The beginning of health information technologies has improved health care practice and delivery by providing new technologies, which are designed to enhance productivity, patient satisfaction, and the workflow while maintaining the required quality, safety, continuity, and efficiency standards (Trusko et al. 794).
The current applications of health IT are focused on enhancing communication among healthcare providers, communication between the health care providers and their clients, automation of medical information, implementation of evidence-based practices, and reduction of medical errors. Most importantly, health IT seeks to codify the medical information in the electronic medical records into standardized and structured medical terminologies. When the normal clinical information is transformed into a standardized and structured language, the resultant information is called Controlled Medical Terminologies (CMTs).
The importance of CMTs is that they reduce ambiguities besides enhancing consistency in the way medical information is shared between health care providers and their clients. Further, CMTs help clinicians to summarize medical information in such a way that it can be obtained in a timely manner. Some examples of applications of CMTs include the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), the Unified Medical Language System (UMLS), and the Logical Observation Identifiers Names and Codes (LOINC) (Trusko et al. 795). This paper summarizes, interprets, and evaluates the contents of a research study that seeks to examine the representation of posttraumatic stress disorder (PTSD) terminologies in the SNOMED-CT controlled medical terminologies.
The Purpose of the Research
In the study under review, Trusko and his colleagues examined the extent to which the normal language used to make reference to different aspects of PTSD is represented in the SNOMED-CT controlled medical terminologies. Accordingly, the researchers mapped a list of 153 PTSD terminologies drawn from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and other mental health publications to a collection of over 800,000 SNOMED-CT controlled medical terminologies (Trusko et al. 794).
The Questions Addressed
To achieve the purpose of the current research, Trusko and his colleagues sought to address the question whether there are content shortcomings in the way SNOMED-CT controlled medical terminologies are used to represent various aspects of PTSD including its symptoms, signs, and other terms used in the diagnosis of the disorder.
Further, the researchers wanted to highlight the potential applications of electronic health systems in the retrieval, automation, and codification of the PTSD-specific free text by assessing whether there are any PTSD-related concepts and terms in the existing controlled medical terminologies. Moreover, Trusko and his colleagues sought to answer the question whether there are ways of mapping the PTSD-related concepts and terms to the controlled medical terminologies contained in SNOMED-CT and other applications of the unified medical language system (Trusko et al. 796).
Results
Based on the research questions described in the foregoing discussions, the researchers mapped a total of 153 PTSD-specific concepts and terms to the SNOMED-CT controlled medical terminologies and concept codes. According to the research findings, there were about 104 of the PTSD-related concepts and terms among the pre-coordinated concept codes of SNOMED-CT (Trusko et al. 796). This represents about 68% of the 153 clinical terms generated by the researchers in reference to the symptoms, signs, events, and outcomes of PTSD.
With the inclusion of the post-coordinated concept codes into the pre-coordinated concepts of SNOMED-CT controlled medical terminologies, the researchers found out that more than 91 % of the 153 clinical terms and concepts related to PTSD were represented in the SNOMED-CT unified codes. However, significant variations were noted in the coverage of concepts and terms for different PTSD criteria in the SNOMED-CT concepts.
For example, there were about 53% of PTSD criteria A, 56% of PTSD criteria B, and 80% of PTSD criteria C clinical terms in the pre-coordinated SNOMED-CT concepts. Finally, about 14 (9%) PTSD clinical terms were completely absent in the overall SNOMED-CT concept coverage (Trusko et al. 796).
The Striking Features of the Research
The unique element of the study under review is that it highlights the importance of information technologies, and more specifically, the application of codified language in the area of mental health. Although a lot of studies have documented the applications and effectiveness of health information technologies in different areas of clinical practice, relatively minimal studies have examined the relationship between electronic medical records, health IT, and controlled medical terminologies (Trusko et al. 794).
Moreover, among the studies highlighting the applications of health IT and controlled medical terminologies in the retrieval, automation, and codification of concepts and terms related to different diseases, only a few have documented the use of different applications such as SNOMED-CT in PTSD and other mental health complications. Therefore, the current study is unique in that it seeks to highlight the specific applications of health IT and controlled medical terminologies in the area of mental health disorders.
Further, the most striking feature of the study findings in the current research is that the researchers were able to map out more than 90% of the selected PTSD clinical terms to the SNOMED-CT concepts (Trusko et al. 796). Therefore, these results are promising and very significant to the area of mental health because mental health clinicians can now implement different applications of health IT such as SNOMED-CT in their respective clinical practices with little or no impediments at all.
Implications of the Research
The results of the current research have many implications on the practice and delivery of healthcare services, particularly in the area of mental health. First, the fact that a lot of concepts and clinical terms used in the diagnosis and treatment of PTSD are represented in the SNOMED-CT controlled medical terminologies are very significant to the area of mental health because SNOMED-CT is the largest reference source for the codified information stored in electronic medical records (Trusko et al. 794).
This implies that mental health clinicians will no longer face the challenge of interpreting different kinds of languages, which refer to the same clinical concept. The importance of SNOMED-CT in this regard is that it simplifies the identification of different terms referring to the same clinical concept by designating a numerical identifier to a group of related clinical terms. Hence, the SNOMED-CT system addresses the issue of concept synonymy by grouping related terms and concepts under one numerical identifier. For instance, a single numerical identifier representing the concept of Myocardial Infarction can be assigned to a group of related terms such as heart attack, infarction of heart, MI, and cardiac infarction (Trusko et al. 795).
Therefore, the importance of the SNOMED-CT system of codifying clinical concepts and terms is that it creates a set of standardized and structured clinical terminologies that can be made available to different categories of clinicians through electronic medical records. This will, in turn, reduce ambiguity and inconsistencies in the manner in which different clinicians, health care providers, or researchers communicate and interact with the aim of providing evidence-based care.
Moreover, the existence of a common clinical terminology reference system such as SNOMED-CT reduces the differences that exist in the way medical information is indexed, stored, retrieved, collected, compared, and shared in different care settings and hospitals. Most importantly, the codification of clinical data into a standardized and structured language eliminates or reduces the challenges experienced by clinicians, researchers, and other stakeholders in the utilization of clinical data. Overall, there is the need to encourage the implementation of health information technologies such as SNOMED-CT in the contemporary health care practice to improve efficiency, workflow, productivity, and satisfaction while maintaining the required safety and quality standards.
Unanswered Questions
The current study is limited to the extent that it addresses the representation of very few clinical terms and concepts related to different aspects of PTSD in the SNOMED-CT controlled medical terminologies. Hence, the study does not address a lot of PTSD terms and concepts, especially those related to stressors, functional assessment, treatment/interventions, and other symptoms of PTSD.
Therefore, future studies should employ the same approach as the one used in this study with the aim of expanding the number of clinical terms and concepts of PTSD that can be mapped to the overall SNOMED-CT concept coverage. Further, the issue of concept synonymy in the area of mental health is not clearly articulated in this research. As a result, future studies should address this issue by implementing the SNOMED-CT terminology system in the retrieval and codification of more clinical information related to PTSD and other mental health complications.
Works Cited
Trusko, Brett, et al. Are Posttraumatic Stress Disorder Mental Health Terms Found in SNOMED-CT Medical Terminology? Journal of Traumatic Stress 23.6 (2010): 794-801. Print.
Secondary PTSD is a relevant and widespread mental health problem in many places and communities in the United States (US). It needs to be mentioned that secondary traumatic stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another ( Secondary traumatic stress, n.d.b, para. 1). Unfortunately, the condition is common in all age groups, including children. Researchers note that each year more than 10 million children in the United States endure the trauma of abuse, violence, natural disasters, and other adverse events ( Secondary traumatic stress, n.d.b, para. 1). The number of children with secondary PTSD is even higher.
Most of the children with firsthand conditions have friends and minor relatives. They constantly contact and interact with each other, and the latter inadvertently affects the mental health of the former, which leads to the development of secondary PTSD. One should also add to this number the children affected by their parents with PTSD to make a whole and unfavorable picture ( Secondary trauma effects, 2020). To find an effective way to ensure the healthy development of the mental health of children and future US generations, one needs to explore and analyze the existing knowledge about secondary PTSD in children.
When analyzing the discussed topic, the first question that comes to mind is what causes secondary traumatic stress in children. Medical experts argue that there are two major sources of the condition, which are parental genes and interaction with an individual with firsthand PTSD ( Secondary trauma effects, 2020). Researchers note that secondary traumatic stress can be passed down from a victim of trauma to the next generation ( Secondary trauma effects, 2020, para. 2). As noted above, communicating with and hearing from a traumatized person about their negative experiences may negatively influence the listeners mental health and trigger the condition.
Other big questions are how secondary PTSD affects a child and how a health professional detects the condition. Vicarious trauma includes many physical and mental symptoms of varying severity. Sleep disturbance and eating disorders are some of the mild ones ( Secondary trauma effects, 2020). Severe signs and symptoms are stress, anxiety, and negative behavioral and emotional changes ( Secondary trauma effects, 2020). Secondary PTSD can lead to depression and physical health issues in children, such as exhaustion and a weakened immune system (Marsac & Ragsdale, 2020). Parents should immediately send their children to a mental health specialist after the first signs of the disorder are detected.
Like any other mental or physical condition, secondary PTSD requires treatment. The scientific community allows patients to prevent and treat vicarious trauma both by themselves and with the help of mental health workers. There are two categories of techniques for preventing and treating compassion fatigue, namely non-pharmacological and pharmacological. The non-pharmacological approach includes counseling with a psychologist, self-validation and relaxation techniques, regular exercise, daily planning, sleep schedule, and journaling ( Secondary traumatic stress, n.d.a). Medication is mainly used to prevent the development of secondary traumatic stress and to treat severe cases.
One should recognize that PTSD and PTG are widespread diseases that often affect former soldiers from ethnic minorities. According to Fogle et al. (2020, p. 12), these combat veterans are more likely to have disabilities and positive screening results for PTSD. As practice shows, such severe mental illness affects Black and Hispanic citizens (Fogle et al., 2020, p. 14). In general, based on numerous studies, it becomes evident that the prevalence of PTSD is approximately 15%, and men are more likely to suffer from it (Gradus, n.d., para. 4). However, one must admit that about half of the survivors, after participating in hostilities, experience PTG and strive to discover new talents and hidden potential (Stokes, 2021, para. 7). Therefore, PTSD and PTG are equally most often found in veterans, mainly if they belong to ethnic minorities (Seol, 2021, p. 1).
Prevalence of PTSD
Veterans from racial and ethnic minorities like African Americans or Latinos often have PTSD, unlike, for example, white non-Hispanic citizens (Friedman et al., 2020, p. 2). Moreover, citizens belonging to the minority category are less likely to seek medical help, experiencing a higher burden of life stress. This information is reported by Friedman et al. (2020, p. 6), and in addition to this statement, they claim that this circumstance most clearly demonstrates the inequality in treatment. From this, it follows that belonging to ethnic minorities is one of the most common factors determining the presence of PTSD in a veteran.
Prevalence of PTG
Often, PTG is observed in veterans who have or have survived PTSD (Bachem et al., 2018, p. 731). However, one must admit that PTG is usually found in veterans from the minority category, as opposed to white non-Hispanic individuals (Whealin et al., 2020, p. 186). More than half of all veterans have post-traumatic growth; they also report better mental functioning and overall health ( Study suggests high rates, n.d., para. 2). In particular, this phenomenon affects specific domains as an assessment of the quality of life, personal strength, and spiritual change (Whealin et al., 2020, p. 185).
Factors
Psychosocial factors are some of the most well-known factors associated with PTG in veterans (Prati & Pietrantoni, p. 374). In addition, injuries sustained in childhood can also have far-reaching consequences, regardless of whether a person participated in hostilities or not (Kadri, 2022, p. 1). Demographic factors, such as age and gender, affect the degree of PTG in individuals (Prati & Pietrantoni, p. 367). At present, there is no established relationship between PTSD and consequent PTG; however, the examined variables have a notable impact on the individuals positive development (Tsai et al., 2015, p. 166).
Social Support and Coping Style
Indeed, both social support and coping style affect the correlation between factors and PTG among veterans (Prati & Pietrantoni, p. 379). At least, this phenomenon largely depends on several side variables, one of which is age (Prati & Pietrantoni, p. 367). While some variables might negatively affect the impact of social support and coping style on PTG, the research confirms the overall positive relationship between these factors and the development of PTG (Prati & Pietrantoni, p. 374).
Conclusion
It should be recognized that the influence of the presented factors on PTG is most reflected in veterans from among minorities rather than those who do not belong to them (Mark et al., p. 6). Mostly, people from social minorities have fewer resources available to receive medical care and often face negative experiences in receiving social support (Mark et al., p. 6). Ultimately, the variables related to the research question include demographic (gender, age, ethnicity), socio-economic, the degree of PTSD, and military (exposure to combat). Each of the mentioned variables can be measured and operationalized through in-depth interviews and medical evaluations.
Post-traumatic stress disorder commonly referred to as PTSD, is a mental trauma that mostly affects people who have witnessed horrible events in their lifetime. Events such events as sexual harassment, sudden deaths, accidents, wars and harmful natural catastrophes have led to post-traumatic stress disorder over time. These events distort the biological mechanisms of a normally functioning human being. PTSD affects both children and adults and may become complicated with time.
Victims who have been diagnosed with PTSD are associated with lack of sleep, frightening dreams during sleep, and tend to avoid various things. It is also worth noting that there is a correlation between PTSD and violence, though this has been cited to be of minimal significance. This paper will discuss the effects of post-traumatic stress disorder to victims. It will also examine the existence of a correlation between post-traumatic stress disorder and violence.
Effects of post-traumatic stress disorder
Victims of post-traumatic stress disorders are likely to develop sleep disorders associated with high risk of mortality, weight gain, depression, and coronary heart diseases (Kobayashi, Cowdin, & Mellman, 2012). Kobayashi et al. (2012) note that sleep disorders are more prevalent for women than men. Adult women are more likely to record nightmares than their male counterparts. In general, PTSD leads to insomnia which has far reaching consequences to the wellbeing of an individual.
Avoidance is another effect of PTSD. Victims tend to debar themselves from talking about the abuses they have undergone. They show total unwillingness and always avoid such things that would trigger their emotions (Entringer et al., 2012). For this reason, they avoid such sounds, sights, scents, and people who can make them remember the respective past incidences. In some instances, these individuals will try much to distract themselves when they are with people talking about the ordeals.
The victims experience arousal problems. These people are alert most of the times. A small traumatic happening is enough to cause arousal and keep them on guard to danger signals. This may result in irritability, anger, lack of concentration, and sleep difficulties. Children suffering from PTSD are normally inattentive, and seem to be daydreaming most of the time. Arousal problems can sometimes make individuals develop aggression and hypersensitive personalities.
Another effect of PTSD is that of re-experiencing. Events connected to the respective horrible events trigger a sense to the victim as if they are happening again. A car accident victim may come across an accident, a terrorism survivor may hear a loud bang, and a sexually assaulted woman may see the news being shown on a TV screen and so on. These traumatic memories are so real that they make them feel as if the events are happening again.
Depression is another common phenomenon among PTSD victims. PTSD survivors have constantly suffered depression (Zaetta, Santonastaso,& Favaro, 2011). Research conducted by the University of Padua in Italy showed that six out of twenty-five survivors suffered from depression. Though it is a small number, it shows that there is a correlation between depression and PTSD. In fact, insomnia and other resultant effects of PTSD are critical as far as depression is concerned.
Correlation between diagnosis and violence
After the diagnosis of post-traumatic stress disorder, it is critical to pay attention to various contributors. Various things like disaster, violence, trauma, barbarism, and catastrophes are reflected upon in clarifying post-traumatic stress disorder clinically. It, therefore, calls for understanding of violence in order to establish correlation between it and PTSD.
Violence can be defined as an act of aggression when, for example, a perpetrator uses physical force against the opponent. It is intentional and has a probability of causing physical injury, death, deprivation, or psychological torture. Violence can also be sexual or a result of total or partial neglect or deprivation.
Thus, It is worth noting that events that lead to post-traumatic stress disorder are violent. These events have social, political, natural, economic origins that are beyond psychiatric scope boundaries (Braga, Fiks, Mari, & Mello, 2008). Defining violence in the context of post-traumatic stress disorder remains equally important.
A high number of violent prisoners have been diagnosed with PTSD. It is likely to be a result of abuse in childhood. Ex-prisoners are also affected by PTSD (Post Traumatic Stress Disorder and Violence, 2001, para. 2). It should be mentioned that sex offenders, who have suffered similar ordeals in the past, have a high likelihood of suffering PTSD as well. It is, therefore, apparent that violent acts lead to most cases of post-traumatic stress disorder.
In conclusion, post-traumatic stress disorders have far reaching consequences for survivors. Second, it is important to note that the word ‘violence’ might be abusive in definition, but in this context it will bring terminological clarity for better understanding of PTSD. Third, though it is complicated to make clear identification of violence, apparently there is a correlation between PTSD and violence. Finally, one should clearly understand that early diagnosing of PTSD will have positive effects on achieving good results in its treatment.
Entringer, S., Epel, E.S., Lin, J., Buss, C., Blackburn, E.H., Simhan, H.N., Wadhwa, P.D. (2012). Prenatal programming of newborn and infant telomere length. European Journal of Psychotraumatology Supplement, 3(1): 1-37.
Kobayashi, I., Cowdin, N., & Mellman, T.A. (2012). One’s sex, sleep, and posttraumatic stress disorder. Biology of Sex Differences, 3(1), 29. Web.
Post Traumatic Stress Disorder and Violence. (2011). Web.
Zaetta, C., Santonastaso, P., & Favaro, A. (2011). Long-term physical and psychological effects of the vajont disaster. European Journal of Psychotraumatology, 2(1) 1-5. Web.
The book The War at Home: One Family’s Fight Against PTSD by Shawn Gourley describes the problems of post-traumatic stress disorder (PTSD) in the family. In my opinion, the book is undoubtedly worth reading as it reveals complex relationships in the family as between husband (vet) and wife as well as between parents and children. The book is based on real events and is written in a simple and understandable language unlike plenty of other books and textbooks on psychology.
I believe that the book would be useful for veterans and their family members, and it would help them to realize themselves and their behaviour. In addition, relatives can also learn a lot of useful information about the PTSD. I consider that the book is required reading not only for those people who find themselves in this situation, but also for ordinary people because nobody knows what can happen, and it is a good chance to learn how to react to PTSD.
Narrative
The story depicts a military culture in which Justin spent some years. Being an Operation’s Specialist, he coached men to see death and do not notice it. Every day, he saw hundreds of corpses and severed limbs. His responsibilities also included reassuring the military and ensuring their protection. Although, he was an expert Machinist Mate, too.
Finally, when Justin came back home, Shawn was expecting that everything turns as it was. However, Justin became irritable and torn between work and family, and those rare evenings they spent together ended in a quarrel. Sometimes Justin threatened to “shoot this whole fucking house up” (Gourley, 2015, p. 48). It was the first warning sign. As one of the manifestations of his disorder, Justin was “yelling in his sleep and kicking and hitting things” (Gourley, 2015, p. 32). Shawn realized something was wrong first and asked for assistance in getting Justin the necessary psychological help or treatment.
Comparing Justin’s behaviour with four main characteristics of PTSD that include intrusive memories, negative changes in thinking and mood, avoidance, and changes in emotional reactions, I can note that it coincides with the most features (Friedman, 2012). For example, a feeling of emotional numbness and emotional blunting haunted him all the time.
In my point of view, Justin’s turning point occurred when he found someone to talk about the military, someone who went through the same obstacles. It was a counselor, who precipitated the harmony in the family explaining both husband and spouse the fact that their life could not be the same as before. Nevertheless, they still have a chance to be happy together accepting each other in a new perspective.
Conclusion
In conclusion, it should be stressed that it was a great struggle within a man resulting from his previous experience in the armed forces. Justin thought he never copes with what is happening, or would never return to the normal life. However, the treatment and the family support became a decisive factor. Knowing that he is not alone, gave him the strength to survive. Reading this book, I have learned a substantial truth about post-traumatic stress disorder on the example of Gourleys’ family. I understood that in spite of difficulties of PTSD, it is possible to handle them with the help of family, counselor, and own efforts, and begin a new life full of emotions and joy.
References
Friedman, M. (2012). Post-Traumatic and Acute Stress Disorders. (5th edition). Sudbury, MA: Jones & Bartlett Learning.
Gourley, S. (2015). The war at home: One family’s fight against PTSD. Colorado Springs, Col.: Grumpy Dragon.
The beginning of health information technologies has improved health care practice and delivery by providing new technologies, which are designed to enhance productivity, patient satisfaction, and the workflow while maintaining the required quality, safety, continuity, and efficiency standards (Trusko et al. 794).
The current applications of health IT are focused on enhancing communication among healthcare providers, communication between the health care providers and their clients, automation of medical information, implementation of evidence-based practices, and reduction of medical errors. Most importantly, health IT seeks to codify the medical information in the electronic medical records into standardized and structured medical terminologies. When the normal clinical information is transformed into a standardized and structured language, the resultant information is called Controlled Medical Terminologies (CMTs).
The importance of CMTs is that they reduce ambiguities besides enhancing consistency in the way medical information is shared between health care providers and their clients. Further, CMTs help clinicians to summarize medical information in such a way that it can be obtained in a timely manner. Some examples of applications of CMTs include the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), the Unified Medical Language System (UMLS), and the Logical Observation Identifiers Names and Codes (LOINC) (Trusko et al. 795). This paper summarizes, interprets, and evaluates the contents of a research study that seeks to examine the representation of posttraumatic stress disorder (PTSD) terminologies in the SNOMED-CT controlled medical terminologies.
The Purpose of the Research
In the study under review, Trusko and his colleagues examined the extent to which the normal language used to make reference to different aspects of PTSD is represented in the SNOMED-CT controlled medical terminologies. Accordingly, the researchers mapped a list of 153 PTSD terminologies drawn from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and other mental health publications to a collection of over 800,000 SNOMED-CT controlled medical terminologies (Trusko et al. 794).
The Questions Addressed
To achieve the purpose of the current research, Trusko and his colleagues sought to address the question whether there are content shortcomings in the way SNOMED-CT controlled medical terminologies are used to represent various aspects of PTSD including its symptoms, signs, and other terms used in the diagnosis of the disorder.
Further, the researchers wanted to highlight the potential applications of electronic health systems in the retrieval, automation, and codification of the PTSD-specific free text by assessing whether there are any PTSD-related concepts and terms in the existing controlled medical terminologies. Moreover, Trusko and his colleagues sought to answer the question whether there are ways of mapping the PTSD-related concepts and terms to the controlled medical terminologies contained in SNOMED-CT and other applications of the unified medical language system (Trusko et al. 796).
Results
Based on the research questions described in the foregoing discussions, the researchers mapped a total of 153 PTSD-specific concepts and terms to the SNOMED-CT controlled medical terminologies and concept codes. According to the research findings, there were about 104 of the PTSD-related concepts and terms among the pre-coordinated concept codes of SNOMED-CT (Trusko et al. 796). This represents about 68% of the 153 clinical terms generated by the researchers in reference to the symptoms, signs, events, and outcomes of PTSD.
With the inclusion of the post-coordinated concept codes into the pre-coordinated concepts of SNOMED-CT controlled medical terminologies, the researchers found out that more than 91 % of the 153 clinical terms and concepts related to PTSD were represented in the SNOMED-CT unified codes. However, significant variations were noted in the coverage of concepts and terms for different PTSD criteria in the SNOMED-CT concepts.
For example, there were about 53% of PTSD criteria A, 56% of PTSD criteria B, and 80% of PTSD criteria C clinical terms in the pre-coordinated SNOMED-CT concepts. Finally, about 14 (9%) PTSD clinical terms were completely absent in the overall SNOMED-CT concept coverage (Trusko et al. 796).
The Striking Features of the Research
The unique element of the study under review is that it highlights the importance of information technologies, and more specifically, the application of codified language in the area of mental health. Although a lot of studies have documented the applications and effectiveness of health information technologies in different areas of clinical practice, relatively minimal studies have examined the relationship between electronic medical records, health IT, and controlled medical terminologies (Trusko et al. 794).
Moreover, among the studies highlighting the applications of health IT and controlled medical terminologies in the retrieval, automation, and codification of concepts and terms related to different diseases, only a few have documented the use of different applications such as SNOMED-CT in PTSD and other mental health complications. Therefore, the current study is unique in that it seeks to highlight the specific applications of health IT and controlled medical terminologies in the area of mental health disorders.
Further, the most striking feature of the study findings in the current research is that the researchers were able to map out more than 90% of the selected PTSD clinical terms to the SNOMED-CT concepts (Trusko et al. 796). Therefore, these results are promising and very significant to the area of mental health because mental health clinicians can now implement different applications of health IT such as SNOMED-CT in their respective clinical practices with little or no impediments at all.
Implications of the Research
The results of the current research have many implications on the practice and delivery of healthcare services, particularly in the area of mental health. First, the fact that a lot of concepts and clinical terms used in the diagnosis and treatment of PTSD are represented in the SNOMED-CT controlled medical terminologies are very significant to the area of mental health because SNOMED-CT is the largest reference source for the codified information stored in electronic medical records (Trusko et al. 794).
This implies that mental health clinicians will no longer face the challenge of interpreting different kinds of languages, which refer to the same clinical concept. The importance of SNOMED-CT in this regard is that it simplifies the identification of different terms referring to the same clinical concept by designating a numerical identifier to a group of related clinical terms. Hence, the SNOMED-CT system addresses the issue of concept synonymy by grouping related terms and concepts under one numerical identifier. For instance, a single numerical identifier representing the concept of “Myocardial Infarction” can be assigned to a group of related terms such as heart attack, infarction of heart, MI, and cardiac infarction (Trusko et al. 795).
Therefore, the importance of the SNOMED-CT system of codifying clinical concepts and terms is that it creates a set of standardized and structured clinical terminologies that can be made available to different categories of clinicians through electronic medical records. This will, in turn, reduce ambiguity and inconsistencies in the manner in which different clinicians, health care providers, or researchers communicate and interact with the aim of providing evidence-based care.
Moreover, the existence of a common clinical terminology reference system such as SNOMED-CT reduces the differences that exist in the way medical information is indexed, stored, retrieved, collected, compared, and shared in different care settings and hospitals. Most importantly, the codification of clinical data into a standardized and structured language eliminates or reduces the challenges experienced by clinicians, researchers, and other stakeholders in the utilization of clinical data. Overall, there is the need to encourage the implementation of health information technologies such as SNOMED-CT in the contemporary health care practice to improve efficiency, workflow, productivity, and satisfaction while maintaining the required safety and quality standards.
Unanswered Questions
The current study is limited to the extent that it addresses the representation of very few clinical terms and concepts related to different aspects of PTSD in the SNOMED-CT controlled medical terminologies. Hence, the study does not address a lot of PTSD terms and concepts, especially those related to stressors, functional assessment, treatment/interventions, and other symptoms of PTSD.
Therefore, future studies should employ the same approach as the one used in this study with the aim of expanding the number of clinical terms and concepts of PTSD that can be mapped to the overall SNOMED-CT concept coverage. Further, the issue of concept synonymy in the area of mental health is not clearly articulated in this research. As a result, future studies should address this issue by implementing the SNOMED-CT terminology system in the retrieval and codification of more clinical information related to PTSD and other mental health complications.
Works Cited
Trusko, Brett, et al. “Are Posttraumatic Stress Disorder Mental Health Terms Found in SNOMED-CT Medical Terminology?” Journal of Traumatic Stress 23.6 (2010): 794-801. Print.
Traumatic events may trigger immune alterations, and this could lead to the development of post- traumatic stress disorder (PTSD). Therefore, it is important to understand and define the biological underpinnings of immune dysregulation in PTSD as it also plays a crucial role in helping us to understand the nature of the associations between PTSD and other medical and psychiatric illnesses. This is important, given that it is well established that PTSD is associated with the occurrence of co-morbid major depressive disorder (MDD) and other psychiatric illnesses.
Peripheral pro-inflammatory cytokines are capable of signaling the brain to induce behavioral symptoms like fatigue, sleep disturbance, and depressive mood (Dantzer, 2001a: Dantzer, 2004a: Dantzer & Kelley, 2007: Myers, 2008). Cytokine-to-brain signaling provides a theoretical base consistent with the evidence demonstrating an association between proinflammatory cytokines and behavioral symptoms of depressive disorders (Dantzer, 2001b: Dantzer, 2004b: Dantzer & Kelley, 2007: Myers, 2008). The result of a hyperactive pro-inflammatory state marked by excess production of the pro-inflammatory cytokines IL-6 may contribute to the pathophysiology of major depressive disorders (Sternberg, 2006).
Frink et al. (2009) have postulated that cytokines released in response to infection or inflammation alert the brain to any real or potential threats and initiate behaviors that are thought to be important for survival. Some scholars even refer to the ability of the immune system to alert or communicate with the brain as a “sixth sense” (for example, Fu, Zunich, O’Connor, Kavelaars, Dantzer & Kelley, 2010). Sickness behavior is believed to be adaptive in that it forces an individual to rest and withdraw from activities so that physiological processes can produce healing in an effective manner (Gudmundsdottir, Beck, Coffey, Miller & Palyo, 2004: Quale & Schanke, 2010). It is now known that pro-inflammatory cytokines released during infection, inflammation, injury, and even psychological stress can signal the brain to initiate behavioral changes that facilitate adaptation to these threats.
As mentioned earlier, cytokine-to-brain signaling has been implicated in mood disorders, particularly depression that accompanies illness (Dantzer, 2009). As such, a sufficient regulation of cytokine production is crucial for better physical and psychological outcomes (Gill, Saligan, Woods, & Page, 2009). Accordingly, it would be prudent to undertake an investigation of the acute circulating pro-inflammatory cytokines and their predictive values with a view to providing insight into the role of psychoneuroimmunological processes in trauma patients. The purpose of this critical literature review is to examine the literature that describes the association between PTSD and predictive value of the pro-inflammatory marker interleukin 6 (IL-6). At the end of this paper, conclusions and recommendations are discussed along with areas where further research may contribute to a broader understanding of this phenomenon.
Literature Review
A search of the databases (CINAHL, MEDLINE, and Pub Med) was used to locate articles relating to PTSD and the pro-inflammatory IL-6. The keywords used in searching the databases included PTSD, trauma, and IL-6 and depression. To further broaden the researcher, sources cited by the articles obtained were also tracked.
Review and Critique of Selected Articles
Cytokines have substantial psychological and physiological effects that are vital in understanding the immune dysregulations linked to the development of PTSD. Rohleder, Joksimovic, Wolf, & Kirschbaum, (2004) conducted a study to compare the production of pro-inflammatory cytokines and the glucocorticoid sensitivity of stimulated cytokine production among Bosnian war refugees. In the study, PTSD (n=12), age and gender matched German healthy control individuals (n=13). The researchers collected the samples on 2 consecutive days; saliva samples were collected at four different time points. Glucocorticoid (GC) sensitivity was measured by dexamethasone inhibition of lipopolysaccharide -induced IL-6 and tumor necrosis factor-alpha production measured in whole blood (Rohleder, Joksimovic, Wolf, & Kirschbaum, 2004)
Results of this study revealed that PTSD patients showed an increased sensitivity to pro-inflammatory cytokine production, along with a higher cytokine producing capacity in peripheral blood. However, the study also identified a number of limitations that need to be considered with a lot of caution. To start with, the health control subjects were not comparable because they were German and not Bosnian war refugees. Therefore, this diversity in regards to ethnicity variations could affect the results. Another limitation of the study is that the use of ex-vivo stimulation may not replicate in vivo changes in the organism. As such, result are not generalizable.
This is in line with a classic study conducted by Maes et al. (1999) to examine the inflammatory response system in patients with PTSD, with or without major depressive disorders (MDD), through measurements of serum IL-6, soluble IL-6 receptor (sIL-6R), sgp130 (the IL-6 signal transducing protein), as well as other pro-inflammatory cytokines. The researchers recruited 45 individuals, PTSD patients (n=13) who were victims of two types of traumatic events (fire event and motor vehicle accidents events), and control healthy individuals (n=32) with negative history of psychiatric disorders.
This study was based on previous findings of elevated increased serum IL-1????and the presence of inflammatory response system activation, which is associated with increased serum IL-6 because both cytokines can induce the production of one another (Durum & Oppenheim, 1989). A major contribution of this study is the inclusion of male and female accident survivors with PTSD, with MMD, because MMD demonstrate high degree of co-morbidity with PTSD, and is also characterized by activation of the IRS with increased serum level of IL-6 (Maes et al., 1999).
Results from this study revealed that Serum IL-6 and sIL-6R concentrations were significantly higher in PTSD patients in comparison with normal participants. Additionally, serum sIL-6R concentrations were significantly higher in PTSD patients with co-morbid MMD than in PTSD patients without MMD and normal participants. The researchers concluded that PTSD is associated with increased IL-6 signaling. They also hypothesized that stress-induced secretion of pro-inflammatory cytokines (IL-6) is involved in the catecholaminergic pathophysiology of PTSD, which represents a positive relationship between indicators of IRS activation and HPA axis activity in PTSD.
These results are in agreement with those of naother study conducted by Baker et al. (2001), who found elevated cerebrospinal spinal IL-6 levels in PTSD patients with a past diagnosis of MDD. Although Baker et al. (2001) reported conflicting results of unchanged blood plasma IL-6 levels they also made an important revelation that cerebrospinal fluid (CSF) levels of IL-6 were higher in PTSD patients compared with control subjects. Their study examined the relation of IL-6 levels and hypothalamic-pituitary-adrenal and noradrenergic activity in PTSD patients. The finding from this study reveals that plasma IL-6 was not different between the two groups; however, PTSD patients have increased CSF concentrations of IL-6. They explained that the low cortisol secretion as a result of lowered glucocorticoid suppression of IL-6 secretion contributed to their findings. The researchers concluded that the higher levels of CSF IL-6 could be possibly a sign of neurological deterioration or compensatory protection (Baker et al., 2001),
In another prospective study, Pervanidou et al. (2007) investigated the hypothalamic-pituitary-adrenal axis activity, the sympathetic nervous system and inflammatory factors in children and adolescent following motor vehicle accidents related to later PTSD development. They concluded that high levels of IL-6 are associated with PTSD development in children and adolescents following a motor vehicle accident (Pervanidou et al., 2007).
Collectively, these findings reveal that immune dysfunction is present in PTSD patients with MDD. Furthermore, a good number of studies confirm that increased IL-6 levels in PTSD civilians (Maes et al., 1999; Gill, Vythilingam, & Page, 2008), Bosnian refugees with PTSD (Rohelder et al., 2004), and in the cerebrospinal fluid of Vietnam combat veterans with PTSD (Baker et al. 2001). However IL-6 findings are inconsistent. These inconsistencies are related to the timing of blood sample collection. In particular, it is well established that IL-6 demonstrates a unique circadian rhythm (Vgontzas et al, 2005). Given this fact, it is thus clear that the discrepancies in the timing of the sampling may contribute to the inconsistencies of previous studies.
Consequently, Gill, Luckenbaugh, Charney & Vythilingam (2010), conducted the first unique study by comparing serial overnight serum levels of IL-6 in a well-distinguished sample of PTSD participants (with and without MDD) and non-traumatized healthy control participants as well. This study attends to the identified methodological limitations of prior reports and will help to clarify the incoherent results. They also investigated serum IL-6, plasma ACTH and cortisol, along with their response to hydrocortisone. The researchers hypothesized that patients with PTSD with MDD will have higher serum IL-6 levels compared with those with PTSD without MDD and healthy control subjects. The research findings demonstrated sustained, basal, overnight elevations of serum IL-6 levels in patients with PTSD with co-morbid MDD but not in subjects with PTSD without co-morbid MDD.
The results are in line with the findings of a previous study by Gill, Vythilingam, & Page (2008), who compared hypothalamic-pituitary-adrenal axis and immune function in women with PTSD (n=26, with and without MMD) with traumatized controls (n =24) and non-traumatized healthy controls (n=21). Findings from this study revealed higher IL-6 levels in women with PTSD with MDD compared with PTSD without MDD. However, this study is limited by its cross sectional design in regards to the use of non-stimulated basal samples for cortisol and DHEA which hindered how these alterations resulted and how best to address them with an intervention. In addition, this study is not generalizable due to its limited sample size and the inclusion of only African Americans. On the contrary, this study is unique in the sense that it recruited African Americans only and the inclusion of healthy controls as well as traumatized controls without PTSD, which reflected a vigorous comparison. A final critique of the study is the limited two time points for saliva collection, which hindered understanding the biological differences that could have been detected better by serial time points.
However, in Gill, Luckenbaugh, Charney & Vythilingam (2010) the overnight elevation led to a more comprehensive conclusion, in addition to helping clarify the inconsistent results obtained from previous single time point studies of IL-6 in PTSD (Maes et al., 1999; Gill, Vythilingam, & Page, 2008; Rohelder et al., 2004; Baker et al. 2001). These results confirm that increased IL-6 levels are only observed in patients with PTSD with MDD. The most interesting contribution of this study is that the researchers were able to differentiate between PTSD with and without co-morbid MDD by investigating overnight levels of IL-6 and their sensitivity to the glucocorticoid hydrocortisone. These distinctions are useful in clarifying the differences in symptoms presentation, treatment responses, and the medical co-morbidity, which are more pronounced in patients with PTSD with MDD.
Nevertheless, several critiques were identified in this study; a major critique is the limited sample size of both PTSD participants (n=18; with MDD n=9 and without MDD n=9) and healthy control individuals with negative previous trauma (n=14) that resulted in some discrepancies in the ACTH findings. Another limitation of the study is that the PTSD with MDD participants had more females than the PTSD with MDD participants; researchers should have attempted to reduce variability attributaed to gender as confounding factors. A final critique is that the study did not elucidate if IL-6 insensitivity to hydrocortisone in patients with PTSD and MDD could be resolved with an alteration in the dose or duration of hydrocortisone treatment. This study delineated an important distinction that should be investigated further.
Cortisol
Traumatic events result in physiologic responses that stimulate the hypothamic pituitary adrenal axis and the sympathetic nervous system. These activations cause immune dysregulations. Hypothamic pituitary adrenal axis controls inflammation by releasing cortisol, which then reduces inflammation (Gill & Szanton, 2011). The immune system also interacts with the HPA axis in order to adjust its activities; for example interleukin-6 (IL-6) activates the HPA axis, resulting in higher cortisol levels, which decreases IL-6, thereby reducing or preventing further inflammation (Bauer, Wieck, Lopes, Teixeira, & Grassi-Oliveira, 2010).
Empirical evidence also indicates dysregulation of inflammatory activities by low levels of circulating cortisol could increase IL-6 levels. It is well established in psychoneuroimmunology that in normal healthy individuals, a bidirectional relationship exist between the immune and endocrine systems. This bidirectional communication can be interrupted by frequent and sustained stress states, leading to biological changes that likely underlie the risk for psychological and physical health declines. Prolonged activation of hypothalamic-pituitary-adrenal axis along with immune dysregulation and inflammation lead to undesirable consequences such as the development of physical and psychological disorders (Gill & Szanton, 2011). Traumatic events can interferes with this relationship, causing an alteration in both systems because of the chronic or acute stress it exerts on human bodies (Gill, Saliga, Woods, & Page, 2009).
In support of this assertion, as previously mentioned, Gill et al. (2008) found decreased levels of cortisol and increased levels ofIL-6 in PTSD patients. Together, these findings extend those of Gill et al. (2010), which further supported this relationship and investigated glucocorticoid sensitivity in PTSD patients. Their results revealed that PTSD patients were more sensitive and responsive as evidenced by an immense decrease in IL-6 levels; nevertheless PTSD patients with co-morbid MDD were less responsive. Hence, endocrine alteration will possibly contribute to increased levels of IL-6, for example increased cortisol levels in PTSD subjects without co-morbid MDD may decrease IL-6 production, while decreased or inadequate cortisol levels in PTSD subjects with co-morbid MDD may increase IL-6 production (Gill, Luckenbaugh, Charney & Vythilingam, 2010). In line with this, Fries, Hesse, Hellhammer and Hellhammer (2005) investigated Low cortisol levels in patients with PTSD and other psychological co-morbid disorders. They anticipated that the occurrence of lower levels of cortisol is a result of sustained hypothalamic-pituitary-adrenal axis activation. Further evidence suggested that low levels of circulating cortisol might lead to the development of PTSD in women due to the immune alteration as a result of sustained inflammation.
In summary, there is evidence suggesting that PTSD is associated with elevations of IL-6, which is more prevalent in co-morbid MDD patients. These studies suggest that chronic inflammation is likely present in PTSD and that additional studies are needed in larger samples to determine the role of IL-6 in PTSD-associated health declines.
Epigenetic
Segman et al. (2005) found that traumatic events may induce epigenetic modifications for genes that encode immuno-regulatory proteins in individuals with PTSD. Patients are known to have heightened stress reactivity, in addition to exhibiting a distinct expression profile for genes that influence immune function (Kerlinger & Lee, 2000: Li, 2002). Epigenetic modifications may possibly induce gene activity, and this could result in an increase in inflammatory cytokine levels (Dulac, 2010). Recent evidence reveal that for PTSD patients, the experience of a traumatic event triggers downstream alterations in immune function by decreasing methylation of immune-related genes (Uddin et al., 2010). The study by Uddin et al. (2010) identified a set of uniquely unmethylated genes that encode for immune function in individuals with PTSD. Their findings demonstrate the capacity of a traumatic event to trigger long-lasting epigenetic-induced alterations in immune function, possibly through brain-immune interactions, which could contribute to high levels of peripheral inflammation (Uddin et al, 2010). This study suggests that higher levels of pro-inflammatory cytokines in PTSD patients are associated with gene function deregulations. In spite of this, the study is limited by its cross-sectional design, which prevents determining whether the PTSD methylation pattern was present prior to the traumatic exposure representing a pre-existing biologic vulnerability. However, the results reveal the possibility of a traumatic life event inducing long-lasting alterations in immune function through epigenetic modification.
Although currently there is little evaluation of stress-related epigenetic modifications in humans, the findings in individuals with PTSD provides preliminary evidence suggesting that the experience of a traumatic event results in epigenetic imprinting of genes that encode for immune function (Uddin et al, 2010). In support of this study, Yehuda et al. (2009) reported that altered gene activity lead to increased levels of inflammation in PTSD patients. These preliminary evidences also suggest that the experience of a traumatic event results in epigenetic imprinting of genes that encode for immune function (Uddin et al, 2010). Collectively, these findings provide an impetus for further exploration in epigenetic and PNI paradigm that could lead to innovative interventions for PTSD patients.
Summary
In conclusion, this critical literature review examined the association between PTSD and the value of the pro-inflammatory marker IL-6 as a potential biomarker for predicting the development of PTSD symptoms, as well as co-morbid MDD as a medical burden related to PTSD. Collectively, the studies mentioned in this review indicate that PTSD is associated with increased blood and plasma levels of IL-6. High levels of IL-6 following a trauma have also been linked to PTSD development. In addition, low cortisol levels are indicative of higher levels of IL-6, demonstrating inflammatory actions dysregulation.
As for the state of science, based on the literature review it is clear that the association between IL-6 and the development of PTSD is extremely multifaceted. It is doubtful that a simple blood assay will provide significant predictive biomarker for the development of PTSD. Since most of the findings from previous studies have not yet replicated consistently, rigorous studies are still needed in order for these comparisons to hold. This review links PTSD to depression and suggests that chronic inflammation underlies this association. However, it is still unclear whether immune dysregulation are fundamental or marginal to the development of PTSD. Nonetheless, it has been established that inadequate regulation of IL-6 production flowing traumatic events may increase the risk for developing PTSD. The implications of dysregulated immunity in PTSD are significant and remain to be an area of vigorous research that may eventually lead to the development of novel immune-related -interventions.
Nursing research has proved crucial in studies aimed at examining the effects of traumatic events on the person as a whole. It is emphasized that developing a better understanding of immune dysregulation and its impact to physical and psychological health in trauma patients, this will lead to the development of novel interventions. With the combination of both pharmacological and psychological interventions, nurses can provide greater benefits and better outcomes to the physical and psychological health of trauma patients in the hope of preventing the development of PTSD and other associated co-morbidities resulting from immune dysregulation (Gill, Saligan, Woods, & Page, 2009).
Existing research reveal that sustained inflammatory alterations of the immune system are associated with inadequate regulation of the cortisol. However, results are inconsistent and further research is necessary in order to enhance the knowledge to better understand the mechanisms that will inform the development of future interventions. Further research is also needed to better understand intrinsic confounding variables of trauma patients and its role in immune alterations, which enhance the risk of PTSD development (Gill, Saligan, Woods, & Page, 2009).
Recommendations and Future Research
In conclusion, most studies were not generalizable and there is insufficient evidence in literature to support a clear recommendation for the utilization of IL-6 as a potential biomarker for predicting the development of PTSD. Although these findings indicate that PTSD is associated with excessive inflammation, prospective studies are warranted to investigate the timing of immune dysregulation occurrence in patients experiencing traumatic events, and how the link between immune system and the endocrine system in regards to the development of PTSD and health outcomes.
There are many confounding factors that might account for the lack of inconsistent and significant results, hence larger vigorous cross-sectional studies of PTSD individuals that reduce variability attributable to confounding factors such as, types, timing, and duration of traumatic events experienced, as well as gender and other co-morbid psychiatric disorders.
Furthermore, it is still unclear how immune dysregulation relate to the development PTSD. Future studies should investigate the effect of psychological and pharmacological interventions on the inflammatory processes in PTSD. These studies could investigate immune function before and after introducing pharmacological and psychological interventions, which will aid in understanding how immune dysregulation contribute to the development PTSD.
In addition, although there is little evaluation of stress-related epigenetic in regards to epigenetic, findings provide impetus for further exploration in epigenetic and PNI paradigm that could lead to innovative interventions for PTSD patients. Furthermore, it is fundamentally important to understand epigenetic modifications that could contribute to the excessive inflammation and higher levels of IL-6 observed in PTSD patients. These types of studies may provide a greater insight into the mechanisms of excessive inflammation in PTSD and possibly to the development of unique interventions to both prevent and treat PTSD.
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The current level of medical development imposes severe requirements for making a diagnosis, preventing any problems and errors related to bias and low qualification of the specialist. Thus, relying only on the physician’s personal experience is no longer reliable, and instead, medical communication encourages scientific validity and an instrumental approach to research. A similar philosophy applies to this situation, in which a 35-year-old man is experiencing severe mental and physical health problems.
Several key details should be taken into consideration by the physician when making a diagnosis of a man. First, the man has a whole family with two children who, crucially, are of school age. It is essential to understand that children’s teenage years are often stressful for parents (Crnic & Ross, 2017). Second, information about former jobs — namely, military service and bank — is also clinically valuable because it helps gather a complete patient portrait. Job satisfaction and related occupational stress are seen as essential metrics of mental well-being. Finally, diagnostic tests should always be performed before a specific diagnosis is made to confirm or refute the physician’s hypotheses. Laboratory test results should be available to the treating physician for evaluation.
However, current information is still insufficient to make an accurate diagnosis. The case study points to “multiple tests” from the emergency teams, but these tests are unclear. In terms of the physician’s critical information, the blood pressure measurement and the electrocardiogram should be mentioned. It is likely that the man suffers from cardiovascular disease, which affects back and head pain (Torgashov & Myakotnykh, 2020). In addition, stress and anger can be mediated by feelings of fear, which is caused by a lack of oxygen supply to the tissues. Such feelings of fear often occur in patients with angina and heart attack, so it is very likely that this man suffers from the same. Nevertheless, any cardiovascular abnormalities would have been identified at the screening stages, but his results were excellent according to the scenario. In such a case, it is recommended — this is precisely a recommendation, not a requirement — to do an MRI, which would allow a better study of the patient’s body.
Taking into account all the current circumstances and excellent physical health results, a clinical opinion must be made. In all likelihood, the man suffers from masked depression, in which the body signals a problem through associated symptoms (Shetty et al., 2018). In other words, depression is hard to detect because it is always hidden under the symptoms of various illnesses or addictions, and depression and bad moods are barely noticeable. This description perfectly satisfies this cognitive dysfunction in the male context, but it is interesting to try to determine the causes. It is very likely that military service in Iraq resulted in post-traumatic syndrome — concussion, killing, death-watching — as a result of which the man’s consciousness began to suppress over time (PTSD and DSM-5, 2020). Thus, the patient’s ultimate diagnosis is masked depression against a background of post-traumatic stress disorder.
Therapy for this disorder aims for the long term, as expecting too quick results by now will lead to noncompliance and frustration. Prescription of psychotropic medications such as Fluoxetine, Paroxetine, or Sertraline is suggested as medication therapy (Bhandari, 2021). In addition, systematic consultation with an experienced psychotherapist must allow for an in-depth dissection of the patient’s main fears and overcome the dysfunctional state. It is appropriate to use spiritual practices, meditations, and breathing exercises to go into a trance to be more open to change and overcome anger.
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Secondary PTSD is a relevant and widespread mental health problem in many places and communities in the United States (US). It needs to be mentioned that “secondary traumatic stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another” (“Secondary traumatic stress,” n.d.b, para. 1). Unfortunately, the condition is common in all age groups, including children. Researchers note that “each year more than 10 million children in the United States endure the trauma of abuse, violence, natural disasters, and other adverse events” (“Secondary traumatic stress,” n.d.b, para. 1). The number of children with secondary PTSD is even higher.
Most of the children with firsthand conditions have friends and minor relatives. They constantly contact and interact with each other, and the latter inadvertently affects the mental health of the former, which leads to the development of secondary PTSD. One should also add to this number the children affected by their parents with PTSD to make a whole and unfavorable picture (“Secondary trauma effects,” 2020). To find an effective way to ensure the healthy development of the mental health of children and future US generations, one needs to explore and analyze the existing knowledge about secondary PTSD in children.
When analyzing the discussed topic, the first question that comes to mind is what causes secondary traumatic stress in children. Medical experts argue that there are two major sources of the condition, which are parental genes and interaction with an individual with firsthand PTSD (“Secondary trauma effects,” 2020). Researchers note that secondary traumatic stress “can be passed down from a victim of trauma to the next generation” (“Secondary trauma effects,” 2020, para. 2). As noted above, communicating with and hearing from a traumatized person about their negative experiences may negatively influence the listener’s mental health and trigger the condition.
Other big questions are how secondary PTSD affects a child and how a health professional detects the condition. Vicarious trauma includes many physical and mental symptoms of varying severity. Sleep disturbance and eating disorders are some of the mild ones (“Secondary trauma effects,” 2020). Severe signs and symptoms are stress, anxiety, and negative behavioral and emotional changes (“Secondary trauma effects,” 2020). Secondary PTSD can lead to depression and physical health issues in children, such as exhaustion and a weakened immune system (Marsac & Ragsdale, 2020). Parents should immediately send their children to a mental health specialist after the first signs of the disorder are detected.
Like any other mental or physical condition, secondary PTSD requires treatment. The scientific community allows patients to prevent and treat vicarious trauma both by themselves and with the help of mental health workers. There are two categories of techniques for preventing and treating compassion fatigue, namely non-pharmacological and pharmacological. The non-pharmacological approach includes counseling with a psychologist, self-validation and relaxation techniques, regular exercise, daily planning, sleep schedule, and journaling (“Secondary traumatic stress,” n.d.a). Medication is mainly used to prevent the development of secondary traumatic stress and to treat severe cases.
Mental illnesses have a long history of being represented in books, movies, and TV shows, with varying degrees of success. When executed carelessly, these portrayals perpetuate the social stigma and pre-existing negative stereotypes about mental disorders. On the contrary, proper representation of post-traumatic stress disorder, depression, and antisocial personality disorder are instrumental in shaping productive societal conversations about these topics. As an example of the latter, this paper focuses on the analysis of Charlie Kelmeckis, the protagonist of Stephen Chbosky’s novel The Perks of Being a Wallflower, and his PTSD.
Charlie’s PTSD: A Summary with In-Text Evidence
Charlie is the protagonist and the unreliable narrator of Chbosky’s coming-of-age novel The Perks of Being a Wallflower. He is a lonely and awkward teenager with a history of psychiatric treatment who struggles to adapt to the high school social life while grieving his friend’s suicide. The novel is comprised of Charlie’s letters to the anonymous reader, in which Charlie depicts his daily life and internal thoughts that take a self-destructive turn as the story develops. As the protagonist navigates his romantic feelings for an older girl Sam, it eventually becomes apparent that Charlie is a childhood sexual assault survivor, previously groomed by his late aunt.
Post-traumatic stress disorder, or PTSD, is a mental health condition that develops as a response to a severely traumatic event. The spectrum of symptoms and their intensity may vary from case to case depending on the specifics of the event at fault. However, the common signs of the disorder include involuntary memories or intrusive thoughts, avoidance of trauma-related triggers, alterations in cognition and mood, as well as changes in arousal and reactivity. Interestingly, all of these behaviors have been demonstrated by Charlie over the course of the novel.
From the early stages of the story, Charlie exhibits discomfort in sexually charged situations, mainly addressing them as non-consensual in his narration. When Charlie’s friend Patrick becomes a target of homophobic bullying in school, the protagonist’s attempt to defend him manifests in a violent outburst that greatly contrasts his usual manner. During the truth-or-dare game, when asked to kiss the prettiest girl in the room, Charlie impulsively reaches for his crush Sam, despite dating another girl at the time (Chbosky, 2009). Towards the finale, in an intimate situation with Sam, Charlie can’t separate the pleasant experience of touching from the sensation of “something being very wrong” (Chbosky, 2009, p. 202). The encounter ends abruptly as the protagonist goes through feelings of fear, shame, and disgust he cannot explain rationally that manifest in intense physical trembling. On the following morning, Charlie undergoes a mental breakdown with intrusive memories of his aunt and the flashbacks of the sexual abuse she has put him through.
Perspectives and Reactions within the Story
Despite PTSD not being named directly in the book, its symptoms are depicted with care and intent. The book addresses Charlie’s typical symptoms of the disorder, having him go through mood swings, blackouts, and derealization, in which he compares life to a dream (Austriani, 2017). The reader is deliberately made aware of Charlie’s mental health issues, with him indicating his past stay in the psychiatric hospital in the narration. Hence, the novel can be treated as the canonical representation, rather than the interpretation, of a mentally ill person.
From the beginning of the story, Charlie’s family is somewhat aware of his mental condition, though its roots are partially misinterpreted. Charlie’s parents link his mood swings and social difficulties to the recent suicide of his friend Michael, being unaware of the other traumatic events from his past. Admittedly, Michael’s storyline and the impact his suicide has had on Charlie get quickly side-lined, without the proper exploration of how it has contributed to the disorder (Monaghan, 2016). Yet, after the aforementioned breakdown, Charlie’s family is quick to act: his sister calls 911, and the protagonist is appropriately put into the psychiatric hospital. Throughout the course of the novel, Charlie’s family and, eventually, his friends demonstrate concern and compassion for his mental well-being. Their reaction is not portrayed overtly idealistically, as internal tensions and consequences of Charlie’s irrational actions are also addressed. Particularly, his friends’ justified frustration with his inability to react appropriately in sexually charged situations gets him temporarily excluded from their group.
Implications and Representational Value
The novel contains a generally accurate depiction of PTSD, as it demonstrates Charlie experiencing symptoms in accordance with the Diagnostic and Statistical Manual of Mental Disorder (Austriani, 2017). His memories of his abuser are recurrent and involuntary, often transpiring in sexual situations, which, understandably, disturbs him. Charlie is anxious about physical intimacy and, despite having romantic and sexual feelings towards girls, subconsciously associates sex primarily with threat and display of force (Monaghan, 2016). In particular, the author has him recall witnessing a party rape scene near the beginning of the book, thematically hinting at how the subject is triggering for Charlie.
Furthermore, “Perks of Being a Wallflower” avoids falling into the trap of stigmatization or trivialization of mental disorders. Charlie has experienced bullying at school for displaying socially punishable behavior, yet the narration never justifies it. He receives appropriate treatment and is not perceived as lesser by his friends for being in need of it. As it deals with the mental health issues of young adults, the novel could potentially be used as a discussion tool to dismantle the existing stigma around such disorders. Finally, the novel ends on an optimistic note, with Charlie going through therapy and taking medication, now with full awareness of what has happened to him. In the closing letter of the novel, the author outright states that recovery from mental health conditions is possible, which is an undoubtedly strong epilogue for a coming-of-age novel.
Conclusion
In conclusion, “Perks of Being a Wallflower” provides the reader with a detailed and sympathetic, although graphic, depiction of PTSD. Interestingly enough, the novel has been banned from several school libraries in the United States due to its allegedly shocking content. The first-person perspective highlights the intensity of Charlie’s internal struggles as his mental health deteriorates under the trigger of adolescent sexual exploration. Nonetheless, the novel contains one of the most informative and positively handled depictions of PTSD in coming-of-age fiction. It avoids trivialization; Charlie’s life is undoubtedly disturbed by the trauma he has gone through and the disorder he has developed in response. At the same time, the protagonist is not defined by his illness and gets to experience young friendship and first love. In the end, Charlie receives appropriate healthcare and full support from his friends, finishing the book with a letter to all the struggling readers, encouraging them to not give up.
References
Austriani, F. (2017). Traumatic Experience resulting from sexual abuse in Stephen Chbosky’ The Perks of Being a Wallflower, Lantern, 6(1). Web.