Analysis of the Stressful Event. her bed. She soon saw there was a man creeping along side her bed. When she began to scream,

Transcription

1 1 Identifying Post Traumatic Stress Disorder Angela Hoffman Analysis of the Stressful Event Annie was a nineteen-year old college student studying journalism at the local university. One hot summer evening she was awoken from her sleep by the sound of someone rustling near her bed. She soon saw there was a man creeping along side her bed. When she began to scream, he jumped on her and told her that if she screamed he would not only kill her but wait for her roommate to arrive home and brutally rape and kill her too. Scared but promising herself she was not going to die, Annie vowed to make it out of the situation alive and to put the man away in jail forever. As he forced himself on her she focused on his face, searched for a tattoo, a mole, a marking, anything that would make it easier for her to identify in a police sketch or lineup. She eventually convinced the man to let her get him a drink. She went to the kitchen with him following her with the knife jabbed into her back. When they got to the kitchen, she threw a ceramic bowl at him and ran out of the house. Alone in the street and barely clothed she ran to local corner store and called the police. Presentation of the Symptoms Annie was evaluated and interviewed by the police department and a psychologist immediately after the event. Annie was very jumpy throughout the assessments and she continued to look around the room and hold her arms close around her. Annie continued to see the psychologist for the next couple of months and at the ninth counseling session that took place two months after the incident Annie complained of still struggling with the same terrible nightmares that she had had every night since the incident. Annie complained of not being able to get to sleep of night, in part because she knew she would have the nightmares and would wake up feeling as though the man was holding a knife to her throat again. Sometimes she said she

2 2 would dream of she was her mother. Annie s mother was murdered when Annie was 16. Annie reported that she keeps a knife in her bedside stand now and that she will not go to sleep until her roommate is home with her. Annie, also said she was having trouble focusing on her studies and that every time she would sit at her desk and try to brainstorm ideas for her journal articles she would look over to her bed and think back to that night. She reported that she tried to push the thoughts out of her mind but every time recollections of that night entered her mind, she was overtaken by feelings that her heart was beating uncontrollably fast, her chest was tight, and she would try to scream aloud but no sound would come out. Annie has found that because she could not focus on her journal articles or course assignments that her work and school performance was suffering. She feared she would not make sufficient grades to pass her classes. In addition, Annie used to have several friends that she would spend time with. She really enjoyed volunteering in the local community and would visit elderly homes and humane societies at least once a week with her friends. Since the incident, Annie has stopped spending time with her friends and said she does not volunteer much anymore. Describing the Disorder Annie was diagnosed with post-traumatic stress disorder. Post-traumatic stress disorder is an anxiety disorder that results from exposure to harmful levels of stress. The stressful situations that individuals with post-traumatic stress disorder may have been exposed to include but are not limited to military combat, natural disasters, terrorist attacks, accidents, child abuse, and rape (Butcher, Mineka, Hooley, 2011). The stressful event that results in the development of post-traumatic stress disorder is typically life threatening and is outside the realm of everyday life events or natural stress. Post-traumatic stress disorder is more likely to be diagnosed when the stressful event is the result of human intent to harm another person than if the event is the

3 3 result of a natural disaster or unintentional causes (Butcher, et al., 2011). The lifetime prevalence rate of post-traumatic stress disorder is 6.8%, with 9.7% of women being diagnosed at some point in their life and 3.6% of men being diagnosed at some point in their life (Butcher, et al., 2011). In addition, not only are women in the United States experiencing higher lifetime prevalence rates of post-traumatic stress disorder, women are also more likely to experience more severe symptoms (Butcher, et al., 2011). Although the development of post-traumatic stress disorder is triggered by a specific stressful event, there are risk factors that can increase the likelihood that individuals will develop the disorder and that prevent individuals from overcoming the anxiety caused by the stressful event. Risk factors for being exposed to a traumatic event that may result in the development of post-traumatic stress disorder are being male, having a dangerous occupation, lower obtained education level, and a history of conduct problems as a child (Butcher, et al., 2011). Risk factors for developing post-traumatic stress disorder include but are not limited to being female, being exposed to a traumatic event that is the result of human intent, high levels of cortisol, smaller hippocampal volume, increased exposure to traumatic events (Butcher, et al, 2011). DSM-IV-TR Criteria The Diagnostic and Statistics Manual of Mental Disorders (DSM-IV-TR) that is published by the American Psychiatric Association provides a classification system for disorders, including post-traumatic stress disorder and similar stress or anxiety related disorders. Stress and anxiety disorders fall under Axis I of the DSM-IV-TR as a clinical syndrome. As found in Butcher, et al. (2011, 130) the diagnostic criteria for post-traumatic stress disorder includes all the following:

4 4 a) Exposure to a life threatening or injurious traumatic event that involves intense feelings of fear, helplessness, or horror. b) Re-experiencing the traumatic event by recurrent, intrusive memories, nightmares, feelings that the event is recurring, and physical and psychological distress when exposed to cues related to event. c) Avoidance of stimuli associated with the traumatic event and general emotional numbing. d) Feelings of increased arousal that were not present before the traumatic event, that include: sleep problems, irritability, difficulty concentrating, startle responses, and excessive vigilance. e) Symptoms must last more than one month and cause clinically significant distress or impairment in functioning. The diagnostic criteria for post-traumatic stress disorder are very important because there are other stress anxiety disorders that relate to post-traumatic stress disorder. For example, posttraumatic stress disorder is very similar to acute stress disorder except for the defining feature that the diagnostic criteria for post-traumatic stress disorder requires that symptoms persist for more than one month while symptoms for acute stress disorder persist for less than one month. Analysis of the Diagnosis The symptoms that Annie has been experiencing since her traumatic experience fit the DSM-IV-TR diagnostic criteria for post-traumatic stress disorder. Annie has been exposed to a life threatening traumatic event as she was raped and could have been murdered. Annie also is re-experiencing the event by recurrent, intrusive memories and nightmares that impair her daily functioning. Annie is losing interest her friends and activities that she used to enjoy doing as she

5 5 is experiencing general emotional numbing. Symptoms of increased arousal are seen as Annie struggles to sleep at night, has trouble concentrating, and is being excessively vigilant by only going to bed if her roommate is home and by keeping a knife in her nightstand. Lastly, Annie fits the diagnostic criteria for post-traumatic stress disorder as she has been experiencing these symptoms for more than one month. Annie also has several of the risk factors for developing post-traumatic stress disorder such as being female, enduring a traumatic life event, and experiencing the traumatic death of her mother. Evaluating the Daily Impact The symptoms that Annie is experiencing as part of this disorder are clearly causing suffering and are interfering in Annie s daily life. For the past two months, Annie has been struggling with maintaining her occupational and educational goals as she struggles to complete tasks and perform at the level she did prior to the traumatic event. Annie is also isolating herself from her friends by not spending time with them as she did before the traumatic event. Annie isolating herself not only limits her ability to use her friends as a protective factor but also puts her at risk of developing other mental disorders. Evaluating Treatment and Outcomes The psychologist decides to treat Annie by teaching her relaxation techniques. These techniques help Annie overcome some of the recurring stress and anxiety without the use of medication. The psychologist also uses cognitive-behavioral therapy to assist Annie in evaluating irrational thoughts so that Annie feels more comfortable going out with her friends and doing the activities, she did before the traumatic event. Since Annie was promptly diagnosed with post-traumatic stress disorder and is receiving prompt treatment, the likelihood that she will overcome this disorder and regain the lifestyle she once knew is very promising.

6 6 References Butcher, J. N., Mineka, S., & Hooley, J. M. (2011). Abnormal Psychology Core Concepts (2nd ed.). Boston, MA: Pearson Education, Inc.