Post-Traumatic Stress Disorder (PTSD)
PTSD is a condition of persistent emotional and mental stress occurring as a result of severe psychological shock or injury, involving disturbance of sleep, vivid recall of experience constantly with dulled responses to the world (Thomas, 2008). The PTSD diagnosis procedure is under the ICD-9-CM and ICD-10-CM codes 309.81 and F43.10 respectively on the DSM-5 Manual (American Psychiatric Association, 2013). On January 28, 1998, Art Artisan was involved in a tragedy and traumatizing event in his house. He received a knock and his dog barked; standing on the door step was a lady wanting to talk to his son. It was followed by his denial for his son to go out, three gunned men forced in, pointing their guns at him and his fiancée. The son broke the window and run, this was followed by seven gun shots, five rested on his fiancée.
Art Artisan is nervous at door bells and it reminds him of the event, he checks before opening his door. He is nervous of his dog barking. The two events remind him about the traumatizing event and he associates them with the trauma. He wakes up at about 2.00am and does not fall asleep again, a condition known as late sleep insomnia. He experiences numbness flashes with avoidance and withdrawal from previous activities causing emotional anaesthesia. Art avoided sleeping in his house and he had ideas of selling it as he associates it with the scene and even after many years he cannot trust people.
Art Artisan Diagnoses
In Artisan’s case, the emotion reaction of the event is no longer in criteria A and dissociative symptoms predominate. Fear-based experiences, behavioural and emotional symptoms also predominate and thus a combination of symptom patterns. He has criteria A traumatic event as it is a physical witnessed assault and it is re-experienced through involuntary and recurrent recollections of the events (Criterion B1). Artisan’s experience dissociative states lasting for hours when event components are relived, and he behaves as if the event is occurring at that time (Criterion B3). The episodes are referred to as flashbacks; they are typically brief but associated with prolonged distress and increased arousal.
Artisan persistently avoids stimuli he associates with the incident; dog barking and door bells, he makes the efforts of checking on people at his door step before opening (Criterion C2). As in Criterion D3, he has persistent erroneous cognitions about the cause of the trauma where he blames himself for opening the door without checking. He had diminished interest and participation in his previous work and stayed for 6months before working again (Criterion D5). He had sleeping disturbances waking up at 2.00am a condition known as late insomnia which is in Criterion E5. When traumatic events produce violent death, PTSD and problematic bereavement symptoms may be available as in the case of Artisan.
Adjustment disorders and stressors can be of any severity rather than the required PSTD Criterion A. Its diagnoses is used when stressor response that meets Criterion A does not meet the other PSTD Criteria or of any other mental disorder (Thomas, 2008). Acute stress disorder is distinguished from PSTD as its symptom is restricted to 3 days to 1 month after traumatic exposure. Major depressive disorder does not include any PSTD Criterion B or C symptoms together with some of Criterion D or E. PTSD flashbacks should be distinguished from psychotic disorders that are represented by hallucinations, illusions, and perceptual disturbances in schizophrenia. Other differential disorders include traumatic brain injury, conversion disorder, dissociative disorder, personality disorder, anxiety disorder, and obsessive-compulsive disorder (Johnson, 2009). Since Artisan meets all the criteria of PTSD, he should definitely be diagnosed with the condition. He should also start up on medication and intervention at once.
Desyrel trazodone medications would be preferred for this client as antidepressants due to sleep disturbances especially in the morning hours. The client should be involved in cognitive processing therapy that includes an exposure component while placing greater emphasis on cognitive strategies that will help him alter erroneous thinking (Corcoran & Walsh, 2014). Eye-Movement Desensitization and Reprocessing (EMDR) can be used, where he is guided to make eye-movements while recounting traumatic events. Stress inoculation training is one intervention where clients are taught on management techniques that reduce anxiety such as muscle relaxation, breathing, and positive self-talk. The pro-longed exposure therapy developed by Keane guides the client to recall traumatic events and memories in a fashionable way so that they eventually regain mastery of their feelings and thoughts (Johnson, 2009).
Culture or Ethnicity Influence on Assessment and Diagnoses
Cultural idioms and syndromes of distress influence PTSD expression and comorbid disorder ranges of different cultures by providing cognitive and behavioural templates that link traumatic exposures with specific symptoms. Clinical expression of symptoms of PTSD may vary culturally due to distressing dreams, avoidance and numbing symptoms, and somatic symptoms. PTSD relative risks of particular exposures vary across cultural groups, for example, involvement in Vietnam War. Risk of severity and onset of PTSD may vary across cultural groups due to variation in the type of traumatic exposure. The society expected Artisan to be strong as he is a man, he acted with strength but he explains he was weak inside.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Corcoran, J. & Walsh, J. (2014). Mental Health in Social Work: A Casebook on Diagnosis and Strenghts Based Assessment (DSM 5 Update). Pearson College Division.
Johnson, S. (2009). Therapist’s guide to posttraumatic stress disorder intervention. Amsterdam: Elsevier/Academic Press.
Thomas, P. (2008). Posttraumatic stress disorder. Farmington Hills, MI: Lucent Books.
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