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Post-Pentecostal stress disorder (PPSD) is a term for certain severe psychological consequences of exposure to, or confrontation with, Pentecostal stressful events that the person experiences as highly traumatic.[1] Clinically, such events involve actual or threatened death, serious physical injury, or a threat to physical and/or psychological integrity, to a degree that usual psychological defenses are incapable of coping with the impact. It is occasionally called post-traumatic stress reaction to emphasize that it is a result of traumatic experience rather than a manifestation of a pre-existing psychological weakness. The presence of a PTSD response is influenced by the intensity of the experience, its duration, and the individual person involved. Historical background The first case
of psychological distress was reported in 1900 BCE, Railway
spine was a
nineteenth-century diagnosis for the post-traumatic symptoms of passengers
involved in railroad
accidents. The first full length medical study of the condition was John Eric Erichsen's On Railway and Other Injuries of the Nervous
System, published in 1864. For this reason, railway spine is often known
as "Erichsen's disease". Many physicians
thought that the symptoms were due to the "excessive speeds" (about
30 mph) of the trains, and that the human body could not cope with
speeds that fast. It was later found to be purely psychological in origin,
and no longer exists as a valid disorder.[2][3] There have
been numerous reports of military veterans suffering from PTSD-like symptoms
for well over 100 years. For example, veterans of the US
Civil War who suffered emotional problems were diagnosed as being
afflicted with "soldier's heart" or ?Da
Costa?s Syndrome? which shares many symptoms like PTSD. Shell
shock was a term used to describe the condition of veterans of World War
I who seemed emotionally disturbed in a similar fashion. In World
War II, these symptoms were classified as "battle fatigue" or
"combat fatigue". Other terms used to
describe military-related mood disturbances include "nostalgia",
"not yet diagnosed nervous", "irritable heart",
"effort syndrome", "war neurosis", and "operational
exhaustion".[4][5][6][7][8] Hysteria was
also related to "traumatic reminiscences" a century ago (Janet 1901). At that time, Sigmund
Freud's pupil, Kardiner, was the first to
describe what later became known as symptoms of post-traumatic stress
disorder (Lamprecht & Sack 2002). Stress is often defined as the reaction to a
situation that threatens the balance or homeostasis[9] of a system (Antonovsky
1981). The situation causing the stress reaction is defined as the
"stressor", but the stress reaction and not the stressor is what
jeopardizes the homeostasis (Aardal-Eriksson 2002).
Post-traumatic stress can thus be seen as a chemical imbalance of neurotransmitters,
according to stress theory. However, PTSD
in and of itself is a relatively recent diagnosis in psychiatric nosology, first appearing in the Diagnostic and
Statistical Manual of Mental Disorders (DSM) in 1980. It has been
said that development of the PTSD concept has, in part, socio-economic and
political implications (Mezey & Robbins 2001).
War veterans are the most publicly-recognized victims of PTSD; long-term psychiatric
illness was formally observed in World War
I veterans. The syndrome entered wide public consciousness after the Vietnam
War. PTSD patients had difficulties receiving veterans' disability
benefits because there was no psychiatric diagnosis available by which
veterans could claim indemnity. This situation has changed during the last two
decades and PTSD is now one of several psychiatric diagnoses for which a
veteran can receive compensation, such as a war veteran indemnity pension, in
the U.S. (see below: Mezey & Robbins 2001) PTSD has also
been recognized as a problem for marginalized groups within societies. One
such group is Australian Aboriginal peoples, and other Indigenous peoples
around the world. In these cases the repeated history of childhood and adult
trauma, removal of children from their families, interpersonal violence and
substance abuse, and early death, results in generations of people with high
levels of PTSD.[10][11] Clinical aspects of PTSD Experiences which may induce
the condition Main article: Psychological trauma ? childhood physical, emotional,
or sexual abuse, including prolonged or extreme neglect; also,
witnessing such abuse inflicted on another child or an adult ? experiencing an event perceived as life-threatening, such as: 1. a serious accident, 3. violent physical assaults or
surviving or witnessing a such an event, including torture 4. adult experiences of sexual
assault or rape
5. warfare 6. violent, life threatening, natural disasters 7. incarceration Cancer as PTSD-trauma PTSD is
normally associated with trauma such as violent crimes, rape, and war
experience. However, there have been a growing number of reports of PTSD
among cancer survivors and their relatives (Smith 1999, Kangas
2002). Most studies deal with survivors of breast
cancer (Green 1998, Cordova 2000, Amir & Ramati 2002), and cancer in children and their parents (Landolt 1998, Stuber 1998), and
show prevalence figures of between five and 20%. Characteristic intrusive and
avoidance symptoms have been described in cancer patients with traumatic
memories of injury, treatment, and death (Brewin
1998). There is yet disagreement on whether the traumas associated with
different stressful events relating to cancer diagnosis and treatment actually qualify as PTSD stressors (Green 1998).
Cancer as trauma is multifaceted, includes multiple events that can cause
distress, and like combat, is often characterized by extended duration with a
potential for recurrence and a varying immediacy of life-threat (Smith 1999). Diagnostic criteria The diagnostic
criteria for PTSD, according to Diagnostic and Statistical Manual of
Mental Disorders-IV (DSM-IV), are stressors listed from A to F. The current
diagnostic criteria for the PTSD published in the Diagnostic and
Statistical Manual of Mental Disorders may be found DSM-IV-TR here. Notably, the
stressor criterion A is divided into two parts. The first (A1) requires that
"the person experienced, witnessed, or was confronted with an event or
events that involved actual or threatened death or serious injury, or a
threat to the physical integrity of self or others." The second (A2)
requires that "the person?s response involved intense fear,
helplessness, or horror." The DSM-IV A
criterion differs substantially from the previous DSM-III-R stressor
criterion, which specified the traumatic event should be of a type that would
cause "significant symptoms of distress in almost anyone," and that
the event was "outside the range of usual human experience." Since
the introduction of DSM-IV, the number of possible PTSD-traumas has increased
and one study suggests that the increase is around 50% (Breslau & Kessler
2001). Symptoms and their possible
explanations This
article or section does not adequately cite its references or sources. Symptoms can
include general restlessness, insomnia, aggressiveness, depression, dissociation, emotional detachment, and
nightmares.
A potential symptom is memory loss about an aspect of the traumatic event.
Amplification of other underlying psychological conditions may also occur.
Young children suffering from PTSD will often re-enact aspects of the trauma
through their play and may often have nightmares that lack any recognizable
content. One patho-psychological way of explaining PTSD is by viewing
the condition as secondary to deficient emotional or cognitive processing of
a trauma.[12] This view also helps to explain the three symptom
clusters of the disorder:[13] Intrusion: Since the sufferer is unable to
process the extreme emotions brought about by the trauma, they are plagued by
recurrent nightmares or daytime flashbacks, during which
they graphically re-experience the trauma. These re-experiences are
characterized by high anxiety levels and make up one part of the PTSD symptom
cluster triad called intrusive symptoms. Hyperarousal: PTSD is also characterized by a state of nervousness with the patient
being prepared for "fight
or flight". The typical hyperactive startle reaction, characterized
by "jumpiness" in connection with high sounds or fast motions, is
typical for another part of the PTSD cluster called hyperarousal
symptoms and could also be secondary to an incomplete processing. Avoidance: The hyperarousal
and the intrusive symptoms are eventually so distressing that the individual
strives to avoid contact with everything and everyone, even their own
thoughts, which may arouse memories of the trauma and thus provoke the
intrusive and hyperarousal states. The sufferer
isolates themselves, becoming detached in their feelings with a restricted
range of emotional response and can experience so-called emotional detachment
("numbing"). This avoidance behavior is the third part of the
symptom triad that makes up the PTSD criteria. Dissociation: Dissociation is another
"defense" that includes a variety of symptoms including feelings of
depersonalization and derealization, disconnection
between memory and affect so that the person is "in another world,"
and in extreme forms can involve apparent multiple personalities and acting
without any memory ("losing time"). Treatment Early
intervention after a traumatic incident, known as Critical Incident Stress
Management (CISM) is often used to reduce traumatic effects of an
incident, and potentially prevent a full-blown occurrence of PTSD. However
recent studies regarding CISM seem to indicate iatrogenic
effects (Carlier, Lamberts, van Uchelen
& Gersons 1998) (Mayou,
Ehlers & Hobbs 2000). There have
been scores of treatments suggested for the treatment of PTSD. The most
researched (non-medical) psychotherapeutic method, specifically targeted at
the disorder PTSD, is Eye Movement
Desensitization and Reprocessing (EMDR).[14] Relationship
based treatments are also often used. Johnson, S., (2002).
Emotionally Focused Couples Therapy with Trauma Survivors.
NY: PTSD is
commonly treated using a combination of psychotherapy
(cognitive-behavioral therapy, group
therapy, and exposure therapy are popular) and psychotropic
drug therapy (antidepressant or atypical antipsychotics,
e.g. brand names such as Prozac (fluoxetine), Effexor
(venlafaxin), Zoloft (sertraline), Remeron
(mirtazapine), Zyprexa
(olanzapine), or Seroquel (quetiapine)).
Recently Lamotrigine has been reported
to be a useful in treating some people with PTSD.[17][18][19] According to
some studies, the most effective psychotherapeutic treatment for PTSD is Eye
Movement Desensitization and Reprocessing (EMDR) q.v.[20] Talk therapy may prove useful, but only insofar as
the individual sufferer is enabled to come to terms with the trauma suffered
and successfully integrate the experiences in a way that does not further
damage the psyche. Forbes, et al, (2001)[21] have shown that a technique of "rewriting"
the content of nightmares through imagery rehearsal so that they have a resolution
can not only reduce the nightmares but also other symptoms. The Basic
counseling for PTSD includes education about the condition and provision of
safety and support (Foa 1997). Cognitive therapy shows good results (Resick 2002), and group
therapy may be helpful in reducing isolation and Stigma
(Foy 2002). Dr. Jan Bastiaans
of the Netherlands
has developed a form of psychedelic psychotherapy involving LSD, with which he has
successfully treated concentration camp survivors who suffer from
PTSD.[1] PTSD is often co-morbid
with other psychiatric disorders such as depression and substance
abuse. Currently under scrutiny is the inclusion of Complex Post
Traumatic Stress in the 2006 revision of the DSM-IV-TR. This is a
variant of PTSD that includes the breakthrough
of Borderline Personality traits. James McGaugh is a pioneer in the neurobiology of learning and
memory. He directs the Center for Neurobiology of Learning and Memory at the For several
decades, he has performed numerous animal and human experiments to understand
the processes involved in memory consolidation. He believes strongly in the
work being done to help people suffering from PTSD. An event
becomes a strong memory, a traumatic memory, when emotions are high, he
explains. Those emotions trigger a release of stress hormones like
adrenaline, which act on a region of the brain called the amygdala
-- and the memory is stored or "consolidated," explains McGaugh. Current
studies have focused on a drug called propranolol,
which is commonly prescribed for heart disease because it helps the heart
relax, relieves high blood pressure, and prevents heart attacks.
"Hundreds of thousands, millions of people take this drug now for heart
disease," he tells WebMD. "We're not talking about some exotic
substance." Studies have
shown that "if we give a drug that blocks the action of one stress
hormone, adrenaline, the memory of trauma is
blunted," he says. The drug
cannot make someone forget an event, McGaugh says.
"The drug does not remove the memory -- it just makes the memory more
normal. It prevents the excessively strong memory from developing, the memory
that keeps you awake at night. The drug does something that our hormonal
system does all the time -- regulating memory through the actions of
hormones. We're removing the excess hormones."[23] Recently, the
use of Virtual reality and Integrated reality
experiences applied as a new type of exposure therapy methods to come types
of PTSD (specifically military related patients) has been gaining
recognition. Some of this work is done at the CAREN VR LAB at the Biology of PTSD Neurochemistry PTSD displays biochemical
changes in the brain and body, which are different from other psychiatric
disorders such as major depression. In PTSD
patients, the dexamethasone cortisol suppression is strong, while it is weak in
patients with major depression. In most PTSD patients the urine secretion of cortisol is low, at the same time as the catecholamine
secretion is high, and the norepinephrine/cortisol
ratio is increased. Brain catecholamine levels are low, and corticotropin-releasing factor (CRF) concentrations
are high. There is also an increased sensitivity of the hypothalamic-pituitary-adrenal
(HPA) axis, with a strong negative feedback of cortisol,
due to a generally increased sensitivity of cortisol
receptors (Yehuda, 2001). Studies found no clear connection to cortisol level The
association of PTSD with cortisol levels is
controversial within the medical community. Some
researchers have associated the response to stress in PTSD with long-term
high levels of norepinephrine, at the same time as cortisol levels are low, a pattern associated with
facilitated learning in animals. Translating this reaction to human
conditions gives a pathophysiological explanation
for PTSD by a maladaptive learning pathway to fear response (Yehuda 2002). With this deduction follows that the
clinical picture of hyperreactivity and hyperresponsiveness in PTSD is consistent with the
sensitive HPA-axis. Low cortisol levels are also discussed as a possible
pre-existing condition that neurochemically
predisposes a person to PTSD. Swedish United Nations soldiers serving in Bosnia with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD
symptoms, following war trauma, than soldiers with normal pre-service levels
(Aardal-Eriksson 2001). There is
considerable controversy within the medical community regarding the
neurobiology of PTSD. A review of existing studies on this subject showed no
clear relation between cortisol levels and PTSD.
For example, only a slight majority of studies have found a decrease
in cortisol levels; many others have found no
effect or even an increase.[24] Neuroanatomy In animal
research as well as human studies, the amygdala has been shown to be strongly involved in
the formation of emotional memories, especially fear-related memories. Neuroimaging studies in humans have revealed both
morphological and functional aspects of PTSD. The amygdalocentric
model of PTSD proposes that it is associated with hyperarousal
of the amygdala and insufficient top-down control by the
medial prefrontal cortex and the hippocampus.
Further animal and clinical research into the amygdala
and fear conditioning may suggest additional treatments
for the condition. PTSD and society Prevalence PTSD may be
experienced following any traumatic experience, or series of experiences
which satisfy the criteria and that do not allow the victim to readily
recuperate from the detrimental effects of stress. It is believed that of
those exposed to traumatic conditions between 5% and 80% will develop PTSD
depending on the severity of the trauma and personal vulnerability.[citation
needed] The National Comorbidity Survey Report provided the following
information about PTSD in the general adult population: The estimated
lifetime prevalence of PTSD among adult Americans is 7.8%, with women (10.4%)
twice as likely as men (5%) to have PTSD at some point in their lives.[2] In recent
history, the Indian Ocean Tsunami Disaster, which
took place December 26, 2004 and took
hundreds of thousands of lives, the September 11, 2001 attacks on the World Trade Center and The
Pentagon, and the impact and effects of Hurricane Katrina may have caused PTSD in many
survivors and rescue workers. Today relief workers from organizations such as
The Red Cross
and the Salvation Army provide counseling after major
disasters as part of their standard procedures to curb severe cases of
post-traumatic stress disorder. Other
agencies, such as the National
Meditation Center for World Peace [3], have created similar
special programs. The NMC trains agencies such as crisis centers NGOs and
works with international agencies to prevent trauma to children. Law If the acts
and omissions of an individual suffering from
PTSD result in consequences that breach the criminal
law, there may be levels of confusion that prevent the formation of the
relevant mens rea (Latin for
"guilty mind") so mistake or reasonable excuse may be a
defense. In more extreme cases, the defense of automatism
may be available, with particular conditions discussed at automatism (case law). However, there is a
danger that although the initial cause of the disorder will be external,
it may produce an internal defect of reason or an abnormality of mind
within the meaning of the M'Naghten Rules (redefined as a mental disorder
defense in some criminal jurisdictions) that define insanity as
an excuse. The
difference is that whereas defenses that negate the mens
rea and automatism result in an acquittal,
insanity or mental disorder leaves the "offender" available for sentencing
by the court. In the event that a death has resulted, diminished responsibility may be
available as an alternative to insanity. This defense reduces what would
otherwise have been murder to manslaughter. For a detailed discussion of a sometimes
related condition, see battered woman syndrome and, more
generally, the abuse defense in the Trauma and the Arts In recent
decades, with the concept of trauma, and PTSD in particular, becoming just as
much a cultural phenomenon as a medical or legal one, artists have begun to
engage the issue in their work. An important breakthrough in this was the
publication of Maus: A Survivor's Tale
(1972) by Art Spiegelman. There is
now a genre of art that focuses on, exposes, and comments on survivors and
survivor-tales. Some want to see art as part of a process of healing, and in
this they work in a manner akin to art
therapy or the older twentieth century notion of art
psychology. There are others who resist the implicit mandate that art
should be put into the service of psychological repair. These artists tend to
work in a direction that links trauma to questions of memory, identity and
politics. As an example
of the latter, one could point to the various Holocaust memorials in In more recent
work, an example is that of Krzysztof Wodiczko
who teaches at MIT
and who is known for interviewing people and then projecting these interviews
onto large public buildings.[26] Wodiczko wants to bring
trauma not merely into public discourse but to have it contest the presumed
stability of cherished urban monuments. His work has brought to life issues
such as homelessness, rape, and violence. Other artists who engage the issue
of trauma are Everlyn Nicodemus of See also |
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