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Posttraumatic Stress Disorder (PTSD), Complex-postraumatic stress disorder (C-PTSD)

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Posttraumatic stress disorder is thought to be caused by childhood "trauma" that was never moved from the mind to the hippocampus of the brain where it should have been processed. [1] When unprocessed trauma events build up and reach a certain point, then the individual's mind, followed by the the brain become overwhelmed due to the lack of communication between them. [1] When all communication stops them the person becomes overwhelmed. [1] [2] This results in a barrier dividing the ganglia of the personality that are affected by the unprocessed events and the part that the mind attempts to keep from being affected by it. [1] [3] This process is known as structural dissociation of the personality. [3] [4] [3] At this point the person then has posttraumatic stress disorder. [1] [3] It's unknown if childhood abuse plays a role, but it is well accepted that "childhood neglect" (which can be unintentional) is critical to the formation of this disorder. Some older ideas are that the cause could have been when a child is subjected to loss, constant pain or some other emotional distress that is not inflicted upon them. [5] When structural dissociation takes place, one distinct state and one less than distinct state are created, which along with other factors cause the disturbing symptoms experienced in those with posttraumatic stress disorder. [1] [3]

Complex PTSD

After an individual already has posttraumatic stress disorder and unprocessed trauma events continue to build up in the mind, and are not processed into memory, then a second less than distinct state can be created. At this point, the individual will experience far greater symptoms than they did before the extra state was made. Once an person has created their second less than distinct state, this disorder is hard to ignore. The less than distinct states will wreck havoc in an individuals life. Less than distinct states are parts of the personality that react and interact with unprocessed trauma events. [1] [3]

fMRI scans

When a fMRI scan is performed on an individual with posttraumatic stress disorder their distinct state is brightly lit up, and as soon as a "trigger" is introduced to the individual, that distinct state is immediately replaced by a small, dimly lit spot, which is the less than distinct state. This state responds to the trigger by causing undesirable symptoms such as flashbacks, exaggerated startle response, hyperarousalIncreased arousal response, which is a diagnostic criteria for PTSD. Symptoms include "hypervigilance, exaggerated startle, sleep disturbance, concentration difficulties and anger"{{Rp|82}} plus physical tension, and emotions include anxiety and fear, a feeling of "experiencing too much" {{Rp|3,40,213}}., anxiety, anger and so on. As the individual calms, the less than distinct state is replaced by the distinct state. What is happening is the brain and mind are miscommunicating back and forth. (See Structural Dissociation for in-depth information) It's the miscomunication between the mind and brain that are causing the symptoms. The brain can't understand what the mind is trying to say, so it sends out a signal, and depending on what that signal is, the person feels an array of symptoms. If the individual has complex-posttraumatic stress disorder, their two less than distinct states will show up on the fMRI scan in unison, and they confuse the brain even more, and in response to that confusion, the brain sends out signals causing enhanced symptoms. The individual is now highly distressed, with symptoms that are probably overwhelming, leaving the person unable to function well while the less than distinct states are in control. [1]

Dissociative boundaries and elaboration of states

The less than distinct states in posttraumatic stress disorder are basic and primitive when compared to the less than distinct states in the complex Dissociative Disorders: other specified dissociative disorder and dissociative identity disorder. In addition, the dissociative boundaries that are associated with each of the disorders are highly specific to the disorder and to each state they are associated with. At the most extreme end of the spectrum is dissociative identity disorder with states so elaborated they have their own way of being, and can even have different physiological characteristics. In this disorder you will find an individual who's dissociative boundaries are so phobic of each other that each of the states are isolated from the others in a number of ways that are not found in posttraumatic stress disorder. In dissociative identity disorder, one state could be literally blind, another deaf, another with an IQ of 70 and another could be a genius and none have any idea of what is going on. Posttraumatic stress disorder does not have the advantage of the highly dissociated boundaries, and so the symptoms are glaringly painful and obvious to the person with them. [1] [3]

In PTSD there is only one less than distinct state and one distinct state, and both stay conscious until a trigger causes the less than distinct state to respond, (flashback, fear, anxiety or other like symptom) and when it does the distinct state leaves consciousness. In the complex version of PTSD there are always two less than distinct states, and one distinct state. The less than distinct states are polarized, staying together, with both always conscious at the same time, but otherwise behave the same as simple PTSD. In "image B", this fMRI scan shows a distinct state switching with an other distinct state, which is only possible in DID, because this is the only disorder with two or more distinct states. "Image A" shows three less than distinct states which are the parts that manage "unprocessed trauma," and react to it with vehement emotion. This is obviously an fMRI scan of DID since it shows there are two distinct states and three less than distinct states. In OSDD fMRI scans reveal only one distinct state is possible, and it switches with less than distinct states randomly, and the distinct state also switches in response to a "trigger." In contrast to DID, every single state can literally be conscious (lit up) at one time, but in response to a trigger, all but one state will leave consciousness, which is again in contrast with DID. BPD involves one distinct state and it's always conscious until the individual is in distress, and then two less than distinct states show up together, but unlike C-PTSD these less than distinct states do not take over consciousness. The distinct state always remains with them. There are no flashbacks or other symptoms caused from unprocessed trauma events in BPD like there are in all the other disorders mentioned so far, but there are other dissociative symptoms. [6] [3]

History of posttraumatic stress disorder

Posttraumatic stress disorder first become an official diagnosis in the DSM-III, which was published in 1980. [7] Prior to this the experience of posttraumatic stress was represented in both the DSM-I, [8] [9] published in 1952, and the DSM-II, published in 1968. [10] Another diagnostic manual, the International Classification of Diseases (ICD) is produced by the World Health Organization, and originally focused on physical illness only, first including a section of mental disorders in the ICD-6 version, published in 1948.[11]

Diagnostic manuals

Diagnostic manuals like the DSM and ICD are not meant to be used to understand any mental disorder. Their intent is to give the minimum criteria needed to diagnose a disorder. The criteria listed here is paraphrased, as proper etiquette demands.

PTSD preSchool subtype

For children 6 years and younger the criteria is slightly different. This is included in the DSM-5 manual for children younger than six years. [12] The criteria for posttraumatic stress disorder needed to be slightly different from those for older children and adults because young children their cognitive and verbal expression capacities as still forming, so the criteria are more "developmentally sensitive" for preschool children. Some of these changes in wording include:

  • constricted play is an example of "diminished interest in significant activities"
  • social withdrawal or behavioral changes can indicate "feelings of detachmentCharacterized by distant interpersonal relationships and lack of emotional involvement {{Rp|24}} or estrangement"
  • extreme temper tantrums are now included with "irritability or outbursts of anger"
  • intrusive symptoms such as flashbacks and intrusive thoughts do not always manifest overt distress in preschool children, Scheeringa (2013) states that "while distressed reactions are common, parents also commonly reported no affect or what appeared to be excitement"
  • fewer avoidance symptoms are included because avoidance is internalized, and harder to detect by observation, for example in pre-verbal children

Research has shown preschool children with posttraumatic stress disorder do have impaired functioning across a range of domains, and both the diagnosis and impairment are stable over the longer-term. [13] Scheeringa and Zeanah (2008) studied posttraumatic stress disorder in 70 three to six-year old's directly effected by Hurricane Katrina. They found that children who stayed in New Orleans had significantly higher rates of posttraumatic stress disorder than children who were evacuated (62.5%, in comparison to 43.5%); of the children who did not develop posttraumatic stress disorder, none of them developed other mental disorders as a result of the trauma. The children had significantly higher rates of posttraumatic stress disorder than their caregivers, Scheeringa and Zeanah (2008) stated that "caregivers' rate of posttraumatic stress disorder was 35.6%, of which 47.6% was new post-Katrina". Caregivers' rate of posttraumatic stress disorderwas 35.6%, of which 47.6% was new post-Katrina.

Meiser-Stedman et al. (2008) studied children aged 2–6 years old, and aged 7–10 years old, after traumatic motor vehicle accidents. They found that parent's and children's reports of the traumatic experience had "poor agreement" between them, reflecting the fact that relying only on parent's reports of the trauma would lead to a lack of information for clinicians when assessing posttraumatic stress disorder, given the subjective nature of the experience. [14] Effective treatment for posttraumatic stress disorder in very young children includes cognitive behavioral therapy, long-term, relationally-based treatment (in cases of interpersonal violence), play therapy, eye movement desensitization and reprocessing (EMDRA valid psychotherapeutic approach, especially for treating trauma. ), and other forms of therapy, however, the methods of addressing trauma need to be developmentally-appropriate methods for the child's age.

DSM-5 adult PTSD criteria

DSM-5 was last updated May 2013
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
  1. Directly experiencing the traumatic event(s).
  2. Witnessing, in person, the events(s) as it occurred to others.
  3. Learning that the traumatic events(s) occurred to a close family member or close friend. In cases of actual or threatened by death of a family member or friend, the events(s) must have been violent or accidental.
  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). This does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related.
Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s) occurred:
  1. Recurrent, involuntary, and intrusive distressing effects from the unprocessed trauma events. In children older than 6, there may be frightening dreams without recognizable content.
  2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic events(s).
  3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the trauma event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings). In children, trauma-specific reenactment may occur in play.
  4. Intense or prolonged psychological distress at exposure to internal or external clues that symbolize or resemble an aspect of the traumatic events.
  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following.
  1. Avoidance of or efforts to avoid distressing unprocessed trauma events, thoughts, or feelings about or closely associated with the traumatic event(s).
  2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Negative alterations in cognitions and mood associated with the traumatic events(s), beginning or worsening after the traumatic event(s)
  1. Inability to remember an important aspect of the traumatic events(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
  2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," no one can be trusted," the world is completely dangerous, my whole nervousness system is permanently ruined.).
  3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
  4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
  5. Markedly diminished interest or participating in significant activities.
  6. Feelings of detachment or estrangement from others.
  7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following.
  1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
  2. Reckless or self-destructive behavior
  3. Hypervigilance"Excessive attention to and focus on all internal and external stimuli."{{Rp|26} A pattern presenting with fight or flight reactions is common in individuals with unprocessed trauma memories. {{Rp|217}} A PTSD symptom. Hypervigilance is an arousal symptom within PTSD and acute stress disorder.
  4. Exaggerated startle response
  5. Problems with concentration
  6. Sleep disturbances
Criteria B, C, D and E last more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the effects of a substance (e.g., medication, alcohol) or another medical condition.
Specify if with depersonalization
Specify if with derealization
Specify if with delayed expression [15]:272-274[12]:143-145

References

  1. ^ a b c d e f g h i Lanius, Ulrich (2014) (coauthors: Sandra L. Paulsen, Frank M. Corrigan). . New York:Springer Publishing Company. 10: 0826106315.
  2. ^ Siegel, Daniel (2012). . Guilford press. 13: 978-1462503902.
  3. ^ a b c d e f g h Vanderhart, Onno (2006) (coauthors: Nijenhuis, Ellert; Steele, Kathy). . New York:Norton. 13: 978-0393704013.
  4. ^ Nijenhuis, Ellert; van der Hart, Onno (2011). Dissociation in Trauma: A New Definition and Comparison with Previous Formulations. Journal of Trauma & Dissociation, volume 12, issue 4, 2011. (doi:10.1080/152992)
  5. ^ Courtois, Christine (2012) (coauthors: Ford, Julian). . The Guilford Press. .
  6. ^ Schlumpf, YR; Reinders, AATS, Nijenhuis, ERS, Luechinger, R, van Osch, MJP, et al. (2014). Dissociative Part-Dependent Resting-State Activity in Dissociative Identity Disorder: A Controlled fMRI Perfusion Study. PLoS ONE, volume 9, issue 6, 2014. (doi:10.1371/journal.pone.0098795)
  7. ^ Wilson, John P.. The historical evolution of PTSD diagnostic criteria: From freud to DSM-IV. Journal of Traumatic Stress, volume 7, issue 4, page 681–698. (doi:10.1007/BF02103015)
  8. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mentral Disorders. (First edition) Washington, D.C. 1952
  9. ^ Blair Simpson, Helen (2010) (coauthors: Neria, Yuval, Lewis-Fernández, Roberto (Eds)). Anxiety Disorders: Theory, Research and Clinical Perspectives edited by Helen Blair Simpson, Yuval Neria, Roberto. Cambridge Illustrated University Press..
  10. ^ The Committee on Nomenclature and Statistics of the American Psychiatric Association, (1968). DSM-II DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (Second Edition). American Psychiatric Association.
  11. ^ Brett, Elizabeth A. (1996) (coauthors: van der Kolk, Bessel A., McFarlane, Alexander C., Weisaeth, Lars (Eds.)). The classification of Posttraumatic stress disorder. In Traumatic Stress the Effects of Overwhelming Experience on Mind, Body, and Society. New York:Guilford Publications..
  12. ^ a b American Psychiatric Association, (2013). . APA..
  13. ^ Scheeringa, Michael. PTSD: National Center for PTSD: PTSD for Children 6 Years and Younger. retrieved on 9 July, 2014
  14. ^ Scheeringa, Michael S.. Developmental Considerations for Diagnosing PTSD and Acute Stress Disorder in Preschool and School-Age Children. Am J Psychiatry, volume 165, issue 10, October 01, 2008, page 1237-1239. (doi:10.1176/appi.ajp.2008.08070974)
  15. ^ American Psychiatric Association, (2013). . Washington, D.C:American Psychiatric Association.541.

Cite error: Reference "Meiser-Stedman2008" "$2" "$3" is not used in prior text.

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