Posttraumatic stress disorder Posttraumatic stress disorder (PTSD)(PTSD)

Basically anxiety disorderBasically anxiety disorder Can happen after experiencing a situation, Can happen after experiencing a situation,

which constitute heavy stress and emotional which constitute heavy stress and emotional load, surpass usual human experience and load, surpass usual human experience and would be traumatizing for most of the people would be traumatizing for most of the people

Main symptoms are posttraumatic flashbacks, Main symptoms are posttraumatic flashbacks, avoidant behaviour and non-specific avoidant behaviour and non-specific symptoms like sleep and mood disorderssymptoms like sleep and mood disorders

Trauma – definitionTrauma – definition Trauma happens in case of existence of a such external Trauma happens in case of existence of a such external

stimulus, which evokes extreme horror and shock, entails stimulus, which evokes extreme horror and shock, entails immediate experiencing of life imperilment or body and/or immediate experiencing of life imperilment or body and/or psychic integrity, brings feeling of helplessness, impossibility psychic integrity, brings feeling of helplessness, impossibility to escape, inconceivability.to escape, inconceivability.

Reaction of the organism is more important than the stimulus Reaction of the organism is more important than the stimulus which causes trauma (it depends on our interpretation, if we which causes trauma (it depends on our interpretation, if we perceive some stimulus as traumatogenic and the other not). perceive some stimulus as traumatogenic and the other not).

Developmental trauma in comparison to a shock trauma Developmental trauma in comparison to a shock trauma happens in a long time span, often in a period of preverbal happens in a long time span, often in a period of preverbal development. Usually, most patients are not aware of it.development. Usually, most patients are not aware of it.

There is a difference between cause and trigger of traumaThere is a difference between cause and trigger of trauma

Factors influencing traumaFactors influencing trauma The situations itself, its lenght, intensity, frequencyThe situations itself, its lenght, intensity, frequency The individual – age, somatic and psychic health, The individual – age, somatic and psychic health,

tolerance to stresstolerance to stress Life context in the situations of traumaLife context in the situations of trauma Life experiencies (failures, achievements)Life experiencies (failures, achievements) Learned capabilities to cope with traumatogenic Learned capabilities to cope with traumatogenic

situationssituations Self-confidence and availibility of resources of Self-confidence and availibility of resources of

support (external resources -personality, internal support (external resources -personality, internal resources, social network)resources, social network)

Faith, valuesFaith, values

Traumatogenic factors ITraumatogenic factors I Natural catastropheNatural catastrophe Loss of close personLoss of close person Infidelity, divorce, loss of childInfidelity, divorce, loss of child Accidents, injuriesAccidents, injuries Physical and psychical bullyingPhysical and psychical bullying Neglect (childrens, older persons) Neglect (childrens, older persons) Assault, kidnap, blackmail (or just perceiving these acts)Assault, kidnap, blackmail (or just perceiving these acts) Unintentional killingUnintentional killing Iatrogenic traumatisation due to way of giving informations to Iatrogenic traumatisation due to way of giving informations to

patientpatient

Traumatogenic factors IITraumatogenic factors II

Intrauterine trauma, child birth traumaIntrauterine trauma, child birth trauma Disease, high temperature (febrile smasms), random Disease, high temperature (febrile smasms), random

intoxications, loss of orientation, apneusis)intoxications, loss of orientation, apneusis) Abortion, interruptionAbortion, interruption Some medical, chirurgic, stomatologic operations Some medical, chirurgic, stomatologic operations

(tonsilectomia) (tonsilectomia) Anaesthesia, narcosis Anaesthesia, narcosis Loss of intimacy, dehumanization (doctor´s round)Loss of intimacy, dehumanization (doctor´s round) Long-term fixation of limbs, immobility Long-term fixation of limbs, immobility Dying, or experience of dyingDying, or experience of dying

Symptoms of traumaSymptoms of trauma

Excessive irritability (also light, sound,pain), Excessive irritability (also light, sound,pain), alertnes, hyperactivity alertnes, hyperactivity

Withrawal, dissociation, feeling helplessWithrawal, dissociation, feeling helpless flashbacks flashbacks Sleep disorders, fear of darkness, nightmaresSleep disorders, fear of darkness, nightmares Swings of mood and energy, excessive Swings of mood and energy, excessive

emotional reactions or no reactionsemotional reactions or no reactions Panic, anxiety, phobiaPanic, anxiety, phobia

Symptoms of trauma IISymptoms of trauma II

Psychical emptiness, derealisation avoidance Psychical emptiness, derealisation avoidance behaviourbehaviour

fascination with dangerous situationsfascination with dangerous situations frewuent cryingfrewuent crying excessive or diminished sexuality excessive or diminished sexuality Amnesia, memory disordersAmnesia, memory disorders Loss of ability tu love, care of others, make friends Loss of ability tu love, care of others, make friends fear of intimacyfear of intimacy fear of going insanefear of going insane

Symptoms of trauma IIISymptoms of trauma III

Excessive or no shyness Excessive or no shyness Inability to keep a promise Inability to keep a promise Chronic fatigue or lack of energy Chronic fatigue or lack of energy Feelings of isolation, derealisation Feelings of isolation, derealisation Jubilee syndromJubilee syndrom

Characteristics of burns – patients with experienceCharacteristics of burns – patients with experienceof psycho-trauma or high stress in their historyof psycho-trauma or high stress in their history

Anxieties, mood swings, tension, low ability or inability to relax, abnormal Anxieties, mood swings, tension, low ability or inability to relax, abnormal emotional reactions regarding timing and intensity.emotional reactions regarding timing and intensity.

Regressive behaviour, alexithymia, psychosomatic problems.Regressive behaviour, alexithymia, psychosomatic problems. Too high or too low abashmend.Too high or too low abashmend. Unability to plan and to orient oneself on future.Unability to plan and to orient oneself on future. Abnormal sensitivity to pain (too high or too low pain threshold).Abnormal sensitivity to pain (too high or too low pain threshold). Abnormal or weak reaction to psychiatric medication.Abnormal or weak reaction to psychiatric medication. Resistance to psychological treatment (banal informations, avoidance).Resistance to psychological treatment (banal informations, avoidance). Little or no ability to follow voluntarily procedures prescribed by Little or no ability to follow voluntarily procedures prescribed by

specialists.specialists. Hazardous behaviour, frequent injuries, accidents or selfinfliction, signs of Hazardous behaviour, frequent injuries, accidents or selfinfliction, signs of

deprivation, dependency behaviour in the patients´ history.deprivation, dependency behaviour in the patients´ history. Dysfunctional family (often masked by family members).Dysfunctional family (often masked by family members).

Research on traumaResearch on trauma Delinquency. According to the research, children which experienced Delinquency. According to the research, children which experienced

developmental trauma, have disorders of attention, of recognition of social danger, developmental trauma, have disorders of attention, of recognition of social danger, disorders of perceiving of space (depth, lenght), of gross and fine motoric activity. disorders of perceiving of space (depth, lenght), of gross and fine motoric activity. Consequently, they suffer from injuries more often than other children. For Consequently, they suffer from injuries more often than other children. For example, almost 20 % of youth in South America´s favelas die because of example, almost 20 % of youth in South America´s favelas die because of hazardeous games, such as ridding on the roof of the train in front of tunnels. These hazardeous games, such as ridding on the roof of the train in front of tunnels. These children are often traumatized by their deficient social enviroment. children are often traumatized by their deficient social enviroment.

Alcoholism. As far as 90 % of women – alcoholics, are in fact PTSD, similarly Alcoholism. As far as 90 % of women – alcoholics, are in fact PTSD, similarly many drug users. many drug users.

Also border-line, dissociative (multiple), narcistic personality disorder, bipolar Also border-line, dissociative (multiple), narcistic personality disorder, bipolar behaviour (in fact alternating of alfa-activation and beta- avoidance stress reaction) behaviour (in fact alternating of alfa-activation and beta- avoidance stress reaction) can be the consequences of trauma.can be the consequences of trauma.

Disorders of body sensitivity, automutilations, also prostitutionDisorders of body sensitivity, automutilations, also prostitution Pseudo-inflammations of tendons (carpal tunnel, tennis elbow, tendon of Achilles)Pseudo-inflammations of tendons (carpal tunnel, tennis elbow, tendon of Achilles) Multiple sclerosisMultiple sclerosis Algic syndrom, somatizations in various musclesAlgic syndrom, somatizations in various muscles Chronic fatigue syndromChronic fatigue syndrom Polyartritis, thyroid gland, kidneys etc….Polyartritis, thyroid gland, kidneys etc….

Ethical problemsEthical problems

Many patient´s can be traumatized by their injury, Many patient´s can be traumatized by their injury, illness or due to other life experiences preceding illness or due to other life experiences preceding medical treatment. This is not often recognized and medical treatment. This is not often recognized and properly treated with respect.properly treated with respect.

Many patient´s can be traumatized or retraumatized in Many patient´s can be traumatized or retraumatized in the context of medical treatment and because of the the context of medical treatment and because of the variability of trauma symptoms, this is often even not variability of trauma symptoms, this is often even not recognized by the medical staff or even by the patient recognized by the medical staff or even by the patient himself.himself.