Traumatic Stress Disorders

Currently the Veterans Administration (VA) is the world’s largest recipient of per patient funding for PTSD. The VA treats 200,000 veterans with this diagnosis annually at a cost of $4 billion. But research calls into question the very existence of the “PTSD” syndrome, and its diagnostic formulation remains invalid. We do not minimize the suffering of those who experience trauma or the need for comfort and restitution. We seek only to reexamine research evidence, to clarify the impact of culture on diagnosis, to reevaluate the consequences of trauma, and to ensure optimal allocation of resources.

Traumatic experiences are common in childhood and adolescence and can have significant psychological effects on the child’s emotional well-being and overall development. Outcomes can be affected positively or negatively depending on responses and interventions.

Our returning military veterans remind us dramatically of the importance to consider traumatic brain injury (TBI) as a potential comorbid illness in cases of posttraumatic stress disorder (PTSD). The common causes of comorbid TBI and PTSD are assault and battery to the head, head trauma (personal or work-related injuries), civilian or military explosions, inflicted head trauma in children, motor vehicle accidents, and suicide attempts by jumping. Prevalence figures for comorbid TBI and PTSD historically have been lacking

Reports of 1 in 5 military service members returning from Iraq or Afghanistan with posttraumatic stress disorder (PTSD) and/or depression and rising suicide rates have led researchers and military leaders to warn civilian psychiatric care providers of a “gathering storm”1 headed their way.

Despite an abundance of studies linking both traumatic experiences and anxiety disorders with eating disorders, relatively little has been reported on the prevalence of associated posttraumatic stress disorder (PTSD) or partial PTSD in patients with eating disorders.

This is the last installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). In Part 1, I described some basic clinical observations of PTSD and the challenges these observations pose to researchers attempting to understand underlying biological substrates.1 Part 2 examined progress on addressing these challenges at the level of the tissue and cell.2 In Part 3, I will discuss efforts to understand PTSD at the level of DNA, including potential genetic underpinnings and heritable risk factors.

This is the second installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). The first installment described clinical aspects of PTSD and how these characteristics make understanding the underlying biological substrates so challenging. In this installment, I discuss progress addressing these challenges at the tissue and cell level. In the final installment, I will review potential genetic underpinnings of PTSD, with emphasis on potentially heritable risk factors.

Having grown up as a "military brat," I have been familiar for decades with how my family's friends coped with war experiences. I did not know the term "PTSD" in those days, but I could see the enduring, horrific marks that posttraumatic stress disorder had left on them. I learned early on that wars could keep killing soldiers long after the peace treaties had been signed and weapons had been rendered silent.

Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.

Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.

It is not uncommon for combat veterans to exhibit a wide range of psychological conditions, from schizophrenia to depression to posttraumatic stress disorder (PTSD), but how do these disorders affect domestic partners, who often serve as veterans' caregivers?

Posttraumatic stress disorder (PTSD) is a severe and often chronic anxiety disorder that can develop following exposure to an event involving actual or perceived threat to the life or physical integrity of oneself or another person. Epidemiological studies such as the National Comorbidity Survey1 estimate that more than half the population of the United States has experienced one or more traumatic events and that 8% of the population has met criteria for lifetime PTSD. Thus, trauma and PTSD are significant mental health problems.

In 2001, the US Surgeon General issued a report about the status of mental health with respect to racial and ethnic minority groups, which stated that ethnic and racial disparities were likely due to racism and discrimination. Empiric investigations have linked racism to poor mental health and have shown that racism is stressful and compromises the mental health of persons of color.

The following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.

As many as 90% of Americans are exposed to at least one traumatic event in the course of their lives. Many more are exposed to more than one traumatic event. Short- and long-term sequelae of traumatic exposure vary greatly and range from complete recovery, to severe and debilitating PTSD.

stress, trauma

Attempting litigation based on a claim of posttraumatic stress disorder can be difficult. What is the proper DSM definition of PTSD and in what ways can and can't it be used in court to properly defend a client? What should the role of the psychiatrist be in this process?

Posttraumatic stress disorder is one of the most devastating psychiatric disorders. Research has shown that a combination of multiple genes can lead to conditions for PTSD. Environmental factors, as well as comorbidities, must also be considered when looking for genetic conditions of PTSD.

The distress and functional impairment associated with PTSD may make it difficult for IPV victims to benefit from interventions to increase their safety and reduce their exposure to violence. Empirically supported PTSD treatments include pharmacotherapy and cognitive behavioral therapy. Incorporating these treatments into interventions to improve victims' safety and reduce exposure to violence may improve their effectiveness in protecting women from IPV.

The majority of people experience acute stress symptoms following trauma, but the development of posttraumatic stress disorder is the exception rather than the rule. Some investigators hypothesize that PTSD develops following increased nervous system response to trauma. Why only a minority of individuals experience this response, what their risk factors are and when should they be treated is the subject of ongoing research.

Combination treatment with both a selective serotonin reuptake inhibitor and a form of cognitive-behavioral therapy may be more effective than either treatment alone for this debilitating and often chronic disorder.

A groundbreaking program at UCLA goes into inner-city schools to help students work through trauma. By learning how to deal with the trauma itself and reminders of the trauma, students are able to improve their academic and social performance.

In this overview of research into the biopsychosocial changes caused by traumatic events, Dr. Novac discusses psychopathology, brain development and the effect a traumatic event can have on the victim's family-even long after the event occurred.

Developmental traumatology research is the systemic investigation of the psychiatric and psychobiological impact of overwhelming and chronic interpersonal violence on the developing child.

The most common psychiatric sequelae following trauma include major depressive disorder, somatoform pain disorder, adjustment disorder and posttraumatic stress disorder (PTSD). In law, trauma that precipitates PTSD is viewed as a tort, which stems from the root word "torquere" (to twist), as does the word torture. In a sense, plaintiffs do allege torture in personal injury cases. A tort constitutes a civil or private wrong, as opposed to a criminal wrong, and rests on the general principle that every act of a person causing damage to a legally protected interest of another obliges that person, if at fault, to repair the damage (Slovenko, 1973).