POST TRAUMATIC STRESS DISORDERS IN A GLOBAL CONTEXT Edited by Emilio Ovuga Post Traumatic Stress Disorders in a Global Context Edited by Emilio Ovuga Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Publishing Process Manager Igor Babic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published January 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Post Traumatic Stress Disorders in a Global Context, Edited by Emilio Ovuga p. cm. ISBN 978-953-307-825-0 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Part 1 Overview of Clinical Aspects 1 Chapter 1 Post Traumatic Stress Disorder – An Overview 3 Amarendra Narayan Prasad Chapter 2 Combat Related Posttraumatic Stress Disorder – History, Prevalence, Etiology, Treatment, and Comorbidity 25 Jenny A. Bannister, James J. Mahoney III and Tam K. Dao Chapter 3 Psychiatric Management of Military- Related PTSD: Focus on Psychopharmacology 51 Don J. Richardson, Jitender Sareen and Murray B. Stein Part 2 Review of Etiological Factors 71 Chapter 4 Acquisition of Active Avoidance Behavior as a Precursor to Changes in General Arousal in an Animal Model of PTSD 73 Thomas M. Ricart, Richard J. Servatius and Kevin D. Beck Chapter 5 Peritraumatic Distress in Accident Survivors: An Indicator for Posttraumatic Stress, Depressive and Anxiety Symptoms, and Posttraumatic Growth 97 Daisuke Nishi, Masato Usuki and Yutaka Matsuoka Chapter 6 Sex Differences in PTSD 113 Dorte Christiansen and Ask Elklit Chapter 7 Risk Factors and Hypothesis for Posttraumatic Stress Disorder (PTSD) in Post Disaster Survivors 143 Frank Huang-Chih Chou and Chao-Yueh Su VI Contents Part 3 African Perspective 157 Chapter 8 War in Côte d'Ivoire and Management of Child’s Post Traumatic Stress Disorders 179 A. C. Bissouma, M. Anoumatacky A.P.N and M. D. Te Bonle Chapter 9 Post Traumatic Stress Disorder – A Northern Uganda Clinical Perspective 183 Emilio Ovuga and Carol Larroque Part 4 Post-Traumatic Stress in Special Situations 209 Chapter 10 Earthquake and Mental Health 211 Xueyi Wang and Kezhi Liu Chapter 11 PTSD in the Context of Malignant Disease 227 A.M. Tacón Chapter 12 Posttraumatic Stress Disorder after Stroke: A Review of Quantitative Studies 247 Paul Norman, Meaghan L. O’Donnell, Mark Creamer and Jane Barton Part 5 Stress Management Training 269 Chapter 13 The Potential of Stress Management Training as a Coping Strategy for Stressors Experienced in Theater of Operation: A Systematic Review 271 Stéphane Bouchard, Tanya Guitard, Mylène Laforest, Stéphanie Dumoulin, Julie Boulanger and François Bernier Preface One of my most nurse clients once told me in therapy; “When you have an abscess you know the source of the pain, you can get at it and remove it at source. When you have a wound on the body you know the source of the pain and you can get at the source and remove it. This pain of mental illness is different. You know the pain is there and it is real but you do not know where the source is and cannot get at it.” Yes the pain of emotional illness is real and it is there deep inside our clients. Psychiatrists and other mental health professionals grapple with the problem of emotional pain on a daily basis. Unfortunately our understanding of how mental health problems arise is not yet adequate. Our only diagnostic gold standard in psychiatry remains the psychiatric interview and this can unfortunately be very subjective. There are multiple theories of causation and there is no single proven magic therapeutic bullet that can help our clients. In this volume titled: Post-traumatic Stress Disorder in a Global Context, authors from around the world share their valuable insights, knowledge, experience, and research in the hope that mental health practitioners gain a better understanding of this special mental disorder, post-traumatic stress disorder (PTSD) that arises after individuals are exposed to severe, terrifying, and horrifying experiences that threaten their safety, life, or integrity. The pain of what has evolved to be known as post-traumatic stress disorder is peculiar. A common factor in the origins of PTSD appears to be an injury to the inner integrity of its victims, which psychoanalysts refer to as narcissistic injury. Author Corrine Anna Bissouma from Ivory Coast refers to this narcissistic injury as a “wound in the mind” to make it easier for her community of former child soldiers to understand what she means in her communications with them and their caregivers. What makes PTSD peculiar is the fact that it is often caused by people who are close to us; those we rely on everyday in our households; the people that we place our inner most trust in; the people that we believe cannot betray us; the people who are significant to us and are the reason we possibly exist. As humans even though most people may not be close to us in terms of their not being our family members, we still expect that they should not violate our integrity and cause emotional pain in us for whatever reason. In the course of time psychiatrists from as early as Sigmund Freud have identified two major origins of PTSD; i.e. those arising secondary to the experience of natural X Preface disasters, and the ones that result from traumatic experiences in our interactions with each other. Freud particularly traced the origins of neurosis to the sexual violations of young children by their own adult kin. The commonplace experience of traumatic experiences, whether natural or manmade, makes one wonder if traumatic stress is in fact not the initial common pathway through which all major psychiatric disorders including post-traumatic stress disorder arise. After all according to Sigmund Freud, neurosis arising from childhood experience of sexual abuse, and sexual and physical childhood abuse, continues to be cited as one of the leading causes of mental health problems such as depression, suicide behavior, and post-traumatic stress disorder. The authors of post-traumatic Stress Disorder in a Global Context present a wide array of information that practitioners will find useful in understanding PTSD in practice. Carefully chosen, each chapter blends in with the others without unnecessary repetition and redundant overlaps. The book is divided into four sections. Section I provides an overview of PTSD as is currently understood. Dr Prasad Amarendra provides an overview of clinical features and current management approaches while Banister and associates present the history, prevalence, etiology, treatment, and comorbid disorders in PTSD related to combat situations. Dr Richardson and associates describe the military related psychiatric management of PTSD. Section II describes etiologic theories and risk factors for PTSD. Dr Kevin provides an interesting animal model of how avoidant behavior in PTSD is actively acquired, and highlights strain and sex differences in the acquisition process. Dr Yukata brings research-based data indicating the need for clinicians to screen accident victims for PTSD, as the emotional reactions of accident victims to their experience and their heart rate predict the potential development of post-traumatic stress disorder after motor vehicle accidents. Dr Ask and Dr Christiansen describe sex differences in the manifestation of post-traumatic stress disorder among males and females while Dr Chou attributes the development of post-traumatic stress disorder to the complex interaction of individual’s biologic, psychological, environmental, and social factors, and low resource availability that predispose the vulnerable individual with sub-threshold psychiatric disorder to the full manifestation of post-traumatic stress disorder. In section III Dr Bissouma describes the invaluable role of social and community support in the rehabilitation of former child soldiers in Ivory Coast. Dr Ovuga and Dr Larroque describe the precarious situation of children in northern Uganda who live in abject poverty and social adversity with significant levels of aggression in the daily lives of the children four years after active war in the region ceased. Dr Ovuga and Dr Larroque further provide possible evidence of post-traumatic stress disorder across the lifespan related to exposure to trauma not only in military but also civilian situations in northern Uganda and Southern Africa. Using clinical vignettes, Dr Ovuga and Dr Larroque describe the difficulties in the recognition of post-traumatic stress disorder in clinical practice. In Section IV research in special situations suggests that post-traumatic stress disorder can indeed present in malignant disease (Dr Tacon), after stroke (Dr. Norman) and after exposure to earthquake (Dr Wang). Awareness of any malignancy as a significant cause of traumatic stress for the sufferer, family and [...]... Association, posttraumatic stress disorder (PTSD) is defined as "an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, such as terrorist attacks, motor vehicle accidents, rape, physical and sexual abuse, and... Neuropharmacologic and neuroendocrine abnormalities have been detected in the noradrenergic, hypothalamic-pituitary-adrenocortical, and endogenous opioid systems[27] There is increasing evidence that PTSD is associated with biological alterations or abnormalities Individuals with PTSD have an atypical stress response Instead of producing increases in cortisol, a stress related hormone, the usual hypothalamic-pituitary... reconditioning of the emotionally aversive associations to trauma memories [41] Gradually being reminded or remembering the trauma will lose the intense negative quality Breathing retraining to assist with relaxation is an initial component of the approach The treatment ordinarily is carried out over ninety minute Post Traumatic Stress Disorder – An Overview 13 sessions that may occur twice a week High-risk... current research examining PTSD-related intrusions provides further evidence that they are not qualitatively distinct from other intrusive cognitions 10 References [1] American Psychiatric Association Diagnostic and statistical manual of mental disorders: DSM-IV Washington, DC: American Psychiatric Association, 1994 [2] American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders: ... largely as a result of the problems that were still being experienced by US military veterans of the war in Vietnam In its initial DSM-III (formulation 1980), a traumatic event was conceptualized as a catastrophic stressor that was outside the range of usual human experience The framers of the original PTSD diagnosis had in mind events such as war, torture, rape, the Nazi Holocaust, the atomic bombings... with a wide variety of populations suffering from anxious response including trauma SIT involved explaining the physical, cognitive and behavioral components of fear and anxiety reactions Then victims are taught various coping strategies to address dysfunctional thoughts and unpleasant feelings that come up with exposure to certain trauma reminders These include relaxation, shifting attention and self-coaching... this approach has been advocated as a treatment for a variety of psychological problems involving intense emotions and intrusive thoughts It is generally considered a form of imaginal exposure accompanied by cognitive re-framing, which are standard elements of CBT Victims are encouraged to imagine a stressful scene and replace dysfunctional cognitions with more adaptive ones while engaging in lateral... uncomfortable or may be expressed in appropriate behaviors In addition, avoidance coping may temporarily reduce anxiety but lead to maladaptive behavior patterns 8.3.1 Teaching stress management techniques Stress management techniques such as progressive muscle relaxation, thought-stopping, positive imagery, and controlled breathing are often taught to accompany direct traumafocused discussion in treatment... capacity to talk about the trauma without experiencing significant distress or use of avoidance coping is an indication of successful emotional processing However, a child’s unwillingness to talk about it may not be because of post- traumatic stress reaction but instead a legitimate response( e.g., tired of talking about it, embarrassed) In these situations, various indirect methods of addressing trauma-related... military combat [1]." PTSD is a problem in which the human brain continues to react with nervousness after the horrific trauma even though the original trauma is over Brain can react by staying in "overdrive" and being hyperalert in preparation for the next possible trauma Sometimes the brain continues to "remember" the trauma by having "flashbacks" about the event or nightmares even though the trauma . Clinical Aspects 1 Post Traumatic Stress Disorder – An Overview Amarendra Narayan Prasad Ministry of Defence (Indian Army), India 1. Introduction Posttraumatic stress disorder (PTSD) is a. whether natural or manmade, makes one wonder if traumatic stress is in fact not the initial common pathway through which all major psychiatric disorders including post- traumatic stress disorder arise Training 269 Chapter 13 The Potential of Stress Management Training as a Coping Strategy for Stressors Experienced in Theater of Operation: A Systematic Review 271 Stéphane Bouchard, Tanya