User:Lochabar/sandbox

Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD) is a psychological disorder that may result in response to severe psychologically traumatic events. PTSD may result as the direct result of, the witnessing of, or learning of a traumatic event, or first-hand exposure to details of a traumatic event (such as seeing the aftermath of a murder). Most individuals experiencing traumatic events do not develop PTSD, however, higher degrees of traumatic exposure and genetic factors have varying impacts upon symptom development

Classicifation
PTSD is classified as a trauma- and stressor-related disorder by the DSM-V. A chief criterion for PTSD is the persistence of symptoms for more than one month after introduction of the trauma. PTSD is divided into two classification groups - one for those above age six, and one for those who are age six or under (DSM). The DSM-5 has removed the differential criteria which divided PTSD into acute and chronic cases. Chief symptoms of PTSD include varying degrees of anxiety, and flashbacks, and sufferers attempt to avoid elements of the stressor in order to avoid the associated emotional responses.

Criterion and Diagnosis
Typically, PTSD is a response to direct exposure to a traumatic event, such as death or serious injury, in which cases the individual feels helpless or extremely fearful. Commonly at-risk individuals include combat-deployed military personnel, survivors of extreme violence, and accidents such as automobile collisions, public transportation accidents, and natural disasters. Diagnostic and Statistical Manual of Mental Disorders - 5th Edition

Adults, Adolescents, and Children over Six
more) of the following ways: traumatic event(s), beginning after the traumatic event(s) occurred: beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following: (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
 * A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or
 * 1) 	 Directly experiencing the traumatic event(s).
 * 2) 	 Witnessing, in person, the event(s) as it occurred to others.
 * 3) 	 Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
 * 4) 	 Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains: police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
 * B. Presence of one (or more) of the following intrusion symptoms associated with the
 * 1) 	 Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
 * 2) 	 Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
 * 3) 	 Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
 * 4) 	 Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
 * 5) 	 Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
 * C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
 * 1) 	 Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
 * 2) 	 Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
 * D. Negative alterations in cognitions and mood associated with the traumatic event(s),
 * 1) 	 Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
 * 2) 	 Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” ‘The world is completely dangerous,” “My whole nervous system is permanently ruined”).
 * 3) 	 Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
 * 4) 	 Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
 * 5) 	 Markedly diminished interest or participation in significant activities.
 * 6) 	 Feelings of detachment or estrangement from others.
 * 7) 	 Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
 * E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
 * 1) 	 Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
 * 2) 	 Reckless or self-destructive behavior.
 * 3) 	 Hypervigilance.
 * 4) 	 Exaggerated startle response.
 * 5) 	 Problems with concentration.
 * 6) 	 Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
 * F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
 * G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
 * H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
 * Specify whether:
 * 1)  Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
 * 2)  Dereaiization: Persistent or recurrent experiences of unreality of surroundings
 * Specify if:

Children Six Years and Younger

 * A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
 * 1) 	 Directly experiencing the traumatic event(s).
 * 2) 	 Witnessing, in person, the event(s) as it occurred to others, especially primary caregivers. *Note: Witnessing does not include events that are witnessed only in electronic media, television, movies, or pictures.
 * 3) 	 Learning that the traumatic event(s) occurred to a parent or caregiving figure.
 * B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
 * 1) 	 Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.
 * 2) 	 Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: It may not be possible to ascertain that the frightening content is related to the traumatic event.
 * 3) 	 Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Such trauma-specific reenactment may occur in play.
 * 4) 	 Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
 * 5) 	 Marked physiological reactions to reminders of the traumatic event(s).
 * C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):
 * Persistent Avoidance of Stimuli
 * 1) 	 Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of the traumatic event(s).
 * 2) 	 Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event(s).
 * Negative Alterations in Cognitions
 * 1) 	 Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
 * 2) 	 Markedly diminished interest or participation in significant activities, including constriction of play.
 * 3) 	 Socially withdrawn behavior.
 * 4) 	 Persistent reduction in expression of positive emotions.
 * D. Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
 * 1) 	 Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects (including extreme temper tantrums).
 * 2) 	 Hypervigilance.
 * 3) 	 Exaggerated startle response.
 * 4) 	 Problems with concentration.
 * 5) 	 Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
 * E. The duration of the disturbance is more than 1 month.
 * F. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.
 * G. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition.
 * Specify whether:
 * With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following:
 * 1)  Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
 * 2)  Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts) or another medical condition (e.g., complex partial seizures).
 * Specify if:
 * With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

Causes
The causes of PTSD cover a wide range of events which cause extreme stress or trauma. Evolutional Psychology Evolutionary psychologists view PTSD as an evolutionary overreaction to avoidance or coping mechanisms, used to defend against predators or other threats.

Genetics
Some evidence supports that incidents of PTSD may be genetically-linked. However, a recent study conducted at the University of California showed contradictions in the association between PTSD and the DRD2 and DAT genes Studies of twins, especially concerning twins who served in different areas during the Vietnam War have also yielded results indicating a possible genetic link between family and symptomatic susceptibility and comorbidity with other mental disorders.

Neuroanatomy
Several areas of the brain respond to PTSD: the amygdala, the ventral-medial prefrontal cortex, and the hippocampus. During PTDS episodes, fear-evoking stimuli cause an increase in activity correlating to the severity of subjects' s symptoms, as according to Clinician Administered PTSD Scale scores. Additionally, it has been noted that there is a negative correlation between activity and blood flow in the amygdala and medial prefrontal cortex, the executive control center of the brain. These findings may indicate why PTSD causes erratic behavior, lapses in judgment, goal inhibition, and errors in social control, although the direction of this negative relationship has yet to be determined. Further, studies of activity in the hippocampus, which is associated with directing the ability to properly organize memories in their correct spacial and temporal contexts, have noted a decrease in activity during the presentation of stressful stimuli, indicating a possible correlation between stimulus presentation and flashback response. Studies of chronic stress in animals has yielded resulting evidence which shows that chronic exposure to glucocorticoids, a series of hormones which support a variety of bodily functions, is associated with a decrease in the size of the hippocampus ; similarly, evidence supports that this nature of exposure may cause similar decreases in hippocampus size in PTSD sufferers, indicating the reasons for change in memory and disorientation. Further studies of molecular changes in the brain indicate a decrease in levels of N-acetylaspartate in the hippocampus, possibly leading to the reductions in activity and decrease in size.

Risk Factors
Researchers have identified a number of risk-factors for PTSD, including the following: •	Being female •	Experiencing intense or long-lasting trauma •	Having experienced other trauma earlier in life •	Having other mental health problems, such as anxiety or depression •	Lacking a good support system of family and friends •	Having first-degree relatives with mental health problems, including PTSD •	Having first-degree relatives with depression •	Having been abused or neglected as a child •	Living through dangerous events and traumas •	Having a history of mental illness •	Getting hurt •	Seeing people hurt or killed •	Feeling horror, helplessness, or extreme fear •	Having little or no social support after the event •	Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home. Evidence from twin studies supports that smaller hippocampus size could be indicative of a risk factor for development of PTSD, although some evidence does support that the differences in size are more closely associated with vulnerability of traumatic exposure. Prevention Most evidence supports that the best prevention for PTSD development comes from ready availability of therapy following traumatic events, including clinical, family, and faith support, in order to prevent short-term and natural stress reactions from developing into PTSD ; this includes preventing sufferers from indulging in substance-based coping, like alcohol use.

Early Detection and Intervention
Early detection for PTSD is difficult, but there are detectable contributing factors. Research indicates that elevated numbers of glucocorticoid receptors and mylenation in an individual can be a possible indicator of susceptibility, though the results yield a great degree of overlap between high- and low-number groups.

Treatment
Main treatments for PTSD are psychotherapy, medications, or both, with success rates around 85% for cognitive behavioral therapy.

Cognitive Behavioral Therapy
CBT is a process by which advocates attempt to change sufferers' outlook of trauma and patterns of behavior and thinking. The intent is to provide social support and alter responses to stressors through behavioral changes in the hopes that they can change or reverse cognitive changes which occurred as a result of exposure to stressors. CBT/cognitive processing therapy (CPT) is advocated by the VA and DoD as the most effective treatment for PTSD.

Prolonged Exposure Therapy
PE is a, 8-15 session therapy whose target goal is to teach sufferers to manage reactions and habituate to stressors through breathing practices and controlled thought ; it is advocated by the VA and DoD, and can include virtual reality simulations of traumatic events to relieve fear and stress responses to stimuli similar in nature to triggering events ; documented results seem to indicate that a combination of CBT and PE offer the most therapeutic results to military personnel who have suffered deployment-related symptoms.

Eye Movement Desensitization and Reprocessing
EMDR is a therapy by which therapists teach patients to use hang gestures to distract negative ideas and memories until they are no longer distressful, then begin to associate positive imagery with the aforementioned gestures. It typically takes place over 4-12 sessions, and is advocated by the VA and DoD. Various studies have indicated elimination of PTSD in 77-90% of patients.

Medication
Though medications are an option for treatment, it has been shown that some of the effect is psychological. When tested against placebo groups, research has indicated as much as 22% difference in response to sertaline, as well as a 4% difference in discontinuation due to aversive responses. Holists and dieticians suggest ensuring a daily nutritional balance, as well as a number of other supplements, herbs, and minerals to promote healthy body function and speed recovery, including :
 * Paroxetine
 * Sertraline
 * Benzodiazepines
 * Antipsychotics
 * Other Antidepressents
 * B Vitamins
 * Chromium
 * Magnesium
 * EFAs
 * 5-HTP

Developmental and Experimental Treatments
Tetris Therapy A 2009 study indicates that the performance of visuospatial tasks, such as playing the game Tetris, soon after viewing traumatic material can help to reduce the incidence of unwanted recall (flashbacks) by around 50%. It is hoped that this method of prevention can be utilized to block the formation of traumatic event recall and prevent symptoms of PTSD.

History
Though PTSD was not officially diagnosed as such until the release of the DSM-III in 1980, there were several instances of writings on PTSD or PTSD-like symptoms in Egyptian texts as much as 3000 years ago, include violent shaking, temporary paralysis, loss of confidence, nightmares, and loss of appetite. These symptoms have arisen as a result of several kinds of natural disasters, as well as a response to human warfare, and were classified in many cultures, spanning the world. It was not until the introduction of the DSM-III that the stressors involved in PTSD were classified as a separate kind of stress, which occurred in response to a wider range of traumatic events, and that people experience trauma from a less objective standpoint. Later editions of the DSM revised classifications of PTSD in response to information pertaining to prevalence and a more specific variety of symptoms. It is estimated that 7.8% of Americans will experience PTSD during their lifetime, with women estimated at 10.4% and men at 5%; additionally, roughly 30% of those people serving in war zones will develop PTSD, with an another 20-25% experiencing at least some symptoms