Psychology of Trauma PTSD: Diagnosis and Treatment

The PTSD diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association was revised. The criteria for diagnosis for PTSD include exposure history to traumas that are qualified by specified stipulations and signs from a cluster of four: negative alterations, avoidance, intrusion, mood, changes are arousal creativity and alterations in cognitions. The sixth edition contains the time span the symptoms, the seventh one is concerned with the functioning, the eight states clearly states the symptoms that are not attributable to substances or a medical condition that occurs at the same time (American Psychiatric Association, 2013).

Effective diagnosis of PTSD requires observation of several criteria. The clinician should establish that the patient was, indeed exposed to a traumatic experience and manifest symptoms of that can be linked to trauma from the cluster of four following symptoms:

Intrusion

Avoidance

Alterations in arousal creativity

Alterations in cognitions

The sixth criterion relates to the time the symptoms have lasted. They should have been observed for a minimum period of one month following the traumatic experience.

The seventh criterion states that the symptoms must affect the daily functioning of the individual. The distress must be impairing. The eight criterion states that the symptoms should not be attributable to a medical condition that is co- occurring. The DSM-V criteria states that that a potential traumatic stressor should incorporate exposure to death threat, death, threatened or serious injury and threatened or actual sexual violence. Such exposure is possible in four ways

i. Directly

ii. direct witnessing iii. learning directly that a close relation or friend has been subjected to actual or threatened trauma

iv. Extreme or repeated exposure to distressing details of the experience (Greenberg, Brooks & Dunn, 2015).

The interview should reveal information that meets specified criteria in order for the clinical to make a formal diagnosis. PTSD diagnosis may be subclinical (he criteria may be close but not quite fully met). Virginia's case was subclinical

DSM-5 diagnostic criteria

PTSD diagnostic follows on 8 criteria derived from DSM-5. The initial 4 DSM criteria constitutes four elements:

Experiencing the traumatic event directly

First person witnessing

Getting to know that the traumatic experience affected a close relative such as one's mother

Being subjected to extended or repeated details of traumatic experience. Such experience excludes media such as pictures, TV or movies.

The subsequent criteria entail persistent exposure in any of the following ways

Perception or thought

Hallucinations or illusions

Dissociative flashback episodes

Images

Reaction to signs that relate to the event or intensive psychological distress

Children re-experience via repetitive play. This is different from the way adults re-experience.

The next Criterion (third) entails avoiding any stimuli that is associated with the trauma and even the numbing of responsiveness as pointed out by the observation of any of the following two

i. Someone avoiding any feelings or thoughts linked to the event

ii. Avoiding places, people, feelings or talk that relate to that event

The fourth criterion meets the following signs of negative alterations in mood and cognitions relating to the traumatic event.

i. Repeated and persistent negative perception of life and oneself or others.

ii. Negative emotional state that is persistent iii. Listlessness in participating in activities that matter

iv. Detachment or estrangement from other people

v. Persistent failure to experience positive thoughts or emotions

The fifth criterion relates to alteration in reactivity as exhibited by Angry outbursts and irritable behaviour

Self-destructive behaviour or recklessness

Hyper-vigilance

The last three criteria entail:

The symptoms exceed one month

The condition leads to clinically significant distress to the individual or even impairs functionality

The disturbance cannot be traced to the effects of a substance or some other medical condition First DSM Diagnostic Criteria (American Psychiatric Association, 2013)

Vignette Analysis

Virginia is a 45-year-old African-American who remembers her dad beating her mom. "It seemed as though it was on daily basis but it was just frequent." She says that her dad parted ways with her mom when she was 8 years old after meeting a young skinny woman. Virginia's mother, in turn, married a careless man with a son who thought that Virginia was a sex toy for him and friends (Virginia was 13 years then). Although Virginia tried revealing her experiences to her mother, her mother insisted that she keep quiet about it. Virginia...

Currently, Virginia is married to a man who happens to be her second husband. They have been together for 6 years. She says she has had a history of turmoil and relationships that have been abusive. It is clear from the vignette that the patient suffers from PTSD
Couple and family therapy

There are many therapies available to treat PTSD patients. For this 45-year-old mother and wife, the ideal option for her is couple and family therapy. PTSD distress not only hurts the victim subjected to the trauma but also negatively affects their family. Their spouses or partners are the ones usually caught in this distress. Virginia admits that she has no idea why her man condones her. He is the great father she never had. Virginia feels that she deserves love and should love back in turn, but she is apprehensive of allowing her man to get close to her (emotionally, and physically) since she is afraid he might then leave her. Family members may be incorporated in the therapy that is called generic couple therapy.

The approach seeks to improve functioning of relationship. It is the one generally applied in family therapy for mentally ill adults by most clinicians. Improving relationship functioning help reduce a patient's PTSD symptoms. It also enhances the well-being and health of family members. It does so by reducing the recurrent stress that has been affecting their relationships.

The approach aims to improve the relationship and does not target particular mechanisms that could be maintaining the disorder. Therefore, family therapy is used here as an adjunctive therapy. Other therapies should be applied alongside this approach for the treatment of PTSD symptoms. Partner assisted interventions may also be applied to family members in which they are used as surrogate coaches for the therapist. The approach is educative to the family members concerning the reason behind therapy. This way they will support the patient actively or boost he therapies designed for the individual. These interventions do not focus on relational maters; rather, the delivery of the interventions is more important.

Family members may also take part in disorder-specific family therapies. These therapies have dual and simultaneous objectives of enhancing positive relationship and reducing PTSD. In order to attain maximum effectiveness, the interventions are tailored in such a way that they target the mechanisms that lead the development of the PTSD condition and the distress in relationships (Friedman, Keane & Resick, 2014).

Emptiness on the Inside

A research on the psychological effects of bullying, incorporating children and adults, exposure to abusive and lasting behaviour has been linked to a myriad of negative health effects. These are both somatic and psychological symptoms (Nielsen et al., 2015). Emotional neglect of children can lead to complex forms of PTSD. Virginia's father left when she was only 8. Although she requested him to stay, he laughed and left any way. The persistent emotional neglect led to her psyche becoming a quagmire of empty thoughts, shame and fear. This affliction keeps replaying in her mind in adulthood. She understands it and lives through these childhood experiences yet again in her mind in adulthood. Such understanding is necessary if the persistent disturbance is to be averted or reduced. Virginia's emotional intelligence and the accompanying relational intelligence never really developed. She never learnt in childhood that relating with a healthy individual could be a source of comfort. Additionally, she was never guided to manage her emotions needed to sustain relationships. Therefore, her emotional intelligence regarding the functional and healthy elements of anger, fear, distress and sadness is empty and lacks discipline (Walker, n.d).

Minimization, that relates to the neglect of Virginia's emotional intelligence modelling drives the dynamics in her case of PTSD. She feels worthless because she grew up emotionally neglected. She felt unloved, empty, and was generally uncomfortable in her dispensations with normative worldly affairs. She was starved of human comfort and warmth. She hungers and impulsively craves for substances and addictive practices (Walker, n.d). Virginia succumbs to her emptiness and the fear of disintegrating. She is terrified from within

Unresolved loss and trauma

Psychological trauma puts an end to innocence. It makes an individual cast doubt on life. One doubts whether there is meaning or hope and safety in life. One does not believe that there is a safe retreat in the world. There is total disillusionment. The mind is usually unable to process traumatic experiences. The patients therefore cannot digest or integrate negative experiences to fruitful outcomes. This means that the trauma assumes an independent shape and life and haunts the individual continually until they seek help from experts (Margolies, 2010).

Virginia says that she learnt that if she cut herself, the pain would be taken away. Any self-inflicted injury of any severity is regarded as self-harm. Self-harm is usually a desperate attempt to cope with the psychological or emotional distress…