Post-Traumatic Stress Disorder

During the month of February, I will do a short series of posts on Post-Traumatic Stress Disorder.  Starting today and for the next 3 Tuesdays in February we will look at what PTSD is, the types of causes of PTSD, treatment plans, and. finally, litigation issues.

I.               What is Post Traumatic Stress Disorder?

The National Institutes of Mental Health defines Post Traumatic Stress Disorder, also known as PTSD, as “an anxiety disorder that some people get after seeing or living through a dangerous event.” It is natural to feel afraid when faced with danger. The fear or “fight or flight” response triggers split second changes in the body to prepare to defend against the danger or to avoid it. The reaction is designed to protect a person from harm. However in people with post-traumatic stress disorder, PTSD, the reaction is changed or damaged. These folks feel stressed or frightened even when they are no longer in danger.

Some of the classic characteristics of post-traumatic stress disorder include:

  •  Nervousness
  •  Preoccupation with the trauma
  •  Pain or physical discomfort
  • Sleeplessness and nightmares
  • Flashbacks and intrusive thoughts
  • Deterioration of performance
  • Phobia
  • Personality change
  • Unprovoked outbursts

A concept, known as the “Traumatic Principle,” helps to sort out those victims of trauma more likely to develop PTSD. Important elements of serious trauma include:

  •        Vulnerability

Predisposition recognizes the role of genetics, family upbringing, and other risk factors in the diagnosis of PTSD.

  •        Environmental Stimulus

This refers to any traumatic event coming from outside of the individual.

  •       Realistic Threat

This means that by observable and obvious standards, the environmental event has the capacity to produce physical injury or death.

  •       Perception by Five Senses

Here is the acknowledgment that neurobiological components exist from the traumatic event.

  •       Cognitive Awareness

Perception involves cognitive awareness and the nervous system.

  •       Activation of the Sympathetic Nervous System

This is the most obvious neurobiological indication of intense fear, helplessness, or horror.

  •       Zone of Danger

This concept, somewhat controversial among experts, holds that before PTSD can develop, the victim must be present at the traumatic scene and experience, witness, or be confronted with a dangerous situation that can be actual or threatened death or serious injury.

A compilation of these factors results in the Traumatic Principle which C.B. Scignar, M.D. describes as:

Any environmental stimulus which poses a realistic threat  to life or limb, if perceived by one, or more likely a combination of the five sensory pathways to the brain, if cognitively interpreted as dangerous (a serious threat to life or physical integrity to self or others), and followed by intense stimulation of the sympathetic nervous system, whether it produces a physical injury or not, can be regarded as a traumatic event which can precipitate PTSD in a vulnerable individual who is in the zone of danger.

Anyone, according to the National Institutes of Mental Health, can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. In contrast to Dr. Scignar, the National Institutes of Mental Health endorses that not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. For instance, the sudden, unexpected death of a loved one can also cause PTSD.

In the posts to follow this month we will examine the types of trauma, treatment and some of the issues in litigation that are affected by post-traumatic stress disorder.