PTSD: What is it, and Does it Only Occur in Soldiers?
September 15, 2015
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that occurs in a percentage of people who have been exposed to a traumatic event. This diagnosis was formulated to account for the set of anxious symptoms that some soldiers experienced after combat. Current research suggests that approximately 2 to 14 percent of soldiers show symptoms of PTSD. Unfortunately, the symptoms are often debilitating and disrupt an individual’s occupational and social functioning. Research has shown that the divorce rates for ex-soldiers with PTSD are twice the rate for soldiers without PTSD. With this high divorce rate among PTSD-diagnosed soldiers, it is very likely that family attorneys will represent either a client with PTSD or the spouse of someone with PTSD. Therefore, it is important to understand the disorder and the challenges it may pose on a case. Individuals do not have to experience war to be diagnosed with PTSD. The same symptoms can exist in an individual who has experienced any traumatic event.
PTSD is a disorder with symptoms that first occur AFTER exposure to a traumatic event. According to the DSM-IV, the individual must have, “…experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (p. 218).” In addition, “the person’s response involved intense fear, helplessness, or horror. Note: In Children, this may be expressed instead by disorganized or agitated behavior (p. 219).” Thus, the traumatic events can be real or threatened. What is important is how the individual perceives the event or threat of the event.
The next feature of PTSD has to do with the individual reexperiencing the traumatic event in a variety of ways.
According to the DSM-IV, people with PTSD will reexperience the traumatic event through one of the following ways:
- Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed
- Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content
- Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In children, trauma-specific reenactment may occur
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event (p. 219)
These episodes of reexperiencing the trauma keeps the person with the disorder in a near constant state of having the perceptual experience of being in the traumatic situation over and over again, with little relief.
The third diagnostic feature of PTSD is the avoidance an individual engages in to protect him or herself from reexperiencing the trauma.
To meet the diagnosis the individual must indicate at least three of seven avoidance symptoms:
- Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
- Efforts to avoid activities, places, or people that arouse recollections of the trauma.
- Inability to recall an important aspect of the trauma
- Markedly diminished interest or participation in significant activities
- Feeling of detachment or estrangement from others
- Restricted range of affect (e.g., unable to have loving feelings)
- Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
These protective behaviors are ineffective attempts at distancing oneself from the traumatic experience. And worse, the behaviors also distance the person with PTSD from healthy interactions with others who offer comfort and emotional support.
The final diagnostic feature has to do with persistent arousal in the individual:
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Exaggerated startle response
Having a heightened state of arousal stresses the mind and body. When sleep is disturbed, it can negatively affect our thinking, feeling, and behavior, often resulting in anger. The chronic anger and mood instability will tax relationships and leave the individual exhausted from the emotional vicissitudes.
In order to make the diagnosis, the DSM-IV criteria must be met, the disturbance must have being going on for more than a month, and there must be distress or impairment in social, occupational, or other important areas of functioning.
Of course, traumatic events can extend beyond those experienced by soldiers, occurring in the course of everyday life. Diagnoses of a life-threatening illness, an auto accident, or experiencing an assault, are examples. Experiencing child abuse or spousal abuse are also events that can be classified as traumatic.