Post-traumatic Stress Disorder Health Article

Diagnosis

Consultation with a mental health professional for diagnosis and a plan of treatment is always advised. Many of the responses to trauma, such as shock, terror, irritability, blame, guilt, grief, sadness, emotional numbing, and feelings of helplessness, are natural reactions. For most people, resilience is an overriding factor and trauma effects diminish within six to sixteen months. It is when these responses continue or become debilitating that PTSD is often diagnosed. The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) outlined three forms of the disorder:

• Acute: onset within six months of the event and lasting less than six months
• Chronic: symptoms lasting six months or more
• Delayed: onset at least six months after the event

As outlined in DSM-IV, the exposure to a traumatic stressor means that an individual experienced, witnessed or was confronted by an event or events involving death or threat of death, serious injury or the threat of bodily harm to oneself or others. The individual's response must involve intense fear, helplessness, or horror. A two-pronged approach to evaluation is considered the best way to make a valid diagnosis because it can gauge under-reporting or over-reporting of symptoms. The two primary forms are structured interviews and self-report questionnaires. Spouses, partners and other family members may be interviewed. Because the evaluation may involve subtle reminders of the trauma in order to gauge a patient's reactions, individuals should ask for a full description of the evaluation process beforehand. Asking what results can be expected from the evaluation is also advised.

A number of structured interview forms have been devised to facilitate the diagnosis of post traumatic stress disorder:

• The Clinician Administered PTSD Scale (CAPS) developed by the National Center for PTSD
• The Structured Clinical Interview for DSM (SCID)
• Anxiety Disorders Interview Schedule-Revised (ADIS)
• PTSD-Interview
• Structured Interview for PTSD (SI-PTSD)
• PTSD Symptom Scale Interview (PSS-I)

Self-reporting checklists provide scores to represent the level of stress experienced. Some of the most commonly used checklists are:

• The PTSD Checklist (PCL), which has one list for civilians and one for military personnel and veterans
• Impact of Event Scale-Revised (IES-R)
• Keane PTSD Scale of the MMPI-2
• The Mississippi Scale for Combat Related PTSD and the Mississippi Scale for Civilians
• The Post Traumatic Diagnostic Scale (PDS)
• The Penn Inventory for Post-Traumatic Stress
• Los Angeles Symptom Checklist (LASC)

Treatment

A definitive treatment does not yet exist for PTSD nor is there a known cure. However, a number of therapies such as cognitive-behavior therapy, group therapy, and exposure therapy are showing promise. Cognitive-behavioral therapy focuses on changing specific actions and thoughts with the help of relaxation training and breathing techniques. In exposure therapy, the person relives the traumatic event repeatedly in a controlled environment and then works through the trauma.

A treatment technique known as eye movement desensitization and reprocessing (EMDR) has been employed with some success to treat PTSD. EMDR involves desensitizing the patient to his or her traumatic memories by associating a series of eye movements with both negative and positive events and emotions. The specific eye movements associated with the negative memories are thought to help the brain process the event and come to terms with the trauma. EDMR should only be performed by a healthcare practitioner, usually a clinical psychologist, certified in the technique.

Relaxation training, which is sometimes called anxiety management training, includes breathing exercises and similar techniques intended to help the patient prevent hyperventilation and relieve the muscle tension associated with the fight-or-flight reaction of anxiety. Yoga, aikido, t'ai chi, and dance therapy help patients work with the physical as well as the emotional tensions that either promote anxiety or are created by the anxiety.

Other alternative or complementary therapies are based on physiological and/or energetic understanding of how the trauma is imprinted in the body. These therapies affect a release of stored emotions and resolution of them by working with the body rather than merely talking through the experience. One example of such a therapy is Somatic Experiencing (SE), developed by Dr. Peter Levine. SE is a short-term, biological, body-oriented approach to PTSD or other trauma. This approach heals by emphasizing physiological and emotional responses, without re-traumatizing the person, without placing the person on medication, and without the long hours of conventional therapy.

When used in conjunction with therapies that address the underlying cause of PTSD, relaxation therapies such as hydrotherapy, massage therapy, and aromatherapy are useful to some patients in easing PTSD symptoms. Essential oils of lavender, chamomile, neroli, sweet marjoram, and ylang-ylang are commonly recommended by aromatherapists for stress relief and anxietyreduction.

Research into the prevention of PTSD is also undergoing intensive research. The National Mental Health Association provides RAPID grants that allow researchers to visit disaster scenes to study acute effects and the effectiveness of early intervention. Rapid disaster relief and positive community response appear to be key. Not identifying individual survivors as "victims" also seems to help. Debriefing survivors as quickly as possible after the event can stem the development of PTSD symptoms.