Post-Traumatic Stress Disorder (PTSD)

People who have witnessed the Beirut Blast are at high risk of developing PTSD

Post-Traumatic Stress Disorder (PTSD) is triggered by the exposure to a traumatic stressful event which may lead to possible death, serious injury or sexual violation.

There are different types of exposures to traumatic events:

• Directly experiencing the traumatic event
• Witnessing the traumatic event in person
• Learning that the traumatic event occurred to a close family member or friend
• Experiencing first-hand repeated or extreme exposure to details of the traumatic event (not through media, pictures, television, movies, etc.)

Traumatic event reactions are normal responses to abnormal situations that any individual might face. The persistence and severity of those responses dictate the different etiologies leading to PTSD

If within 3 days to 1 month following the traumatism symptoms appear, then Acute Stress Disorder (Trauma and Stressor-related Disorder” (DSM-5) is diagnosed and can be treated by immediate psychotherapy (Psychological First Aid).

The degree of the trauma’s psychological impact on each individual depends on:

• Gender (risk is increased in women
• Prior traumatic exposure
• Pre-existing mental illness or childhood adversity
• Low educational attainment and low socio-economic status
• The type and characteristics of the trauma (severity, nature, repetition)
• Direct consequences of the trauma (material damage, creation of other stressors like financial problems and consequences on daily life)
• Lack of support
• Sociocultural factors (stigma regarding seeking help, etc.)

If symptoms persist for over 1 month following the traumatism, a diagnosis of PTSD can be made

PTSD’s symptoms fall into four categories (intrusive memories, avoidance, alteration in cognition and mood, and changes in arousal and reactivity) and vary chronologically and from person to person depending on every case and every event.

Type 1: Intrusive memories

• Recurrent, unwanted distressing memories of the traumatic event
• Vivid flashbacks, reliving the traumatic experience
• Nightmares about the traumatic event
• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Type 2: Avoidance

• Trying to resist thinking or talking about the traumatic event
• Avoiding reminders of the traumatic event (places, activities or people)

Type 3: Alteration in cognition and mood

• Negative thoughts about yourself, other people or the world
• Hopelessness about the future
• Memory problems
• Difficulty maintaining close relationships
• Lack of interest in activities once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

Type 4: Changes in arousal and reactivity

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior
• Trouble sleeping, concentrating
• Irritability, angry outbursts or aggressive behavior

PTSD’s diagnosis is attentively given based on several criteria and history taking from the patient’s previous exposures. Witnessing a traumatic event, finding symptoms of one of the four listed categories, recognizing symptoms persisting for more than one month, perceiving functional, social and occupational impairments of normal life, and identifying disturbances not related to other all could correlate to PTSD. Moreover, depression, substance abuse, eating disorders, memory problems, suicidal thoughts and stressful environments are deeply and strongly associated with PTSD.

The first-line treatment is psychotherapy, but can also include medications if necessary. Combining these treatments can help improve symptoms by:

• Teaching skills to address symptoms
• Allowing you to think better about yourself, others and the world
• Learning ways to cope if any symptoms arise again
• Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs

Some types of psychotherapy used in PTSD treatment include:

• Cognitive therapy: Helps in recognizing one’s ways of thinking (cognitive patterns
• Exposure therapy: Helps in facing both situations and memories to cope more effectively
• Eye movement desensitization and reprocessing (EMDR): EMDR combines exposure therapy with a series of guided eye movements that help in processing traumatic memories
• Group therapy sessions have been shown to be more effective than individualized ones especially in stress management skills.

Medications in PTSD’s therapy are not used in every case. Their use depends on the severity and chronological development of the disease with every patient. People diagnosed with PTSD after one month usually undergo psychotherapy exclusively as a first step in improvement. If the patients don’t improve after 3 months or more of exclusive psychotherapy, then they are selectively and cautiously given medical treatment to help them through their recovery. Such medications are usually FDA-approved and given with thorough follow up sessions.

 To name a few medications:

• Antidepressants: Help improve sleep problems and concentration. e.g: The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil)
• Anti-anxiety medications: Relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short period of time. e.g: Benzodiazepines, Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam)
• Prazosin (Minipress) : an alpha-blocker. May reduce or suppress nightmares in some people with PTSD.

Please consult with your health care provider before using any medications listed above