Post-Traumatic Stress Disorder PTSD Diagnosis and Treatment

Written by HealthyPlace.com Staff Writer

online conference transcript

Dr. Darien Fenn, our guest, is an expert in trauma psychology. The discussion focused on the causes, symptoms and treatment of PTSD (Post Traumatic Stress Disorder).

David Roberts: HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Post-Traumatic Stress Disorder, (PTSD)." Before I introduce our guest, here is some basic information on PTSD. You can also visit the HealthyPlace.com Abuse Issues Community.

Our guest is Dr. Darien Fenn, who is a clinical psychologist in private practice in Wilsonville, Oregon. He is also an assistant professor of psychiatry and a research psychologist with the Department of Psychiatry at the Oregon Health Sciences University in Portland. Dr. Fenn has written many articles on depression and suicide and is an expert in the field of trauma psychology.

Good evening, Dr. Fenn and welcome to HealthyPlace.com. We appreciate you being our guest tonight. I have read that many times PTSD is misunderstood or misdiagnosed. So, I'd like to start with you giving us a general overview of what PTSD is and is not?

Dr. Fenn: Hi, and thanks for the introduction. PTSD is one of a spectrum of anxiety disorders. Unlike most psychiatric diagnoses, PTSD is tied to a specific event. Although we usually think of the event as traumatic, it is not always that way. PTSD has been seen after assaults, disasters, witnessing a trauma, chronic stress, chronic illness, and even sometimes after learning of a severe illness. PTSD is closely related to Acute Stress Disorder (ASD). The main difference being that ASD is what you get if the trauma is recent (30 days or less), and PTSD is what you get if it goes longer. The disorder is characterized by four types of symptoms:

1. Re-experiencing - which can include the classic flashback symptom.
2. Avoidance - usually of places or reminders of the trauma, but sometimes also avoidance of the memories of the trauma.
3. Emotional numbing - when people's emotions seem to shut down.
4. Arousal - including jumpiness, difficulty concentrating, anger, and sleep problems.

David: What is it in the individual that leads to PTSD? To clarify, two people can suffer from a similar traumatic event, let's say sexual abuse, but one will develop PTSD, the other will not. Why is that?

Dr. Fenn: That's one of the most interesting things about the disorder, is that some people "don't" get it, even after terrible traumas, and sometimes side-by-side with someone that does get it. There are a number of factors that seem to matter.

1. First, there does seem to be "some" genetic predisposition, but this is not a big part of it.
2. More important seems to be psychological factors, such as whether the victim thinks they are going to die.
3. Also, people who have a past history of psychological problems are more vulnerable.
4. Depression also adds an increment of risk.
5. Post-Traumatic Stress Disorder seems to stem primarily from a hormonal response to the trauma. Hormones released into the brain can create a long-lasting chemical imbalance that is responsible for many of the symptoms. People who have more of this surge of stress hormones seem to be at more risk.
6. Also, trauma experiences are cumulative. If you have more than one, you are more and more sensitive, so they seem to be additive.

Then, there is a separate set of factors that relate to how the person reacts to the initial symptoms.

1. People who dissociate (space out the emotional reaction) are at risk for lingering PTSD,
2. people who ruminate over the incident (why me), are chronically angry about the experience,
3. or people that have some chronic reminder of the trauma, such as a lingering physical disability, or sometimes even involvement in the legal system itself.

David: So, what may be extremely stressful for one person experiencing an event, may be better psychologically handled by another. Is that what you are saying?

Dr. Fenn: Yes, and in truth, for the most part, we don't know why.

David: We have a lot of audience questions, Dr. Fenn. Let's get to a few, then we'll continue with the conversation:

angel905d: How long does PTSD last?

Dr. Fenn: Post-Traumatic Stress Disorder seems to have a natural course for healing on its own. Some studies done with auto accident victims show that about 60% of people who initially have PTSD get over it within the first six months. After that, however, things pretty much level off. There appear to be something upwards of 20% that go into a chronic course. In chronic PTSD, symptoms have been found to persist in concentration camp survivors (more than 50 years!). So, without treatment, the condition can become pretty persistent.