1. POST TRAUMATIC STRESS
DISORDER

2. History
First described as shell shock
(Kardina 1941)
Formally recognised as a condition after
collective descriptors and research with
Vietnam veterans (Beck 1967)

3. Since then it has become recognised as a
condition that arises in other situations
outside of combat, such as:
 Fire-fighters (Mcfarlane 1988)
 Police (Gersons 1989)

4. Symptoms
• Flashbacks
• Anxiety
• Avoidance
• Hyper Vigilance
• Live in Past
• Loss of Sleep
• Feeling of Helplessness
• Utter Despair

5. These symptoms can be triggered by a memory by any of
the senses. Sight , Sound and Smell. Sometimes by
something very small where the connection is seemingly
quite distant.
The flashback particularly is effected by memory. This
means that the sufferer relives the actual experience.
The implications are far reaching and the sufferer will go to
extreme lengths to avoid any chance of a familiar
sensation.
Their life’s can become restricted any chance of a normal
day to day life is ended.
Post Traumatic Stress Disorder has an expected
face, There are assumptions made within society of what
the precursors are. Sufferers who are outside of this
perceived norm find it difficult to obtain help or be
diagnosed

6. Precursors
 Threat of Death or Serious Injury
 No Control over Situation
 Response of Extreme Fear and Helplessness
 (Damasio 1989)

7.  Victims of rape, accidents, or witness to an
extreme event such as 9/11, or a tsunami
(Heltzer, Robbins, 1987)

8. Sex differences for PTSD have been looked
at, and prevalence rates have shown:
5/1000 in men, (yehuda 2001)
25/1000 in women.

9. Main Precursors for Women
 Physical Attack,
 Rape,
 Sexual Abuse,
 Harm to Family,
 Murder,
 Natural Disasters.
(Kessler 2002)

10. Main Precursors for Men
 Combat,
 Traumatic Accidents,
 Fire,
 Murder,
 Natural Disasters.
(Kessler 2002)

11. Factors that can attribute
to PTSD
 Some people have risk factors which make them
more prone to develop PTSD when they are
exposed to a traumatic event. These include:
 Previous mental health problems.
 Being female.
 Coming from a poor background.
 Lack of education.
 Coming from an ethnic minority.
 Being exposed to trauma in the past.
 A family history of mental illness.

12. So the Face of PDSD...
http://vimeo.com/8682583

13. One in every 200 births within the UK
results in some form of PTSD
http://www.youtube.com/watch?v=M0LrtVUe
GfU

14. Post Traumatic Stress After
a Traumatic Birth
Birth is seen as a natural process. There is social
pressure from society and peers. Birth is seen
as a happy event.
The experience to most is seen as incomparable
to war, major accidents, and so forth.
There is little or marked empathy for
women, who experience this.

15. Effect on family’s
 The mood swings and irrational behaviour can cause problems
within the family unit.
 Even when understanding that there is a genuine reason for the
behaviour it can be hard to act in an understanding manner when
it impacts on day to day family life . Quite often the loved one
can become unrecognisable.
 Sufferers quite often become isolated within the family unit
compacting their symptoms.
 In some case’s it can become dangerous to live within the family
unit until the symptoms are more under control .
 Many family’s find the reasons beyond their true understanding
having not the same perception of the event.
 If undiagnosed it can go on for years and can often manifest into
another illness or behaviour , i.e. drug/alchol abuse ( Van de Kolk
2005)

16. Treatment
 Talking treatments and other nondrug treatments
 Cognitive behavioural therapy (CBT) may be advised. Briefly, CBT is based on the idea
that certain ways of thinking can trigger, or fuel, certain mental health problems such as
PTSD. The therapist helps you to understand your current thought patterns. In particular, to
identify any harmful, unhelpful, and false ideas or thoughts. The aim is then to change your
ways of thinking to avoid these ideas. Also, to help your thought patterns to be more
realistic and helpful. It may help especially to counter recurring distressing thoughts, and
avoidance behaviour. Therapy is usually done in weekly sessions of about 50 minutes
each, for several weeks. You have to take an active part, and are given homework between
sessions.
 Eye movement desensitisation and reprocessing (EMDR) is a treatment that seems to
work quite well for PTSD. Briefly, during this treatment a therapist asks you to think of
aspects of the traumatic event. Whilst you are thinking about this you follow the movement
of the therapist's moving fingers with your eyes. It is not clear how this works. It seems to
desensitise your thought patterns about the traumatic event. After a few sessions of
therapy, you may find that the memories of the event do not upset you as much as before.
 Other forms of talking treatments such as anxiety management, counselling, group
therapy, and learning to relax may be advised.
 Self-help. Joining a group where members have similar symptoms can be useful. This does
not appeal to everyone, but books and leaflets on understanding PTSD and how to combat
it may help

17. Treatment cont......
 Medication
 Antidepressant medicines are often prescribed. These are commonly used to treat
depression, but have been found to help reduce the main symptoms of PTSD even if you
are not depressed. They work by interfering with brain chemicals (neurotransmitters) such
as serotonin which may be involved in causing symptoms.
Antidepressants take 2-4 weeks before their effect builds up, and can take up to three
months. A common problem is that some people stop the medicine after a week or so as
they feel that it is doing no good. You need to give an antidepressant time to work. If one
does help, it is usual to stay on the medication for 6-12 months, sometimes longer.
There are several types of antidepressants. However, selective serotonin reuptake inhibitor
(SSRI) antidepressants are the ones most commonly used for PTSD. There are various types
and brands of SSRI. Paroxetine has been found particularly useful for general use. Non-SSRI
drugs sometimes used by specialists include mirtazipine and phenelzine.
 Benzodiazepines such as diazepam are sometimes prescribed for a short time to ease
symptoms of anxiety, poor sleep, and irritability. The problem is, they are addictive and can
lose their effect if you take them for more than a few weeks. They may also make you
drowsy. Therefore, they are not used long-term. A short course of up to 2-3 weeks may be
prescribed now and then if you have a particularly bad spell of anxiety symptoms.
 Other medicines such as betablockers, mood stabilisers, and anticonvulsants are being
studied. These are normally used to treat other conditions but there is some evidence that
they may help some people with PTSD. Further research is needed to clarify their role.
 A combination of treatments such as cognitive behavioural therapy and an SSRI
antidepressant may work better in some cases than either treatment alone.

18. PTSD is often misdiagnosed and mistreated
after traumatic birth.
Suicide is known as the single largest cause or
maternal death in the UK.
Full numbers are unknown and under
estimated as the UK only deals with death
up to a year after birth. (Weiss et al 2005)

19. References
 Kardiner, A. (1941). The traumatic neuroses of war. New York: Hoeber
Beck AT. Depression: Clinical, Experimental, and
Theoretical Aspects. New York,Harper and Row 1967.
Yehuda R. Immune neuroanatomic neuroendocrine
gender differences in PTSD. Program and abstracts of
the 154th Annual Meeting of the American Psychiatric
Association; May 5-10, 2001; New Orleans, Louisiana.
Symposium 12A.
GERSONS B., CARLIER I.
Post-Traumatic Stress Disorder: The history of a Recent
Concept
British Journal of Psychiatry, vol. 161, 742-748. , 1992
HELZER J.E., ROBINS L.N., McEVOY L.
Post-Traumatic Stress Disorder in the General
Population
The New England Journal of Medicine, vol. 317, n°
23, 1630-1634, 1987

20. REF cont......
 Kessler RC. Posttraumatic stress disorder: The burden to the individual and
to society. J Clin Psychiatry. 2002;61 suppl 5:4–12.
 McFarlane AC: Vulnerahility to posttraumatic stress disorder, in
Posttraumatic Stress Disorder: Etiology Phenomenology and Treatment.
Edited by Wolf ME, Mosnaim AD. Washington, DC, American Psychiatric
Press, 1990.
 Damasio, A. (1994). Descartes' error: Emotion, reason, and the human brain.
New York: Putnam
 Robbinson J Holditch-Davis, D., Bartlett, T.R., Blickman, A.L., & Shandor
Miles, M. (2000).
 Posttraumatic stress symptoms in mothers JOGNN, 32,
 161–171.
 Van der Kolk, B. A. (1996b). Trauma and memory. In BA van der Kolk, AC
MacFarlane, & L Weisaeth (Eds.), Traumatic stress: The effects of
overwhelming experience on mind, body, and society (pp. 279-302). New
York: Guilford Press.
 Weiss D, Marmar CR: The Impact of Event Scale—Revised, in Assessing
Psychological Trauma and PTSD: A Practitioner’s Handbook. Edited by
Wilson JP, Keane TM. New York, Guilford, 2005 pp 399–411