: In-Depth OverviewPTSD 12
overwhelmed. Being honest during family gathers about levels of stress sets healthy boundaries
for everyone (Jongsma, Peterson & Bruce, 2007).
There are also strategies for family members. If a family member is navigating PTSD
during the holidays it is important to accept their mixed feelings about the holiday itself.
Respecting the individual's decisions about involvement in celebration is crucial. Planning
ahead and making decisions such as how long to attend can be helpful. Lastly, family members
are encouraged to keep their expectations of the individual realistic (Jongsma, Peterson & Bruce,
2007).
Depression
Experiencing a traumatic event can leave people feeling very upset. Individuals can
experience flashbacks, nightmares, and vivid memories. This causes individuals to be numb and
lose interest in things they once cared about (PTSD and Depression, 2011).
In cases of PTSD, depression occurs more often in women than it does in men.
Depression will make the individual feel hopeless, sad, and overwhelmed (Barlow, D. & Durand,
2012). Symptoms of depressive feelings can last a while, or just come and go. Along with
hopelessness, individuals with depression may experience weight gain or lose, increase or
decrease in sleep, as well as feel guilty or unworthy (Kessler, 1995).
Both PTSD and depression have been strong ties to suicide. Individuals may plan to
harm themselves or others. They may talk, write, read or draw about death. Hallucinations
may be included in strong cases of depression or PTSD. The individual may report hearing or
seeing things that are not real. Contacting emergency services is encouraged if the above
descriptions occur (PTSD and Depression, 2011).
Some studies have found a high incidence of PTSD after trauma. A sample of more than
PTSD: In-Depth Overview
PTSD 13
2,000 adults women who had personally experienced such trauma as rape, sexual molestation,
robbery, and aggravated assault. Participants were asked whether they had thought about
suicide after the trauma, attempted suicide, or had a nervous breakdown. The table below
displays the findings (Barlow & Durand, 2012).
Table 1
Treatment
There are many short term treatment goals and interventions assigned to PTSD that can
be found in treatment planners and online resources. While these are effective, it is also
important to keep long term goals in focus. Traumatic events can bring cause a negative impact
on many aspects of an individuals life. One long term goal is to reduce these negative impacts
PTSD: In-Depth Overview
"PTSD 14
in order for the individual to return to the pre-trauma level of functioning they once had.
Coping skills can be very helpful in accomplishing this. (Romito & Hamblen, 2011).
The individual must develop and implement effective coping skills in order to carry out
normal responsibilities. This will help the individual participate constructively in relationships.
The individual must utilize these coping skills to terminate destructive behaviors. Destructive
behaviors serve to maintain escape and denial. Once these destructive behaviors are managed,
the individual can focus on implementing behaviors that promote healing, acceptance, and
responsible living. (Jongsma, Peterson & Bruce, 2007).
A very large goal is to be able to narrate the traumatic event. An individual can benefit
from being able to tell their story. Recalling the traumatic event without becoming
overwhelmed with negativity, urges, or bad feelings (Jongsma, Peterson & Bruce, 2007).
Catharsis can be used within psychoanalytic therapy to relive emotional trauma in order to
relieve emotional suffering. This can help set the stage for narration. Cognitive therapy is used
to correct negative assumptions about trauma, such as blaming oneself in some way or feeling
guilty over things outside their control (Cahill, 2009).
Drugs can also be effective for symptoms of PTSD. Prozac and Paxil are effective in
relieving anxiety and panic attacks. They are helpful with symptoms of PTSD (Barlow, D. &
Durand, 2012). Research of PTSD has lead scientists to focus on prevention and the exploration
of new medications. As gene research continues to improve, there will be a higher likelihood to
pinpoint when and where PTSD begins. This will allow for targeted treatment, preventing the
disorder before it causes harm.
PTSD: In-Depth Overview
SHORT TITLE (50 CHARACTERS OR LESS). , ALL CAPS 15
Citations and References
References
American Psychiatric Association, & American Psychiatric Association (2013). Diagnostic and
statistical manual of mental disorders: DSM-5.
Barlow, D. & Durand, V. (2012). Abnormal psychology : an integrative approach. Belmont,
CA: Wadsworth, Cengage Learning.
Cahill SP, et al. (2009). Cognitive-behavioral therapy for adults. In EB Foa et al., eds.
, Effective Treatments for PTSD: Practice Guidelines From the International Society for
Traumatic Stress Studies, 2nd ed., pp.139-222. New York: Guilford Press.
Hoge, C. W. (2010). Once a warrior, always a warrior. Guilford: Gpp Life.
Jongsma, A. E. , Peterson, L. M. , & Bruce, T. J.(2007).The complete adult psychotherapy
treatment planner.
Kessler RC, et al. (1995). Posttraumatic stress disorders in the National Comorbidity Survey.
Archives of GeneralPsychiatry, 52 (12). : 1048-1060.
Romito, K. , & Hamblen, J. (2011, January 13). PTSD and Your Family - Overview. Retrieved
from http://www. webmd. com/anxiety-panic/tc/ptsd-and-your-family-overview
Romito, K. , & Hamblen, J. (2011, January 13). PTSD and Depression - Overview.
Retrieved from http://www. webmd. com/anxiety-panic/tc/ptsd-and-depression-
overview
Romito, K. , & Hamblen, J. (2011, January 13). Post-traumatic stress disorder recovery.
Retrieved from http://www. webmd. com/anxiety-panic/tc/post-traumatic-stress-
disorder-recovery
(post-traumatic-stress-disorder, n. d. ). Retrieved fromhttp://www. nimh. nih.
gov/health/topics/post-traumatic-stress-disorder-ptsd/index