Synonyms

Post Traumatic Stress Disorder, PTSD, Trauma

definition

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.

Epidemiology

stress disorder

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.

diagnostics

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.

  • Those affected were exposed to an event or event of extraordinary threat or catastrophic magnitude that would trigger almost profound despair.
  • Lingering memories or re-experiencing the stress of intrusive retro-flash memories, vivid memories, repetitive dreams, or inner distress in situations that are similar or related to stress. (Evidently there is also a kind of emotional dullness or indifference and indifference)
  • Similar circumstances are actually or possibly avoided. This behavior did not exist before the event
  • One of the points below:
    • Inability to remember some important aspects of the trauma
    • Persistent symptoms of increased mental sensitivity and arousal (not before the dream) with two of the following features:
      • Insomnia and sleep disorder (sleep disorder)
      • Irritability or temper tantrums
      • difficulty concentrating
      • Hypervigilance (state of increased agitation)
      • Increased dreadfulness

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:

  • "Intrusion" (reverberations)
  • 'Prevention'
  • "Hyperarousal"
  • "Numbing" (emotional deafness)


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.

  • Negative cognitions about one's own person
  • Negative cognitions about the world
  • self-incrimination

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.

  1. The Individual Interpretation of the Event and Its Consequences: It is believed that patients with PTSD can not see the bad event as a time-limited event that will not necessarily have a negative impact on their lives. It is also believed that patients with PTSD (post-traumatic stress disorder) so often negatively evaluate and interpret the event and its consequences, resulting in the perception of a very recent threat.
  2. The so-called "dream memory": Patients with PTSD often have great difficulty in fully remembering the event. Often there are only fragmentary memories. Opposed to this are unwanted memories, which are imposed on the patient. In these moments, he experiences them as if the event happened again at the present moment. The trauma can not be inserted into the actual structures of the memory. Normally we put memories in a temporal context (Eg that was in 1999. It was hard, but it's over ... "). This is not possible with the PTSD. Due to relatively low stimuli, the feeling of threat can occur at any time (eg slamming a car door is reminiscent of the car accident, etc.).
Psychological stress

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.

differential diagnosis

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:

  1. Acute stress reaction: If the symptoms (see point ICD-10 / Symptomatology) stop for a few hours or days (4 weeks at the most) due to an event and then disappear again, this is called the acute stress reaction.
  2. Adjustment disorder: Adjustment disorder typically does not meet all the symptoms of PTSD (post-traumatic stress disorder). Often, this disorder results from events that are less "catastrophic" in severity (usually after disconnections, bereavement or serious physical illnesses). (However, even the worst catastrophes can lead to an adjustment disorder.)
  3. Mourning reaction: Mourning reactions are completely normal. However, if you do not subside for a while (6 months), it is called an "abnormal mourning reaction". This falls under the adjustment disorders.
  4. Persistent Personality Change: As a result of prolonged or repeated traumatic experiences (abuse, torture, captivity, etc.), permanent changes in the personality of the person can occur.

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