Complex trauma stress disorder

How can I help someone who has experienced a traumatic event?

For those who have experienced a traumatic event, the following actions may help:

• Be there - invite people to be with them. If they refuse, you can reassure them that you will be with them if they change their mind. Should not be imposed, but try to convince them to accept your help.
• Listen - try not to pressure people if they don't want something. If they want to talk, try to listen without interrupting or trying to share your own experience with them.
• Ask general questions - When you ask questions, try to keep them general and non-judgmental. For example, you might ask, "Have you talked about this with anyone else?" or “Can I help you find more help?”
• Offer real (practical) help - Some people may have difficulty taking care of themselves or doing daily activities. Offer help, such as cleaning the house or preparing meals;

Try not to tell people:

• That you know how they feel - even if you have experienced something like this, people experience situations differently. Comparing your experience with that of others is not always helpful;
• How lucky they are to be alive - people who have experienced traumatic events often don't think they are "lucky". Often they feel guilty about the fact that they survived while others died;
• Belittling the significance and seriousness of the experience - try not to tell people that things could be much worse, even if you do it out of good intentions and thereby try to help them. Such statements can make people feel that their experiences are not being taken seriously by others;
• Giving inappropriate advice - Try not to give advice or suggestions, even if it has helped you in the past. All people are different and often they have already tried what you offer.

References:

This information was prepared by the Public Engagement Editorial Board of the Royal College of Psychiatrists (PEEB). It reflects the best available evidence at the time of writing.

Special thanks to PTSD UK for kindly providing feedback on this resource.

Expert Editor: Prof. Neil Greenberg

Full links to this resource are available upon request.

Translated by Elena Fage, senior intern psychiatrist

Translated by Elena Fage, Specialty doctor in CAMHS

PTSD - post-traumatic stress disorder

Initially, the term "post-traumatic stress disorder" appeared as a diagnosis in the military. It happened during the Vietnam War. Then he firmly established himself in medical circles, and already at 1968 entered the ICD. But the disorder is actually very ancient - they learned to define it back in ancient Rome.

PTSD - what is it?

Complex post-traumatic stress disorder is a mental disorder that occurs in a person after some kind of traumatic impact. It was not for nothing that the violation was first diagnosed in the military - it was the military operations that caused PTSD. After the disease became generally accepted, the reasons for its appearance became more "domestic". And the range of causes that cause it has become more extensive. But, as before, the largest part of patients with this disorder are those who did military service.

Post-traumatic stress disorder, in simple words, is a disorder that appears after trauma of a very different nature. For example, after violence, disaster, death of a loved one. Any threat to life can lead to PTSD. Often the diagnosis is misused and applied to people whose symptoms are completely different from those confirmed by psychiatric researchers. Therefore, in recent years, the term has somewhat depreciated. But it is important to understand that the cause has always been and remains strong stress.

According to the ICD, post-traumatic stress disorder always appears as an abandoned and prolonged reaction of the psyche to a stressful event. In this case, the event necessarily has the character of a threat or catastrophe. Here it is necessary to introduce the concept of distress, which is used as a counterweight to eustress - positive stress that does not bring the psyche out of balance. Distress, on the other hand, is always negative, destructive, and it is this that is applied to PTSD. It brings the nervous system out of a stable state, from which the whole organism suffers. The stronger the stress factor, the more likely it is that eustress will turn into distress.

It must always be remembered that PTSD, if not treated in time, can change the patient's personality and destroy his life, leaving an imprint on every area of ​​it.

According to statistics, post-traumatic stress personality disorder is most common among women. Since the most common cause of violation is rape. In percentage terms, the data are as follows: PTSD affects 1.2% of women and 0.5% of men. But not always a stressful event can lead to PTSD. Firstly, not all people are susceptible to it, and secondly, in many cases it can be prevented.

Post-traumatic stress disorder in the ICD-10 is in the group "Neurotic, stress-related and somatoform disorders". Due to the unstable psyche, the disorder is most often diagnosed in the elderly and in children. Resistance to stress in these groups is much lower, and in older people it is also accompanied by a gradual loss of mental adaptation. Plus, the rigidity of mental processes increases.

PTSD needs to be examined comprehensively, so the observation is usually carried out by more than one specialized specialist. Among the areas of medicine that deal with the treatment of patients with post-traumatic stress disorder are psychiatry, psychotherapy and clinical psychology. Often the disorder is accompanied by depression, but it is also not uncommon for the patient to seek a way out of it with the help of chemical addictions. The disorder has relatively recently been recognized by the psychiatric community as a diagnosis in its own right. Therefore, the methods of treatment are still at the research stage. Experts often choose experimental methods, but it is still unclear whether they have high efficiency.

PTSD (Post-Traumatic Stress Disorder) is a disorder that provokes instantaneous reactions of the psyche under the influence of a negative event. In patients without PTSD, a self-preservation reaction occurs during stressful moments, but a person with a disorder feels in danger even at a time when nothing threatens his life. And there is no natural fight-or-flight response to a threat. There is no guarantee that the disorder will not occur, even if the person is mentally stable. After all, it is not known what event can bring a person out of balance and how he will react to this or that stress.

Like any mental disorder, post-traumatic disorder syndrome should be detected in a timely manner, and treatment should be carried out under the strict supervision of a specialist. In this, close people who recognize PTSD by the first signs can play a key role. We cannot close our eyes to the changed state of a person and his inappropriate behavior. The statistics in this disease are disappointing - 8 people out of 100 at least once experienced the condition of this disorder.

Mentally stable people are more at risk of developing this disease under the influence of traumatic circumstances, from calm to go into a state of post-traumatic stress disorder. At the same time, it can also be due to a genetic predisposition and manifest itself during minor shocks. Interestingly, people diagnosed with this condition rarely experience a single stressful shock. Most often, the violation is manifested due to several shocks. They can occur with a significant temporary break or go one after another. The presence of a diagnosis significantly reduces the patient's quality of life, and the disorder itself can take on a more advanced form and become complex - it is more complicated and requires a more thorough approach to treatment.

Why PTSD occurs

The causes of the disease are various and very extensive. Not always the disorder can be acquired, heredity also often plays a decisive role in the appearance of signs of PTSD.

The main causes of post-traumatic stress disorder are:

• Military events, military service, participation in hostilities.
• Act of terrorism.
• Cultural and ethnic conflicts.
• Assault causing bodily harm, threat of death.
• Death of loved ones, protracted illnesses that threaten death.
• Psychological or physical abuse.
• Political prerequisites are revolutions, genocide, forced migration, repressions.
• Man-made or natural disasters.
• Epidemics and pandemics.

The number of people with PTSD has increased significantly over the past two years. Because post-traumatic stress disorder usually occurs in a stressful situation, and general panic only exacerbates the situation. This is demonstrated by the situation in the world, which is faced with a coronavirus infection. This suggests that the list of reasons is very dynamic and can expand in connection with the changing situation in society.

In general, the factors that provoke PTSD are past events that led to psychological trauma. They are called acquired. But they can also be congenital - when post-traumatic stress disorder occurs due to heredity. It has been proven that there is a strong connection between a woman and a child. If the first suffered physical abuse during pregnancy, then it is likely that the baby will be predisposed to a mental disorder.

Pathogenesis of PTSD

When a traumatic event occurs, there is an instant rush of adrenaline. As a result, a neurological response appears in the brain. For a long time it persists, and provokes various mental reactions in the future in response to similar situations. Each time similar events occur, the activity of the hypothalamus decreases due to the high level of adrenaline. This is what causes the violation.

The pathogenesis of PTSD is also associated with low production of cortisol, increased excretion of corticotropin in the urine. The dexamethasone suppression test in people with PTSD is significantly higher than in those who suffer from clinical depression.

All of these factors indicate an abnormality in the axis of the hypothalamic-pituitary-adrenal axis (HPA). The HRA axis turns on in response to constantly arising fear. Therefore, there is also a connection between the frontal cortex and the limbic system. The axis triggers a hormonal surge, but in turn triggers the LC-noradrenergic system, which is associated with reinforcing bad memories. The subcortical basal nucleus (amygdala) is responsible for emerging threats and natural responses to them.

People with the syndrome have low levels of serotonin, which causes non-standard behavioral symptoms. The patient develops irritability, thoughts of suicide, unreasonable aggression. The secretion of the hormone dopamine is also involved. Its decrease causes apathy, inhibition in actions, and an increased level of dopamine provokes arousal - psychosis, unreasonable anxiety appears.

Symptoms of PTSD

Usually, signs of post-traumatic stress disorder appear within three months after the traumatic event. But there are also patients in whom symptoms do not appear earlier than after 6 months. It is possible at the same time a regular manifestation of a mental state, which allows us to talk about the chronic nature of PTSD.

Symptoms of post-traumatic stress disorder:

• One or more cases of avoiding a traumatic situation.
• One or more recollections of the traumatic situation.
• Two or more cases of violation of an adequate perception of reality, a sharp change in mood.
• Two or more cases of sudden excitability and increased activity.

Characterizing post-traumatic stress disorders, one cannot fail to mention the changing behavior of a person, which leaves an imprint on interaction with people, personal life and career.

1. It seems to the patient that he is in a state of nervous breakdown or is about to break loose.
2. There are uncontrollable outbursts of anger, sleep disturbance.
3. A person enters an anxious state very quickly, instantly passes from a calm state to a frightened one.

The symptoms of this group have a permanent property. If the rest can appear from time to time, then excitability and activity will accompany the patient's behavior throughout the entire period marked by the presence of PTSD.

Characterization of post-traumatic stress disorder necessarily includes the presence of symptoms in the patient. It is important to monitor the patient - these symptoms should be observed for at least a month. Their severity also plays a role - they must have a negative impact on a person's life, his interaction with society.

How PTSD is classified

The disease can pass into different stages, have a different nature of the course and be characterized by different degrees of severity. All these parameters, as well as signs of post-traumatic stress disorder, allow us to classify the disease.

If we give a general classification of the violation, then experts define it as an anxiety disorder, the accompanying signs of which are unpleasant experiences, behavior unusual for a calm person. Physiological reactions often also occur when contact with a traumatic situation occurs. All of these functions are observed within a month - this is the main distinguishing aspect in comparison with short-term stress.

The disease is divided into 3 forms:

1. Sharp. Occurs after 30 days, it is preceded by a strong shock.
2. Chronic. The appearance of this form is associated with heredity. Some traumatic event provoked PTSD, but the person had preconditions for this.
3. Delayed. When much more than a month passes after the event. Sometimes the event can be repeated, but does not have consequences in the form of PTSD. But the origin of the corresponding biochemical processes provokes the development of the disease.

Post-traumatic stress disorder is also divided into several stages:

• A traumatic situation affects the psyche.
• A person begins to constantly think about it, rethink how it could have been prevented, feels guilty for what happened.
• The subject begins to avoid the place, people and things associated with the situation.
• There are symptoms of arousal, which become permanent.
• Symptoms persist for 30 days or more.
• The symptoms of post-traumatic stress disorder leave an imprint on the patient's habitual life, he has problems in communication and organization of activities.

According to the ICD-10 classification, there are 4 types of PTSD:

1. Dysphoric type. The patient is characterized by constant irritability, aggressive behavior, dissatisfaction with the behavior of other people. Such people feel resentment, they can even take revenge, inflict physical damage on others. At the same time, regret about such behavior is not ruled out, but often satisfaction with destructive actions. People with this type of disease try to avoid outside help, refuse to see a doctor.
2. Anxious type. He has frequent unmotivated anxiety attacks. It is realized not only mentally, but also manifests itself bodily. Describing post-traumatic stress disorder, specialists note frequent changes in the patient's mood and sleep disturbance in this type. A person strives for communication, as this helps him relieve anxiety.
3. somatoform type. Accompanied by massive painful sensations in the body. Most people complain of pain in the heart area, a little less of changes in the gastrointestinal tract, some complain of headaches. These symptoms usually appear six months after the event. This type refers to the delayed form of the disease. The patient is constantly fixed on these sensations, which makes him go to the doctor.
4. Asthenic type. Characteristics of post-traumatic stress disorders in this case include apathy, lethargy, indifference to everything that happens. This state is depressing. Drowsiness appears, the person does not want to get out of bed. At the same time, dreams do not take the form of nightmares, they may not even appear. This type is most supportive of medical intervention - he willingly responds to the help of loved ones and agrees to appear to a specialist without unnecessary persuasion.

Post-traumatic stress disorder may take up to a month to appear, or it may take much longer. Diagnosis can be complicated by different behavior between types, but one thing unites patients - the indispensable presence in life of a situation that disrupts the usual course of life.

Once diagnosed, PTSD can also be classified as a treatable disorder or a disorder whose symptoms can be completely eliminated. PTSD usually causes disturbances in social, professional and other areas of activity.

Stages of PTSD

There are several stages of the onset of this disease:

1. Traumatic stress. Occurs during a critical incident and immediately after it for 2 days.
2. Acute stress disorder. It appears within two days, can last up to 4 weeks.
3. Post-traumatic stress disorder. Must have been more than 4 weeks.
4. Post-traumatic personality disorder. It can run throughout life.

The last stage is considered incurable, so it is important to recognize the disease in the early stages. Symptoms at all stages are similar, but at each stage the conditions become more and more intrusive, getting rid of them becomes more and more difficult.

The signs themselves depend on the type - at each stage, an asthenic, somatoform, dysphoric or anxious type can manifest itself. Passing through all the stages, PTSD manifests itself brighter, but the main signs remain the same.

Complications of PTSD

In post-traumatic stress disorder, the consequences can be devastating to a person’s psyche, his physical health, but can also affect other people. This disease greatly increases the risk of problems such as:

• Drug use, alcoholism.
• Constant depression, which is accompanied by medication and the inability to lead a normal life.
• Eating disorder, deterioration of the brain, central nervous system and heart.

When to see a doctor

If a frightening situation has occurred in a person’s life that entails a traumatic experience, then this is already a reason to turn to the text. The patient may notice non-standard behavior behind him or heed the advice of loved ones who have noted changes in his condition.

The presence of symptoms also plays an important role - constantly occurring destructive deviations, disturbing dreams, aggression, or vice versa, an apathetic state. If they appear after a traumatic situation and do not let a person go for 30 days, then you should make an appointment with a psychiatrist or psychotherapist.

Only a specialist is able to establish the correct diagnosis and prescribe treatment. It is better to exclude an independent solution to the problem in this disease.

Diagnosis of disorder

Screening is usually used to diagnose PTSD. First of all, this is the PTSD scale, generally accepted in the ranks of researchers of mental disorders. It was developed by the Mississippi Group of Scientists. It is a questionnaire of 35 questions (for the military) or 39(a variation of the test for those suspected of having non-war related PTSD). Answers are ranked on a Likert scale. After the analysis, the final coefficient is derived. The questionnaire form contains inverted values ​​- this prevents the possibility of setting a potential patient. It is also excluded that they are filled in random order.

Diagnostic criteria for post-traumatic stress disorder are established by a psychologist, psychiatrist or psychotherapist - they depend on the stage of the disease, the type and severity of the course.

Before proceeding with the diagnosis, the doctor gets acquainted with the anamnesis and talks with the patient. Often, friends and relatives of the patient are involved and interviewed for diagnosis. A doctor, based on third-party reviews, can create an unbiased and most complete picture of the condition of a potential patient.

Criteria for diagnosing post-traumatic stress disorder always involve the use by a doctor of tests, questionnaires, scales - everything that will help to fully assess the patient's condition. All these tools are used in a conversation not only with the patient himself, but also with his relatives.

The main method of diagnosing the disease is SCID (structured clinical diagnostic interview). It includes blocks of questions that are interconnected and help to smoothly move from one block to another. This technique is convenient in that it can be adjusted depending on specific tasks.

Other methods for diagnosing post-traumatic stress disorder include the Beck questionnaire (used to identify a depressive state), the Keane scale (used to assess the severity of combat experience), the Derogatis scale (assesses the severity of psychopathologies), the scale for assessing the severity of a traumatic event. A significant disadvantage of the listed scales is that they were developed by world scientists and their adaptation into Russian may cause certain difficulties, which will distort the results. At the moment, this problem is a priority in the community of Russian psychiatrists.

Post-traumatic stress disorder, its diagnosis and treatment should be under the strict supervision of a competent specialist.

In general, the diagnosis can be divided into several stages:

1. observation.
2. Conducting a survey.
3. Projective method of personality research. At this stage, generally accepted tests in psychology are used - Rorschach, Luscher, apperceptive.
4. Use of standardized personality questionnaires.
5. The use of questionnaires that diagnose the severity of pathopsychological symptoms in accordance with ICD-10.

Treatment of disorder

Depending on the nature of the disease, concomitant factors and the degree of neglect of the patient, the psychotherapist prescribes appropriate treatment. Sometimes medical intervention is required. Treatment for PTSD (post-traumatic stress disorder) often involves a holistic approach.

In the early stages, cognitive behavioral therapy is used. The specialist corrects the behavior model by replacing negative emotions with positive ones. With this approach, the patient can learn to identify depressing thoughts and use various techniques to get rid of them. The goal of therapy is to identify the symptoms of PTSD, monitor stress, behavioral changes, emotional outbursts and understand the nature of their origin. Correction of post-traumatic stress disorder with the help of cognitive therapy is often crowned with success.

Medication is an under-researched method of dealing with PTSD. It is believed that many drugs have a placebo effect - the patient drinks them and through self-hypnosis believes in getting rid of the disease. But the likelihood of relapse is high when prescribing such medications. Today, experts usually prescribe three drugs - paroxetine, venlafaxine and fluoxetine, which have successfully proven their effectiveness.

When authentic, PTSD is best treated with antibiotics. Serotonin-norepinephrine and serotonin reuptake inhibitors are prescribed. Tricyclic antidepressants such as sertraline and venlafaxine have been shown to be effective in some cases. These are second-line drugs for PTSD.

Benzodiazepines are also prescribed as medications. But their effectiveness has not yet been proven and their use is associated with a certain risk. Therefore, many doctors try to refuse these drugs, but some still prescribe them for severe insomnia.

Treatment of PTSD in the early stages of symptoms may include the use of glucocorticoids. The purpose of their appointment is to neutralize neurodegeneration, however, long-term use of them can, on the contrary, enhance it.

Children can also be affected. This is where play therapy helps. Studies have shown that it helps the child connect internal experiences with the outside world.

Psychotherapy for post-traumatic stress disorder, based on repetitive games, involves abstract thinking, helps children experience negative emotions.

As an additional recommendation, the specialist may advise physical activity. It must be moderate. Exercise and sports distract from bad thoughts, can improve self-esteem and control the physiological manifestations of a mental disorder. The main thing is not to overdo it so that the desire to get in shape does not become an obsession.

Therapy for complex post-traumatic stress disorder always includes an individual visit to a psychotherapist - a specialist identifies the causes of the disease, helps to recognize the signs of the condition, and accepts that the patient has a mental disorder.

For the treatment of PTSD, it is better to choose clinics that specialize in the treatment of mental disorders. Doctors with many years of experience work in such institutions, who have been practicing and conducting effective treatment for many years.

Some patients try to cope with the disease on their own. They try to contact other people, seek solace in conversations, recreational activities, hit on religion, practice breathing exercises. But the use of all these methods as a therapy for post-traumatic stress disorder cannot become the basis for its treatment and get rid of it forever.

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Disease prevention

There is no effective prevention for PTSD. A person cannot always predict whether a traumatic event will occur in his life, and what consequences it will lead to.

Some of the research on disorder prevention has focused on learning resilience—the ability to bounce back from tragic events. Such a strategy can be useful for people at risk - military personnel, journalists, members of rapid response teams. But the clinical guidelines for post-traumatic stress disorder don't place much emphasis on the effectiveness of this approach. Such strategies include teaching people how to respond to stressful situations and self-management techniques such as sleep control and mindfulness.

The support of loved ones plays an important role in preventing violations. A person can be helped to adapt to the outside world through conversations, visits to interest groups. It would be useful to contact a psychologist at the slightest symptoms. Prevention of post-traumatic stress disorder is effective only in the early stages. Therefore, contacting a specialist is a prerequisite for its successful treatment.

References:

1. Alexandrov, E.O. Stages of clinical dynamics of post-traumatic stress disorder in combatants
2. Alexandrov, E. O. Post-traumatic stress disorder: clinic, treatment
3. Andryushchenko, A. V. Post-traumatic stress disorder in situations of loss of an object of extraordinary significance
4. Voloshin, V.

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