Critical Review of a Mental Disorder: The Post Traumatic Stress Disorder in DSM-IV-TR

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There is a variety of mental disorders that are a result of various causes. However, a significant example is the Post traumatic stress disorder (PTSD). It is a convoluted typology of a mental disorder that affects the patient’s nervous system, reminiscence, emotional responses and coherent abilities.

The condition destabilizes the patient’s nervous system through the uncontrollable recurrence of memories of past traumatic experiences (Beth, 2002). There are various causes of the condition that determine its intensity. They include:

The Physiological factor affects the human nervous system; it is characterized by irregular secretion of stress hormones in the brain. Initial research on the patients suffering from post-traumatic stress disorder indicate that at some point in life, when an individual witnesses harrowing events, he/she may later in life develop symptoms of PTSD, depending on the intensity of the experience and the length of time exposed (Beth, 2002).

The disorder results in the fact that the person is undergoing chemical changes in the amygdale and the hippocampus. These are the parts of the mind which form the boundary between fear and memory.

This variation alters with the normal functioning of the mind, trials carried out by researchers with ketamine; the medicine that inhibits some of the neurotransmitter compounds in the human mind implies that, trauma effect works in a similar manner to dent coordination processes, in the human central nervous system. The resultant effects are observed as inhibitions to speech and language abilities of the patient (Beth, 2002).

Secondly, we look at the social cultural causes of PTSD. According to research activities carried out on PTSD patients like long serving soldiers, survivors of rape, genocide survivors and horror victims.

The research showed that, in communities where harrowing incidents are prevalent like Iraq and the war dominated countries like Somalia in Africa, cases of patients with PTSD are very common. This is evidence by a direct link between the disorder, the terrorism, harrowing events and activities (Beth, 2002).

Work related causes also come up as some of the major causes of the condition. Doctors and individuals, whose work involves consistent harrowing scenes, may end up developing symptoms of the condition. This form of the disorder is called secondary PTSD, as it results from the continuous exposure of the person, to observable consequences of traumatic events.

Examples of such professions are the rescues personnel, emergency doctors, psychiatric therapist and catastrophe investigators. However, the risk to contracting the condition is always determined by the resilience of the personnel to these exposures, past unsettled concerns in their life history, and the quantity as well as intensity of depiction to the suffering of trauma victims.

Individual variations also determine the probability of the person to develop the condition. The traumatic events play a major role as the cause of PTSD; however, people vary in their cognitive resilience and expressive response to shocking exposures. Some people have more emotional stability than others.

For example, in burial some people even faint due to the weight of the loss while others don’t even cry. Furthermore, some of the cases may be due to natural abilities of the person’s intellect, while others are caused by chronic diseases, upbringing challenges during child hood and life challenges experienced by the patient (Dalenberg, 2000).

Diagnosis criteria

The most widely used diagnostic criteria employed in the diagnosis of PTSD, is the standard Diagnostic and statistical manual of mental disorders (DSM-IV-TR). It is the specific criteria recommended, and used by medical personnel while making a diagnosis on a patient with the condition. It involves establishing the existence of the key symptoms of the disorder in the patient which include:

1. Observable constant nervous tension by the patient. This is where the patient suffers from frequent flashbacks that cause revulsion feelings of intense fear. The fear may be as a result of a past exposure to a harrowing event, in which the patient experienced fast hand threats to his life which stuck to his mint. In most cases, threats caused by humans have extreme consequences than events due to natural causes like tsunamis and earthquakes. As a result, it keeps recurring in the memory of the patient; causing feelings of helplessness and dissolution in life (Dalenberg, 2000).
2. Regular invasive symptoms; if the patient experiences constant uncontrollable flashbacks they cause him to undergo harrowing daydreams or nightmares. The flashbacks happen in such a way that the patient feels as if the incidents are presently happening all over again. This is due to an unusual memory formation processes caused by the intensity of the event to the patient. This is seen when the flashback is triggered by an enticement, which reminds the patient of the harrowing experience, or a speechless eminence with images solely seen by the patient (Schiraldi, 2000).
3. Constant Avoidant symptoms where, the patient tries everything possible to avoiding things, occasions and places that might remind him/her of the harrowing experience. The patient does this aiming at reducing the frequency of the flashbacks to him/her. It is characterized by the patient’s constant need to isolate himself from other people, constrained feelings and avoidance of things related to the ordeal. Those suffering from the condition, if not properly handled, have a high probability of abusing drug in an attempt to control the feelings (Dalenberg, 2000)..
4. The symptoms must have been consistently observable on the patient, for more than one month to be considered as a symptom.
5. The intensity of the condition, may sometimes determine the ability of the patient to maintain a regular relationships in his life. He/she may have difficulty working properly due to PTSD, and may be seen to withdraw from people such as, family and friends. In extreme cases, the patient dissociates from the society completely and other sources of meaning in life.
6. Hyper-arousal is the states of mind were the individual is constantly, unusually attentive and watchful for any signs of danger, even where there is none. It is characterized by an extremely startled response, inability to concentrate on detailed tasks and a short temper. According to most doctors, this is believed to be the major symptom of PTSD (Dalenberg, 2000)..

Factors Affecting Diagnosis of PTSD

In other cases, it becomes a challenge for the doctor to make the correct diagnosis of the condition due to the following challenges;

The fact that the condition is based on psychological measures is a challenge. Unlike other conditions that involve running tests on the patient before a clear diagnosis is done. PTSD involves listening to the history of the patient, and relying on the given information to make conclusions. Some of the instruments used to make inferences on the patient may include: the Hamilton Anxiety Scale, the Impact of event scale and the Beck Depression on Inventory (Foa, 2000).

There is also the problem of dual diagnoses. This occurs when the patient is diagnosed of having two disorders at the same time. It affects the progress of the treatment and as a result complicates the whole process.

Some of the conditions of double diagnosis include: A patient with PTSD diagnosed with substance abuse, someone with PTSD diagnosed with personality disorder and someone with PTSD diagnosed with anxiety dissociative disorder. The task of treating two disorders with different effects on the patient is both challenging to the doctor and complicating (Foa, 2000).

Naturally, people are different and they tend to respond differently to medication as well as to effects of PTSD. The variation in reaction to causes of stress, may also affect the response of the patient to treatment. Depending on the resilience of the patient to the disorder, it may take longer or shorter for the patient to completely recover from the condition.

To ease the whole process, the benchmarks used in the diagnosis of PTSD incorporated the use of adjustment disorder; in categorization and setting a limit between anomalous responses to normal life strains and devastation from horrors (Foa, 2000).

Conceptualization based on your theoretical perspective

PTSD is a condition that has been in existence since time immemorial. Henry IV, a close relative to Shakespeare, had all the characteristics that define the present day PTSD due to his past experiences. Although at that time the condition was not taken seriously because of its complicated nature.

The symptoms were prevalent to war veterans, and other victims of harrowing experiences. Initially, the condition was referred to with several names such as post rape syndrome, battle fatigue, shell shock and accident neurosis (French, 1998).

However, it took a very long time for the condition to be recognized officially as a disorder. This was after a relentless research activity by researchers like Gersons and Carlier. In 1980, the condition was recognized by the American Psychiatric Association, after the recognition of its standard diagnostic criteria in the DSM III.

At first, the condition was full of controversy due to its nature. Over time it has proved to be of greater significance in the psychiatric theory and concept. This is because of the external causative agents of the disorder, and not the patient’s personal weakness as it was initially thought (French, 1998).

Overtime, the criterion for the diagnosis has been improving for the people’s well fare. Initially, there were no clear distinctions between the stressors, which resulted from normal life activities such as divorce, job loss and rejection. And catastrophic events such as battle field stressors, terrorism explosions and rape ordeals.

This lack of a clear distinction may lead to, poor diagnosis of the condition and complication during treatment. Since that time, there has been considerable interest by researchers on the condition; with diagnoses mainly being made in soldiers and individuals, from countries that have been experiencing war activities for some time (French, 1998).

The interests by scientists lead to the development of longitudinal research in PTSD. According to these research activities, if PTSD is not treated early, it may affect the patient for a longer time than imagined. Those suffering from chronic PTSD may undergo longitudinal itinerary, characterized by diminutions and degeneration.

Sometimes, it may take a longer time to diagnose the condition due to the presence of inadequate symptoms, until after a long time ranging from a few months to several years when the symptoms resurface. Initially, the patient may experience conditions similar to the horrifying circumstances (French, 1998).

Special concerns from the legal/ ethical issues

Some times, the intense effects of PTSD may make the person to undergo traumatizing memories, which result in irritable moods. In extreme cases, the patient may be perceived to be insane. The psychological association supports the law in defending such patients, in the event that a crime was committed when the patient was suffering from the condition. This is done on the grounds of insanity, because the patient may not be in a mental position to control his actions, or comprehend happenings in his immediate environment (French, 1998).

In some cases, due to the sensitivity of the case involved, forensic applications are employed to improve on the reliability of the evidence in court. A Professional psychiatrist, who may be a witness for a case that is in progress in a court of law, should be able to maintain both honesty and professional integrity.

He/she should consider the use of both standard psychological criteria and medical evaluations. Furthermore, he must be able to specify the criteria for diagnosis, and give a well detailed report, of whether the patient measures up as a beneficiary of this scope of the law or not. Where compensation is being sort, the professionals must be very cautious, as the patient may exaggerate his condition due to personal interest, unlike in other cases (Hart, 2001).

On the other hand, the law enforcers have also grown to become victims of the condition due to the nature of their job. However, the expectation of the society to the police of always expecting them to be perfect has also put a challenge to the police themselves. This is why, it is very hard for police personnel to take initiative, and seek professional help in their own case.

Police are always trying to measure up to this expectation, and provide their service to the society. In the process they put up to being at work, even immediately after horrifying experiences. This may lead to piled up pressure, causing symptoms of PTSD. It should be therefore noted that, police officers are also human and prone to the disorder (Hart, 2001).

In the ethical perspective, PTSD has increased cases of ethical dilemmas. In the USA alone, approximately a quarter a million war veterans are in prison, mostly due to murder. Majority of the soldiers come back home as changed people, due to their experiences in the battle field.

Most of them do not seek professional help, leading to chronic PTSD. As a result, some commit serious crimes believed to be due to the effects of PTSD, and end up being imprisoned. Surprisingly according to records, majority of these veterans lacked criminal records before they went to war (Hart, 2001).

Later on, after the government discovered that rates of suicide among veterans of resent wars were increasing. It initiated national studies in 2005, and they established that, veterans had twice the probability to commit suicide as compared to those who had never served in the army.

It is increasingly becoming evident that most of the crimes committed by the ex- soldiers are the consequences of PTSD symptoms on the patients. The condition has compromised the ethics of even those soldiers that, before the war, were law abiding citizen and cautious to morals (Schiraldi, 2000).

It becomes even worse, for those individuals who were involved in the battlefield either as rescuers or doctors. When they come back home from the war, they experience PTSD and if not treated early, some of them end up as drug addicts.

A good example is Anthony Ortega, who ended up as a drug addict, before recuperation and now serves at Union Mission. In some cases, the ex-soldiers ends up living in the streets of Los Angeles were they make up to 25% of the homeless. To make it worse, they are prone to more crimes (Matsakis, 1994).

Cross-cultural perspectives related to assessment and treatment

Cultural perspective if expressed in terms of meaning and various insights vary from culture to culture. However, as a major source of the framework within which facts and major aspect are formulated to form rationality and relations. Culture, either directly or indirectly affects how the various parties involved treat and relate to PTSD as the major effect of horror.

Due to the diversity presented by culture, it may be better if the perception of trauma is dealt with in a dynamic way. This is a form that incorporates the use of universal diagnostic criteria. Treatment such as therapy should be formulated depending on the culture of the people to be treated.

A research carried in Mozambique proves that, what is perceived to be a traumatic event in one culture may not be so in another culture. To be able to understand the distinctions, one must be able to establish the relationship between death and the living people.

We must also be able to understand, the person believes in relation to, government and their patriotism. There are various methodologies used in the cross culture analysis of PTSD, depending on the aim of the research activity. The appropriate criterion is always the one that can accommodate as many views and perceptions as possible.

The criterion to be used in cross cultural perspective must incorporate the socialized view of psychological health. In the non western world, individuals take the effects of the war as a community, but not as an individual as it is observed in the western world. This is a form of automatic precaution in the non western world and as a result, the effect of the trauma to individuals is much less than to the western personnel.

Currently, research activities by the VA scientists in their examination of the prescription practices in the treatment of PTSD indicate a continuously high medication of anti depressants; and a decrease in the antipsychotics and benzodiazepines in the last 10 years (Volkman, 2005).

It was also established that most doctors preferred the use of first line PTSD treatment. However, for those patients that may not respond to the first line treatment, other psychotropic medication may be used although they may involve some significant risk.

In another research carried out it was established that, regardless of the presence of pain, the patients are more likely to be prescribed with opioids. Unfortunately, this increases the possibility of a poor feedback. The study identified an increased use of off-label antipsychotics and opioid therapies in patients; the current levels are too high and should be managed at lower levels.

Current research related to diagnosis and assessment of the disorder

Current research like research carried out in May 2011 established that, a soldier who experienced mental illnesses before going to war had increased chance of developing symptoms of PTSD after returning from the battle field. Such soldiers were more than twice likely to contract PTSD, than other soldiers who never suffered from any mental diseases.

The army has also taken initiative to put in place activities that may prevent PTSD, like giving counseling sessions for those that may show signs of weakness just before combat. Studies also showed that, if soldiers were married, they were allowed to communicate through emails and letters to their spouses. During the period of combat they exhibited reduced chances of developing PTSD.

Transcendedental medication is one of the new forms of treatment for PTSD, studies on the medication proved that it helped to reduce symptoms of PTSD on the patients thus improving their life (Volkman, 2005).

Future trend

According to research activities, it is clear that the effects of PTSD are overwhelming to the patients especially ex-soldiers. It is, therefore, necessary for the community and the government to take extra measures to reduce the effects. Some of the efforts may include giving the patients more support. The government may collaborate with professional psychiatrists, and invest more in counseling personnel, and research on better treatment methods.

References

Beth, W.M. (2002). The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms. New York: Penguin publishers.

Dalenberg, C. J. (2000). Countertransference and the Treatment of Trauma. San Francisco: Brooks Cole publishers.

Foa, E. B. (2000). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. OXFORD: Oxford University press.

French, G. D. (1998). Traumatic Incident Reduction (TIR). New York: CRC PRESS LLC.

Hart, A. (2001). An Operators Manual for Combat PTSD: Essays for Coping. London: Universal publishers.

Matsakis, A. (1994). Post-Traumatic Stress Disorder: A Complete Treatment Guide. California: New Harbinger Publications.

Schiraldi, G. (2000). Post- Traumatic Stress Disorder Source Book. ILLINOISE: Lowell House publishers.

Volkman, V.R. (2005). Beyond Trauma: Conversations on Traumatic Incident Reduction, Second Edition (Explorations in Metapsychology). Chicago: Williamson & Sons publishers.

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