POST

TRAUMATIC
STRESS
DISORDER
By
Mr.Loganathan.N
Lecturer
M.Sc ( Mental Health Nursing)
DEFINITION
PTSD are defined as individual who have been
exposed to a traumatic event in which one person
experienced witnessed or was confronted with actual
or threatened death or serious injury or the threat to
the physical integrity of self or other.
-DSM-IV,
 Terrorist
War Natural attacks
disasters

Kidnapping

Sexual
abuse
 factors for PTSD include:

Women are at greater risk than males

Previous traumatic experiences, especially in early life

Family history of PTSD or depression

History of physical or sexual abuse

History of substance abuse

History of depression, anxiety, or another mental illness

High level of stress in everyday life

Lack of support after the trauma

Lack of coping skills
Signs and symptoms
1.Symptoms of PTSD: Re-experiencing
the traumatic event

Intrusive, upsetting memories of the event

Flashbacks

Nightmares

Feelings of intense distress when reminded of
the trauma

Intense physical reactions to reminders of the
event (e.g. pounding heart, rapid breathing, nausea,
muscle tension, sweating)
2.Symptoms of PTSD: Avoidance and numbing

Avoiding activities, places, thoughts, or
feelings that remind the trauma

Inability to remember important aspects of
the trauma

Loss of interest in activities and life in
general

Feeling detached from others and
emotionally numb

Sense of a limited future (you don’t expect to
live a normal life span, get married, have a
career)
3.Symptoms of PTSD: Increased
anxiety and emotional arousal

Difficulty falling or staying asleep

Irritability or outbursts of anger

Difficulty concentrating

Hypervigilance (on constant “red
alert”)

Feeling jumpy and easily startled
Other common symptoms

Anger and irritability

Guilt, shame, or self-blame

Substance abuse

Feelings of mistrust

Depression and hopelessness

Suicidal thoughts and feelings

Feeling alienated and alone

Physical aches and pains
Symptoms of PTSD in children and
adolescents

Fear of being separated from parent

Losing previously-acquired skills (such as toilet training)

Sleep problems and nightmares without recognizable content

Compulsive play in which themes or aspects of the trauma are
repeated

New phobias and anxieties that seem unrelated to the trauma
(such as a fear of monsters)

Acting out the trauma through play, stories, or drawings

Aches and pains with no apparent cause

Irritability and aggression
A Mnemonic for Screening Patients for
Post-traumatic Stress Disorder

etachment

eexperiencing the event

vent had emotional effects

voidance

onth in duration

ympathetic hyperactivity or hypervigilance
DSMIVTR Diagnostic Criteria
A. The person has been exposed to a traumatic
event in which both of the following were
present:
1. the person experienced, witnessed, or was confronted with
an event or events that involved actual or threatened death
or serious injury.
2. the person's response involved intense fear, helplessness,
or horror.
B. The traumatic event is persistently reexperienced
in one (or more) of the following ways:
1. recollections of the event, including images, thoughts, or
perceptions.
2. dreams of the event.
3. acting or feeling as the traumatic event were recurring
(includes a sense of reliving the experience, illusions,
hallucinations, and dissociative flashback episodes)
4. intense psychological distress at exposure to internal or
external cues that symbolize or resemble an aspect of the
traumatic event
5. physiological reactivity on exposure to internal or external
cues that symbolize or resemble an aspect of the traumatic
event
C. Persistent avoidance of stimuli associated with the trauma
and numbing of general responsiveness (not present before
the trauma), as indicated by three (or more) of the
following:
1. efforts to avoid thoughts, feelings, or conversations associated
with the trauma
2. efforts to avoid activities, places, or people that arouse
recollections of the trauma
3. inability to recall an important aspect of the trauma
4. markedly diminished interest or participation in significant activities
5. feeling of detachment
6. restricted range of affect (e.g., unable to have loving feelings)
7. sense of a foreshortened future (e.g., does not expect to have a
career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not
present before the trauma), as indicated by two (or
more) of the following:
1. difficulty falling or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hypervigilance
5. exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B,
C, and D) is more than 1 month.
F. Impairment in social, occupational, or other
important areas of functioning.
1. Antidepressants
SSRIs – Sertraline, Fluoxetine
TCAs- Imipremine
2. Antianxiety drugs
- Lorazepam
i) TRAUMA-FOCUSED
COGNITIVE-BEHAVIORAL THERAPY

It involves carefully and gradually “exposing”
yourself to thoughts, feelings, and situations that
remind you of the trauma.

Teaching the patient specific techniques within a
limited number of sessions (with “homework
exercises” between sessions).

Identifying upsetting thoughts about the traumatic
event
ii) Exposure therapy
It involves gradually facing the thoughts and
memories of the traumatic event or situations (places
where the event occurred) that make one anxious.
This can be done by using imaging techniques or by
actually returning to the place where one had an
accident.
Exposure should be gradual and done
with the help of an experienced
clinician.
iii) Cognitive restructuring therapy

Cognitive restructuring involves identifying irrational (but
understandable) patterns of thought, feeling and behavior
that emerge after a traumatic event.

Cognitive restructuring aims at replacing dysfunctional
thoughts with more realistic & helpful ones.
e.g.
“I’ll never be normal again..I am gonna die”
“I’ll get better..It will just take time”
Or “I feel scared..But I am safe”
 iv)Eye movement desensitization and
reprocessing (EMDR)

The patient is asked to concentrate on an image connected
to the traumatic event and the related negative emotions,
sensations and thoughts,

At that time usually the therapist’s fingers moving from
side to side in front of your eyes.

After each set of eye movements (about 20 seconds), the
patient is encouraged to let go of the memories and
discuss the images and emotions he experienced during
the eye movements.

This process is repeated, this time with a
focus on any difficult, persisting memories.

Once you feel less distressed about the image,
you should be asked to concentrate on it while
having a positive thought relating to it.

It is hoped that through EMDR you can have
more positive emotions, thoughts and behavior
in the future.
v) Family therapy

Family therapy can help your
loved ones understand what
you’re going through.

It can also help everyone in the
family communicate better and
work through relationship
problems caused by PTSD
symptoms.
vi) Group Psychotherapy
They often feel more confident and able to trust.

Telling one’s story (the “trauma narrative”) and

directly facing the grief, anxiety and guilt related to
trauma enables many survivors to go on with their lives
rather than getting stuck in unspoken despair and
helplessness.
POSITIVE WAYS OF COPING WITH PTSD:

Learn about trauma and PTSD

Join a PTSD support group

Practice relaxation techniques

Confide in a person you trust

Spend time with positive people

Avoid alcohol and drugs
SELF-HELP TREATMENT FOR (PTSD)

PTSD self-help tip 1: Reach out to others for support

PTSD self-help tip 2: Avoid alcohol and drugs

PTSD self-help tip 3: Challenge your sense of
helplessness
 NURSING DIAGNOSIS
1. Post trauma syndrome related to distressing event
considered to be outside the range of usual
experience.

Accept client; establish trust

Stay with client during flashbacks

Encourage verbalization about the trauma when ready

Discuss coping strategies

Assist client to try to comprehend the trauma and how it
will be assimilated into his or her personal

Dysfunctional grieving related to loss off self as
perceived prior to the trauma or other
actual/perceived losses incurred during/following
the event.

Acknowledge feelings of guilt or self-blame

Assess client's stage in grief process

Assess impact of trauma on ability to resume ADLs

Assess for self-destructive ideas or behavior

Assess for maladaptive coping (e.g., substance
abuse)