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Post traumatic Stress Disorder (PSTD) is developed by people who suffered crisis which traumatized them. For example, a person who lost his child because of flash floods will find himself agitated at the slightest hint of rain. A soldier who just survived a war will find himself easily startled when something drops. A woman who was raped will find herself having difficulties forming relationships.

PTSD is classified under Anxiety Disorders. A person who has PTSD will experience flashbacks of a traumatic event that a person has experienced or witnessed which is serious enough causing him or her impairment in his or her ability to function as a person. Symptoms range from nightmares to thoughts of suicide.

PTSD can affect nearly every aspect of the person’s life depending on the extent of its effect to a person. Usually, people with PTSD are irritable, anxious, and fatigues.They have a tendency to be socially-withdrawn too. At times, they are hyper vigilant, easily aroused and startled. Most develop survivor’s guilt especially if the traumatic event caused loss of multiple lives.

PTSD can be acute or chronic. PTSD is acute if symptoms appear within 6 months while it is chronic if symptoms begin later than 6 months.There is remission within 6 months in 50% of cases.

These events include disasters, wars, accidents, and acts of violence. It is estimated that 5-10% of people in the United States have experienced PSTD at some point in their lives. In the Philippines, 1.6 M Filipinos are affected by it. Moreover, people with PSTD have higher chance of developing other anxiety, substance-related, and mood disorders.

Causes

  • Triggering traumatic event (e.g. rape, violence, combats)
  • Impairment of alpha2 –adrenergic receptor response which inhibits stress-induced release of norepinephrine

Risk Factors

  • Limited social support. Support system helps in facilitating a traumatized person’s expression of feelings.
  • Limited social support is linked to higher risk of repressing traumatic experiences.
  • High anxiety levels. A person who has relatively higher levels of anxiety will be more psychologically affected than a person who manages to keep his anxiety low or mild whenever facing adversaries.
  • Low self-esteem. Low self-esteem can inhibit developing or sustaining positive coping mechanisms.
  • Family history of PTSD or depression
  • History of PTSD
  • Genetic factors

Signs and Symptoms

  • Anger
  • Poor impulse control
  • Emotional detachment or numbness
  • Hyperalertness, hyperarousal, and exaggerated startle reflex
  • Social withdrawal
  • Self-destructive behavior
  • Survivor’s guilt
  • Relationship problems
  • Avoidance of people,places, and things associated with the traumatic experience
  • Depersonalization (sense of loss of identity as a person)
  • Relationship problems
  • Difficulty falling or staying asleep
  • Decreased self-esteem

Nursing Interventions

  1. Establish rapport with client to gain his trust. It is important that the nurse should accept client’s current level of functioning. She should also be consistent, positive, and honest as well as adapt a nonjudgmental attitude when working with the client.
  2. Provide time and opportunity for client to express his feelings. It is essential that nurse should detect an ongoing grieving process and help client to find conclusion.
  3. To manage outbursts of anger, assist client to identify sources of emotions. Assist client in regaining control.
  4. Assist client in using displacement whenever he is angry by providing things he can manipulate or destroy such as clay.
  5. After every outburst, discuss with the client how his anger escalates.
  6. Desensitize client to his memories of traumatic event.
  7. Administer prescribed medications as needed. Evaluate his responses to the medications and if client is taking and not hoarding them.
  8. Remind patient that setbacks on the process of treatment are not failures but an expected part of the therapy.
  9. Encourage client to accept forgiveness from his self and others.
  10. Emphasize with the client the importance of strict adherence to his medications.
  11. Refer client to other sources of support such as community organizations and support groups.
  12. Encourage client to express his anger verbally rather than physically.

References:

  • Keltner, N., Bostrom, C., McGuness, T. Psychiatric Nursing 6th Edition. 2012
  • Lippincott Williams and Wilikins Straight A’s in Psychiatric and Mental Health Nursing. 2006
  • http://www.rightdiagnosis.com/p/post_traumatic_stress_disorder/stats-country.htm
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