Under the DSM-5 classification, PTSD is an anxiety disorder that a person develops after witnessing or being a part of a stressful event. This event can be life-threatening, result in severe injuries, or involve sexual violence. As a result, an individual experiences fear, a sense of helplessness, and anxiety. One way of diagnosing PTSD is by using the classification developed by the American Psychiatric Association (APA) (2013), which includes the following symptoms: having an experience of a traumatic event, distressing memories or flashbacks, avoidance of potential triggers, and adverse effects on one’s cognition. Hence, a person with PTSD can either be a participant in a traumatic event, witness it, or learn about something that happened to a relative or a loved one, which can cause PTSD. They develop physical and psychological reactions as a response to this stress that continuously repeats, together with traumatic memories. The affected individual may choose to avoid places, events, or people that remind them of their PTSD. This condition results from cognitive distortions, issues with memories, and poor emotional state. Additionally, these symptoms have to last for over a month to be considered PTSD, although they may develop right after the stressful event.
The APA (2013) also notes that in order for the diagnosis to be PTSD, the professional has to check if the disturbances are not caused by other issues, such as medication or mental illness. Also, a PTSD diagnosis must involve avoidance of social events for at least one month. Hence, PTSD is diagnosed after one experiences a highly stressful and traumatic event and continues to suffer from emotional, cognitive, and physical disturbances. These criteria are valid for children aged six and older, as well as adults. For children younger than six, the diagnosis criteria differ. This paper intends to review the neurological basis for PTSD, examining a case presentation and ways of appropriate treatment.
Neurological Basis of PTSD
The stress that underlines PTSD diagnosis affects the fear processing pathway. As a result, the amygdala, prefrontal cortex, hippocampus, and hypothalamus are damaged (Rousseau et al., 2019). For instance, the effect of PTSD on the amygdala causes the activation of this part of the brain, and the person has a heightened experience of fear and more anxiety when compared to their pre-trauma state. Also, the amygdala is linked to the prefrontal cortex, and the former’s function is emotional regulation. Amygdala’s increased activity decreases serotonin and GABA and leads to an increase in dopamine, norepinephrine, and glutamate.
Joe is a young male patient who developed PTSD after his car was rear-ended by another driver. As a result of this accident, Joe’s father was injured, while Joe experienced no physical damage. However, after this accident, he experienced fear, which intensified when the boy traveled through the road on which their car was hit. Also, the patient began to have nightmares. Other symptoms include increased irritability and poor performance at school. Joe also would not want to discuss the accident and would have random outbursts. Based on these symptoms, Joe meets the criteria for the PTSD diagnosis.
Alternative diagnoses, in this case, include oppositional defiant disorder (ODD). However, for Joe to be diagnosed with ODD, he has to present the symptoms for over six months. Additionally, Joe does not behave aggressively or has been cruel to animals, which are other diagnostic criteria for ODD. Previously Joe was diagnosed with ADHD, which might explain his issues with concentration. Separation anxiety is a possible diagnosis since Joe experiences anxiety when he is left without his father.
APA (2017) recommends psychotherapy as the best-suited method for treating PTSD. There are several modalities that a trained professional can choose, including trauma-focused cognitive behavioral therapy (TF-CBT), EMDR, prolonged exposure (PE), and cognitive processing therapy. Evidence-based research shows that patients with PTSD who have had EMDR therapy have a decrease in the gray matter function and amygdala function, which contributes to them not experiencing the symptoms of their condition (Rousseau et al., 2019). Additionally, Van Minnen et al. (2020) report that a combination of different modalities is more effective for the treatment of PTSD. For example, a combination of PE and EMDR can affect different neurological mechanisms and help improve treatment outcomes. A meta-analysis of PTSD treatment studies by Cusack
et al. (2016) shows that no treatment is more effective than the other. Hence, a trained professional should choose an approach based on each therapy method’s expected outcomes and potential adverse effects.
In summary, this paper examines the neurological processes underlying PTSD, symptoms outlined by APA, and therapeutic treatment options. Advanced practice nurses can rely on evidence-based research and best clinical practices when working with patients who have PTSD. The best approach to treating PTSD is using multiple modalities, a combination of which should be selected based on the benefits and potential adverse effects of each. APA provides clinical guidance and best practice treatment methods that are based on evidence and can help achieve the best outcome for the patient.
American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). APA.
American Psychological Association. (2017). Treatments for PTSD. Web.
Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., Feltner, C., Brownley, K. A., Olmsted, K. R., Greenblatt, A., Weil, A., & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141.
Rousseau, P. F., El Khoury-Malhame, M., Reynaud, E., Zendjidjian, X., Samuelian, J. C., & Khalfa, S. (2019). Neurobiological correlates of EMDR therapy affect in PTSD. European Journal of Trauma & Dissociation, 3(2), 103–111.
Van Minnen, A., Voorendonk, E. M., Rozendaal, L., & de Jongh, A. (2020). Sequence matters: Combining prolonged exposure and EMDR therapy for PTSD. Psychiatry Research, 290, 113032.