History of post-traumatic stress disorder While combat-related trauma had been documented for centuries, PTSD was first formally identified in Vietnam veterans and was added to the American Psychiatric Association’s list of mental afflictions (in the Diagnostic and Statistical Manual of Mental Disorders [DSM]) in 1980. Before PTSD was officially recognized as its own condition, it was most often recognized in soldiers. Even as far back as the U.S. civil war, there are many documented cases of soldiers coming back with “melancholia” or “nostalgia,” as it was being diagnosed at the time. Symptoms had been reported as having “over emotionality” or being withdrawn, and even with recognition of physical cardiac symptoms as well. These symptoms were called “soldier’s heart” or “irritable heart.” It was believed at the time that these conditions were a result of the physical exhaustion that was demanded of the men coming back from war (U.S. Department of Veteran Affairs, 2023b) When PTSD became officially recognized as a psychological disorder, it was limited to clinical documentation of Vietnam Symptoms and signs Many times, the patient who walks into your office who has suffered from trauma and is experiencing PTSD will not feel comfortable enough to share that they are experiencing this condition. Often, they may not even be aware of the benefit therapy, specifically manual therapy, can have on their condition or the effects that physical touch can awaken in a session. Therapists should consider including post-traumatic stress disorder as an option to check under the medical conditions listed on your physical intake form. This allows the patient a certain amount of privacy and sense of security when informing their therapist about their condition. However, it is also important to educate yourself around the other surrounding physical and emotional signs of PTSD that may present with your clients. Having a better understanding of the symptoms of this disorder can help you be more mindful of your treatment plan with the client. Possible symptoms can include (NIMH, 2023): ● Emotional signs : Sadness, helplessness, feeling numb, anxiety, fear, apprehension, uncertainty, grief, denial, guilt, depression, feeling overwhelmed, loss of emotional control, irritability, agitation, intense anger with self or others, shame. ● Cognitive (thinking) effects : Confusion or mental fuzziness; poor attention and concentration; poor problem-solving; poor decision-making; memory problems; loss of orientation; disturbing thoughts; flashbacks and intrusive images; avoidance of thinking; nightmares, panic attacks, hyper-vigilance, guilt, and blaming others or yourself. ● Behavioral signs : Withdrawal; tearfulness and emotional outbursts; an inability to feel settled; suspiciousness; consumption; increased use of medication; change in sexual functioning; altered sleep patterns; strained relationships; increased accidents; avoidance of places, people, or situations; loss of interest in life; reluctance to discuss the event or wanting to talk about it all the time; apparent personality change or antisocial behavior. ● Physical effects : Fatigue, weakness, nausea, dizziness, chest pain, elevated blood pressure, difficulty breathing, hyper-alertness/intensified startle-response; a loss or increase in appetite; increased alcohol sweating, teeth-grinding, rapid heart rate, muscle tremors, visual difficulties, menstrual changes, feeling faint, stomach upsets, muscular tension leading to head, neck, or backache.
vets, combining symptoms described before as “shell shock,” “battle fatigue,” “dissociative amnesia,” and “physio neurosis.” Once the diagnosis was developed, it became clear that other types of traumas produced the same types of symptoms. With this new name and growing awareness of the condition, the amount of research addressing post-traumatic care and treatment increased sharply. Dr. Bessel van der Kolk (2000), one of the first researchers to describe the psychobiology of PTSD, noted: In a well-functioning organism, stress produces rapid and pronounced hormonal responses. However, chronic and persistent stress inhibits the effectiveness of the stress response and induces desensitization. PTSD develops following exposure to events that overwhelm the individual's capacity to reestablish homeostasis. Instead of returning to baseline, there is a progressive kindling of the individual’s stress response. As mentioned, if symptoms last more than a month, the condition is called post-traumatic stress disorder (PTSD). Before that symptoms after a traumatic event can be called acute stress disorder (NIMH, 2023). Symptoms can present in various ways, including (NIMH, 2023): ● Reexperiencing the trauma : Through troublesome or obsessive thoughts or dreams; flashbacks and/or panic attacks or feeling like the experience is happening again ● Avoidance or numbing : Avoiding topics, places, people, etc., who remind you of the trauma, mentally blocking out significant portions of memory of the event, feeling numb or emotionally distant from relatives and friends; lack of feelings, or feelings of hopelessness. ● Hyper-alertness : Difficulty sleeping or resting, frequent anger, irritability, or suspicion, poor concentration or ability to focus, and/or easily startled or scared, constant readiness or feeling “on guard” Other specific problems associated with PTSD include (NIMH, 2023): ● Panic attacks : Individuals who have experienced a trauma may have panic attacks when exposed to something that reminds them of the trauma. Physical symptoms include pounding or racing heart, sweating, trembling or shaking, a feeling of shortness of breath or choking, chest pain, nausea, dizziness, chills, hot flushes, numbness, or tingling. The person may also experience psychological symptoms such as feeling unreal or detached or fearing that they are going crazy, dying, or having a heart attack. ● Severe avoidance behavior : Sometimes avoidance begins to extend far beyond reminders of the original trauma to all sorts of situations in everyday life. This can become so severe that the person becomes virtually housebound. ● Depression : Many people become depressed and no longer take interest or pleasure in things they used to enjoy before. They may also develop unjustified feelings of guilt and self-blame and feel that the experience was their fault, even when this is clearly not true. For example, an activist may blame themselves for being attacked by the police or not being able to prevent someone else being beaten.
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