Ptrs disease. PTSD (post-traumatic stress disorder): how to identify and treat

PTSD (Post Traumatic Stress Disorder) is a special complex psychological problems or painful deviations in behavior dictated by a stressful situation. Synonyms for PTSD are PTSS (Post Traumatic Stress Syndrome), "Chechen Syndrome", "Vietnamese Syndrome", "Afghan Syndrome". This condition occurs after a single traumatic or multiple repetitive situations, for example, physical trauma, participation in hostilities, sexual violence, death threats.

Features of PTSD are manifestations of characteristic symptoms for more than a month: involuntary recurring memories, a high level of anxiety, avoidance or loss of traumatic events from memory. According to statistics, most people do not develop PTSD after traumatic situations.

PTSD is the most common psychological disorder in the world. Statistics say that up to 8% of all inhabitants of the planet suffer this condition at least once during their lives. Women are subject to this disorder 2 times more often than men due to reactivity and physiological instability to a stressful situation.

Causes of PTSD

This condition is caused by the following traumatic effects: natural disasters, terrorist acts, military actions, which include violence, hostage-taking, torture, as well as severe long-term illness or death of loved ones.

In many cases, if the psychological trauma is severe, then it is expressed in feelings of helplessness, intense, extreme horror. Traumatic events include service in law enforcement agencies, domestic violence, where he witnesses serious crimes.

Post-traumatic stress disorder in humans develops due to post-traumatic stress. Features of PTSD are expressed in the fact that the individual, having managed to adapt to various circumstances of life, has changed internally. The changes taking place with him help to survive, no matter what conditions he finds himself in.

The degree of development of the pathological syndrome depends on the level of participation of the individual in a stressful situation. Also, the development of PTSD can be affected by the social and living conditions in which the individual is located after the trauma. The risk of a disorder is greatly reduced when there are people around who have experienced a similar situation. Often PTSD affects individuals with a weak mental health, as well as increased reactivity to environmental stimuli.

In addition, there are other individual characteristics that provoke the onset of the disorder:

- hereditary factors (mental illness, close relatives, alcoholism, drug addiction);

- children's psychological trauma;

- nervous, concomitant mental pathologies, diseases endocrine system;

— difficult economic and political situation in the country;

- loneliness.

One of the most common causes of PTSD is combat. The military situation develops in people a neutral mental attitude towards difficult situations, but these circumstances, remaining in memory and emerging in peacetime, cause a strong traumatic effect. Most participants in hostilities are characterized by disturbances in their internal balance.

What are the signs of PTSD? The criteria for PTSD are events that go beyond normal human experience. For example, war horrors have an impact with their intensity, as well as frequent repetition, which does not help a person to recover.

The other side of PTSD affects the inner world of the individual and is associated with his reaction to the events experienced. All people react differently. A tragic incident can cause irreparable injury to one person, and it will hardly affect another.

If the injury is relatively minor, then increased anxiety and other signs will disappear within a few hours, days, weeks. If the trauma is severe or traumatic events are repeated many times, then the painful reaction persists for many years. For example, in combat veterans, an explosion or the rumble of a low-flying helicopter can cause an acute stressful situation. At the same time, the individual seeks to feel, think, act in such a way as to avoid unpleasant memories. The human psyche with PTSD develops a special mechanism to protect itself from painful experiences. For example, an individual who has experienced the tragic death of loved ones will subconsciously avoid close emotional connection with anyone in the future, or if a person believes that at a crucial moment he showed irresponsibility, then in the future he will not take responsibility for anything.

"War reflexes" do not seem unusual to a person until he gets into peacetime and makes a strange impression on people.

Help for PTSD participants in tragic events includes creating an atmosphere so that people can rethink everything that happens to them, analyze the feelings and internally accept and come to terms with the experience. This is necessary in order to continue to move on in life and not get stuck on your experiences. It is very important for people who survived military events, violence, that they be surrounded by love, harmony, understanding at home, but often this is not the case and at home people face misunderstanding, lack of a sense of security and emotional contact. Often people are forced to suppress emotions in themselves, not allowing them to come out, risking losing them. In these situations, nervous mental tension does not find a way out. When an individual does not have the opportunity to relieve internal stress for a long time, then his psyche and body themselves find a way to get along with this state.

PTSD symptoms

The course of PTSD is expressed in repetitive and intrusive playback in the minds of traumatic events. Often the stress experienced by the patient is expressed in extremely intense experiences, causing suicidal thoughts to stop the attack. There are also characteristic nightmarish recurring dreams and involuntary memories.

Features of PTSD are expressed in increased avoidance of feelings, thoughts, conversations associated with traumatic events, as well as actions, people and places that initiate these memories.

Signs of PTSD include psychogenic amnesia, which is the inability to recall the traumatic event in detail. People have a constant vigilance, as well as a constant state of expectation of a threat. This condition is often complicated by diseases and somatic disorders of the endocrine, cardiovascular, nervous and digestive systems.

The "trigger" of PTSD is an event that causes an attack in a patient. Often, the “trigger” is only part of the traumatic experience, such as the noise of a car, a crying baby, a picture, being at a height, a text, a TV show, and so on.

Patients with PTSD usually by all means avoid encounters with the factors that provoke this disorder. They do this subconsciously or consciously, trying to avoid a new attack.

PTSD is diagnosed when the following symptoms are present:

- exacerbation of psychopathological re-experiencing, causing serious harm with mental trauma;

- the desire to avoid situations reminiscent of the trauma experienced;

- loss of memory of traumatic situations (amnestic phenomena);

- a significant level of generalized anxiety during the 3rd - 18th week after the traumatic event;

- the manifestation of exacerbation attacks after a meeting with factors provoking the development of this disorder - triggers of anxiety. Triggers are often auditory and visual stimuli - a shot, a screech of brakes, the smell of some substance, crying, the hum of an engine, and so on;

- dullness of emotions (a person partially loses the ability to emotional manifestations - friendship, love, there is a lack of creative upsurge, spontaneity, playfulness);

- violation of memory, as well as concentration of attention when a stress factor appears;

- with an accompanying feeling, a negative attitude to life and nervous exhaustion;

- general anxiety (concern, anxiety, fear of persecution, a sense of fear, a guilt complex, self-doubt);

- (explosions similar to a volcanic eruption, often inherent under the influence of alcohol and drugs);

- abuse of medicinal and narcotic substances;

- uninvited memories that pop up in ugly, creepy scenes associated with traumatic events. Unwelcome memories pop up, both during wakefulness and in sleep. In reality, they appear in cases where the environment resembles what happened during a traumatic situation. What distinguishes them from ordinary memories is a sense of fear and anxiety. Unwanted memories that come in a dream are referred to as nightmares. The individual wakes up "broken", wet with sweat, with tense muscles;

- hallucinatory experiences, which are characterized by behavior, as if a person is re-experiencing a traumatic event;

- insomnia ( intermittent sleep, difficulty falling asleep);

- thoughts of suicide due to despair, lack of strength to live;

Feeling guilty about having survived ordeal, while others do not.

Treatment for PTSD

Therapy given state is complex, at the beginning of the disease, medication is provided, and then psychotherapeutic assistance.

In the treatment of PTSD, all groups of psychotropic drugs are used: hypnotics, tranquilizers, neuroleptics, antidepressants, in some cases, psychostimulants and anticonvulsants.

The most effective in the treatment of antidepressants are SSRIs, as well as tranquilizers and drugs that act on MT receptors.

Effective in treatment is a technique in which the patient at the beginning of an attack focuses on a distracting vivid memory, which over time contributes to the formation of a habit of automatically switching to positive or neutral emotions, bypassing the traumatic experience when a trigger appears. The psychotherapeutic method in the treatment of PTSD is the method, as well as processing with the help of eye movements.

For patients with severe symptoms, psychedelic psychotherapy is prescribed using serotonergic psychedelics and psychostimulants of the phenethylamine group.

Psychological help in PTSD is aimed at teaching patients to accept the reality of their lives and create new cognitive models of life.

Correction of PTSD is expressed in the acquisition of true mental and physical health, which is not in accordance with someone else's standards and norms, but in coming to terms with oneself. For this, on the path to true recovery, it is not so important to behave as is customary in society, but it is necessary to be extremely honest with yourself, assessing what is currently happening in life. If the circumstances of life are influenced by the way of thinking, disturbing memories, behavior, it is important to honestly acknowledge their existence. Complete relief from PTSD can be obtained by seeking help from specialists (psychologist, psychotherapist).

Post-traumatic syndrome (PTS, post-traumatic stress disorder - PTSD) is a severe mental disorder caused by external influence of a super-strong traumatic factor. Clinical signs of mental disorders arise as a result of violent acts, depletion of the central nervous system, humiliation, fear for the life of loved ones. Pathology develops in the military; individuals who suddenly become aware of their incurable disease; injured in emergencies.

The characteristic symptoms of PTS are: psycho-emotional overstrain, painful memories, anxiety, fear. Memories of a traumatic situation arise paroxysmal when encountering stimuli. They are often sounds, smells, faces and pictures from the past. Due to constant nervous tension sleep is disturbed, the central nervous system is depleted, dysfunction of internal organs and systems develops. Traumatic events have a stressful effect on a person, which leads to depression, isolation, fixation on the situation. Similar signs persist for a long time, the syndrome progresses steadily, causing significant suffering to the patient.

Post-traumatic stress disorder often develops in children and the elderly. This is due to their low resistance to stress, poor development of compensatory mechanisms, rigidity of the psyche and the loss of its adaptive capabilities. Women suffer from this syndrome much more often than men.

The syndrome has the ICD-10 code F43.1 and the name "Post-traumatic stress disorder". PTSD is diagnosed and treated by specialists in the field of psychiatry, psychotherapy, and psychology. After talking with the patient and collecting anamnestic data, doctors prescribe medication and psychotherapy.

A bit of history

The ancient Greek historians Herodotus and Lucretius described the signs of PTSD in their writings. They watched the soldiers, who after the war became irritable and anxious, they were tormented by influxes of unpleasant memories.

Many years later, when examining former soldiers, increased excitability, fixation on difficult memories, immersion in one's own thoughts, and uncontrollable aggression were found. The same symptoms were found in patients after a railway accident. In the middle of the 19th century, a similar condition was called "traumatic neurosis." Scientists of the 20th century proved that the signs of such a neurosis intensify over the years, and not weaken. Former prisoners of concentration camps voluntarily said goodbye to an already calm and well-fed life. Similar changes in the psyche were also observed in people who became victims of man-made or natural disasters. Anxiety and fear have forever entered their daily lives. Decades of experience have made it possible to formulate modern concept about illness. Currently, medical scientists associate PTSD with emotional experiences and psychoneurotic disorders caused not only by extraordinary natural and social events, but also by social and domestic violence.

Classification

There are four types of PTSD:

• Acute - the syndrome lasts 2-3 months and is manifested by a pronounced clinic.
• Chronic - the symptomatology of the pathology increases within 6 months and is characterized by the depletion of the nervous system, a change in character, and a narrowing of the circle of interests.
• The deformation type develops in patients with long-term chronic disorder psyche, leading to the development of anxiety, phobias, neuroses.
• Delayed - symptoms appear six months after the injury. Various external stimuli can provoke its occurrence.

Causes

The main cause of PTSD is a stress disorder that arose after a tragic event. Traumatic factors or situations that can lead to the development of the syndrome:

1. armed conflicts,
2. catastrophe,
3. terrorist attacks,
4. physical violence,
5. torture,
6. attack,
7. brutal beating and robbery,
8. kidnapping,
9. incurable disease,
10. death of loved ones
11. miscarriages.

PTSD has an undulating course and often provokes a permanent personality change.

The formation of PTSD contribute to:

• moral trauma and shock arising from the loss of a loved one, during the conduct of hostilities and under other traumatic circumstances,
• a feeling of guilt towards the dead or a feeling of guilt about the deed,
• destruction of old ideals and ideas,
• reassessment of the personality, the formation of new ideas about one's own role in the world around.

According to statistics, the following are most at risk of developing PTSD:

1. victims of violence,
2. witnesses of rapes and murders,
3. individuals with high susceptibility and poor mental health,
4. doctors, rescuers and journalists present on duty at the scene,
5. women experiencing domestic violence
6. persons with a burdened heredity - psychopathology and suicide in a family history,
7. socially lonely people - without family and friends,
8. persons who received severe injuries and injuries in childhood,
9. prostitutes,
10. policemen,
11. persons with a tendency to neurotic reactions,
12. people with antisocial behavior - alcoholics, drug addicts, mental patients.

In children, the cause of the syndrome is often the divorce of the parents. They often feel guilty about this, they worry that they will see less of one of them. Another topical cause of frustration in today's violent world is conflict situations at school. Stronger children may bully the weaker ones, intimidate them, threaten them with reprisals if they complain to their elders. PTSD also develops as a result of child abuse and neglect by relatives. Regular exposure to a traumatic factor leads to emotional exhaustion.

Post-traumatic syndrome is a consequence of severe mental trauma, requiring medical and psychotherapeutic treatment. Currently, psychiatrists, psychotherapists and psychologists are studying post-traumatic stress. This is actual direction in medicine and psychology, the study of which is devoted to scientific works, articles, seminars. Modern psychological trainings more and more often begin with a conversation about post-traumatic stress, diagnostic features and main symptoms.

The timely introduction of someone else's traumatic experience into your life, emotional self-control, adequate self-esteem, and social support will help stop the further progression of the disease.

Symptoms

In PTSD, a traumatic event is compulsively repeated in the minds of patients. Such stress leads to an extremely intense experience and causes suicidal thoughts.

The symptoms of PTSD are:

• Anxiety-phobic states, manifested by tearfulness, nightmares, derealization and depersonalization.
• Constant mental immersion in past events, unpleasant sensations and memories of a traumatic situation.
• Intrusive memories of a tragic nature, leading to uncertainty, indecision, fear, irritability, irascibility.
• The desire to avoid everything that can remind you of the stress experienced.
• Memory impairment.
• Apathy, poor relationship with family, loneliness.
• Disruption of contact with needs.
• Feelings of tension and anxiety that do not go away even in sleep.
• Pictures of the experience, "flashing" in the mind.
• Inability to verbally express their emotions.
• antisocial behavior.
• Symptoms of CNS depletion are the development of cerebrosthenia with a decrease in physical activity.
• Emotional coldness or dullness of emotions.
• Social alienation, decreased reaction to surrounding events.
• Anhedonia is the absence of a sense of pleasure, the joy of life.
• Violation social adaptation and alienation from society.
• Narrowing of consciousness.

Patients cannot be distracted from haunting thoughts and find their salvation in drugs, alcohol, gambling, extreme entertainment. They constantly change jobs, often conflict with family and friends, and tend to wander.

Symptoms of the disease in children are: fear of parting with their parents, the development of phobias, enuresis, infantilism, distrust and aggressive attitude towards others, nightmares, isolation, low self-esteem.

Kinds

Types of post-traumatic syndrome:

1. alarm type characterized by bouts of unmotivated anxiety, which the patient is aware of or feels bodily. Nervous strain does not allow sleep and leads to frequent mood swings. At night, they lack air, sweating and fever, followed by chills. Social adaptation is due increased irritability. To alleviate the condition, people seek to communicate. Patients often seek medical help themselves.
2. Asthenic type manifested by the corresponding signs: lethargy, indifference to everything that happens, increased drowsiness, lack of appetite. Patients are oppressed by their own failure. They easily agree to treatment and gladly respond to the help of loved ones.
3. Dysphoric type characterized by excessive irritability, turning into aggression, resentment, vindictiveness, depression. After outbursts of anger, swearing and fights, patients regret it or experience moral satisfaction. They do not consider themselves in need of medical attention and avoid treatment. This type of pathology often ends with the transition of protest aggressiveness into an inadequate reality.
4. somatophoric type manifested by clinical signs of dysfunction of internal organs and systems: headache, interruptions in the work of the heart, cardialgia, dyspeptic disorders. Patients get hung up on these symptoms and are afraid to die during the next attack.

Diagnosis and treatment

Diagnosis of post-traumatic syndrome consists in collecting an anamnesis and questioning the patient. Specialists must find out whether the situation really threatened the life and health of the patient, whether it caused stress, horror, feelings of helplessness and moral distress of the victim.

Specialists must identify at least three symptoms characteristic of the pathology in the patient. Their duration should not be less than a month.

The treatment of PTSD is complex, including medication and psychotherapeutic effects.

Specialists prescribe the following groups of psychotropic drugs:

Psychotherapeutic methods of influence are divided into individual and group. During the sessions, patients immerse themselves in their memories and re-experience the traumatic situation under the supervision of a professional psychotherapist. With the help of behavioral psychotherapy, patients are gradually accustomed to trigger factors. To do this, doctors provoke seizures, starting with the weakest clues.

1. Cognitive-behavioral psychotherapy - correction of negative thoughts, feelings and behavior of patients, allowing to avoid serious life problems. Target similar treatment is to change your stereotype of thinking. If you cannot change the situation, then you need to change your attitude towards it. CPT allows you to stop the main symptoms of mental disorders and achieve stable remission after a course of therapy. This reduces the risk of recurrence of the disease, increases the effectiveness drug treatment, erroneous attitudes of thinking and behavior are eliminated, personal problems are solved.
2. Eye movement desensitization and processing provides self-healing in psychotraumatic situations. This method is based on the theory that any traumatic information is processed by the brain during sleep. Psychological trauma disrupts this process. Instead of ordinary dreams, patients are tormented at night by nightmares and frequent awakenings. Repeated series of eye movements unblock and accelerate the process of assimilation of the received information and processing of traumatic experience.
3. Rational psychotherapy is an explanation to the patient of the causes and mechanisms of the disease.
4. Positive therapy - the existence of problems and diseases, as well as ways to overcome them.
5. Auxiliary methods - hypnotherapy, muscle relaxation, auto-training, active visualization of positive images.

Folk remedies that improve the functioning of the nervous system: infusion of sage, calendula, motherwort, chamomile. Blackcurrants, mint, corn, celery, and nuts are considered beneficial for PTSD.

To strengthen the nervous system, improve sleep and correct increased irritability, the following agents are used:

The severity and type of PTSD determines the prognosis. Acute forms of pathology are relatively easy to treat. chronic syndrome leads to pathological development of personality. Drug and alcohol dependence, narcissistic and avoidant personality traits are poor prognostic signs.

Self-healing is possible with mild form syndrome. With the help of drug and psychotherapy reduces the risk of developing negative consequences. Not all patients recognize themselves as sick and visit a doctor. About 30% of patients with advanced forms of PTSD end their lives by suicide.

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

What is post-traumatic stress disorder?

post-traumatic syndrome or post-traumatic stress disorder (PTSD) is an integral complex of symptoms of a mental disorder resulting from a one-time or repeated external superstrong traumatic effect on the patient's psyche (physical and / or sexual abuse, constant nervous strain associated with fear, humiliation, empathy with the suffering of others etc.).

Post-traumatic syndrome is characterized by a state of increased anxiety, against the background of which attacks of unusually vivid memories of a traumatic event occur from time to time.

Such seizures most often develop when meeting with triggers (keys), which are stimuli that are a fragment of the memory of a traumatic event (crying of a child, screeching brakes, the smell of gasoline, the rumble of a flying plane, etc.). On the other hand, PTSD is characterized by partial amnesia, so that the patient cannot remember all the details of the traumatic situation.

Due to constant nervous tension and characteristic sleep disorders (nightmares, insomnia), over time, patients with post-traumatic syndrome develop the so-called cerebrasthenic syndrome (a set of symptoms indicating depletion of the central nervous system), as well as disorders of the cardiovascular, endocrine, digestive and other leading systems of the body.

Characteristically, the clinical symptoms of PTSD, as a rule, manifest themselves after a certain latent period after the traumatic event (from 3 to 18 weeks) and persist for quite a long time (months, years, and often decades).

Post-traumatic stress conditions: a history of study
pathology

Fragmentary descriptions of the signs of post-traumatic syndrome are found in the works of historians and philosophers. Ancient Greece such as Herodotus and Lucretius. The characteristic symptoms of mental pathology in former soldiers, such as irritability, anxiety, and influxes of unpleasant memories, have long attracted the attention of scientists.

However, the first scientific developments of this problem appeared much later and at first also had a fragmented and disordered character. It was only in the middle of the nineteenth century that the first comprehensive study of clinical data was carried out, revealing in many former combatants increased excitability, fixation on painful memories of the past, a tendency to escape from reality and a predisposition to uncontrolled aggression.

At the end of the nineteenth century, similar symptoms were described in patients who survived a railway accident, as a result of which the term "traumatic neurosis" was introduced into psychiatric practice.

The twentieth century, filled with natural, social and political cataclysms, has provided researchers of post-traumatic neurosis with a lot of clinical material. So, German doctors in the treatment of patients, participants in the hostilities of the First World War, it was found that the clinical signs of traumatic neurosis do not weaken, but intensify over the years.

A similar picture was discovered by scientists studying the "survivor syndrome" - pathological changes in the psyche of people who survived natural disasters - earthquakes, floods, tsunamis, etc. Difficult memories and nightmares, bringing anxiety and fear into real life, tormented the victims of disasters for years and decades.

Thus, by the 1980s, quite a lot of material had been accumulated on mental disorders developing in people who have experienced extreme situations. As a result, the modern concept of post-traumatic syndrome (PTSD) was formulated.

It should be noted that initially, post-traumatic stress disorder was spoken of in cases where severe emotional experiences were associated with extraordinary natural or social events (military operations, acts of terror, natural and man-made disasters, etc.).

Then the boundaries of the use of the term were expanded and it began to be used to describe similar neurotic disorders in persons who had experienced domestic and social violence (rape, robbery, domestic violence, etc.).

How often does post-traumatic stress, which is a physiological response to super-strong trauma, turn into a severe pathology - post-traumatic stress syndrome

Today, post-traumatic stress disorder is one of the five most common psychological pathologies. It is believed that about 7.8% of the inhabitants of our planet suffer from PTSD throughout their lives. At the same time, women suffer much more often than men (5 and 10.2%, respectively).

It is known that post-traumatic stress, which is a physiological reaction to super-strong trauma, turns into pathological condition PTSD is not always the case. Much depends on the degree of involvement of the person in extreme situation: a witness, an active participant, a victim (including a severely injured person). For example, in the case of socio-political cataclysms (wars, revolutions, riots), the risk of developing post-traumatic syndrome ranges from 30% for witnesses to 95% for active participants in events who have received severe physical injuries.

The risk of developing PTSD also depends on the nature external influence. Thus, certain manifestations of post-traumatic syndrome were found in 30% of Vietnam War veterans and in 80-95% of former prisoners of concentration camps.

In addition, the risk of developing a serious mental illness is influenced by age and gender. Children, women and the elderly are more susceptible to PTSD than adult men. Thus, when analyzing many clinical data, it was found that post-traumatic stress disorder develops within two years after a fire in 80% of children who have suffered severe burns, while for burned adults this figure is only 30%.

Of great importance are the social conditions in which a person lives after a psychological shock. It has been observed that the risk of developing PTMS is significantly reduced when the patient is surrounded by people who have undergone such an injury.

Of course, there are individual characteristics that increase the risk of developing post-traumatic syndrome, such as:

• burdened heredity ( mental illness, suicide, alcohol, drug or other addiction in the immediate family);
• psychological trauma suffered in childhood;
• concomitant nervous, mental or endocrine diseases;
• social loneliness (lack of family, close friends);
• difficult economic situation.

Causes of PTSD

The cause of post-traumatic stress disorder can be any strong experience that goes beyond ordinary experience and causes extreme overstrain of the entire emotional-volitional sphere of a person.

The most studied causative factor is military conflicts causing PTSD in active participants with some characteristic features("military neurosis", "Vietnamese syndrome", "Afghan syndrome", "Chechen syndrome").

The fact is that the symptoms of PTSD in military neurosis are exacerbated by the difficulties of adapting former combatants to a peaceful existence. The experience of military psychologists shows that post-traumatic syndrome rarely develops in people who have quickly become involved in the life of society (work, family, friends, hobbies, etc.).

In peacetime, the most powerful stress factor causing the development of post-traumatic syndrome in more than 60% of victims is captivity (abduction, hostage-taking). This type of PTSD also has its own distinctive features, consisting primarily in the fact that serious psychological disorders occur already during the period of exposure to a stress factor.

In particular, many hostages lose the ability to adequately perceive the situation and begin to feel sincere sympathy for the terrorists (Stockholm Syndrome). It should be noted that this state is partly due to objective reasons: the hostage understands that his life is valuable for the invaders, while the state machine rarely makes concessions and conducts an anti-terrorist operation, putting the lives of the hostages in serious danger.

A long stay in a state of complete dependence on the actions of terrorists and the plans of the security forces, a state of fear, anxiety and humiliation, as a rule, cause a post-traumatic syndrome that requires long-term rehabilitation for psychologists who specialize in working with this category of patients.

There is also a very high risk of developing post-traumatic syndrome in victims of sexual violence(from 30 to 60%). This type of PTSD was described at the dawn of the last century under the name "rape syndrome". Even then it was indicated that the likelihood of developing this pathology largely depends on the traditions of the social environment. Puritan mores can exacerbate the feelings of guilt common to all post-traumatic stress disorder and contribute to the development of secondary depression.

The risk of developing PTSD is somewhat lower in survivors of non-sexual criminal incidents. Yes, at severe beating the probability of occurrence of post-traumatic syndrome is about 30%, with robbery– 16%, murder witnesses– about 8%.

The likelihood of developing post-traumatic syndrome in people who survived natural or man-made disasters, including road and rail accidents, depends on the magnitude of personal losses (death of loved ones, severe injuries, loss of property) and can range from 3% (in the absence of severe losses) to 83% (in an unfortunate set of circumstances). At the same time, many patients with the "survivor syndrome" develop a sense of guilt (often completely unjustified) in the death of loved ones or strangers.

Recently, a lot of clinical data has appeared on post-traumatic stress syndrome in people who have experienced domestic violence(physical, moral, sexual). Since the victims, as a rule, are persons with a gender and age predisposition to the development of PTSD (children, women, the elderly), post-traumatic syndrome in such cases is especially difficult.

The condition of such patients in many ways resembles the condition of former prisoners of concentration camps. Victims of domestic violence, as a rule, find it extremely difficult to adapt to a normal life, they feel helpless, humiliated and inferior, they often develop an inferiority complex and severe depression.

Symptoms of post-traumatic stress disorder

Intrusive memories of a traumatic event - a specific system-forming symptom of the syndrome of post-traumatic stress disorders

Most characteristic symptom post-traumatic stress disorder are intrusive memories of a traumatic event that have unusually vivid but sketchy character(pictures from the past).

While the memories accompanied by a feeling of horror, anxiety, melancholy, helplessness, which are not inferior in strength to the emotional experiences suffered during the disaster.

As a rule, such an attack of experiences is combined with various disorders of the autonomic nervous system(increased blood pressure and heart rate, heart rhythm disturbances, palpitations, profuse cold sweat, increased diuresis, etc.).

Often there is a so-called flashback symptoms- the patient has a feeling that the past breaks into real life. The most characteristic illusions, that is, pathological perceptions of real-life stimuli. So, for example, the patient can hear the screams of people in the sound of wheels, distinguish the silhouettes of enemies in the twilight shadows, etc.

In severe cases it is possible episodes of visual and auditory hallucinations when a PTSD patient sees dead people, hears voices, feels the movement of a hot wind, etc. Flashback symptoms can cause inappropriate actions - impulsive movements, aggression, suicide attempts.

Influxes of illusions and hallucinations in patients with post-traumatic stress syndrome are most often provoked by nervous strain, prolonged insomnia, alcohol or drug use, although they can occur for no apparent reason, exacerbating one of the attacks of intrusive memories.

Similarly, the attacks of obsessive memories themselves often occur spontaneously, although more often their development is provoked by a meeting with some kind of irritant (key, trigger) that reminds the patient of a catastrophe.

At the same time, the keys have a diverse character and are represented by stimuli of all famous organs feelings (the sight of an object familiar from the catastrophe, characteristic sounds, smells, taste and tactile sensations).

Avoiding anything that might remind you of the tragic situation

As a rule, patients quickly establish a relationship between the clues and the occurrence of flashbacks, so they try their best to avoid any reminder of the extreme situation.

So, for example, PTSD patients who have survived a train accident often try to avoid not only traveling by this mode of transport, but also everything that reminds them of them.

Fear of memories is fixed at a subconscious level, so that patients with post-traumatic syndrome involuntarily "forget" many details of the tragic event.

Sleep disorders

The most characteristic sleep disturbance in post-traumatic syndrome are nightmares, the plot of which is an experienced emergency. Such dreams are of extraordinary vividness and are in many ways reminiscent of attacks of intrusive memories during wakefulness (an acute feeling of horror, emotional pain, helplessness, disturbances in the autonomic system).

In severe cases, frightening dreams can follow one after another with short period awakening, so that the patient loses the ability to distinguish between dream and reality. It is nightmares that, as a rule, force the patient to seek help from a doctor.

In addition, in patients with post-traumatic syndrome, there are non-specific, that is, observed in many other pathologies, sleep disorders, such as perversion of the rhythm of sleep (drowsiness during the day and insomnia at night), insomnia (difficulty falling asleep), disturbing superficial sleep.

Guilt

A common symptom of post-traumatic stress disorder is a pathological sense of guilt. As a rule, patients try to rationalize this feeling in one way or another, that is, they look for certain rational explanations for it.

Patients with anxious type of PTSD suffer from a disorder of social adaptation, which, however, is not associated with pathological changes in character traits, but with a severe psychological state and increased irritability. Such patients easily make contact and often seek medical help on their own. They are ready to discuss their problems with a psychologist, although in everyday life they avoid situations in every possible way that remind them of the trauma they have received.

Asthenic type post-traumatic stress disorder is characterized by a predominance of symptoms of exhaustion of the nervous system (in translation, asthenia means lack of tone) - symptoms such as weakness, lethargy, a sharp decline mental and physical performance.

Patients with asthenic type of PTSD are characterized by a loss of interest in life and a sense of their own inferiority. Attacks of obsessive memories are not so vivid, therefore, they are not accompanied by a feeling of horror and symptoms of a violation of the activity of the autonomic nervous system.

Such patients, as a rule, do not complain of insomnia, but it is difficult for them to get out of bed in the morning, and during the day they are often in a state of half-asleep.

As a rule, patients with asthenic type of post-traumatic syndrome do not avoid talking about their experiences and often seek medical help on their own.

Dysphoric type PTSD can be characterized as an angry-explosive state. Patients are constantly in a gloomy depressed mood. At the same time, their internal discontent breaks out from time to time in outbursts of unmotivated or poorly motivated aggression.

Such patients are closed and try to avoid others. They never make any complaints, so they come to the attention of doctors solely in connection with their inappropriate behavior.

somatophoric type post-traumatic syndrome, as a rule, develops with delayed PTSD and is characterized by the presence of a large number of heterogeneous complaints from the nervous and of cardio-vascular system as well as the gastrointestinal tract.

As a rule, such patients do not avoid communication with others, but do not turn to a psychologist, but to doctors of other profiles (cardiologist, gastroenterologist, neuropathologist).

Diagnosis of post-traumatic stress disorder

The diagnosis of post-traumatic stress disorder is established in the presence of the following criteria, which were developed during clinical observations of participants in military events and survivors of natural disasters.

1. The presence of the fact of varying degrees of involvement in an extreme situation of a catastrophic nature:

• the situation was real threat for the life, health and well-being of the patient and/or other people;
• stress reaction to the situation (horror, feeling of helplessness, moral feelings from the suffering of others).

2. Intrusive memories of the experience:

• vivid intrusive memories;
• nightmares, the plots of which are a traumatic situation;
• signs of "flashback" syndrome;
• a pronounced psychological reaction to a reminder of the situation (horror, anxiety, feeling of helplessness);
• symptoms of the reaction of the autonomic nervous system in response to a reminder of the situation (increased heart rate, palpitations, cold sweat, etc.).

3. The subconscious desire to "forget" about the catastrophe, to delete it from life:

• avoiding talking about the situation, as well as thinking about the disaster;
• avoidance of everything that can somehow trigger a memory of the situation (places, people, actions, smells, sounds, etc.);
• the disappearance from memory of many details about what happened.

4. Increased stress activity of the central nervous system:

• sleep disorders;
• increased irritability, outbreaks of aggression;
• decreased attention function;
• general anxiety, a state of hypervigilance;
• increased response to fear.

5. Sufficient retention time pathological symptoms(minimum one month).

6. Violations of social adaptation:

• decreased interest in activities that previously brought pleasure (work, hobbies, communication);
• decrease in emotional contacts with others up to complete alienation;
• lack of plans for the long term.

Post-traumatic stress disorder in children

Causes of post-traumatic illness in children

Children and adolescents are more sensitive to psychic trauma than adults, so they are much more likely to develop PTSD. This applies to absolutely all extreme situations that cause post-traumatic syndrome in adulthood (wars, disasters, abductions, physical and sexual violence, etc.).

In addition, many experts believe that the list of reasons for the development of post-traumatic stress disorders in children and adolescents should additionally include such extreme situations for them as:

• severe illness of one of the parents;
• death of one of the parents;
• boarding school.

Psychology of symptoms of post-traumatic stress in children

Like adults, children with post-traumatic stress try to avoid situations that are reminiscent of a tragic incident. They also often have emotional attacks when meeting with the key manifested by screaming, crying, inappropriate behavior. However, on the whole, flashes of memories during the day are much less common in children than in adults and are easier to bear.

Therefore, quite often, small patients try to relive the situation again. They are use plots of a traumatic situation for their drawings and games, which often become the same. Children and adolescents who have experienced physical violence often become aggressors in the children's team.

The most common sleep disorder in children is nightmares and daytime sleepiness, adolescents are often afraid to fall asleep and for this reason do not get enough sleep.

In children preschool age the psychology of post-traumatic stress includes such a feature as regression, when the child, as it were, returns back in his development and begins to behave like a child younger age (certain self-service skills are lost, speech is simplified, etc.).

Violations of social adaptation in children, in particular, are manifested in the fact that the child loses the opportunity to imagine himself as an adult even in fantasy. Children with PTSD become withdrawn, capricious, irritable, young children are afraid to part with their mother.

How to Diagnose Post Traumatic Stress Syndrome in Children

Diagnosis of post-traumatic stress syndrome in children is much more difficult than in adults. At the same time, the success of treatment and rehabilitation largely depends on timely medical intervention.

With a long course of PTSD, children significantly lag behind in mental and physical development, they develop an irreversible pathological deformation of character traits, adolescents earlier than adults develop a tendency to antisocial behavior and the development of various kinds of addictions.

Meanwhile, some extreme situations, such as, for example, physical and / or sexual abuse, may occur without the knowledge of the parents or guardians of the baby. Therefore, you should immediately seek medical help if the following alarming symptoms occur:

• nightmares, development of enuresis;
• sleep and appetite disturbance;
• monotonous games or drawings with a strange repetitive plot;
• inadequate behavioral response to certain stimuli (fright, crying, aggressive actions);
• loss of some self-care skills, the appearance of lisping or other behaviors characteristic of young children;
• unexpectedly arising or renewed fear of parting with the mother;
• refusal to attend kindergarten (school);
• lower academic performance in school-age children;
• constant complaints of teachers (educators) about attacks of aggression in a child;
• increased anxiety, startle when exposed to strong stimuli ( loud noise, light, etc.), fearfulness;
• loss of interest in activities that used to bring pleasure;
• complaints of pain in the region of the heart or in the epigastrium, sudden onset of migraine attacks;
• lethargy, weakness, drowsiness, avoidance of communication with peers and unfamiliar people;
• decreased ability to concentrate;
• prone to accidents.

Post Traumatic Stress Disorder: Treatment and Rehabilitation

Is there an effective drug therapy for post-traumatic stress disorder?

Drug therapy for post-traumatic stress disorder is carried out if there are indications, such as:

• constant nervous strain;
• anxiety with an increased response to fear;
• a sharp decrease in the general background of mood;
• frequent attacks of obsessive memories, accompanied by a feeling of horror and / or vegetative disorders (palpitations, a feeling of interruptions in the work of the heart, cold sweat, etc.);
• influx of illusions and hallucinations.

At the same time, it should be noted that drug therapy, unlike psychotherapy and psychocorrection, is never prescribed as independent method treatment. Medicines are taken under the supervision of a professional doctor and combined with psychotherapy sessions.

With a mild course of post-traumatic syndrome with a predominance of symptoms of nervous overstrain, sedatives (sedatives) are prescribed, such as corvalol, validol, valerian tincture, etc.

However, the effect of sedatives is insufficient to relieve severe symptoms of PTSD. Recently, antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Fevarin), have gained great popularity.

These drugs are characterized a wide range effects, namely:

• increase the general background of mood;
• return the desire to live;
• relieve anxiety;
• stabilize the state of the autonomic nervous system;
• reduce the number of attacks of intrusive memories;
• reduce irritability and reduce the likelihood of outbreaks of aggression;
• reduce cravings for alcohol.

Taking these drugs has its own characteristics: in the first days of the appointment, the opposite effect is possible in the form of increased anxiety. Therefore, SSRIs are prescribed in small doses, which are subsequently increased. For severe symptoms nervous tension in the first three weeks of admission, tranquilizers are additionally prescribed (phenazepam, seduxen).

The basic drugs for the treatment of PTSD also include beta-blockers (anaprilin, propranolol, atenolol), which are especially indicated for severe autonomic disorders.

In cases where outbreaks of aggression are combined with drug dependence, carbamazepine or lithium salts are prescribed.

With the influx of illusions and hallucinations against the background of constant anxiety, antipsychotics of a calming effect (chlorprothixene, thioridazine, levomenromazine) are used in small doses.

In severe cases of PTSD in the absence of psychotic symptoms, it is preferable to prescribe tranquilizers from the benzodiazepine group. With anxiety, combined with severe autonomic disorders, Tranxen, Xanax or Seduxen are used, and for nighttime anxiety attacks and severe sleep disorders, Halcyon or Dormicum is used.

In the asthenic type of post-traumatic syndrome, medicines from the group of nootropics (Nootropil, etc.), which have a general stimulating effect on the central nervous system.

These are relatively harmless medicines that do not have serious contraindications. However, it should be taken into account that side effect stimulation of the nervous system can be insomnia, so nootropics should be taken in the morning.

Psychotherapy for post-traumatic stress disorder

Psychotherapy is a must complex treatment post-traumatic disorder, which is carried out in several stages.

On the first, preparatory stage a trusting relationship is established between the doctor and the patient, without which it is impossible complete treatment. Psychologist in an accessible form provides information about the nature of the disease and the main methods of therapy, setting up the patient for a positive result.

Then proceed to the actual treatment of PTSD. Most psychologists believe that the development of post-traumatic syndrome is based on a violation of the processing of life experience of an extreme situation, so that instead of becoming the property of memory, the past continues to exist simultaneously with reality, preventing the patient from living and enjoying life.

Therefore, in order to get rid of obsessive memories, the patient should not avoid, but, on the contrary, accept and process this difficult life experience. There are many ways to help the patient make peace with your past.

Psychotherapeutic sessions bring good results, during which the patient re-experiences an extreme situation, telling about the details of the events to a professional psychologist.

In addition, methods of behavioral psychotherapy are quite popular, which aim to neutralize the trigger keys that initiate attacks, gradually "accustoming" the patient to them.

To do this, first, with the help of the patient, a kind of gradation of triggers is carried out according to the degree of impact on the psyche. And then, in the safe environment of a doctor's office, seizures are provoked, starting with the keys of the smallest initiating ability.

New promising methods for dealing with attacks of intrusive memories include a specially developed technique of rapid eye movements or the EMDR method (desensitization and processing by eye movements).

Parallel psychocorrection of feelings of guilt, attacks of aggression and self-aggression. In addition to the individual work of the patient with a psychologist, group psychotherapy sessions are successfully used, which are therapeutic interaction a doctor and a group of patients united by a common problem - the fight against post-traumatic stress disorder.

A variation of group psychotherapy is family psychotherapy, which is especially indicated for the youngest patients. In some cases, it is possible to achieve fairly rapid and lasting success in the treatment of PTSD in children with the help of neuro-linguistic programming.

As auxiliary methods of psychotherapy are most often used:

• hypnosis (suggestion);
• auto-training (self-hypnosis);
• relaxation methods (breathing exercises, oculomotor techniques, etc.);
• treatment with the help of fine arts (specialists believe that the positive effect of this method associated with the fact that patients get rid of their fears by depicting them on paper).

One of the characteristic signs of social maladjustment in post-traumatic stress disorder is the patient's lack of any plans for the future. So final stage psychotherapy for PTSD is advisory help of a psychologist in creating a picture of the future(discussion of the main life guidelines, the choice of immediate goals and methods for their implementation).

It should be noted that after the final stage, many patients continue to visit psychotherapy groups for patients with PTSD in order to consolidate the results of treatment and mutual assistance to fellow sufferers.

A method of treating PTSD in a child - video

Does PTSD require long-term treatment?

Post-traumatic syndrome requires a sufficiently long treatment, the duration of which depends primarily on the phase of the process.

For example, when a patient seeks medical care in acute phase PTSD, then the period of treatment and rehabilitation is 6-12 months, with a chronic type of course - 12-24 months, and in the case of delayed PTSD - more than 24 months.

If pathological changes in character traits have developed as a result of the post-traumatic syndrome, there may be a need for lifelong support from a psychotherapist.

Consequences of post-traumatic stress

Negative effects of post-traumatic stress include:

• psychopathization of the patient's personality (irreversible pathological change character traits that make it difficult for a person to adapt to society);
• development of secondary depression;
• the appearance of obsessions and phobias (fears), such as, for example, agoraphobia (fear of open space (square, etc.)), claustrophobia (panic when entering a closed space (elevator, etc.)), fear of the dark, etc. ;
• the occurrence of attacks of unmotivated panic;
• development of various kinds psychological addictions(alcoholism, drug addiction, gambling addiction, etc.);
• antisocial behavior (aggression towards others, criminalization of lifestyle);
• suicide.

Is it possible to determine the chances of a successful post-traumatic
rehabilitation

The success of post-traumatic rehabilitation in PTSD largely depends on the intensity of the traumatic factor and the degree of involvement of the patient in an extreme situation, as well as on the individual characteristics of the patient's psyche, which determine his ability to resist the development of pathology.

With a mild course of post-traumatic syndrome, spontaneous healing is possible. However clinical researches showed that patients with mild forms of PTSD undergoing rehabilitation courses recovered twice as fast. Besides, specialized treatment significantly reduced the likelihood of developing negative consequences of post-traumatic syndrome.

In the case of severe symptoms of post-traumatic stress, spontaneous healing is impossible. About a third of patients with severe forms of PTSD commit suicide. The success of treatment and rehabilitation largely depends on the following factors:

• timely access to medical care;
• support of the immediate social environment;
• the patient's mood for successful treatment;
• the absence of additional psychological trauma during the rehabilitation.

Is it possible to return the symptoms of post-traumatic shock after
successful treatment and rehabilitation?

Cases of recurrence of post-traumatic shock are described. As a rule, this happens under an unfavorable set of circumstances (psychological trauma, serious illness, nervous and / or physical strain, alcohol or drug abuse).

Relapses of post-traumatic stress disorder most often proceed like a chronic or delayed form of PTSD and require long-term treatment.

To avoid the return of symptoms of post-traumatic shock, it is necessary to lead a healthy lifestyle, avoid stress, and when the first symptoms of psychological distress appear, seek help from a specialist.

Psychological assistance to survivors of an extreme situation as
prevention of post-traumatic stress disorder

The clinic of post-traumatic stress disorder is characterized by the presence of a latent period between exposure to a traumatic factor and the appearance of specific symptoms of PTSD (flushes of memories, nightmares, etc.).

Therefore, the prevention of the development of post-traumatic stress disorder is the counseling of survivors of post-traumatic shock, even in cases where patients feel quite satisfactory and do not present any complaints.

Before use, you should consult with a specialist.

A PHOTO Getty Images

It is known that post-traumatic stress disorder (PTSD) affects an average of 8-9% of the population, but among doctors this figure is higher. For example, PTSD develops in 11–18% of military medics and approximately 12% of emergency physicians. medical care. It is logical to assume that psychiatrists are also at risk, who have to regularly observe the consequences of severe mental disorders and inadequate, and even dangerous, behavior of patients.

Professor clinical psychiatry New York medical center SUNY, MD Michael F. Myers presented a paper titled "The Hidden Epidemic of PTSD Among Psychiatrists" at the American Psychiatric Association Convention in Toronto.

In his report, Michael Myers argues that PTSD can develop in both inexperienced physicians still in training and experienced professionals. The problem begins in medical educational institutions where there is a certain culture of hazing towards students that some believe helps prepare them for the future hardships of medical practice, but such treatment can lead to psychological trauma and, in some cases, contribute to the development of PTSD. Medical students also find themselves in potentially traumatic situations when they first observe severe illness, injury and death of patients - especially when it comes to children and young people. Psychiatrists also have to observe manifestations of severe mental disorders.

The timely diagnosis of PTSD in psychologists is hampered by the denial of the problem by the doctors themselves and society as a whole. To combat this problem, Michael Myers suggests changing the medical culture - in particular, helping medical students be better prepared for potentially shocking situations. Physicians who have been traumatized should be encouraged to seek help and begin therapy as soon as possible. We need to abandon the outdated notion that doctors are not susceptible to PTSD. It is important for physician colleagues to accept the fact that individual manifestations of symptoms may remain after treatment, and this should be treated with understanding.

For a psychologist who is to treat his own colleague for PTSD, it is important to first understand whether the patient is ready to accept the possibility of such a diagnosis. It is also necessary to clarify how the manifestations of the disorder interfere with professional activities.

Referring to the psychologists themselves, Michael Myers recalls the principle "Physician, heal thyself." He suggests that doctors who suspect they have symptoms of PTSD should seek the help of a colleague, and emphasizes that such a disorder does not mean the end of a career. On the contrary, treatment can help the doctor to continue to perform his professional duties effectively.

For more information see Michael F. Myers "PTSD in Psychiatrists: A Hidden Epidemic", American Psychiatric Association (APA) 168th Annual Meeting, May 2015.