Post Traumatic Stress Disorder, PTSD, Trauma
The real name of the post-traumatic stress disorder originates in the military (see also mental disorder). Soldiers who were disqualified during the Vietnam War because of various war events, because they were exposed to the strongest physical or mental stress, got this diagnosis. In previous wars, the disorder was assigned other names. For example, in World War I, the very apt name "Shell Shock" was used. This called quasi the shock (shock) of the innermost psychic core (shell).
Today, the diagnosis is also used in civilian areas. Whenever a person is exposed to an event of exceptional physical or mental threat, there is a risk of developing PTSD.
Women are usually significantly more affected than men. Some studies assume a ratio of 2: 1. Possible reasons for this are, for example, the high probability of rape to develop a PTSD (probability of a post-traumatic stress disorder) (probability approx. 50%), as well as the probability of about 20% in the case of victims of violence.
The risk for women to become the victim of a rape once in their lives is around 8% in Germany.
Overall, the probability of developing PTSD (post-traumatic stress disorder) once a year is between 10-12% in women and between 5-6% in men.
Further traumas with a high risk of PTSD are: combat use in war, child maltreatment, torture, prisoner of war, but also car accidents, or to be an eyewitness of an accident.
Diagnostic criteria according to ICD-10 / Symptomatology / Symptoms
Symptoms typically occur within 6 months after the onset of the event. It may also be possible to start later.
Diagnosis should be made by a physician or psychologist experienced in psychotherapy. 2 instruments typically used in diagnostics are:
Impact of Event Scale - R (IES-R) Horowitz et al. 79, German version: Maercker 98
4 factor structure:
The questionnaire is short and simple.
Questionnaire on thoughts after traumatic experiences (PTCI) Foa, Ehlers 2000
Self-help tool to identify problematic interpretations of the trauma and its consequences, seven-level Likert scale, three factors.
Causes of the development of post-traumatic stress disorder:
Disturbance concept according to Ehlers and Clark:
Fear is a feeling that usually refers to a current or future situation. In the PTSD (post-traumatic stress disorder), however, a massive feeling of anxiety with the above symptoms arises because of a past event. In Ehlers and Clark's perturbation model, it is now assumed that the sufferer has miscalculated the trauma so that memories of the event are perceived as a current, current threat. In general terms, it is assumed that two processes can be held responsible for a human being perceiving past events as currently threatening.
These stimuli remind patients of the stimuli they experienced just before or during the trauma (sounds, smells, etc.). Stimulus and trauma are thus coupled, so to speak. Whenever the patient subsequently perceives such or similar stimuli, the coupling can make the trauma present again in one go, without the patient being able to explain it.
In addition, it seems that in patients with PTSD increased attention is paid to bad, ie trauma-specific, stimuli (so-called priming). (For example, a woman who was attacked by a bearded man often sees men with a beard out of a crowd immediately.)
As a result, such disorders usually result in a shift in behavior and thoughts. Patients are very prone to avoid situations that they suspect may be disruptive. Also, any thoughts about the event are often suppressed. Unfortunately, this avoidance behavior usually has an opposite (paradoxical) effect, that is, there is an increased occurrence of thoughts and threats.
The differential diagnoses (alternative causes of illness) are of particular importance. In the last few years there has been a kind of "PTSD sell-off", especially among "non-therapists". The post-traumatic stress disorder became a kind of "fashion diagnosis". This is problematic in that incorrect diagnosis of wrong therapeutic approaches are followed, which usually does not really help the patient on the one hand and on the other hand causes immense costs that would be saved with a more accurate knowledge of differential diagnoses. In the following, differential diagnosis is to be distinguished: