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Post-traumatic stress disorder. Post-traumatic syndrome or post-traumatic stress disorder (PTSD) - causes, symptoms, diagnosis, treatment and rehabilitation What is PTSD in humans

Post-traumatic stress disorder (PTSD), like acute stress disorder, is characterized by the onset of symptoms immediately after a traumatic event. Consequently, patients with PTSD always exhibit new symptoms or changes in symptoms that reflect the specific nature of the trauma.

Although people with PTSD attribute varying levels of significance to the event, they all experience symptoms related to the trauma. The traumatic event that leads to the development of post-traumatic stress disorder usually involves experiencing the threat of one's own death (or injury) or being present at the death or injury of others. When experiencing a traumatic event, individuals who develop PTSD should experience intense fear or terror. Similar experiences can be experienced by both a witness and a victim of an accident, crime, combat, attack, child theft, or natural disaster. Post-traumatic stress disorder can also develop in a person who learns that he has a terminal illness or who experiences repeated physical or sexual abuse. There has been a direct relationship between the severity of psychological trauma, which, in turn, depends on the degree of threat to life or health, and the likelihood of developing post-traumatic stress disorder.

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ICD-10 code

F43.1 Post-traumatic stress disorder

What Causes Post-Traumatic Stress Disorder?

Post-traumatic stress disorder is sometimes thought to occur after an acute reaction to stress. However, post-traumatic stress disorder can also develop in people who did not show any mental disorders after a disaster (in these cases, post-traumatic stress disorder is considered as a delayed reaction to the event). Post-traumatic stress disorder occurs somewhat less frequently in people who have previously experienced disasters. due to repeated minor mental trauma. Some people who have experienced an acute stress reaction develop post-traumatic stress disorder after a transition period. At the same time, disaster victims often develop the idea that human life is of little value.

Research into PTSD is a relatively new trend and is likely to become increasingly important in forensic psychiatry. There have already been references to post-traumatic stress disorder as a psychological harm in cases of stalking. Childhood trauma, physical abuse, and especially child sexual abuse are closely associated with the transformation of victim to perpetrator and rapist in adulthood. The model of borderline personality disorder suggests a direct causal relationship with long-term and repeated trauma from primary caregivers during childhood. Such prolonged and repeated trauma can greatly impact normal personal development. In adult life, acquired personality disorder may be associated with repeated episodes of maladaptive or violent behavior that “re-enact” elements of childhood trauma. Such individuals are often found in prison populations.

Several characteristics of PTSD are associated with crime. Thus, sensation-seeking (“trauma addiction”), seeking punishment to alleviate feelings of guilt, and the development of comorbid substance abuse are associated with crime. During flashbacks (intrusive re-experiencing), a person may react in an extremely violent manner to environmental stimuli that are reminiscent of the original traumatic event. This phenomenon was noted among participants in the Vietnam War and among police officers, who may react with violence to some stimulus that reflects the situation “on the battlefield.”

How does post-traumatic stress disorder develop?

Because PTSD is a behavioral disorder resulting from direct exposure to trauma, understanding its pathogenesis requires reference to numerous studies of traumatic stress in experimental animals and humans.

Hypothalamic-pituitary-adrenal axis

One of the most commonly identified changes in post-traumatic stress disorder is dysregulation of cortisol secretion. Role hypothalamic-pituitary-adrenal axis (HPA) in acute stress has been studied for many years. A large amount of information has been accumulated on the effects of acute and chronic stress on the functioning of this system. For example, it was revealed: although during acute stress there is an increase in the level corticotropin-releasing factor (CRF), adrenocorticotropic hormone (ACTH) and cortisol, there is a decrease in cortisol release over time, despite an increase in CRF levels.

In contrast to major depression, which is characterized by a violation of the regulatory function of the HPA axis, post-traumatic stress disorder reveals increased feedback in this system.

Thus, patients with post-traumatic stress disorder have lower cortisol levels during its normal daily fluctuations and higher sensitivity of corticosteroid receptors of lymphocytes than patients with depression and mentally healthy individuals. Moreover, neuro-endocrinological tests show that in post-traumatic stress disorder there is increased ACTH secretion with the administration of CRF and increased cortisol reactivity in the dexamethasone test. It is believed that such changes are explained by dysregulation of the HPA axis at the level of the hypothalamus or hippocampus. For example, Sapolsky (1997) argues that traumatic stress, through its effect on cortisol secretion, causes hippocampal pathology over time, and MRI morphometry shows that hippocampal volume reduction is observed in PTSD.

Autonomic nervous system

Since hyperactivation of the autonomic nervous system is one of the key manifestations of post-traumatic stress disorder, research has been undertaken on the noradrenergic system in this condition. When yohimbine (an alpha2-adrenergic receptor blocker) was administered, patients with post-traumatic stress disorder experienced flashbacks and panic-like reactions. Positron emission tomography suggests that these effects may be due to increased sensitivity of the noradrenergic system. These changes can be associated with data on HPA tract dysfunction, taking into account the interaction of the HPA axis and the noradrenergic system.

Serotonin

The clearest evidence for the role of serotonin in PTSD comes from pharmacological studies in humans. There is also evidence from animal models of stress that also suggests the involvement of this neurotransmitter in the development of post-traumatic stress disorder. It has been shown that environmental factors can have a significant impact on the serotonergic system of rodents and great apes. Moreover, preliminary data show that there is a connection between the external conditions of raising children and the activity of their serotonergic system. At the same time, the state of the serotonergic system in post-traumatic stress disorder remains poorly understood. Additional research is needed using neuroendocrinological tests, neuroimaging, and molecular genetic methods.

Conditioned reflex theory

It has been shown that post-traumatic stress disorder can be explained based on the conditioned reflex model of anxiety. In post-traumatic stress disorder, deep trauma can serve as an unconditioned stimulus and could theoretically influence the functional state of the amygdala and associated neural circuits that generate feelings of fear. Overactivity of this system may explain the presence of flashbacks and a general increase in anxiety. External cues associated with trauma (eg, sounds of battle) can serve as conditioned stimuli. Therefore, similar sounds through the mechanism of a conditioned reflex can cause activation of the amygdala, which will lead to a “flashback” and increased anxiety. Through connections between the amygdala and the temporal lobe, activation of the neural circuit that generates fear can “revive” memory traces of a traumatic event even in the absence of corresponding external stimuli.

Among the most promising studies were studies that examined the strengthening of the startle reflex under the influence of fear. A flash of light or sound acted as a conditioned stimulus; they were turned on after the presentation of an unconditional stimulus - an electric shock. An increase in the amplitude of the startle reflex upon presentation of a conditioned stimulus made it possible to assess the degree of influence of fear on the reflex. This response appears to involve the fear circuit described by LeDoux (1996). Although there are some inconsistencies in the findings, they indicate a possible connection between post-traumatic stress disorder and the fear-potentiated startle reflex. Neuroimaging methods also indicate the involvement of structures related to the generation of anxiety and fear in post-traumatic stress disorder, primarily the amygdala, hippocampus and other structures of the temporal lobe.

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Symptoms of Post-Traumatic Stress Disorder

Post-traumatic stress disorder is characterized by three groups of symptoms: constant experience of a traumatic event; desire to avoid stimuli reminiscent of psychological trauma; increased autonomic activation, including increased startle response (startle reflex). Sudden painful plunges into the past, when the patient relives what happened again and again as if it happened just now (so-called “flashbacks”), is a classic manifestation of post-traumatic stress disorder. Constant experiences can also be expressed in unpleasant memories, difficult dreams, increased physiological and psychological reactions to stimuli that are in one way or another associated with traumatic events. To diagnose post-traumatic stress disorder, the patient must exhibit at least one of these symptoms, reflecting the constant experience of a traumatic event. Other symptoms of PTSD include avoidance of trauma-related thoughts and actions, anhedonia, decreased memory for trauma-related events, blunted affect, feelings of alienation or derealization, and feelings of hopelessness.

PTSD is characterized by an exacerbation of the instinct of self-preservation, which is typically characterized by an increase and preservation of constantly increased internal psycho-emotional stress (excitement) in order to maintain a constantly functioning mechanism for comparing (filtering) incoming external stimuli with stimuli imprinted in consciousness as signs of an emergency.

In these cases, there is an increase in internal psycho-emotional stress - hypervigilance (excessive vigilance), concentration, increased stability (noise immunity), attention to situations that the individual regards as threatening. There is a narrowing of the volume of attention (a decrease in the ability to hold a large number of ideas in the circle of voluntary purposeful activity and difficulty in freely operating with them). An excessive increase in attention to external stimuli (the structure of the external field) occurs due to a reduction in attention to the structure of the subject’s internal field, making it difficult to switch attention.

One of the significant signs of post-traumatic stress disorder is disorders that are subjectively perceived as various memory impairments (difficulty in memorizing, retaining certain information in memory and reproducing). These disorders are not associated with true disorders of various memory functions, but are caused primarily by difficulty concentrating on facts that are not directly related to the traumatic event and the threat of its reoccurrence. However, victims cannot remember important aspects of the traumatic event, which is due to disturbances that occurred during the acute stress response stage.

Constantly increased internal psycho-emotional tension (excitement) supports a person’s readiness to respond not only to a real emergency, but also to manifestations that are to one degree or another similar to a traumatic event. Clinically, this manifests itself as an exaggerated startle response. Events symbolizing the emergency and/or reminiscent of it (visiting the grave of the deceased on the 9th and 40th days after death, etc.), a subjective deterioration of the condition and a pronounced vasovegetative reaction are observed.

Simultaneously with the above-mentioned disorders, involuntary (without a sense of accomplishment) memories of the most vivid events associated with the emergency occur. In most cases, they are unpleasant, but some people themselves (through an effort of will) “evoke memories of an emergency,” which, in their opinion, helps them survive this situation: the events associated with it become less scary (more ordinary).

Some people with PTSD may at times experience flashbacks - disorders manifested by the emergence of involuntary, very vivid ideas about a traumatic situation. Sometimes it is difficult to distinguish them from reality (these conditions are close to clouding of consciousness syndromes), and a person at the moment of experiencing a flashback can show aggression.

Sleep disturbances are almost always present in post-traumatic stress disorder. Difficulty falling asleep, as noted by victims, is associated with an influx of unpleasant memories of the emergency. There are frequent night and early awakenings with a feeling of unreasonable anxiety “something must have happened.” Dreams are noted that directly reflect the traumatic event (sometimes the dreams are so vivid and unpleasant that the victims prefer not to fall asleep at night and wait until the morning “to sleep peacefully”).

The constant internal tension in which the victim is (due to the exacerbation of the instinct of self-preservation) makes it difficult to modulate affect: sometimes victims cannot restrain outbursts of anger even for a minor reason. Although outbursts of anger may be associated with other disorders: difficulty (inability) to adequately perceive the emotional mood and emotional gestures of others. Victims also experience alexithymia (the inability to verbalize emotions experienced by themselves and others). At the same time, there is difficulty in understanding and expressing emotional undertones (polite, soft refusal, wary benevolence, etc.).

Individuals suffering from post-traumatic stress disorder may experience emotional indifference, lethargy, apathy, lack of interest in the surrounding reality, a desire to have fun (anhedonia), a desire to learn new, unknown things, as well as decreased interest in previously significant activities. Victims, as a rule, are reluctant to talk about their future and most often perceive it pessimistically, not seeing any prospects. They are irritated by large companies (the only exception being people who have suffered the same stress as the patient himself), they prefer to be alone. However, after a while, loneliness begins to oppress them, and they begin to express dissatisfaction with their loved ones, reproaching them for inattention and callousness. At the same time, a feeling of alienation and distance from other people arises.

Particular attention should be paid to the increased suggestibility of the victims. They are easily persuaded to try their luck at gambling. In some cases, the game is so exciting that the victims often lose everything, including the allowance allocated by the authorities for the purchase of new housing.

As already mentioned, with post-traumatic stress disorder a person is constantly in a state of internal tension, which, in turn, reduces the threshold of fatigue. Along with other disorders (decreased mood, impaired concentration, subjective memory impairment), this leads to a decrease in performance. In particular, when solving certain problems, victims find it difficult to identify the main one, when receiving the next task, they cannot grasp its main meaning, they strive to delegate the making of responsible decisions to others, etc.

It should be especially emphasized that in most cases the victims realize (“feel”) their professional decline and, for one reason or another, refuse the offered work (not interesting, does not correspond to their level and previous social status, is poorly paid), preferring to receive only unemployment benefits , which is much lower than the proposed salary.

The sharpening of the instinct of self-preservation leads to a change in everyday behavior. The basis of these changes are behavioral acts, on the one hand, aimed at early recognition of emergencies, on the other, representing precautionary measures against the possible re-unfolding of a traumatic situation. The precautions taken by the individual determine the nature of the stress experienced.

Earthquake survivors tend to sit close to a door or window so they can quickly leave the room if necessary. They often look at a chandelier or aquarium to determine if an earthquake is starting. At the same time, they choose a hard chair, since soft seats soften the shock and thereby make it difficult to catch the moment the earthquake begins.

Victims who have suffered bombing, upon entering the room, immediately curtain the windows, inspect the room, look under the bed, trying to determine whether it is possible to hide there during the bombing. People who took part in hostilities, upon entering a room, try not to sit with their backs to the door and choose a place from where they can observe everyone present. Former hostages, if they were captured on the street, try not to go out alone and, conversely, if the seizure took place at home, do not stay alone at home.

Persons exposed to emergency situations may develop so-called acquired helplessness: the thoughts of victims are constantly occupied with the anxious anticipation of a recurrence of the emergency. experiences associated with that time and the feeling of helplessness that they experienced. This feeling of helplessness usually makes it difficult to modulate the depth of personal involvement in contact with others. Different sounds, smells, or situations can easily trigger memories of events related to the trauma. And this leads to memories of one’s helplessness.

Thus, in victims of emergencies, there is a decrease in the overall level of personality functioning. However, a person who has experienced an emergency, in most cases, does not perceive the deviations and complaints he has as a whole, believing that they do not go beyond the norm and do not require contacting a doctor. Moreover, the majority of victims consider existing deviations and complaints as a natural reaction to everyday life and are not associated with the emergency that occurred.

The victims’ assessment of the role that the emergency played in their lives is interesting. In the overwhelming majority of cases (even if no one close to them was injured during the emergency, material damage was fully compensated, and living conditions became better), they believe that the emergency had a negative impact on their fate (“the emergency ruined their prospects”). At the same time, a kind of idealization of the past (underestimated abilities and missed opportunities) occurs. Usually, during natural emergencies (earthquake, mudflows, landslides), the victims do not look for the culprits (“God’s will”), while in man-made disasters they strive to “find and punish the culprits.” Although, if the microsocial environment (including the victim) refers to “the will of the Almighty” as “everything that happens under the sun,” both natural and man-made emergencies, there is a gradual de-actualization of the desire to find the perpetrators.

At the same time, some victims (even if they were injured) indicate that the emergency played a positive role in their lives. They note that they had a reassessment of values ​​and began to “truly value human life.” They characterize their life after an emergency as more open, in which providing assistance to other injured and sick people occupies a large place. These people often emphasize that after the emergency, government officials and the microsocial environment showed concern for them and provided great assistance, which prompted them to begin “public philanthropic activities.”

In the dynamics of the development of disorders at the first stage of PSD, the individual is immersed in the world of experiences associated with emergency situations. The individual seems to live in the world, situation, dimension that took place before the emergency. He seems to be trying to return his past life (“return everything the way it was”), trying to understand what happened, looking for those responsible and trying to determine the degree of his guilt in what happened. If an individual has come to the conclusion that an emergency is “the will of the Almighty,” then in these cases the formation of a feeling of guilt does not occur.

In addition to mental disorders, somatic abnormalities also occur during emergencies. In approximately half of the cases, an increase in both systolic and diastolic pressure is noted (by 20-40 mmHg). It should be emphasized that the observed hypertension is accompanied only by an increase in heart rate without deterioration in mental or physical condition.

After an emergency, psychosomatic diseases often worsen (or are diagnosed for the first time) (peptic ulcer of the duodenum and stomach, cholecystitis, cholangitis, colitis, constipation, bronchial asthma, etc.) It should be especially noted that women of childbearing age quite often experience premature menstruation (less often, delayed ), miscarriages in early pregnancy. Among sexual disorders, there is a decrease in libido and erection. Often victims complain of coldness and a tingling feeling in the palms, feet, fingers and toes. excessive sweating of the extremities and deterioration of nail growth (flaking and brittleness). Deterioration in hair growth is noted.

Over time, if a person manages to “digest” the impact of the emergency, memories of the stressful situation become less relevant. He tries to actively avoid even talking about his experience, so as not to “awaken difficult memories.” In these cases, sometimes irritability, conflict and even aggressiveness come to the fore.

The types of responses described above primarily occur during emergencies in which there is a physical threat to life.

Another disorder that develops after the transition period is generalized anxiety disorder.

In addition to an acute reaction to stress, which, as a rule, resolves within three days after an emergency, psychotic-level disorders can develop, which in the domestic literature are called realistic psychoses.

Course of post-traumatic stress disorder

The likelihood of developing symptoms, as well as their severity and persistence, is directly proportional to the reality of the threat, as well as the duration and intensity of the trauma (Davidson and Foa, 1991). Thus, many patients who have suffered prolonged intense trauma with a real threat to life or physical integrity develop acute stress reactions, against the background of which post-traumatic stress disorder may develop over time. However, many patients do not develop post-traumatic stress disorder following acute stress manifestations. Moreover, the full form of post-traumatic stress disorder has a variable course, which also depends on the nature of the trauma. Many patients experience complete remissions, while others retain only mild symptoms. Only 10% of people with PTSD—perhaps those who have suffered the most severe and lasting trauma—have a chronic course. Patients often face reminders of the trauma, which can trigger an exacerbation of chronic symptoms.

Diagnostic criteria for post-traumatic stress disorder

A. The person experienced psychotrauma from an event in which both conditions occurred.

  1. The person was a participant in or witness to an event involving actual or threatened death, serious physical harm, or a threat to the physical integrity of himself or others.
  2. The person experienced intense fear, helplessness, or horror. Note: Children may experience inappropriate behavior or agitation instead.

B. The traumatic event is the subject of ongoing experiences that may take one or more of the following forms.

  1. Recurrent, intrusive, depressing memories of the trauma in the form of images, thoughts, sensations. Note: Young children may have ongoing games that are related to the trauma they have experienced.
  2. Recurring, painful dreams that include scenes from the experience. Note: Children may have frightening dreams without specific content.
  3. The person acts or feels as if he is reliving the traumatic event (in the form of relived experiences, illusions, hallucinations, or dissociative flashback-type episodes, including at the moment of awakening or during intoxication). Note: Children may experience repeated episodes of trauma.
  4. Intense psychological discomfort when in contact with internal or external stimuli that symbolize or resemble a traumatic event.
  5. Physiological reactions upon contact with internal or external stimuli that symbolize or resemble a traumatic event.

B. Persistent avoidance of stimuli associated with the trauma, as well as a number of general symptoms that were not present before the trauma (at least three of the following symptoms are required).

  1. Trying to avoid thoughts, feelings, or conversations about the trauma.
  2. The desire to avoid actions, places, people that can remind you of the trauma.
  3. Inability to remember important details of the injury.
  4. Marked limitation of interests and desire to participate in any activity.
  5. Detachment, isolation.
  6. Weakening of affective reactions (including the inability to experience love feelings).
  7. Feelings of hopelessness (lack of any expectations related to career, marriage, children, or life expectancy).

D. Persistent signs of increased excitability (absent before the injury), which are manifested by at least two of the following symptoms.

  1. Difficulty falling or staying asleep.
  2. Irritability or angry outbursts.
  3. Impaired concentration.
  4. Increased alertness.
  5. Strengthened startle reflex.

D. The duration of symptoms specified in criteria B, C, D is at least one month.

E. The disorder causes clinically significant discomfort or disrupts the patient’s functioning in social, professional, or other important areas.

The disorder is classified as acute if the duration of symptoms does not exceed three months; chronic - when symptoms persist for more than three months; delayed - if symptoms appear no earlier than six months after the traumatic event.

To be diagnosed with PTSD, at least three of the following symptoms must be present. Of the symptoms of increased activation (insomnia, irritability, increased excitability, increased startle reflex), at least two must be present. A diagnosis of post-traumatic stress disorder is made only if the noted symptoms persist for at least a month. Acute stress disorder is diagnosed before the month is reached. The DSM-IV identifies three types of post-traumatic stress disorder with different courses. Acute PTSD lasts less than three months; chronic PTSD lasts longer. Delayed PTSD is diagnosed when symptoms become apparent six months or more after the injury.

Because severe trauma can cause a range of biological and behavioral reactions, the survivor may experience other physical, neurological, or mental disorders. Neurological disorders are especially likely when the injury involved not only psychological, but also physical effects. A patient who has suffered a trauma often develops mood disorders (including dysthymia or major depression), other anxiety disorders (generalized anxiety or panic disorder), and drug addiction. Studies have noted a connection between some mental manifestations of post-traumatic syndromes and premorbid status. For example, post-traumatic symptoms are more likely to occur in individuals with premorbid anxiety or affective symptoms than in previously mentally healthy individuals. Thus, analysis of premorbid mental status is important for understanding symptoms that develop after a traumatic event.

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Differential diagnosis

Caution must be exercised when diagnosing PTSD to first rule out other syndromes that may occur after trauma. It is especially important to recognize treatable neurological or medical conditions that may contribute to the development of post-spout symptoms. For example, traumatic brain injury, drug addiction, or withdrawal symptoms may cause symptoms that appear immediately after the injury or several weeks later. Identification of neurological or somatic disorders requires a detailed history, a thorough physical examination, and sometimes neuropsychological testing. In classic uncomplicated post-traumatic stress disorder, the patient’s consciousness and orientation are not affected. If a neuropsychological examination reveals a cognitive defect that was absent before the injury, organic brain damage should be excluded.

Symptoms of PTSD can be difficult to distinguish from those of panic disorder or generalized anxiety disorder because all three conditions involve significant anxiety and increased autonomic reactivity. Establishing a temporal relationship between the development of symptoms and the traumatic event is important in diagnosing post-traumatic stress disorder. In addition, with post-traumatic stress disorder, there is a constant experience of traumatic events and a desire to avoid any reminder of them, which is not typical for panic and generalized anxiety disorder. Post-traumatic stress disorder often has to be differentiated from major depression. Although these two conditions can be easily distinguished by their phenomenology, it is important not to overlook comorbid depression in patients with PTSD, which can have an important impact on the choice of treatment. Finally, PTSD should be differentiated from borderline personality disorder, dissociative disorder, or symptomatic faking, which may have clinical manifestations similar to PTSD.

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Post-traumatic syndrome is a condition when the shocks experienced in life continue to bother you over time. A random reminder of events causes pain, and a fleeting image can bring you back to the past, which is difficult to remember.

What is Post Traumatic Stress Disorder?

This is a set of symptoms indicating mental disorders. It is formed after a single or multiple traumatic effects of great force, for example:

  • violence, humiliation and other conditions that make you feel horror and helplessness;
  • prolonged stress, associated, among other things, with psychological involvement in the suffering and experiences of other people.

People with post-traumatic stress disorder (PTSD) have a high degree of anxiety, in which they are periodically troubled by unusually realistic memories of terrible situations in the past. More often this happens when in contact with stimuli that lead to episodes of memories (psychologists call them triggers or keys):

  • objects and sounds;
  • images and smells;
  • other circumstances.

Sometimes, after PTSD, fragmentary amnesia develops, which does not allow one to reproduce the traumatic situation in detail.

Causes

Any stressful situation that causes extreme mental stress can provoke PTSD:

  • participation in wars and residence in the territory of military conflicts;
  • being in captivity;
  • the role of the victim in hostage-taking, sexual violence;
  • involvement in illegal activities,
  • participation in accidents and disasters;
  • death and/or injury of loved ones;
  • other events.

It has been proven that stress, as a reaction to extreme trauma, does not always cause mental disorders. It depends:

The environment in which a person finds himself after experiencing a shock is important. The risk of developing PTRS is significantly lower if the victim is in the company of people who have experienced a similar misfortune.

Causes of PTSD

The risk of developing PTSD increases when:


Formation mechanism

There are different approaches to assessing the mechanism of PTSD formation:


Differences in manifestation in people of different genders and ages

Experts who studied the characteristics of the manifestation of PTSD in adult men and women came to the conclusion that in the latter the pathology manifests itself more intensely. As for the features of the manifestation and course of PTSD in children, they exist, but more on that later.

The totality of the results of psychotrauma is manifested by the following blocks of signs:

  1. Periodic reliving of events, namely:
    • The inability to control negative memories leads to their attacks becoming more frequent, displacing reality. Even a musical composition or a strong gust of wind can provoke another attack. Nightmares are tormented at night, which causes fear of falling asleep;
    • a stream of anxious thoughts, unusually clear and precise, arises frequently and uncontrollably. This is called hallucinogenic experiences, which can be caused, for example, by drinking alcohol;
    • persistent rejection of the surrounding reality and persistent feelings of guilt lead to thoughts of suicide.
  2. Rejection of reality, which is expressed by:
    • depression and indifference to everything;
    • anhedonia - loss of the ability to experience joy, love and empathy;
    • refusal to communicate with relatives and people from the past, avoidance of new contacts. Conscious withdrawal from society is a typical symptom of stress disorder.
  3. Aggression, caution and mistrust, which are manifested by:
    • the feeling of insecurity in front of terrible events of the past that could happen again is frightening. This requires constant vigilance and a willingness to fight back;
    • a person reacts inadequately to everything that reminds of psychological trauma: loud and sharp sounds, flashes, screams and other phenomena;
    • aggression flares up in response to a threat, regardless of the degree of its reality and danger, which manifests itself with lightning speed, often with the use of physical force.

The listed symptoms give a detailed picture of the symptoms, but in reality they are rarely present all together. More often there are individual variants and combinations. Because reactions to stress vary from person to person, it is important to understand that the range of post-traumatic symptoms may also vary.

The psyche of children is extremely susceptible and vulnerable, so they suffer from the consequences of stress to a greater extent than adults.

The attachment of children and parents to each other, the state of mind of the latter, and their educational measures towards the child are key factors in the process of a child’s recovery after injury.

The reasons for the development of PTSD in children can be:

  • separation from parents, even when it is temporary;
  • conflicts in the family;
  • the death of a beloved animal, especially if it happened in front of the baby;
  • poor relationships with classmates and/or teachers;
  • poor academic performance as a reason for punishment and reprimand;
  • other traumatic events.

The experienced negativity causes in the child’s psyche:

  • periodic return to episodes of a terrible event, which can be expressed in conversations and games.
  • sleep disorders due to fears from the past disturbing you at night;
  • indifference and absent-mindedness.

In contrast to apathy, aggressiveness and irritability may occur when ordinary requests from family members cause a violent negative reaction.

Types of Post Traumatic Syndrome

The course of PTSD is characterized by features that distinguish it from other conditions:

  1. The syndrome may not form immediately, but after a while. Sometimes he makes himself known after years.
  2. PTSD develops in stages, which is reflected in the severity of symptoms. The brightness of the manifestations also depends on the duration of the remission period.

This served as the basis for the classification of the disorder:

  • acute - lasts up to 3 months and has a wide range of symptoms;
  • chronic - the severity of the main symptoms decreases, but the degree of nervous exhaustion increases. This, among other things, is expressed by a deterioration of character: a person becomes rude, selfish, and the sphere of his interests is significantly narrowed. Character is deformed, symptoms of central nervous system failure appear in the absence of obvious signs of PTSD, which can be expressed by subconscious attempts to get rid of difficult memories, outbreaks of anxiety and fear. This stage is formed when the chronic period of PTSD continues for a long time, but at the same time the person experiences the absence or insufficiency of adequate psychological help.
  • delayed - symptoms occur six months or more after the trauma. Usually this form is the result of the influence of a provoking factor. It can occur both acutely and chronically.

To facilitate the process of choosing the optimal treatment option, a clinical classification of PTSD types based on the characteristics of the pathology has been developed:

  1. The anxious type is characterized by frequent attacks of intrusive memories against the background of nervous overstrain, the number of which varies from several episodes per week to multiple repetitions during the day. Nightmares cause sleep disorders, and when you manage to fall asleep, you wake up in a cold sweat, fever or chills. Those suffering from an anxious type of pathology experience difficulties in social adaptation, which is caused by a severe emotional state and irritability. Meanwhile, they freely communicate with a psychologist, discussing the nuances of their condition, and in everyday life they try to avoid reminders of the psychological trauma they received.
  2. The asthenic type is characterized by an abundance of symptoms indicating nervous exhaustion, including apathy and weakness, a noticeable decrease in performance and other signs. Those suffering from the asthenic type of PTSD lose interest in life and worry about feelings of inferiority. Episodes of flashbacks are moderately disturbing and therefore do not cause horror or vegetative disorders. Patients complain that they can hardly get out of bed in the morning, and feel drowsy during the day, although they do not suffer from nighttime insomnia. They do not like to talk about events that caused mental trauma.
  3. The dysphoric type is defined as a state of anger in which the mood always has a depressive component. Such people are unsociable, avoid others and never complain about anything.
  4. The somatophoric type is formed against the background of delayed PTSD and is distinguished by dysfunctions of the central nervous system, cardiovascular organs and digestive tract. Patients are concerned about:
    • migraines;
    • heart rhythm disturbances,
    • pain in the left side of the chest and epigastric region;
    • abdominal colic;
    • digestive disorders;
    • other somatic abnormalities.

It is noteworthy that despite the abundance of complaints about well-being, diagnostics do not reveal serious health problems. With the somatoform type of PTSD, patients suffer from obsessive states that manifest themselves in attacks and occur against the background of a pronounced reaction from the autonomic part of the central nervous system. However, patients are more worried not about the emotional component, but about their own health. They are reluctant to talk about a traumatic event because they believe that reliving it could cause a heart attack or stroke.

Signs, symptoms, main stages

The formation of a psychological response to large-scale stress occurs in several stages:

  1. Shock, causing denial and a stunned reaction.
  2. Avoidance, when rejection and stupor give way to tears and a feeling of severe failure.
  3. Oscillations. This is the period when the psyche agrees that the events taking place are real.
  4. Transition. Time to analyze and assimilate what is happening.
  5. Integration is the stage when information processing is completed.

The main symptom of post-traumatic stress disorder is haunting memories of terrible events, which are vivid but fragmentary and are accompanied by:

  • horror and melancholy;
  • anxiety and feelings of helplessness.
  • These experiences are equal in strength to those experienced during the events themselves. They are joined by autonomic dysfunctions, causing:
  • increased blood pressure;
  • heart rhythm disturbances:
  • hyperhidrosis with cold sweat;
  • increased urination.

People who have experienced psychotrauma and suffer from PTSD:


In some cases, isolation from real life and destructive changes in character lead to the fact that those suffering from PTSD stop communicating altogether and become completely alone. A feature of social adaptation disorder in post-traumatic syndrome is the lack of life plans, because such people live in the past.

The emerging tendency to suicide is often realized under the influence of psychotropic factors or during hallucinogenic attacks. However, more often than not, taking one’s own life is a planned and conscious decision of a person who has lost the meaning of existence.

Treatment options

Treatment for PTSD is comprehensive. Drug therapy is prescribed if:

  • chronic nervous overstrain;
  • states of increased anxiety;
  • a sharp drop in emotional background;
  • more frequent attacks of intrusive memories, causing horror and vegetative disorders;
  • invasions of hallucinations.

For mild PTSD with many symptoms of central nervous system overstrain, sedative medications are indicated, the effect of which is still not enough to completely suppress mental symptoms.

In recent years, antidepressants from the category of selective serotonin reuptake inhibitors have become popular.

In recent years, antidepressants from the category of selective serotonin reuptake inhibitors, which have a wide spectrum of action, have become popular, namely:

  • improve emotional background;
  • restore interest in life;
  • remove anxiety and tension;
  • normalize the activity of the autonomic nervous system;
  • reduce the number of attacks of intrusive memories;
  • reduce aggression and irritability;
  • suppress the craving for alcohol.

Treatment with such drugs has its own specifics: at the initial stage of treatment, the opposite effect is likely in the form of an increase in anxiety. It is for this reason that therapy begins with small doses, which are subsequently increased.

The main medications for the treatment of PTSD also include beta blockers, which are recommended in cases of obvious autonomic disorders.

For the asthenic form of post-traumatic syndrome, nootropics that stimulate the central nervous system are indicated. They are safe and have no serious contraindications for use.

It is important that the use of medications, unlike psychotherapy sessions, is never prescribed as the only method of treatment.

Psychotherapy for post-traumatic stress disorder is necessarily included in the complex of measures against PTSD and is carried out in stages:

  1. First, there is a conversation in which the doctor talks about the essence of the disease and methods of therapy. To achieve a positive result, it is important that the patient trusts the medical specialist and receives all the information so as not to doubt the successful outcome of the treatment.
  2. Next comes the therapy itself, during which the doctor helps the patient:
    • accept and process a psychotraumatic event:
    • make peace with the past;
    • get rid of feelings of guilt and aggression towards yourself and others;
    • do not respond to triggers.
  3. During psychotherapy, different forms and methods of work are used:
    • individual communication with the patient;
    • psychocorrection sessions involving a group of people with the problem of PTSD;
    • interaction with family members, which is extremely important when working with pediatric patients;
    • neurolinguistic programming;
    • hypnosis;
    • training in auto-training techniques;
    • other methods.

A set of therapeutic measures is always selected individually and in the vast majority of cases allows achieving successful results.

How to live with PTSD

When the traumatic impact was small, its consequences in the form of anxiety, worries and other signs can go away on their own. In different cases, this requires from several hours to several weeks. If the impact was powerful or the episodes were repeated repeatedly, the pathological condition may persist for a long time.

It is very important that loved ones understand the peculiarities of life of a person with a mental disorder, when a special approach and careful attitude are required, excluding stressful situations. A calm and benevolent microclimate in the family, at work and among like-minded people, combined with medical measures, makes it possible to completely get rid of the consequences of psychological trauma.

Many of those who have experienced PTSD say that the path to recovery is difficult and long. For a successful result, the attitude of the victim himself and his willingness to fight are of great importance. Under the supervision of a medical specialist and with the support of loved ones, overcoming a severe syndrome is much easier.

Video: How to overcome PTSD

Each of us dreams of living life calmly, happily, without incidents. But, unfortunately, almost everyone experiences dangerous moments, are subjected to severe stress, threats, even attacks and violence. What should a person who has suffered from post-traumatic stress disorder do? After all, the situation does not always pass without consequences; many suffer from serious mental pathologies.

To make it clear to those who do not have medical knowledge, it is necessary to explain what PTSD means and what its symptoms are. First, you need to imagine, at least for a second, the state of a person who has experienced a terrible incident: a car accident, beating, rape, robbery, death of a loved one, etc. Agree, this is difficult to imagine, and scary. At such moments, any reader will immediately ask for a petition - God forbid! And what can we say about those who actually found themselves victims of a terrible tragedy, how can they forget about everything. A person tries to switch to other activities, get carried away by a hobby, devote all his free time to communicating with loved ones and friends, but all in vain. A severe, irreversible acute reaction to stress, terrible moments, causes stress disorder, post-traumatic stress disorder. The reason for the development of pathology is the inability of the reserves of the human psyche to cope with the transferred situation; it goes beyond the scope of the accumulated experience that a person can survive. The condition often does not appear immediately, but approximately 1.5-2 weeks after the event, for this reason it is called post-traumatic.

A person who has suffered severe trauma may suffer from post-traumatic stress disorder

Situations that are traumatic to the psyche, whether isolated or repeated, can disrupt the normal functioning of the mental sphere. Provoking situations include violence, complex physiological injuries, being in the zone of a man-made or natural disaster, etc. Directly at the moment of danger, a person tries to pull himself together, save his own life, his loved ones, tries not to panic or is in a state of stupor. After a short time, obsessive memories of what happened arise, which the victim tries to get rid of. Post-traumatic stress disorder (PTSD) is a return to a difficult moment that has “affected” the psyche so much that serious consequences arise. According to the international classification, the syndrome belongs to the group of neurotic conditions caused by stress and somatoform disorders. A clear example of PTSD is military personnel who served in “hot” spots, as well as civilians who found themselves in such areas. According to statistics, after experiencing stress, PTSD occurs in approximately 50-70% of cases.

The most vulnerable categories are more susceptible to mental trauma: children and the elderly. The former have insufficiently developed protective mechanisms; the latter, due to the rigidity of processes in the mental sphere, loss of adaptive abilities.

Post-traumatic stress disorder - PTSD: causes

As already indicated, a factor in the development of PTSD are disasters of a mass nature, which pose a real threat to life:

  • war;
  • natural and man-made disasters;
  • terrorist attacks: being held captive as a prisoner, experiencing torture;
  • serious illnesses of loved ones, own life-threatening health problems;
  • physical loss of relatives and friends;
  • experienced violence, rape, robbery.

In most cases, the intensity of anxiety and experiences directly depends on the characteristics of the individual, his degree of susceptibility and impressionability. The person’s gender, age, physiological and mental state also matter. If mental trauma occurs regularly, then mental reserves are depleted. An acute reaction to stress, the symptoms of which are common in children, women who have experienced domestic violence, in prostitutes, can occur in police officers, firefighters, rescuers, etc.

Experts identify another factor that contributes to the development of PTSD - neuroticism, in which obsessive thoughts about bad events arise, there is a tendency to neurotic perception of any information, and a painful desire to constantly reproduce a terrible event. Such people always think about dangers, talk about serious consequences even in non-threatening situations, all thoughts are only about the negative.

Cases of post-traumatic disorder are often diagnosed in people who have survived war.

Important: those prone to PTSD also include individuals suffering from narcissism, any type of addiction - drug addiction, alcoholism, prolonged depression, excessive addiction to psychotropic, neuroleptic, sedative medications.

Post-traumatic stress disorder: symptoms

The psyche’s response to severe stress experienced is manifested by certain behavioral traits. The main ones are:

  • state of emotional numbness;
  • constant reproduction in thoughts of the experienced event;
  • detachment, avoidance of contacts;
  • desire to avoid important events, noisy companies;
  • detachment from society in which the incident is repeated again;
  • excessive excitability;
  • anxiety;
  • attacks of panic, anger;
  • feeling of physical discomfort.

The PTSD condition usually develops over a period of time: from 2 weeks to 6 months. Mental pathology can persist for months or years. Depending on the severity of the manifestations, experts distinguish three types of PTSD:

  1. Spicy.
  2. Chronic.
  3. Deferred.

The acute type lasts for 2-3 months; in the chronic type, symptoms persist for a long period of time. In the delayed form, post-traumatic stress disorder can manifest itself over a long period of time after a dangerous event - 6 months, a year.

A characteristic symptom of PTSD is detachment, alienation, a desire to avoid others, that is, there is an acute reaction to stress and adaptation disorders. There are no elementary types of reactions to events that arouse great interest among ordinary people. Regardless of the fact that the situation that traumatized the psyche is already far behind, patients with PTSD continue to worry and suffer, which causes a depletion of resources capable of perceiving and processing a fresh information flow. Patients lose interest in life, are unable to get pleasure from anything, refuse the joys of life, become unsociable, and move away from former friends and loved ones.

A characteristic symptom of PTSD is detachment, aloofness, and a desire to avoid others.

Acute reaction to stress (micd 10): types

In the post-traumatic state, two types of pathologies are observed: obsessive thoughts about the past and obsessive thoughts about the future. At the first sight, a person constantly “replays” like a film an event that traumatized his psyche. Along with this, other scenes from life that brought emotional and mental discomfort can be “connected” to the memories. The result is a whole “compote” of disturbing memories that cause persistent depression and continue to traumatize the person. For this reason, patients suffer:

  • eating disorders: overeating or loss of appetite:
  • insomnia;
  • nightmares;
  • outbursts of anger;
  • somatic disorders.

Obsessive thoughts about the future manifest themselves in fears, phobias, and groundless predictions of the repetition of dangerous situations. The condition is accompanied by such symptoms as:

  • anxiety;
  • aggression;
  • irritability;
  • isolation;
  • depression.

Often, affected individuals try to disconnect from negative thoughts through the consumption of drugs, alcohol, and psychotropic drugs, which significantly worsens the condition.

Burnout syndrome and post-traumatic stress disorder

Two types of disorders are often confused - EMS and PTSD, however, each pathology has its own roots and is treated differently, although there is a certain similarity in symptoms. Unlike stress disorder after trauma, caused by a dangerous situation, tragedy, etc., emotional burnout can occur during a completely cloudless, joyful life. The cause of SEV may be:

  • monotony, repetitive, monotonous actions;
  • intense rhythm of life, work, study;
  • undeserved, regular criticism from the outside;
  • uncertainty in the assigned tasks;
  • feeling undervalued and useless;
  • lack of material and psychological encouragement for the work performed.

SEW is often called chronic fatigue, which can cause people to experience insomnia, irritability, apathy, loss of appetite, and mood swings. The syndrome is more likely to affect individuals with the following characteristic character traits:

  • maximalists;
  • perfectionists;
  • overly responsible;
  • those who are inclined to give up their interests for the sake of business;
  • dreamy;
  • idealists.

Often housewives who deal with the same routine, monotonous task every day come to specialists with SEV. They are almost always alone, and there is a lack of communication.

Burnout syndrome is almost the same as chronic fatigue

The risk group for pathology includes creative individuals who abuse alcohol, drugs, and psychotropic drugs.

Diagnosis and treatment of post-traumatic stress situations

The specialist makes a diagnosis of PTSD based on the patient’s complaints and analysis of his behavior, collecting information about the psychological and physical trauma he has suffered. The criterion for establishing an accurate diagnosis is also a dangerous situation that can cause horror and numbness in almost all people:

  • flashbacks that occur both in sleep and wakefulness;
  • the desire to avoid moments reminiscent of the stress experienced;
  • excessive excitement;
  • partial erasing of a dangerous moment from memory.

Post-traumatic stress disorder, the treatment of which is prescribed by a specialized specialist - a psychiatrist, requires an integrated approach. An individual approach to the patient is required, taking into account the characteristics of his personality, type of disorder, general health condition and additional types of dysfunctions.

Cognitive behavioral therapy: the doctor conducts sessions with the patient in which the patient fully talks about his fears. The doctor helps him look at life differently, rethink his actions, and directs negative, obsessive thoughts into a positive direction.

Hypnotherapy is indicated for acute phases of PTSD. The specialist brings the patient back to the moment of the situation and makes it clear how lucky the survivor is who has experienced stress. At the same time, thoughts switch to positive aspects of life.

Drug therapy: antidepressants, tranquilizers, beta blockers, antipsychotics are prescribed only when absolutely necessary.

Psychological assistance in post-traumatic situations may include group psychotherapy sessions with individuals who have also experienced an acute reaction during dangerous moments. In such cases, the patient does not feel “abnormal” and understands that most people have difficulty surviving life-threatening tragic events and not everyone can cope with them.

Important: the main thing is to see a doctor on time, when the first signs of a problem appear.

Treatment for PTSD is carried out by a qualified psychotherapist

By eliminating incipient mental problems, the doctor will prevent the development of mental illnesses, make life easier and help you overcome negativity easily and quickly. The behavior of those close to the suffering person is important. If he does not want to go to the clinic, visit the doctor yourself and consult with him, outlining the problem. You should not try to distract him from difficult thoughts on your own, or talk in his presence about the event that caused the mental disorder. Warmth, care, common hobbies and support will be just the thing, by the way, and the black streak will quickly change to a bright one.

(PTSD) is a disruption of the normal functioning of the psyche as a result of a single or repeated traumatic situation. Among the circumstances that provoke the development of PTSD are participation in hostilities, sexual violence, severe physical injuries, exposure to life-threatening situations caused by natural or man-made disasters, etc. PTSD is characterized by increased anxiety and intrusive memories of a traumatic event with persistent avoidance thoughts, feelings, conversations and situations that are somehow related to trauma. The diagnosis of PTSD is made based on interview and anamnestic data. Treatment – ​​psychotherapy, pharmacotherapy.

ICD-10

F43.1

General information

Post-traumatic stress disorder (PTSD, post-traumatic stress syndrome) is a mental disorder caused by a severe traumatic situation that goes beyond the normal human experience. In ICD-10 it belongs to the group of “Neurotic, stress-related and somatoform disorders”. PTSD occurs more often during military operations. In peacetime, it is observed in 1.2% of women and 0.5% of men. Finding yourself in a severe psychotraumatic situation does not necessarily entail the development of PTSD - according to statistics, 50-80% of citizens who have experienced traumatic events suffer from this disorder.

Children and older people are more susceptible to PTSD. Experts suggest that the low resistance of young patients is due to insufficient development of defense mechanisms in childhood. The reason for the frequent development of PTSD in the elderly is probably the increasing rigidity of mental processes and the gradual loss of adaptive capabilities of the psyche. Treatment of PTSD is carried out by specialists in the field of psychotherapy, psychiatry and clinical psychology.

Causes of PTSD

The development of PTSD is usually caused by mass disasters that pose a direct threat to people's lives: military actions, man-made and natural disasters (earthquakes, hurricanes, floods, explosions, building collapses, rubble in mines and caves), terrorist acts (being held hostage, threats, torture, presence during the torture and murder of other hostages). PTSD can also develop after tragic events of an individual scale: severe injuries, long-term illnesses (of one’s own or relatives), death of loved ones, attempted murder, robbery, beating or rape.

In some cases, PTSD symptoms appear after traumatic events that have high individual significance for the patient. Traumatic events that precede PTSD can be single (natural disaster) or repeated (participation in combat), short-term (criminal incident) or long-term (long illness, prolonged stay as a hostage). The severity of the experience during a traumatic situation is of great importance. PTSD results from extreme terror and an acute sense of helplessness in the face of circumstances.

The intensity of the experience depends on the individual characteristics of the PTSD patient, his impressionability and emotional sensitivity, the level of psychological preparation for the situation, age, gender, physical and psychological state and other factors. The repetition of traumatic circumstances is of a certain importance - regular traumatic effects on the psyche entail a depletion of internal reserves. PTSD is often detected in women and children exposed to domestic violence, as well as in prostitutes, police officers and other categories of citizens who often become victims or witnesses of violent acts.

Among the risk factors for the development of PTSD, experts indicate the so-called “neuroticism” - a tendency to neurotic reactions and avoidant behavior in stressful situations, a tendency to “get stuck”, an obsessive need to mentally reproduce traumatic circumstances, focusing on possible threats, perceived negative consequences and other negative aspects events. In addition, psychiatrists note that people with narcissistic, dependent and avoidant personality traits suffer from PTSD more often than people with antisocial behavior. The risk of PTSD also increases with a history of depression, alcoholism, drug addiction, or drug dependence.

Symptoms of PTSD

Post-traumatic stress disorder is a long-term delayed reaction to very severe stress. The main signs of PTSD are constant mental replaying and re-experiencing of the traumatic event; detachment, emotional numbness, tendency to avoid events, people and topics of conversation that can remind you of a traumatic event; increased excitability, anxiety, irritability and physical discomfort.

Typically, PTSD does not develop immediately, but after some time (from several weeks to six months) after a traumatic situation. Symptoms may persist for months or years. Taking into account the time of onset of the first manifestations and the duration of PTSD, three types of the disorder are distinguished: acute, chronic and delayed. Acute post-traumatic stress disorder lasts no more than 3 months; if symptoms persist for a longer time, they speak of chronic PTSD. In the delayed type of disorder, symptoms appear 6 or more months after the traumatic event.

PTSD is characterized by a constant feeling of alienation from others, a lack of reaction or a weakly expressed reaction to current events. Despite the fact that the traumatic situation is in the past, patients with PTSD continue to suffer from experiences associated with this situation, and the psyche does not have the resources to normally perceive and process new information. Patients with PTSD lose the ability to have fun and enjoy life, become less sociable, and move away from other people. Emotions dull, the emotional repertoire becomes more scarce.

In PTSD, there are two types of obsessions: past obsessions and future obsessions. In PTSD, past obsessions manifest themselves in the form of repeated traumatic experiences that appear as memories during the day and nightmares at night. Obsessions about the future in PTSD are characterized by not fully conscious, but frequent unfounded predictions of a repetition of the traumatic situation. When such obsessions appear, externally unmotivated aggression, anxiety and fear are possible. PTSD can be complicated by depression, panic disorder, generalized anxiety disorder, alcoholism, and drug addiction.

Taking into account the prevailing psychological reactions, four types of PTSD are distinguished: anxious, asthenic, dysphoric and somatoform. With the asthenic type of disorder, apathy, weakness and lethargy predominate. Patients with PTSD show indifference both to others and to themselves. The feeling of personal inadequacy and inability to return to normal life has a depressing effect on the psyche and emotional state of patients. Physical activity decreases, and PTSD patients sometimes have difficulty getting out of bed. Heavy napping is possible during the daytime. Patients easily agree to therapy and willingly accept the help of loved ones.

The anxiety type of PTSD is characterized by attacks of causeless anxiety, accompanied by tangible somatic reactions. Emotional instability, insomnia and nightmares are observed. Panic attacks are possible. Anxiety decreases during communication, so patients willingly communicate with others. The dysphoric type of PTSD is manifested by aggressiveness, vindictiveness, resentment, irritability and distrust towards others. Patients often initiate conflicts, are extremely reluctant to accept support from loved ones, and usually categorically refuse to see a specialist.

The somatoform type of PTSD is characterized by a predominance of unpleasant somatic sensations. Headaches, pain in the abdomen and in the heart area are possible. Many patients experience hypochondriacal experiences. As a rule, such symptoms occur with delayed PTSD, which makes diagnosis difficult. Patients who have not lost faith in medicine usually turn to general practitioners. With a combination of somatic and mental disorders, behavior may vary. With increased anxiety, PTSD patients undergo numerous studies and repeatedly turn to various specialists in search of “their doctor.” In the presence of a dysphoric component, patients with PTSD may attempt to self-medicate by using alcohol, drugs, or painkillers.

Diagnosis and treatment of PTSD

The diagnosis of post-traumatic stress disorder is made on the basis of the patient’s complaints, the presence of severe psychological trauma in the recent past and the results of special questionnaires. The diagnostic criteria for PTSD according to ICD-10 are a threatening situation capable of causing horror and despair in most people; persistent and vivid flashbacks that occur both while awake and in sleep, and intensify if the patient consciously or involuntarily associates current events with the circumstances of psychological trauma; attempts to avoid situations reminiscent of the traumatic event; increased excitability and partial loss of memories of a traumatic situation.

Treatment tactics are determined individually, taking into account the patient’s personality characteristics, type of PTSD, level of somatization and the presence of concomitant disorders (depression, generalized anxiety disorder, panic disorder, alcoholism, drug addiction, drug addiction). Cognitive behavioral therapy is considered the most effective method of psychotherapeutic influence. In the acute form of PTSD, hypnotherapy is also used; in the chronic form, work with metaphors and EMDR (eye movement desensitization and processing) are used.

If necessary, psychotherapy for PTSD is carried out against the background. Adrenergic blockers, antidepressants, tranquilizers and sedative neuroleptics are prescribed. The prognosis is determined individually depending on the characteristics of the patient’s personality, the severity and type of PTSD. Acute disorders respond better to treatment, while chronic ones more often turn into pathological personality development. The presence of pronounced dependent, narcissistic and avoidant personality traits, drug addiction and alcoholism is an unfavorable prognostic sign.