How to identify PTSD and what triggers PTSD

More than 75 percent of people suffering from mental health issues in developing countries do not receive any medical treatment.– World Health Organization India may have progressed by leaps and bounds but even though 20 million people are suffering from one or the other form of mental health problems, the subject is still a taboo and is exclusively managed at home! However, social attitudes are changing, and more and more patients are seeking professional help for PTSD and other mental health issues. What is PTSD? Post-Traumatic Stress Disorder is a mental disorder characterized by exposure to traumatic event that can drastically change one’s life and relationships. Psychiatrists define it as ‘debilitating condition that can affect every aspect of a patient’s life due to its multifaceted composition of mental, physical and social symptoms’. [1] Traumatic events generally involve threats to life, sense of personal safety or security, or physical integrity.The event causes significant distress to the affected person, and impairs the individual’s social interactions, capacity to work or other important areas of functioning. It is not something that results from another medical condition, medication, or drug or alcohol addiction, psychiatrists point out. [2] Read more about Yoga can help cope with post-traumatic stress disorder symptoms PTSD is diagnosed only if symptoms persist beyond one month after the event. Triggers for PTSD PTSD can affect anyone irrespective of age, race, and gender. Although, earlier, PTSD was mainly diagnosed in the war veterans, this disorder can occur in anyone who has experienced or witnessed serious motor accidents, torture, kidnapping, natural disasters or even terror attacks. For example, one of the worst natural disasters in India after the Tamil Nadu tsunami was a cloudburst that caused devastating floods and landslides in Uttarakhand in 2013, affecting over 1,00,000 people and claiming more than 5000 lives. A psychological health study done with 86 survivors of the disaster, revealed that 58 percent of survivors had PTSD. [3] Similarly, in the terrorist attacks on the World Trade Center in 2011, a study revealed that 44 percent of 560 adults surveyed reported substantial stress reactions within the first week, and 1-2 months later, another study reported that 4.3 percent of the 2,273 adults studied had PTSD after watching television coverage of the attacks. [4] (Read: Post-traumatic stress disorder (PTSD) impacts brains of boys, girls differently) Physical assault or sexual abuse in adults and children, too, is now included in the criteria for diagnosing PTSD. Identifying PTSD in Adults The four hallmarks of PTSD in adults, according to the American Psychiatric Association, include –

• Re-experiencing the event symptoms
• Avoiding people, places, or situations that serve as a reminder of the trauma
• Negative changes in mood and thoughts
• Chronic hyperarousal symptoms

Dr. Cristopher Warner and his colleagues have suggested the following questions for assessing PTSD: [5]

• Do you re-experience the event, even though it is not happening, during the course of the day?
• Do you have nightmares or think about the event when you don’t want to?
• Do you continue to get fearful or anxious when you remember the event?
• Do you avoid the places, people, and /or situations related to the event?
• Do you stay away from the associated conversations or feelings because they remind you of the event?
• Do you find it difficult to recall an important aspect of the trauma?
• Since the event, have you stopped doing things that used to enjoy doing?
• Do you feel detached from your family and friends? Have they noticed this disconnect?
• Have your life goals or plans changed since the event? How?
• Since the event, do you have hyperarousal symptoms, for example,

1. Do you have trouble sleeping?
2. Are you angrier, or more argumentative, or violent?
3. Are you always on guard and feel unsafe?
4. Do certain things startle you that didn’t before the event?
5. Are you able to remain focused and complete tasks?
6. Are you hypervigilant to potential threat?

Identifying PTSD in children Children may experience a severe traumatic event if they are the victims or witnesses of physical or sexual abuse at home or in the community, dangerous illness, violence, natural disasters or man-made disasters, and situations where someone’s life, especially their parents’ lives, are threatened. Recognizing PTSD in children is far trickier, as manifestation of PTSDin children is different from that of the adults. [6] Re-experiencing the trauma can manifest as –

• Repetitive play in which the trauma is re-enacted
• Dreams which may or may not have specific trauma-related content
• Actual replay of the trauma

Avoidance symptoms can be in the form of hyper-alertness, restlessness, lack of concentration, and behavioural problems. Symptoms of re-experiencing and avoidance do not generally occur simultaneously; rather, the periods of re-experiencing and numbing /avoidance alternate between each other, say psychiatrists at Kasturba Medical College, Manipal. [6 ] Here are New wearable device can improve sleep and reduce PTSD risk Other symptoms include –

• Hallucinations or disorganized thinking and behaviour;
• Fear of monsters, anxiety on meeting a stranger, or avoiding situations that may or may not be associated with the traumatic event, especially in pre-school children;
• ‘Omen’ formation, that is, believing that there are signs which predict a traumatic event and if they are alert, this event can be averted.

Child abuse syndrome PTSD associated with sexual abuse in children can manifest itself with signs and symptoms such as –

• Regression to thumb sucking or bedwetting or any age-inappropriate behaviour
• Loss of interest in things they enjoyed doing prior to the traumatic event
• Loss of talking skills
• Developing a strong attachment to a parent or another person
• Developing unusual fears, for example, of early death
• Developing concentration problems that could interfere with learning and social activities
• Developing suicidal tendencies in their adult life or developing addiction to food, alcohol, or drugs.

And recently, scientists have suggested that abused children with PTSD not only show changes in the structure and function of the brain, but also experience genomic alterations (changes in the DNA). [7] PTSD is a treatable disorder. Treatment includes psychotherapy, such as cognitive behavioural therapy (CBT) and in some cases, medicine. Counselling the key family members and caregivers is also important in the recovery of the PTSD patient. “Always remember, if you have been diagnosed with PTSD, it is not a sign of weakness; rather, it is proof of your strength, because you have survived!” ― Michel Templet Reference

1. Cichocki-Goss K. Taboo Topics: Depression, Anxiety, Sexual Assault, and PTSD; the Influence of Stigma on Help Seeking. 2014.

2. American Psychiatric Publishing. Posttraumatic Stress Disorder. http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf

3. Sharma S, Sharma S, Chandra M, Mina S, Singh Balhara YP, Verma R. Psychological well-being in primary survivors of Uttarakhand disaster in India. Indian J Soc Psychiatry 2015;31:29-36.

4. Neria Y, DiGrande L, Adams BG. Posttraumatic Stress Disorder Following the September 11, 2001, Terrorist Attacks: A Review of the Literature Among Highly Exposed Populations. The American Psychologist. 2011;66(6):429-446. doi:10.1037/a0024791.

5. Warner C. et al. Identifying and Managing Posttraumatic Stress Disorder - American Family Physician. Aafporg. December 15, 2013 Issue.

6. Murali N, Kar N, Jagadisha. Recognition and clinical assessment of childhood PTSD. Indian J Psychiatry 2002;44:82-3.
7. Parano E, Pappalardo XG, Pavone P, Ruggieri M, Cavallaro S. Child Abuse Syndrome (CAS): A Newly Recognized Distinct Entity. The Open Neurology Journal. 2016;10:30-31. doi:10.2174/1874205X01610010030.

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