Post-Traumatic Stress Disorder

When assessing accident victims for the purpose of developing a life care plan, regardless of the nature of their trauma, one commonly reported and diagnosed disorder is Post Traumatic Stress Disorder (PTSD). PTSD is a mental illness that “involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence” (https://cmha.ca/documents/post-traumatic-stress-disorder-ptsd). Traumatic experiences cause a great level of distress and feelings of powerlessness for the victim; traumatic events often involve exposure to life-threatening experiences, such an accident.

People who suffer from PTSD often have intrusive symptoms, such as re-experiencing the accident, nightmares or flashbacks of the accident, etc. They often avoid things that remind them of the accident. For instance, people who have been in a bad car accident might avoid driving as they find it too distressing.

The DSM-V criteria for a diagnosis of PTSD are as follows:

Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related reminders

Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.
Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Source: https://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp

Recommended Treatments:

When formulating recommendations for an individual who suffers from PTSD, a common treatment option involves referral to psychotherapy. “Trauma-focused psychotherapies are the most highly recommended type of treatment for PTSD” (https://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp). These treatments focus on the memory of the event and the meaning(s) attached to it. Several techniques are used to help victims process their experiences and modify unhealthy beliefs they may have about their experience or trauma.

Trauma-focused psychotherapies with the strongest empirical evidence include:

  • Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Eye-Movement Desensitization and Reprocessing (EMDR)

Source: https://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp

Course of Treatment: Typically, 8-16 sessions.

Other types of trauma-focused psychotherapy recommended for people with PTSD include: Brief Eclectic Psychotherapy, Narrative Exposure Therapy, Written Narrative Exposure and Specific cognitive behavioral therapies for PTSD

Pharmacological Intervention:
In addition to psychotherapy, medications that have proven efficacious for treating PTSD are sometimes used to treat anxiety and depression as well.

Other Recommendations:
When the individual suffering from PTSD experiences phobias or anxiety when driving or traveling as a passenger, it may be helpful to participate in a Driver Assessment and Rehabilitation.

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