DR.

RAM MANOHAR LOHIYA NATIONAL LAW

UNIVERSITY
LUCKNOW

Academic Session: 2018-19

Pyschology
Post Traumatic Stress Disorder

UNDER THE GUIDANCE OF: SUBMITTED BY:

Ms. Tanya Dixit AJAY KHEDAR

ASSISTANT PROFESSOR-(Psych) ROLL NO: 10

DR. RAM MANOHAR LOHIYA SECTION: ‘A’

NATIONAL LAW UNIVERSITY B.A. LLB (Hons.), SEMESTER-III

SIGNATURE OF PROFESSOR SIGNATURE OF STUDENT

 Table of Contents
ACKNOWLEDGMENT................................................................................................................. 3
Introduction ..................................................................................................................................... 4
Post-Traumatic Stress Disorder ...................................................................................................... 5
History......................................................................................................................................... 6
Terminology................................................................................................................................ 7
Causes of PTSD .............................................................................................................................. 8
Types of events that can lead to PTSD include .......................................................................... 9
Possible causes ............................................................................................................................ 9
Diagnosis....................................................................................................................................... 11
Symptoms of PTSD ...................................................................................................................... 12
PTSD in Military Veterans ....................................................................................................... 14
Symptoms of PTSD in veterans ................................................................................................ 15
Treatment ...................................................................................................................................... 16
Types of cognitive behavioral therapy...................................................................................... 16
What is EMDR? ........................................................................................................................ 17
Medication ................................................................................................................................ 17
Other types of treatment............................................................................................................ 18
Case Study – A Study of PTSD .................................................................................................... 19
Conclusion .................................................................................................................................... 23
Bibliography ................................................................................................................................. 24
 ACKNOWLEDGMENT

First of all, I would like to thank my teacher of the subject “Psychology”, Miss. Tanya Dixit, for
providing every bit of help and also showing the way in which to proceed and how to go about
the project. I would also like to thank my parents, friends and others who helped me immensely
at every step and gave every possible bit of help that I needed in preparing the project and
making it look presentable in a good way. I would also like to thank the library staff of
RMLNLU who provided me with books that I needed in making and preparing the project and
other pieces of information and help that was required. At last I would like to sincerely thank
God who gave me the much needed strength and power to go ahead with the project and make it
in a presentable way.

Ajay Khedar
 Introduction

This topic center concerns mental and emotional problems people experience in the wake of
'trauma', where trauma is understood to refer to an event involving being a victim of or witness
to atrocity, violence, true horror and/or the death of another or near death of ones self. Examples
might include rape, murder, torture, accidents, terrorism, etc. DSM describes two trauma
disorders: acute stress disorder, and posttraumatic stress disorder, both of which you may read
about in the links to the left of this document. In a nutshell, acute stress disorder occurs in the
time frame between just after exposure to a traumatic event to six months later, and
posttraumatic stress beginning at the six month point and extending thereafter.

All forms of post-trauma response are typically characterized by the presence of three classes of
symptoms. First, the post-trauma victim typically experiences intrusive memories of the
traumatic event. Intrusive recollections may occur during waking hours or sleep (in the form of
repetitive vivid recreation nightmares involving the trauma). Second, the post-trauma victim
makes efforts to avoid exposure to anything that might cause them to recall the trauma they
experienced. Third, the post-trauma victim typically shows an exaggerated startle response and
heightened anxiety levels. As a result of these sorts of symptoms, experienced on a consistent
basis day in and day out, PTSD (as posttraumatic stress is called) can be a very debilitating
condition.

Not all trauma victims experience PTSD immediately after exposure to trauma. Some persons
react quickly to traumatic exposure, while others appear to emerge from traumatic exposure
unscathed, only to experience the sudden emergence of PTSD-type symptoms months or years
later.

Post-trauma reactions such as PTSD and Acute Stress Disorder are classified in the DSM as
members of the family of Anxiety Disorders. This is all right and good, as trauma disorders
definitely involve heightened anxiety symptomology. However, unlike other anxiety disorders,
trauma disorders also frequently may involve Dissociative symptomology. In its mildest form,
dissociation involves 'spacing out' so that events that are occurring appear to be unreal. In more
severe forms of dissociation, memory for events may be misplaced (as in amnesia), or a person
may be so unnerved by what they have experienced that they take on another persona (in a fugue
state; see the movie, "Nurse Betty" for an example). The most tenacious and difficult to treat
forms of PTSD are sometimes those that have formed when a trauma victim was dissociative
during his or her experience of the trauma.

There’s a lot more to say about trauma reactions, of course, but this will serve as an introduction.
 Post-Traumatic Stress Disorder

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or
dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second
changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response
is a typical reaction meant to protect a person from harm. Nearly everyone will experience a
range of reactions after trauma, yet most people recover from initial symptoms naturally. Those
who continue to experience problems may be diagnosed with PTSD. People who have PTSD
may feel stressed or frightened even when they are not in danger.

Post-traumatic stress disorder (PTSD) is a mental disorder that can develop after a person is
exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats
on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the
events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues,
alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These
symptoms last for more than a month after the event. Young children are less likely to show
distress but instead may express their memories through play. Those with PTSD are at a higher
risk of suicide.

Most people who have experienced a traumatic event will not develop PTSD. People who
experience interpersonal trauma (for example rape or child abuse) are more likely to develop
PTSD, as compared to people who experience non-assault based trauma such as accidents and
natural disasters. About half of people develop PTSD following rape. Children are less likely
than adults to develop PTSD after trauma, especially if they are under ten years of
age. Diagnosis is based on the presence of specific symptoms following a traumatic event.

Prevention may be possible when therapy is targeted at those with early symptoms but is not
effective when carried out among all people following trauma. The main treatments for people
with PTSD are counseling and medication. A number of different types of therapy may be
useful. This may occur one-on-one or in a group. Antidepressants of the selective serotonin
reuptake inhibitor type are the first-line medications for PTSD and result in benefit in about half
of people. These benefits are less than those seen with therapy. It is unclear if using medications
and therapy together has greater benefit. Other medications do not have enough evidence to
support their use and in the case of benzodiazepines may worsen outcomes.
History

The risk of exposure to trauma has been a part of the human condition since we evolved as a
species. Attacks by saber tooth tigers or twenty-first century terrorists have probably produced
similar psychological sequelae in the survivors of such violence. Shakespeare's Henry IV appears
to meet many, if not all, of the diagnostic criteria for Posttraumatic Stress Disorder (PTSD), as
have other heroes and heroines throughout the world's literature. The history of the development
of the PTSD concept is described by Trimble.

In 1980, the American Psychiatric Association (APA) added PTSD to the third edition of its
Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification
scheme. Although controversial when first introduced, the PTSD diagnosis has filled an
important gap in psychiatric theory and practice. From an historical perspective, the significant
change ushered in by the PTSD concept was the stipulation that the etiological agent was outside
the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a
traumatic neurosis). The key to understanding the scientific basis and clinical expression of
PTSD is the concept of "trauma."

Early descriptive accounts of stress-related disorders are often linked to the history of
warfare. Stephen Crane’s introspective accounts of a youth’s reaction to the stress of a battle
during the Civil War provide an early example. The Youth (Henry Fleming), the main character
in The Red Badge of Courage, describes a range of anxiety symptoms that he experiences during
combat. The horrors of trench warfare during World War I, and their resultant psychological
consequences, led to formulation of the concept of “shell shock,” initially thought to be a
consequence of exposure to intense artillery. Subsequently clinicians realized that the symptoms
were due to the stress of the combat experience.

Interest in shellshock waned as memories of World War I receded, but it was reawakened by the
advent of World War II. As had happened previously, soldiers who were chronically exposed to
combat experienced a syndrome characterized anxiety, intense autonomic arousal, reliving, and
sensitivity to stimuli that are reminiscent of the original trauma. This syndrome was given a
variety of different names: traumatic war neurosis, combat fatigue, battle stress, and gross stress
reaction. When the war drew to its end, another type of stress was discovered: the experience of
death camp survivors.

In the pre-DSM era a literature also accumulated on psychiatric disorders that occurred as a
consequence of exposure to noncombat injuries. Alexandra Adler wrote seminal papers on the
psychological effects of stress in civilian settings, beginning with her work on the Cocoanut
Grove fire, and described both the clinical picture and the epidemiology. She also compared the
effects of stress reactions occurring as a consequence of head injuries with those that occurred
because of psychological stress, thereby anticipating current discussions of the relationship
between PTSD and traumatic brain injury (TBI) in the context of the conflicts in Iraq and
Afghanistan. Nemiah wrote about the effects of industrial accidents, and Hamburg et al. wrote
about the effects of burn injuries. The descriptions of the syndromes occurring as a consequence
of these diverse stressors were surprisingly similar.

During this time conceptual frameworks for understanding the effects of stress as a
predisposing factor for mental illness also developed and matured. Two main positions were
articulated. The first position (the “biological school”), represented by thinkers such as Selye,
and emphasized the role of physical mechanisms. Selye coined the term “stress” and
hypothesized that it was mediated by the hypothalamic–pituitary–adrenal (HPA) axis. He
described the general adaptation syndrome as a healthy response to stress, and he considered the
traumatic neuroses to be a consequence of chronic or severe stress. The second position (the
“psychological school”) had its roots in the psychodynamic tradition. It emphasized the role of
the unconscious, and of repressed memories and early childhood traumata. It led eventually to
descriptions of mechanisms of defense and of their role in producing or preventing disease.
These two conceptual frameworks set the stage for the history that was to follow.

Terminology

The Diagnostic and Statistical Manual of Mental Disorders does not hyphenate 'post' and
'traumatic', thus, the DSM-5 lists the disorder as posttraumatic stress disorder. However, many
scientific journal articles and other scholarly publications do hyphenate the name of the
disorder, viz., post-traumatic stress disorder. Dictionaries also differ with regard to the preferred
spelling of the disorder with the Collins English Dictionary - Complete and Unabridged using
the hyphenated spelling, and the American Heritage Dictionary of the English Language, Fifth
Edition and the Random House Kernerman Webster's College Dictionary giving the non-
hyphenated spelling.
 Causes of PTSD

PTSD isn't usually related to situations that are simply upsetting, such as divorce, job loss or
failing exams.

PTSD develops in about 1 in 3 people who experience severe trauma. It isn't fully understood
why some people develop the condition while others don't. However, certain factors appear to
make some people more likely to develop PTSD.

If you've had depression or anxiety in the past, or you don't receive much support from family or
friends, you're more susceptible to developing PTSD after a traumatic event.

There may also be a genetic factor involved in PTSD. For example, having a parent with a
mental health problem is thought to increase your chances of developing the condition.

Researchers generally believe that post-traumatic stress disorder is not caused by one single
factor; rather a variety of risk factors and predispositions that work together to cause the
development of PTSD following a traumatic event. The most commonly cited causes for PTSD
include:

 Genetic: Anxiety disorders tend to run in families. People who have first-degree relatives
who struggle with anxiety disorders are at a greater risk for developing the disorder
themselves. While not a definitive cause for PTSD, it does make a person more
vulnerable to developing the disorder after a traumatic event.
 Brain Structures: It’s believed that certain areas of the brain that regulate emotions and
fear are different than those who do not develop PTSD after a traumatic event.
 Environmental: Those who have a history of trauma and stress are more likely to develop
PTSD than those who do not have a similar history. Also, children who grow up in
families where addiction is present are at greater risk for developing post-traumatic stress
disorder.
 Psychological: People who struggle with certain types of mental illness, notably anxiety
and depression, are at a higher risk for developing post-traumatic stress disorder.
Types of events that can lead to PTSD include
 serious road accidents

 violent personal assaults, such as sexual assault, mugging or robbery

 prolonged sexual abuse, violence or severe neglect

 witnessing violent deaths

 military combat

 being held hostage

 terrorist attacks

 natural disasters, such as severe floods, earthquakes or tsunamis

 a diagnosis of a life-threatening condition

 an unexpected severe injury or death of a close family member or friend.

Possible causes

Although it's not clear exactly why people develop PTSD, a number of possible reasons have
been suggested. These are described below.

Survival mechanism

One suggestion is that the symptoms of PTSD are the result of an

instinctive mechanism intended to help you survive further traumatic experiences.

For example, the flashbacks many people with PTSD experience may force you to think about
the event in detail so you're better prepared if it happens again. The feeling of being "on edge"
(hyper arousal) may develop to help you react quickly in another crisis.

However, while these responses may be intended to help you survive, they're actually very
unhelpful in reality because you can't process and move on from the traumatic experience.
Adrenaline levels

Studies have shown that people with PTSD have abnormal levels of stress hormones.

Normally, when in danger, the body produces stress hormones such as adrenaline to trigger a
reaction in the body. This reaction, often known as the "fight or flight" reaction, helps to deaden
the senses and dull pain.

People with PTSD have been found to continue to produce high amounts of fight or flight
hormones even when there's no danger. It's thought this may be responsible for the numbed
emotions and hyper arousal experienced by some people with PTSD.

Changes in the brain

In people with PTSD, parts of the brain involved in emotional processing appear different in
brain scans.

One part of the brain responsible for memory and emotions is known as the hippocampus. In
people with PTSD, the hippocampus appears smaller in size. It's thought that changes in this part
of the brain may be related to fear and anxiety, memory problems and flashbacks.

The malfunctioning hippocampus may prevent flashbacks and nightmares from being properly
processed, so the anxiety they generate doesn't reduce over time.

Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks
and nightmares gradually disappear.
 Diagnosis

To diagnose post-traumatic stress disorder, your doctor will likely:

 Perform a physical exam to check for medical problems that may be causing your
symptoms

 Do a psychological evaluation that includes a discussion of your signs and symptoms

and the event or events that led up to them

 Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-
5), published by the American Psychiatric Association.

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

 You directly experienced the traumatic event

 You witnessed, in person, the traumatic event occurring to others

 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 may have PTSD if the problems you experience after this exposure continue for more than a
month and cause significant problems in your ability to function in social and work settings and
negatively impact relationships
 Symptoms of PTSD

After a trauma in which you think you might die, see someone die, or become seriously injured,
and you feel intense fear, helplessness, or horror, it is very common to become distressed and
anxious. You may have trouble sleeping, have nightmares, think about the trauma a lot, try to
avoid the site of the trauma, and/or try to avoid feelings at all and become more numb. This is
called "acute stress disorder." For most people, this distressing period passes within about four
weeks.

People who develop PTSD do not get over their trauma so quickly. This disorder must be
diagnosed by a medical professional, but there are three main symptoms:

1. Re-experiencing the trauma, such as flashbacks, nightmares, intrusive thoughts, etc.

2. Avoidance: trying to avoid thoughts, feelings, situations, or people who might remind
you of the trauma

3. Hyper arousal: always being on alert, trouble sleeping, irritability, difficulty

concentrating, exaggerated startle response

There are other associated symptoms of PTSD:

 Panic attacks: a feeling of intense fear, which can be accompanied by shortness of

breath, dizziness, sweating, nausea, and a racing heart.

 Physical symptoms: chronic pain, headaches, stomach pain, diarrhea, tightness or

burning in the chest, muscle cramps, or low back pain

 Feelings of mistrust: losing trust in others and thinking the world is a dangerous place

 Problems in daily living: having problems functioning in your job, at school, or in social
situations

 Substance abuse: using drugs or alcohol to cope with the emotional pain

 Relationship problems: having problems with intimacy or feeling detached from your
family and friends

 Depression: persistent sad, anxious, or empty mood; loss of interest in once-enjoyed

activities; feelings of guilt and shame; or hopelessness about the future. Other symptoms
of depression may also develop.

 Suicidal thoughts: thoughts about taking one's own life

PTSD is often associated with other psychiatric and physical problems.

  A majority of men and women with PTSD also have another psychiatric disorder. Nearly
half suffer from major depression, and a significant percentage suffers from anxiety
disorders, and social phobia. They also are more likely to engage in risky health
behaviors such as alcohol abuse, and drug abuse.

 Veterans who have been diagnosed with psychiatric conditions have a significantly
higher prevalence of all cardiovascular disease risk factors (tobacco use, hypertension,
dyslipidemia, obesity and diabetes than those without mental-health diagnoses).

Children and adolescents also experience trauma, and PTSD.

Following the trauma, children may initially show agitated or confused behavior. They also may
show intense fear, helplessness, anger, sadness, horror, or denial. Children who experience
repeated trauma may develop a kind of emotional numbing to deaden or block the pain and
trauma. This is called dissociation. Children with PTSD avoid situations or places that remind
them of the trauma. They may also become less responsive emotionally, depressed, withdrawn,
and more detached from their feelings.

A child with PTSD may also re-experience the traumatic event by

 having frequent memories of the event, or in young children, play in which some or all of
the trauma is repeated over and over;

 having upsetting and frightening dreams;

 acting or feeling like the experience is happening again;

 or developing repeated physical or emotional symptoms when the child is reminded of

the event.

Children with PTSD may also show the following symptoms:

 Worry about dying at an early age

 Losing interest in activities

 Having physical symptoms such as headaches and stomachaches

 Showing more sudden and extreme emotional reactions

 Having problems falling or staying asleep

 Showing irritability or angry outbursts

 Having problems concentrating

 Acting younger than their age (for example, clingy or whiny behavior, thumbsucking)
  Showing increased alertness to the environment

 Repeating behavior that reminds them of the trauma

Teenagers' symptoms might include

 recurrent, intrusive, and distressing memories of the event;

 recurrent, distressing dreams of the event;

 acting or feeling as if the traumatic event were recurring;

 intense psychological distress when exposed to reminders of the traumatic event and
consequent avoidance of those stimuli;

 numbing of general responsiveness (detachment, estrangement from others, decreased

interest in significant activities);

 Persistent symptoms of increased arousal (irritability, sleep disturbances, poor

concentration, hyper-vigilance, anxiety).

PTSD in Military Veterans

What causes PTSD in veterans?

Post-traumatic stress disorder (PTSD), sometimes known as shell shock or combat stress, occurs
after you experience severe trauma or a life-threatening event. It’s normal for your mind and
body to be in shock after such an event, but this normal response becomes PTSD when your
nervous system gets “stuck.”

Your nervous system has two automatic or reflexive ways of responding to stressful events:

Mobilization, or fight-or-flight, occurs when you need to defend yourself or survive the danger
of a combat situation. Your heart pounds faster, your blood pressure rises, and your muscles
tighten, increasing your strength and reaction speed. Once the danger has passed, your nervous
system calms your body, lowering your heart rate and blood pressure, and winding back down to
its normal balance.

Immobilization occurs when you’ve experienced too much stress in a situation and even though
the danger has passed, you find yourself “stuck.” Your nervous system is unable to return to its
normal state of balance and you’re unable to move on from the event. This is PTSD.
Recovering from PTSD involves transitioning out of the mental and emotional war zone you’re
still living in and helping your nervous system become "unstuck."

Symptoms of PTSD in veterans

While you can develop symptoms of PTSD in the hours or days following a traumatic event,
sometimes symptoms don’t surface for months or even years after you return from deployment.
While PTSD develops differently from veteran to veteran, there are four symptom clusters:

1. Recurrent, intrusive reminders of the traumatic event, including distressing thoughts,

nightmares, and flashbacks where you feel like the event is happening again.
Experiencing extreme emotional and physical reactions to reminders of the trauma such
as panic attacks, uncontrollable shaking, and heart palpitations.

2. Extreme avoidance of things that remind you of the traumatic event, including
people, places, thoughts, or situations you associate with the bad memories. Withdrawing
from friends and family and losing interest in everyday activities.

3. Negative changes in your thoughts and mood, such as exaggerated negative beliefs
about yourself or the world and persistent feelings of fear, guilt, or shame. Diminished
ability to experience positive emotions.

4. Being on guard all the time, jumpy, and emotionally reactive, as indicated by
irritability, anger, reckless behavior, difficulty sleeping, trouble concentrating, and
hypervigilance.
 Treatment

When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel,
you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive behavioral therapy (CBT) is one type of counseling. Research shows it is the most
effective type of counseling for PTSD. The VA is providing two forms of cognitive behavioral
therapy to Veterans with PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure
(PE) therapy. To learn more about these types of therapy, see our fact sheets listed on
the Treatment page.

There is a similar kind of therapy called Eye Movement Desensitization and Reprocessing
(EMDR) that is used for PTSD. Also, medications have been shown to be effective. A type of
drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression,
is effective for PTSD.

Types of cognitive behavioral therapy

What is cognitive therapy?

In cognitive therapy, your therapist helps you understand and change how you think about your
trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma
because you stress and make your symptoms worse.

You will learn to identify thoughts about the world and yourself that are making you feel afraid
or upset. With the help of your therapist, you will learn to replace these thoughts with more
accurate and less distressing thoughts. You will also learn ways to cope with feelings such as
anger, guilt, and fear.

After a traumatic event, you might blame yourself for things you couldn't have changed. For
example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive
therapy, a type of CBT, helps you understand that the traumatic event you lived through was not
your fault.

What is exposure therapy?

In exposure therapy your goal is to have less fear about your memories. It is based on the idea
that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic
event.

By talking about your trauma repeatedly with a therapist, you'll learn to get control of your
thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your
memories. This may be hard at first. It might seem strange to think about stressful things on
purpose. But over time, you'll feel less overwhelmed.

With the help of your therapist, you can change how you react to the stressful memories. Talking
in a place where you feel secure makes this easier.

You may focus on memories that are less upsetting before talking about worse ones. This is
called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your
therapist also may ask you to remember a lot of bad memories at once. This is called "flooding,"
and it helps you learn not to feel overwhelmed.

You also may practice different ways to relax when you're having a stressful memory. Breathing
exercises are sometimes used for this.

What is EMDR?

Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD.
Like other kinds of counseling, it can help change how you react to memories of your trauma.

While thinking of or talking about your memories, you'll focus on other stimuli like eye
movements, hand taps, and sounds. For example, your therapist will move his or her hand, and
you'll follow this movement with your eyes.

Experts are still learning how EMDR works, and there is disagreement about whether eye
movements are a necessary part of the treatment.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can
help you feel less sad and worried. They appear to be helpful, and for some people they are very
effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and
sertraline (Zoloft).

Chemicals in your brain affect the way you feel. For example, when you have depression you
may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your
brain.

There are other medications that have been used with some success. Talk to your doctor about
which medications are right for you.
Other types of treatment

Some other kinds of counseling may be helpful in your recovery. However, more evidence is
needed to support these types of treatment for PTSD.

Group therapy

Many people want to talk about their trauma with others who have had similar experiences.

In group therapy, you talk with a group of people who also have been through a trauma and who
have PTSD. Sharing your story with others may help you feel more comfortable talking about
your trauma. This can help you cope with your symptoms, memories, and other parts of your life.

Group therapy helps you build relationships with others who understand what you've been
through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing
with the group also can help you build self-confidence and trust. You'll learn to focus on your
present life, rather than feeling overwhelmed by the past.

Brief psychodynamic psychotherapy

In this type of therapy, you learn ways of dealing with emotional conflicts caused by your
trauma. This therapy helps you understand how your past affects the way you feel now.

Your therapist can help you:

 Identify what triggers your stressful memories and other symptoms

 Find ways to cope with intense feelings about the past

 Become more aware of your thoughts and feelings, so you can change your reactions to
them

 Raise your self-esteem

Family therapy

PTSD can affect your whole family. Your kids or your partner may not understand why you get
angry sometimes, or why you're under so much stress. They may feel scared, guilty, or even
angry about your condition.

Family therapy is a type of counseling that involves your whole family. A therapist helps you
and your family to communicate, maintains good relationships, and copes with tough emotions.
Your family can learn more about PTSD and how it is treated.
In family therapy, each person can express his or her fears and concerns. It's important to be
honest about your feelings and to listen to others. You can talk about your PTSD symptoms and
what triggers them. You also can discuss the important parts of your treatment and recovery. By
doing this, your family will be better prepared to help you.

You may consider having individual therapy for your PTSD symptoms and family therapy to
help you with your relationships.
 Case Study – A Study of PTSD
BY: - CHRIS COBB, OTTAWA CITIZEN

‘The subject was tired all the time but restless and fidgety. He slept poorly and lost weight. The
noise of others in the house upset him but he would not go out except for the occasional hockey
game. He would not go to a doctor. Our findings bear out the impression that psychiatric
disturbances precipitated by the severe mental trauma of warfare are not entirely benign and that
physical and mental symptoms persist into civilian life.’

From a post-Second World War Canadian military analysis of ‘battle exhaustion,’ August 1947

Post-traumatic stress disorder (PTSD) was formally named and recognized as a diagnosis in
1980 by the American Psychiatric Association, but its symptoms has been around, though often
ignored, for at least a century.

PTSD as a medical definition came after years of lobbying by Vietnam veterans who were
seeking benefits and long-term health care, which they were being denied.

The Vietnam vets’ cause through the 1970s was led by Chaim Shatan, a Montreal psychiatrist
working in New York. In a 1972 New York Times article he wrote of veterans suffering from
what he called Post-Vietnam Syndrome: “Their sorrow is unspent, the grief of their wounds is
untold, their guilt un-expiated. Much of what passes for cynicism is really the veterans’ numbed
apathy from a surfeit of bereavement and death.”

Eight years later, the criteria for diagnosing PTSD were added to the American Psychiatric
Association’s third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
and have since been adopted as an international standard. Key to the diagnosis, and what makes
it unique, is exposure to trauma which the DSM defines as experiencing, witnessing, or been
confronted with “an event or events that involve actual or threatened death or serious injury, or a
threat to the physical integrity of oneself or others.”

But as an international gathering of experts in Copenhagen showed earlier this year, the
controversy that can be traced back to the First World War hasn’t completely gone away.

Does PTSD even exist or is it a concoction by experts? Is it a disorder or an injury? Do some

troops fake PTSD because they’re scared or because they see it as a route to early release and the
cushion of financial benefits?

Dubbed “Aftershock,” the conference explored the history of battlefield trauma from Asia to
Europe to North America to Australia and, according to Yale University military historian Jay
Winter, it was during the First World War that psychologists began to realize that traumatized
soldiers were not the deranged cowards their superiors considered them to be.
An estimated 20 per cent of the 70 million men mobilized to fight suffered some form of mental
injury, he told the conference, but official figures claimed it was two per cent.

“That’s larger than any other disability group in history,” he said. (360,000 Canadians troops
survived the First World War; 60,000 were killed and 172,000 physically injured during the
1914-18 conflict.)

“Armies willfully underestimate the proportion of men who face combat, who are not cowards
and don’t run away and who suffer psychological injury,” said winter, who is editor of the
Cambridge (University) History of the First World War.

That official underestimating, plus an unwillingness to seek treatment, remains a reality a

century later.

Kindly doctors were also complicit in the under diagnosing, he said.

“For individuals who lost an arm, or part of their face, doctors would put that on the form
because it would get the soldier a pension,” said winter. “But can we really believe for a moment
that psychological trauma was not associated with that?”

Then, as now, there were mental injury deniers in all militaries who considered people suffering
from “lesions we can’t see” to be malingerers, he said.

“It was considered a tactic,” he said. “Acting disabled to avoid facing the enemy and to cash in
on a pension afterwards. Such opinions have not disappeared.”

“Silence is the contempt for the mentally ill,” added winter. “It is a killer and it cripples. The
stigma is still alive.”

According to Canadian War Museum historian Andrew Burtch, First World War soldiers
traumatized into a catatonic state by the shelling were often given electric shock treatment
whether they objected to it or not.

“It was quite brutal,” he said, “but it was believed that the reaction was a physical one, that the
blasts caused nerve damage in the brain. And the emphasis was getting people back to the
battlefield.”

But mental breakdown on the battlefield, or post-traumatic stress after, has nothing to do with
how brave or otherwise a soldier was — or is.

“There are Victoria Cross winners who suffered from post-traumatic stress during the war and
after,” said Burtch. “Canadian Maj. Thain MacDowell is one. He fought at Vimy Ridge, attacked
several machine gun nests and received a VC. These were people facing off against the first
totally industrialized war and the strain was very great.”
During the Second World War, treatment of mental trauma — or ‘battle exhaustion’ — was
more humane and involved a mix of hypnosis and sedation.

“It was enough to get you through the war,” said Burtch, “but a recurring theme was that ‘you
can’t really talk about what you went through unless you can talk to people who get it.’ So the
first support group tended to be in the pub or around the pool table.”

McGill University anthropology professor Allan Young, who also presented at the Aftershock
conference, says it would be “criminal” for anyone to suggest that PTSD doesn’t afflict many
soldiers. But, he said, skeptics have the ammunition of doubt because despite years of effort and
millions of dollars spent, there is still no physical test to prove conclusively that a person is
suffering from the disorder.

Israeli psychologist Mooli Lahad, who has been treating and researching military and civilian
trauma for 40 years, says he understands why there is “an anti-PTSD” lobby.

“It isn’t as though mental problems haven’t resulted from trauma in history,” he said. “There is
evidence of it in the Bible. And when the American Psychiatric Association defined PTSD it was
a compromise to deal with Vietnam veterans. Everything that starts with a compromise is bound
to produce questions in the long run, but there was a need to free these veterans from the
responsibility of what they’d been through. It was a major break to say, ‘You are not responsible,
it was the incident that caused it.’

“But after 40 years I can tell you that PTSD does exist but it was under-diagnosed and wrongly
diagnosed. So people were diagnosed as psychiatric patients, got the wrong treatment, and were
put in mental hospitals.”

Lahad agreed that for a host of complex reasons, post-traumatic trauma continues to be
underestimated and under-reported.

“When I started to work in the Israeli Defense s in the seventies,” he said, “we thought that out
of four soldiers physically injured one might have emotional troubles. Now it is completely the
opposite and for one injured soldier we can have up to 25 emotionally reacting. This is especially
true of civilians.”

The bottom line, added Lahad, is that in the three decades since PTSD was officially recognized,
its benefits have brought some degree of peace to many.

“It has done a lot of good for people suffering from trauma due to abuse, rape and neglect,” he
said. “It has created a readiness for people to say ‘I suffer’ and seek help.”
 Conclusion

While working with my group on this PTSD project, my perception and understanding of
PTSD has widened as for I knew very little what PTSD was before doing this project. I learned
that post-traumatic stress disorder does not only affect the person with PTSD, but the people
involved in that person’s life. I learned that PTSD is caused by a horrific event that happens to
you or someone that is close to you. I learned the many effects and treatment that are related with
PTSD and understand that a variety of people suffer from it. I understand that PTSD usually
develops within military personnel for they have experienced war. Overall, I feel like I have a
better perception about PTSD and the various ways it is caused and treated.

Before working on this project, PTSD to me was just a name of a disorder that I had little
understanding of. After lots of research and thinking, PTSD has become more personal to me
and I understand it better. Many of my family members have served in the military and may have
experienced a traumatic moment in the past. Knowing how PTSD affects people and how to help
them is very important to know as it is a bigger issue today than it ever was before. Through this
project, I learned how PTSD affects civilians as well as military personnel and how it is treated.
Overall, I learned a lot about PTSD by working with my group on this project and it will affect
my perception of PTSD for the rest of my life.
 Bibliography

 www.webmd.com
 www.ptsd.va.gov
 psychcentral.com
 www.mayoclinic.org
 historyofptsd.wordpress.com
 www.mentalhelp.net
 www.ottawacitizen.com
 www.therefuge-ahealingplace.com
 www.emedicinehealth.com