POST

TRAUMATIC
STRESS
DISORDER

BY- MS. PREETI

SHARMA
MSC. NSG. 2ND YR.
OUTLINES
• INTRODUCTION • POSITIVE WAYS TO
• DEFINITION COPE UP WITH
• TRAUMA EVENTS PTSD
LEAD TO PTSD • COMPLICATION
• RISK FACTORS • NURSING
• SIGN & SYMPTOMS DIAGNOSIS
• DIAGNOSTIC • CONCLUSION
CRITERIA
• TREATMENT
INTRODUCTION

• Post traumatic stress disorder (PTSD) is a

psychiatric disorder that may occur in
people who have experienced or
witnessed a traumatic event such as a
natural disaster, a serious accident, a
terrorist act, war/combat, or rape or who
have been threatened with death, sexual
violence or serious injury.
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
 S U DD E N
WAR RAPE DEATH OF
L O VE D
O RI S T
TERR CKS ON E
A
S ATT
TRAUMAT
I C E V E N TS
THAT CAN
TO PTSD I LEAD
NCLUDE
KIDNAPPING

CAR
CRA S H NATURAL
DISASTER
ASSAUL
T
 FACTORS
• Women are greater risk then male
• Previous traumatic experience
• Family history of PTSD or depression
• History of depression, anxiety
• History of physical or sexual abuse
• History of substance abuse
• High level of stress
• Lack of support after trauma
• Lack of coping skills
SIGNS & SYMPTOMS
1.Re experiencing the traumatic event
 Upsetting memories of the events
 Flashbacks
 Nightmares
 Feelings of intense distress
when reminded of trauma
 Intense physical reactions to
reminders of events
2. Avoidance & Numbing

Avoiding activities, places, thoughts

or feeling that remind the trauma
Inability to remember important
aspects of trauma
Loss of interest in activities & life
Feeling detached from others &
emotionally numb.
 Sense of a limited future
3. Increased anxiety & emotional arousal

Difficulty falling or staying asleep

Irritability or outbursts of anger
Difficulty concentrating
Feeling jumpy and easily startled
Hyper vigilance
(or constant ‘red alert’)
OTHER COMMON SYMPTOMS

 Anger & Irritability

Guilt, blame to self, shame
Substance abuse
Feelings of mistrust
Depression & hopelessness
Suicidal thoughts & feelings
Physical aches and Pain
SYMPTOMS OF PTSD IN CHILDREN & ADOLESCENTS

• Fear of being separated from parent

• Losing previously acquired skills
• Sleep problems & nightmares without
recognizable content
• New phobias & anxieties that seems unrelated to
trauma
• Acting out the trauma through play, stories or
drawings
• Aches & pain with no apparent cause
• Irritability and aggression
DIAGNOSTIC CRITERIA
A. The person has been exposed to a
traumatic event in which both of the
following were present:
• The person experienced, witnessed or was
confronted with an event or events that
involved actual or threatened death or serious
injury.
• The person’s response involved intense fear,
helplessness or horror.
B. The traumatic event is persistently re
experienced in one (or more) of the following
ways:

Recollections of the event, including images,

thoughts or perceptions
Dreams of the event
Acting or feeling as the traumatic event were
reoccurring
Intense psychological distress
Physiological reactivity
C. Persistent avoidance of stimuli associated
with the trauma & numbing of responsiveness
(not present before trauma) as indicated by 3
(or more) of the following:

- Efforts to avoid thoughts, feelings or

conversations associated with trauma
- Efforts to avoid activities
- Inability to recall an important aspects of trauma
- diminished interest
- Feeling of detachment
- Sense of foreshortened future
D. Persistent symptoms of increased arousal
(not present before trauma), as indicated by
two (or more) of the following:

- Difficulty feeling or staying asleep

- Difficulty concentrating
- Hyper vigilance
- Exaggerated startle response
E. Duration of the disturbance (symptoms in
criteria B, C & D) is more than 1 month.

F. Impairment in social, occupational or other

important areas of functioning.
1. Pharmacological Treatment

• Antidepressants:
 SSRIs (Sertraline, Fluoxetine)
 TCAs (Imipramine)

• Antianxiety drugs:
 Lorazepam
2. Psychosocial Treatment
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 no. of 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 & done
with the help of an experienced
clinician.
iii. Cognitive restructuring therapy
• Cognitive restructuring involves identifying
irrational patterns of thought, feeling and
behavior that emerge after a traumatic event.
• Cognitive restructuring aims at replacing
dysfunctional thoughts with more realistic and
helpful ones.
• E.g. I will never be normal again, I am
going to die.
• I will get better, it will just take time or I feel
scared but I am safe.
iv. Eye movement desensitization &
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 finger moving
from side to side in front of your fingers.
• After each set of eye movements (about 20 sec.)
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 & work through
relationship problems caused by PTSD
symptoms.
vi. Group psychotherapy

• They often full more confident and able to

trust.
• Telling one’s story & directing 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 TO COPING WITH
PTSD
• Learn about trauma & PTSD.
• Join a PTSD support group.
• Practice relaxation techniques.
• Confide in a person you trust.
• Spend time with positive people.
• Avoid alcohol and drugs.
COMPLICATION
• Depression and anxiety
• Eating disorders
• Suicidal thoughts
NURSING DIAGNOSIS
1. Anxiety related to traumatic war experience and
environment changes.

Goal- To reduce anxiety.

Intervention-
• Assess anxiety level, perceived threat.
• Develop trusting therapeutic relationship.
• Assess for non threatening items that yield public
reactions.
• Encourage use coping skills.
• Encourage gradual participation in group, activities.
2. Risk for violence directed towards self or others
related to intrusive memory.

Goal- Demonstrate relaxation techniques.

Intervention-
• Evaluate suicidal/ homicidal behavior.
• Contract for safety.
• Encourage identification of triggers.
• Reorient patient when necessary.
• Utilization de-escalation techniques.
3. Sleep disturbance related to psychological
stress, flashbacks insomnia.
Goal- To maintain sleeping pattern.
Intervention-
• Obtain patient sleep hr., keep sleep diary and
observe.
• Check anxiety level a bed.
• Teach relaxation techniques if necessary.
• Teach good sleep hygiene habits.
• Encourage development bedtime routine plan.
• Determine disturbance cause/ trigger.
CONCLUSION
• PTSD is a complex highly disabling and
suffering disorder where the past is always
present in people haunted by the dread frozen
in memory of the traumatic events. However,
PTSD also represents an opportunity for
psychological and spiritual growth due to the
human ability to adapt and thrive despite
experiencing adversity and tough times.
RESEARCH ARTICLE
• Reliability and validity of a brief instrument
for assessing post‐traumatic stress disorder
Edna B. Foa 
David S. Riggs 
 Constance V. Dancu 
 Barbara O. Rothbaum
Abstract
• This study examines the psychometric properties of two
versions of the PTSD Symptom Scale (PSS). The scale
contains 17 items that diagnose PTSD according to DSM‐
III‐R criteria and assess the severity of PTSD symptoms.
• An interview and self‐report version of the PSS were
administered to a sample of 118 recent rape and non‐sexual
assault victims. The results indicate that both versions of
the PSS have satisfactory internal consistency, high test‐
retest reliability, and good concurrent validity.
• The interview version yielded high interrater agreement
when administred separately by two interviewers and
excellent convergent validity with the SCID. When used to
diagnose PTSD, the self‐report version of the PSS was
somewhat more conservative than the interview version.