Many people suffer for a long time after a life-threatening situation; in some cases, their condition becomes such a persistent and debilitating one that it forms a painful disorder. Post-traumatic stress disorder (PTSD) is an anxiety condition caused by highly stressful, frightening, or unpleasant events (Bryant, 2019). A person with PTSD often experiences a traumatic event because of nightmares and memories and may encounter feelings of aloneness, irritability, and guilt. Over time, however, most people’s well-being will improve. If these negative reactions in individuals persist and interfere with their daily lives, it may indicate the presence of PTSD (Bryant, 2019). Thus, it is crucial to establish the reasons, risk factors, pathophysiology, clinical manifestations, and treatment process.
The cause of the pathology can be any strong experience beyond the usual knowledge, which produces an extreme overstrain of the entire emotional-volitional sphere of the person. Factors that affect the severity of the disorder are the nature of the trauma and the duration of the traumatic element (Lewis et al., 2020). Moreover, the negative consequences of the previous trauma and the experience of physical, emotional, or sexual violence in the past. Additionally, risk factors may include aggravated heredity, such as mental illness, anxiety disorders or depression, suicides, and alcohol, drug, or other addictions in immediate family members. A significant risk factor is a lack of social support after a tragedy, additional stress, such as the death of a loved one, pain, trauma, and loss of employment (Lewis et al., 2020). Indeed, concomitant nervous, mental, or endocrine illnesses, alcohol, and substance abuse can also be distinguished.
While most of the pathophysiology of PTSD is unclear, research findings are emerging. Magnetic resonance imaging studies have demonstrated that patients with PTSD have decreased hippocampal, left amygdala, and anterior cingulate cortex volumes compared to a similar control group (Lewis et al., 2020). Other reports have demonstrated elevated levels of central noradrenaline with the downregulation of central adrenoreceptors and chronically decreased levels of glucocorticoids with the upregulation of their receptors (Bryant, 2019). This probably explains the finding that these patients have more autoimmune diseases. In addition, hemispheric lateralization, in which there is a relative insufficiency of left hemispheric function (Bryant, 2019). This explains the confusion associated with the temporal sequence of traumatic events.
Furthermore, it can be specified that genetics may contribute to individual susceptibility to PTSD through interactions with environmental factors. Large-scale genetic studies show that PTSD is a highly polygenic phenotype, possibly influenced by thousands of loci throughout the genome. The presence of one of four stress-related polymorphisms in the FKBP5 gene has been associated with an increased risk of developing PTSD in patients with a history of child abuse (Lewis et al., 2020). Significantly, prior exposure to trauma enhanced the risk of developing PTSD with subsequent traumatic events.
PTSD symptoms can be divided into the following categories: presence symptoms, avoidance symptoms, negative cognitive and mood changes, and changes in arousal and reactivity. Most often, patients have undesirable recollections and replay of the triggering event. Dreams about the event are common (Shalev et al., 2017). Less common are dissociative waking states in which actions are experienced as if they were real. This sometimes leads patients to react as in the original situation. For example, loud noises, such as fireworks, may initiate a memory of fighting, which may lead to seeking shelter or falling to the ground for protection (Shalev et al., 2017). Patients have a hard time avoiding the stimuli associated with trauma, and they often feel emotionally numb in their daily activities.
Occasionally the symptoms represent a continuation of the acute stress disorder. Alternatively, they may arise separately within a period not exceeding six months after the trauma (Shalev et al., 2017). Sometimes the full manifestation of individual symptoms is delayed and does not begin until several months or even years after the traumatic event. It is significant to mention that depression, other anxiety disorders, and substance abuse disorders are characteristic of patients with chronic PTSD (Shalev et al., 2017). Meanwhile, in addition to traumatic anxiety, patients may experience guilt over their actions.
A wide range of psychotherapeutic methods is successfully used to treat PTSD. The basic form of psychotherapy is exposure therapy, which is characterized by patients encountering situations they avoid because they may provoke memories of trauma. Returning in fantasy to the traumatic experience usually reduces stress after some initial increase in discomfort (Shalev et al., 2017). Supportive psychotherapy plays an important role; therapists must be empathic and responsive, acknowledging patients’ mental pain and the reality of traumatic events. Selective serotonin reuptake inhibitors (SSRIs) or other medications are also often used. SSRIs are essential medications because they can reduce anxiety or depression (Shalev et al., 2017). However, prazosin assists in reducing the intensity of nightmares. Occasionally, mood stabilizers and atypical neuroleptics need to be used if patients need support in coping with stress.
Therefore, PTSD is a disorder developing in the person after a traumatic event. Individual features of mentality can serve as the additional factor which influences the occurrence of PTSD in certain life situations. The invading memories can negatively affect the day-to-day flow of a person’s life. Patients with PTSD may suffer from tormenting memories and self-blaming. Additionally, treatment of the illness includes psychotherapy and medication.
Bryant, R. A. (2019). Post‐traumatic stress disorder: A state‐of‐the‐art review of evidence and challenges. World Psychiatry, 18(3), 259-269.
Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633.
Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. New England Journal of Medicine, 376(25), 2459-2469.