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Trauma-Related Disorders: Post-Traumatic Stress Disorder & Acute Stress Disorder

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  • 0:07 History
  • 1:11 Post-Traumatic Stress Disorder
  • 4:07 Acute Stress Disorder
  • 5:09 Treatment
  • 7:52 Lesson Summary
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Lesson Transcript
Instructor: Devin Kowalczyk

Devin has taught psychology and has a master's degree in clinical forensic psychology. He is working on his PhD.

A lot happens in the brain following a traumatic, life threatening event. Sometimes the brain has difficulty managing the stress and can be caught in a loop known as post-traumatic stress disorder, which will be discussed in this lesson along with acute stress disorder.

History of PTSD

History is full of bizarre reports. Ancient soldiers would go blind despite no physical injury. Shakespeare wrote of maladies afflicting warriors and kings, where their mind began to churn and broil without any injury. In the U.S. Civil War, many of the soldiers coming home had difficulties in the field or returning to their normal lives. They were said to have 'soldiers' heart.'

World War I was a trench war, and there was a constant bombardment from cannons and shells. It was hypothesized that tiny pieces of sand were entering the body, and so the description of 'shell shock' was used. Following World War II, many of these soldiers came home and continued to suffer from 'battle fatigue' or 'combat exhaustion.' Similar cases occurred following the Vietnam War as well.

All of the descriptions of all of these maladies, conditions, and syndromes match up with what has been labeled post-traumatic stress disorder. Let's look at the diagnosis and the cause, and then we will look at possible treatment options.

PTSD

Post-traumatic stress disorder, usually shortened to PTSD, is a mental disorder characterized by:

  • Exposure to actual or threatened death, serious injury, or sexual violence
  • Presence of intrusive symptoms following the exposure
  • Persistent avoidance of similar situations or traumatic events
  • Deterioration of cognition and mood
  • Fluctuating arousal and reactivity levels

This is a brief run-through of the basic diagnostic criteria of PTSD, but what does it mean, though?

Exposure can come in many forms, such as being a soldier in war, being the victim of a mugging, living through a natural disaster, or even just viewing any of these things. Exposure doesn't necessarily mean that the person actually had to be in the situation; they just needed to be exposed to it. What this exposure seems to be doing is looping the brain into a fight-or-flight reaction. Many of the symptoms, which we will discuss in a moment, are the body and mind overreacting to a threat that is no longer there.

After the exposure, the brain is replaying the event on some subconscious level. It's like the brain is stuck back in that moment in some ways. This leads to intrusive symptoms like recurrent dreams and flashbacks of the event. Worse is the dissociation that occurs, which is defined as a process of separating from reality. This is where the person believes they are back in the war, where they see the enemies around them. It is entirely real to them in that moment.

With all of this happening, the person afflicted with PTSD doesn't want to trigger more nightmares, flashbacks, or dissociations. So, they actively avoid what may remind them of the traumatic event. This isn't easy for soldiers who can still be reminded of what happened as they fought the war. This is nearly impossible for police officers who live in their own personal war zone. Can you imagine driving down the road with your loved ones and being able to say, 'That's where I found a man who was stabbed to death?' 'That's where I pulled a baby out of a pool... it was already blue.' 'That's where some guy raped a girl.' I don't mean to be morbid or crude; this is a frighteningly real issue.

With the nightmares, the dissociations, and the subsequent avoidance, a person can only take so much. Combining the last two aspects, a person begins to fray under the constant stress. This is exacerbated by hypervigilance, which is a condition of abnormally heightened awareness. People with PTSD often need to be aware of everything that's happening around them at all times. This is exhausting and can make people irritable and irrational because their brain is trying to process more information on an already taxed system.

Remember how grouchy you were when you had to stay up that one night studying? Imagine being up for two months straight? What about two years straight?

Acute Stress Disorder

PTSD has a smaller sibling. Acute stress disorder is a diagnosis modeled after PTSD, but occurring at least three days, and up to one month immediately following a traumatic exposure. The main difference between acute stress disorder and PTSD is time. If you were exposed to something terrible, and you developed PTSD symptoms for at least three days, then you would be said to have acute stress disorder. If the symptoms continue past a month, then you most likely have PTSD. That's really the only difference - if it lasts longer than a month.

The reason acute stress disorder is separate from PTSD is that PTSD is seen as something that is chronic. Many people can develop acute stress following an event. People have trouble going outside and sleeping after a mugging. Or there is a fear of further problems after a home is broken into. Many times the symptoms will go away on their own. However, if they continue, then we're dealing with the bigger sibling.

Treatment

I know the easiest solution to this is to take the person and shake them while yelling, 'Stop being broken!' But that rarely works. What has been done is actually a little more complicated.

Your brain has always had a habit of making conscious actions unconscious over time, taking them from manual mode to automatic mode. Pretty much everything you do - from walking to talking to eating - is something that you learned at one point that you now do without giving it a second thought. Think of this: the next time you're driving, notice that you don't have to pay attention to the exact place your feet and hands are; they just know what they're doing.

What treatment has to focus on is rewiring the brain. What is happening, as we discussed earlier, is the mind is trapped in a danger loop, while the body is going into fight-or-flight mode. A trained and experienced therapist needs to work with the person with PTSD in a series of steps:

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