Post traumatic stress disorder (PTSD) is an anxiety disorder that a
person may develop after experiencing or witnessing an extreme,
overwhelming traumatic event during which they felt intense fear,
helplessness, or horror.
The dominant features of posttraumatic stress disorder are
emotional numbing (i.e., emotional nonresponsiveness), hyperarousal
(e.g., irritability, on constant alert for danger), and
reexperiencing of the trauma (e.g., flashbacks, intrusive emotions).
A trauma is an intensely stressful event during which a person
suffers serious harm or the threat of serious harm or death or
witnesses an event during which another person (or persons) is
killed, seriously injured, or threatened.
Thus the essential characteristics of a traumatic event include
(but are not restricted to):
- A serious threat to one's life
- A serious threat to one's physical integrity
- A serious threat or possible harm to one's
- Sudden destruction of one's home or community
- Seeing another person who has recently been / is being
seriously injured or killed
- Physical violence
- Learning about serious threat / harm to relative / family
Traumatic events are
commonly classified as follows:
- Verbal (i.e., sexual and/or violent content)
- Harmful and fatal accidents
- Natural disasters (floods, earthquakes, tornadoes)
- Terrorism (including hostage taking)
- Violent attack
- Animal attack
- Battery and domestic violence
- War, battle, and combat
Some classic examples include:
- Concentration camps of Nazi Germany
- Bombing of Hiroshima and Nagasaki
- Vietnam War
- Hyatt Regency Hotel disaster
- Buffalo Creek Catastrophe
- Hills and Coconut Graves fire
Types of PTSD
Depending on the onset and duration of symptoms there are four types
Onset of symptoms within 6 months of
of Symptoms longer than 6 months?
||Delayed and Chronic
So the essential characteristics of each are:
- Acute PTSD: Early onset, early resolution (both within first 6
- Chronic PTSD: Early onset, prolonged course (lasting more than
6 months - necessitating a re-diagnosis from the acute type.
- Delayed PTSD: Onset of symptoms after first 6 months of the
- Delayed and Chronic PTSD:
Although not delineated in DSM III and IV, this is another
logical subtype in which the patient has delayed onset of
symptoms (6 months after the traumatic event) and has already
manifested PTSD symptoms for a period of greater than 6 months
prior to daignosis.
Incidence and Prevalence
Kessler et al estimated that the lifetime prevalence of PTSD
is 7.8 %. Women had a higher prevalence than men ( 10.4 versus 5.0).
This was due to both a greater exposure of high-impact trauma
(Rapes, sexual molestation, childhood neglect and childhood physical
abuse) and a greater likelihood of developing PTSD when exposed to a
PTSD is more prevalent among war veterans than among any other
group. The National Vietnam Veterans Readjustment Survey reports
that approximately 25% of U.S. veterans, men and women, were
suffering from PTSD in the early 1990s.
Men with PTSD identify combat and witnessing someone else's injury
or death most often as the cause of their condition. Women identify
physical attack or threat most often as the cause of their PTSD.
Someone with PTSD is at risk for developing other mental health
disorders such as panic disorder, phobias, major depressive
disorder, and obsessive-compulsive disorder. Substance use and
somatization were also found to be common.
The current epidemiological
data stem mainly from studies conducted in United States. As PTSD is
commoner in countries where long-term war, widespread
social upheaval, and frequent natural disasters are prevalent,
namely the developing world, it is possible that the current
statistics is a gross understatement of the morbidity caused.
- Psychological Processes