Post-traumatic stress disorder

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Dr. med. Julia Schwarz is a freelance writer in the medical department.

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Post-traumatic stress disorder (PTSD) is a mental illness that results from an experienced trauma (violence, war, natural disaster, etc.). Their symptoms usually appear within six months and are manifested, for example, by fear, flashbacks, hypersensitivity or sleep problems. Post-traumatic stress disorder should be treated immediately with psychotherapy and possibly also with medication. Read everything you need to know about post-traumatic stress disorder here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F43

Post traumatic stress disorder: description

Post-traumatic stress disorder (PTSD) is a mental illness that occurs after traumatic events. The term trauma comes from the Greek and means "wound" or "defeat". A trauma describes a very stressful situation in which the person concerned feels at their mercy and helpless. This does not mean normal, albeit painful, life situations such as the loss of a job or the death of relatives. Post-traumatic stress disorder is caused by extraordinary and extreme emergencies.

Such a trauma can arise, for example, as a result of directly experienced violence (physical - including sexual - or psychological) or violence that was experienced, such as during a war. Natural disasters, in which people experience severe fear, defenselessness, helplessness and loss of control, can also trigger PTSD.

Post-traumatic stress disorder is also called post-traumatic stress disorder because it can include many different symptoms. Symptoms such as fear, irritability, sleep disorders or panic attacks (palpitations, tremors, shortness of breath) are possible. Flashbacks are also typical - the repeated experience of the traumatic situation in which the affected person is flooded with memories and emotions.

Post traumatic stress disorder: frequency

Post-traumatic stress disorder usually occurs six months after the traumatic experience and can in principle affect anyone. A US study estimates that eight percent of the population will experience post-traumatic stress disorder at some point in their life. According to another study, doctors, soldiers and police officers are at up to 50 percent increased risk of PTSD. German scientists published results that 30 percent of rape leads to post-traumatic stress disorder.

Complex Post Traumatic Stress Disorder

The complex post-traumatic stress disorder requires particularly severe or particularly long-lasting trauma. Those affected usually show a serious clinical picture with personality changes. Symptoms mainly affect personality and behavior.

Post traumatic stress disorder: symptoms

How a post-traumatic stress disorder expresses itself in detail can be found in the article Post-traumatic stress disorder - symptoms.

Post-traumatic stress disorder: causes and risk factors

The causes of post-traumatic stress disorder can be very diverse. In any case, it is a traumatic experience. The affected person is facing a serious threat - it is a matter of their own survival.

Experiences of physical violence in the form of rape, torture or war usually promote post-traumatic stress disorder even more than natural disasters or accidents for which no one can be directly held responsible. As a rule, the human violence experienced cannot be reconciled with the previously existing worldview. There is then a direct "enemy" who is the threat.

People without social support are considered to be more susceptible to post-traumatic stress disorder. This also applies to a lack of support from one's own family. A low level of education on the part of parents also increases the risk of post-traumatic stress disorder. Crime in the immediate vicinity is another risk factor.

People with a mental illness are also particularly at risk of developing post-traumatic stress disorder. Those who suffered from a very authoritarian upbringing style with punitive consequences for their parents also bears a higher risk.

Experts suspect that the risk of complex post-traumatic stress disorder is greater if the trauma has occurred over a longer period of time.

Post Traumatic Stress Disorder: Investigations and Diagnosis

Post-traumatic stress disorder must be distinguished from acute stress reaction. The symptoms are similar in both cases (fear, confusion, isolation, etc.). The acute stress reaction describes a state of mental overload immediately after a severe physical or mental state. A post-traumatic stress disorder, on the other hand, only occurs with a time delay after the trauma.

PTSD is diagnosed based on its symptoms. This is not always easy, as the same symptoms often occur in other illnesses (such as anxiety disorder, borderline disorder, depression).

If an affected person experiences physical ailments such as shortness of breath, palpitations, tremors or sweating, they usually first turn to their family doctor. This will first clarify organic causes. If there is a suspicion of post-traumatic stress disorder, he will refer the person concerned to a psychiatrist or psychotherapist.

anamnese

In the initial consultation with a specially trained trauma therapist, the diagnosis "post-traumatic stress disorder" is usually not made. Rather, the therapist first asks questions about the curriculum vitae and any existing illnesses. In this anamnesis interview, he also has the patient describe the symptoms in detail.

In addition, he asks about any triggering factors for the current ailment - but with great caution. Too direct questions about the trauma can overwhelm the patient and worsen his condition. This may make him inaccessible to subsequent psychotherapy.

Post traumatic stress disorder: test

Various standardized questionnaires are available for diagnosing post-traumatic stress disorder:

The so-called "Clinician-Administered PTSD Scale" (CAPS) was specially developed for the diagnosis of "Post-Traumatic Stress Disorder". It begins with questions about the trauma itself. This is followed by questions about whether, how often and to what extent the various PTSD symptoms occur. Finally, depression or suicidal thoughts are clarified.

The SKID-I test (Structured Clinical Interview) is also a frequently used structured clinical interview to diagnose post-traumatic stress disorder. It is a guided interview: the interviewer asks certain questions and then codes the answers. In inpatients, SKID-I tests take an average of 100 minutes. The diagnosis of PTSD can be confirmed with this test.

Complex Post Traumatic Stress Disorder: Test

An interview is usually also used to clarify whether a complex post-traumatic stress disorder is present. The "Structured Interview of Disorders of Extreme Stress" (SIDES) has proven itself for this.

A German-language test version is the "Interview on Complex Post-Traumatic Stress Disorder" (I-KPTBS). The doctor / therapist also asks the patient questions and then codes the answers.

Post-traumatic stress disorder: diagnostic criteria

According to the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the following criteria must be met to diagnose Post Traumatic Stress Disorder:

• The patient was exposed to a stressful event (of extraordinary threat or catastrophic proportions) which would cause helplessness and despair in almost everyone.
• There are intrusive and persistent memories of the experience (flashbacks).
• The person concerned avoids situations and circumstances that are similar to the triggering situation.
• Irritability and outbursts of anger
• Difficulty concentrating
• Difficulty falling asleep and staying asleep
• Hypersensitivity
• increased jumpiness
• a partial to complete inability to remember the stressful event
• Symptoms must appear within six months of the trauma.

Post traumatic stress disorder: treatment

Post-traumatic stress disorder should be treated by a psychiatrist trained in trauma therapy. If the wrong therapeutic procedure is used, the post-traumatic stress disorder can otherwise become entrenched.

Post-traumatic stress disorder: psychotherapy

Post-traumatic stress disorder can be successfully treated with a psychotherapeutic procedure. The treatment usually takes place in several steps:

1. Security:

The top priority is to create a protected framework and a feeling of security for those affected. The patient needs to feel reasonably safe and protected in order to tackle their post-traumatic stress disorder. A partial or full inpatient stay is therefore often recommended for the start of treatment.

Before psychotherapy is started, the patient is usually informed (psychoeducation) so that he can better understand the post-traumatic stress disorder as a clinical picture.

2. Stabilization:

The planned psychotherapeutic approach is usually discussed jointly by the patient and the therapist. Strategies are developed to cope with everyday life. Relaxation exercises and breathing exercises can help keep your thoughts in check.

Medicinal support can also be helpful in relieving fears. However, patients with post-traumatic stress disorder are at greater risk of becoming drug addicts. The drugs should therefore be used in a targeted manner and under observation.

3. Overcoming trauma / integration and reorientation:

In this phase, the patient has already achieved security and learned techniques with which he can control his emotions. Now it goes to the "trauma work":

Many sufferers quickly feel overwhelmed with emotions. It can therefore be helpful if, therapeutically, the trauma is not initially addressed directly, but an indirect processing of the memory takes place. Step by step, the sick person is then slowly confronted with images and feelings. This advanced form of behavior therapy (exposure therapy) is very often used to treat post-traumatic stress disorder.

Another therapy method specially developed for post-traumatic stress disorder is Eye Movement Desensitization and Reprocessing (EMDR). The patient is slowly introduced to the trauma within the protected framework of PTSD therapy. At the moment of the memory and when the fear rises again, a quick, jerky change in the horizontal line of sight should help to get used to the trauma experience. Ultimately, the traumatizing experience should be embedded in the thought processes and no longer lead to fear and helplessness.

Complex Post Traumatic Stress Disorder: Therapy

In Germany, the complex post-traumatic stress disorder is mostly treated using psychodynamic imaginative trauma therapy according to Luise Reddemann. This imaginative therapy generally combines different treatment techniques. The patient learns to mentally create a safe space in which to withdraw if the emotions of the event become too strong. The aim here is to overcome post-traumatic stress disorder by embedding the experience in the normal world of emotions.

Further treatment options are Prolonged Exposure Therapy (PE), in which the patient puts himself back in the traumatic situation and experiences the trauma again. The therapy session is recorded on tape. The patient should listen to the recording on a daily basis until the emotions triggered by it diminish.

In Cognitive Processing Therapy (CPT), the patient should work through his experiences in writing and restructure "thinking errors" such as feelings of guilt or shame.

Narrative Exposure Therapy (NET) is a combination of Testimony Therapy (a short-term procedure for the treatment of traumatized survivors of political violence) with classic behavioral therapy procedures. The entire résumé of the patient with unresolved trauma is processed. The patient should get used to these and place them in his life story.

The Brief Eclectic Psychotherapy for PTSD (BEPP) combines cognitive-behavioral and psychodynamic elements in 16 therapy sessions. It comprises five elements: psychoeducation, exposure, writing tasks and working with memory gaps, attribution of meaning and integration as well as a farewell ritual.

Post-traumatic stress disorder: disease course and prognosis

How a post-traumatic stress disorder progresses depends on the severity and your own resources. In around a third of those affected, PTSD disappears on its own within twelve months. After extensive psychotherapy, half of those affected live symptom-free after four years. However, a third of those affected still suffer from PTSD ten years after a trauma.

A manifest post-traumatic stress disorder often has a major impact on the everyday life of those affected. It leads to avoidance strategies, but this only increases fear and helplessness. A possible job loss or early retirement can lead to social isolation. Those affected usually feel even more helpless and lonely.

The support from the social environment is extremely important for the healing process. The person concerned must feel safe and secure in everyday life in order to be able to overcome post-traumatic stress disorder.

Some patients manage to see the trauma as a maturation process and to gain something positive from the experience (called "traumatic growth"). Often they then help other sufferers to address their post-traumatic stress disorder, or they stand up for victim organizations.

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