PTSD (post-traumatic stress disorder) - symptoms. Post-traumatic stress disorder: symptoms and treatment of the syndrome Post-traumatic stress conditions

Post-traumatic stress disorder (PTSD) is a mental disorder that arises against the background of a single or repeated traumatic situation. The reasons for the appearance of such a syndrome can be completely different situations, for example, the period after returning from war, news of an incurable illness, disaster or injury, as well as fear for the lives of loved ones or friends.

The main symptoms of this disorder are sleep disturbances, even lack of sleep, constant irritability and a depressed state of the patient. This disorder is most often observed in children and the elderly. For the former, this is due to the fact that the child’s defense mechanisms have not yet fully formed, and for the latter, this is due to slowing processes in the body and thoughts of imminent death. Moreover, PTSD can develop not only in a direct participant in the events, but also in witnesses to the accident.

The duration of this disorder depends on the severity of the incident that led to it. Thus, it can range from several weeks to decades. According to statistics, females are most often susceptible to the syndrome. Only experienced specialists in the field of psychotherapy and psychiatry can diagnose PTSD, based on conversations with the victim and additional methods for confirming the diagnosis. Treatment is carried out with medications and psychocorrective methods.

Etiology

The main cause of PTSD is considered to be a stress disorder that occurs after a tragic event. Based on this, the etiological factors for the manifestation of this syndrome in an adult may be the following:

• various natural disasters;
• a wide range of disasters;
• terrorist attacks;
• extensive and severe personal injuries;
• childhood sexual abuse;
• child theft;
• consequences of surgery;
• military actions often cause PTSD in males;
• Miscarriages very often lead to the manifestation of this disorder in women. Some of them then refuse to plan to have a child again;
• a crime committed in front of a person;
• thoughts about an incurable disease, both one’s own and those of loved ones.

Factors influencing the manifestation of post-traumatic stress disorder in children:

• domestic violence or child abuse. It is most acutely manifested due to the fact that parents themselves often cause pain to their child not only physically, but also morally;
• previous operations in early childhood;
• parents' divorce. It is common for children to blame themselves for the fact that their parents separate. In addition, stress is caused by the fact that the child will see less of one of them;
• neglect from relatives;
• conflicts at school. It is quite common for children to gather in groups and bully someone in class. This process is aggravated by the fact that the child is intimidated so that he does not tell his parents anything;
• violent acts in which the child either takes part or witnesses;
• the death of a close relative can cause PTSD in children;
• moving to another city or country;
• adoption;
• natural disasters or transport accidents.

In addition, there is a risk group whose representatives are most susceptible to the development of PTSD syndrome. These include:

• medical workers who are forced to attend various catastrophic situations;
• rescuers who are in close proximity to the loss of life, rescuing people caught in the middle of catastrophic events;
• journalists and other representatives of the information sphere, who, due to their duty, have to be in the thick of the incident;
• directly the participants of extreme events and members of their families.

Reasons why PTSD may worsen in children:

• the severity of the injury, both physical and emotional;
• parents' reaction. A child may not always understand that this or that situation threatens his health, but because the parents demonstrate this to him, the child develops a panicky feeling of fear;
• the degree of distance of the child from the center of the traumatic event;
• the presence of such a PTSD syndrome in the past;
• age group of the child. Doctors assume that some situations can be traumatic at a certain age, but at an older age they will not cause psychological harm;
• Being without parents for a long time can cause post-traumatic stress disorder in a newborn baby.

The degree to which this syndrome is experienced depends on the individual characteristics of the victim’s character, his sensitivity and emotional perception. The repetition of circumstances that cause mental trauma is important. Their regularity, for example, in domestic violence against women or children, can lead to emotional exhaustion.

Varieties

Depending on the length of time it occurs, post-traumatic stress disorder can be expressed in the following forms:

• chronic - only when symptoms persist for three or more months;
• delayed - in which signs of the disorder do not appear until six months after a particular incident;
• Acute - symptoms appear immediately after the event and last up to three months.

Types of PTSD syndrome, according to the international classification of diseases and manifested signs:

• anxious - the victim suffers from frequent anxiety attacks and sleep disturbances. But such people tend to be in society, which reduces the manifestation of all symptoms;
• asthenic - in this case, a person is characterized by indifference to the people around him and the events taking place. In addition, constant drowsiness appears. Patients with this type of syndrome agree to treatment;
• dysphoric - people tend to change their mood frequently from calm to aggressive. Therapy is forced;
• somatoform - the victim suffers not only from a mental disorder, but also feels painful symptoms, often manifested in the digestive tract, heart and head. As a rule, patients independently seek treatment from doctors.

Symptoms

Symptoms of PTSD in adults may include:

• sleep disorders, depending on the type of disorder, it is insomnia or constant drowsiness;
• fuzzy emotional background - the mood of the victim changes from trifles or for no reason at all;
• prolonged or state of apathy;
• lack of interest in current events and life in general;
• decreased appetite or complete loss of it;
• unmotivated aggression;
• addiction to alcoholic beverages or drugs;
• thoughts about taking your own life.

Symptoms that bring a person painful and unpleasant sensations:

• frequent headaches, up to;
• disruption of the functioning of the gastrointestinal tract;
• discomfort in the heart area;
• increase in heart rate;
• trembling of the upper extremities;
• , alternating with diarrhea, and vice versa;
• bloating;
• dryness of the skin, or, conversely, increased fat content.

Post-traumatic stress disorder affects a person’s social life in the following ways:

• constant change of place of work;
• frequent conflicts in family and with friends;
• isolation;
• tendency to wander;
• aggressive behavior towards strangers.

Symptoms of this syndrome in children under six years of age:

• sleep disturbances - the child often has nightmares about a previously experienced event;
• absent-mindedness and inattention;
• pale skin;
• increased heart rate and breathing;
• refusal to communicate with other children or strangers.

Signs of PTSD in children between the ages of six and twelve:

• aggression towards other children;
• suspiciousness about the fact that a sad event happened through their fault;
• manifestation of a recent event in everyday life, for example, through drawings or stories one can trace some aspects of a previously occurring event.

In adolescents over twelve and up to eighteen years of age, post-traumatic stress disorder manifests itself with the following symptoms:

• fear of death;
• reduced self-esteem;
• a feeling of sidelong glances at oneself;
• alcohol abuse or craving for smoking;
• isolation.

In addition, such symptoms are aggravated by the fact that parents, in most cases, try not to notice changes in their child’s behavior and attribute everything to the fact that he will outgrow it. But in fact, it is necessary to begin treatment immediately, because if treatment is not timely in childhood, in adulthood the likelihood of achieving success and starting a full-fledged family is reduced.

Diagnostics

Diagnostic measures for post-traumatic stress disorder must be applied after one month after the event that provoked the psychological trauma. During the diagnosis, several criteria are taken into account:

• what kind of event happened;
• what is the role of the patient in this or that incident - a direct participant or a witness;
• how often the phenomenon is repeated in the thoughts of the victim;
• what pain symptoms are manifested;
• violations of social life;
• the degree of fear at the time of the incident;
• at what time, day or night, episodes of the event emerge in memory.

In addition, it is very important for a specialist to determine the form and type of psychological disorder. A final diagnosis is made when the patient has at least three symptoms. In diagnosis, it is also important to distinguish this syndrome from other diseases that have similar symptoms, especially pain, for example, prolonged depression or traumatic brain injuries. The main thing is to establish a connection between the event that occurred and the patient’s condition.

Treatment

Treatment methods for the syndrome for each patient are established individually, depending on the symptoms, type and form of the disorder. The main method of getting rid of PTSD is psychotherapy. This method consists of conducting cognitive-behavioral treatment, during which the specialist needs to help the patient get rid of obsessive thoughts and correct his feelings and behavior.

Often, in the acute form of the disorder, a method of therapy such as hypnosis is prescribed. The session lasts one hour, during which the doctor needs to find out the full picture of the event that occurred and select the basic methods of therapy. The number of sessions is set for each patient in a personal form.

In addition, additional treatment with medications may be necessary, including:

• antidepressants;
• tranquilizers;
• drugs that block adrenaline receptors;
• antipsychotic medications.

In the acute course of this syndrome, patients respond much better to treatment than in the chronic form.

Psychotrauma leading to the development post-traumatic stress disorder (PTSD), usually involves experiencing the threat of one's own death (or injury) or being present at the death or injury of others. When experiencing a traumatic event, individuals who develop PTSD should experience intense fear or terror. Similar experiences can be experienced by both the witness and the victim. accident, crime, combat, attack, child theft, natural disaster. Also, post-traumatic stress disorder can develop in a person who finds out that he has a terminal illness, or experiences systematic physical or sexual abuse. There are studies on the relationship between the severity of psychological trauma, which, in turn, depends on the degree of threat to life or health, and the likelihood of developing post-traumatic stress disorder. However, from practice, we have learned that even a minor event can become a trauma that has serious consequences for the psyche and subsequently the health of a person. There are also cases when the most serious dangers pass without any consequences. It all depends on the individual characteristics of each individual.

Symptoms of PTSD:

• sleep and appetite disorders,
• memory impairment – ​​loss of some memories, remembering something that could not have happened,
• disruption of contact with needs - you don’t remember the last time you ate, slept, don’t notice injuries, cold, dirt,
• feeling of tension, anxiety, the body does not relax even in sleep,
• flashbacks (pictures of experiences that “flash” in the mind against one’s will),
• irritability, intolerance to the slightest difficulties, disagreement,
• attacks of guilt, constant scrolling in my head of options that could have been done to save the dead,
• attacks of anger, acute, difficult to control attacks of anger or despair, insatiable desire for revenge,
• dullness, apathy, depression, desire to forget, unwillingness to live

In especially severe cases, psychotic episodes may occur, with loss of adequate perception of reality, as well as suicidal attempts. Post-traumatic stress disorder is characterized by three groups of symptoms:

• constant experience of a traumatic event;
• desire to avoid stimuli reminiscent of psychological trauma;
• increased autonomic activation, including increased startle response (startle reflex).

Sudden painful plunges into the past, when the patient relives what happened again and again as if it happened just now (so-called “flashbacks”), is a classic manifestation of post-traumatic stress disorder. Constant experiences can also be expressed in unpleasant memories, difficult dreams, increased physiological and psychological reactions to stimuli that are in one way or another associated with traumatic events. Other symptoms of PTSD include trying to avoid thoughts and actions related to the trauma, decreased memory for events related to the trauma, blunted affect, feelings of alienation or derealization, and feelings of hopelessness.

Post-traumatic stress is present in every soldier. But not every soldier develops stress into post-traumatic stress disorder.

Features of the behavior of a traumatized person

PTSD is typical exacerbation of the instinct of self-preservation, which is typically characterized by a state of arousal in order to maintain a state of readiness to fight back in the event of a repetition of the traumatic event. Such people have excessive vigilance, concentration. There is a narrowing of the volume of attention (a decrease in the ability to hold a large number of ideas in the circle of voluntary purposeful activity and difficulty in freely operating with them). An excessive increase in attention to external stimuli occurs due to a decrease in attention to the internal processes of the subject with difficulty switching attention.

One of the significant signs of post-traumatic stress disorder is memory impairment(difficulties in memorizing, retaining certain information in memory and reproducing). These disorders are not associated with true disorders of various memory functions, but are caused primarily by difficulty concentrating on facts that are not directly related to the traumatic event and the threat of its reoccurrence. However, victims cannot remember important aspects of the traumatic event, which is due to disturbances that occurred during the acute stress response stage. Constantly increased internal psycho-emotional tension (excitement) supports a person’s readiness to respond not only to a real emergency, but also to manifestations that are to one degree or another similar to a traumatic event. Clinically, this manifests itself as an exaggerated startle response. Events symbolizing the emergency and/or reminiscent of it (visiting the grave of the deceased on the 9th and 40th days after death, etc.), a subjective deterioration of the condition and a pronounced vasovegetative reaction are observed.

Post-traumatic stress disorder is almost always diagnosed sleep disorders. Difficulty falling asleep, as noted by victims, is associated with an influx of unpleasant memories of the emergency. There are frequent night and early awakenings with a feeling of unreasonable anxiety “something must have happened.” Dreams are noted that directly reflect the traumatic event (sometimes the dreams are so vivid and unpleasant that the victims prefer not to fall asleep at night and wait until the morning “to sleep peacefully”).

The constant internal tension in which the victim is (due to the exacerbation of the instinct of self-preservation) makes it difficult to modulate affect: sometimes victims can't contain their temper tantrums even for a minor reason. Although outbursts of anger may be associated with other disorders: difficulty (inability) to adequately perceive the emotional mood and emotional gestures of others.

The victims are also observed Alexithymia (inability to verbally express one's emotions). At the same time, there is difficulty in understanding and expressing emotional undertones (polite, soft refusal, wary benevolence, etc.) - life is perceived more in black and white.

Individuals suffering from post-traumatic stress disorder may experience emotional indifference, lethargy, apathy, lack of interest in the surrounding reality, desire to have fun (anhedonia), desire to learn something new, unknown, as well as decreased interest in previously significant activities. Victims, as a rule, are reluctant to talk about their future and most often perceive it pessimistically, not seeing any prospects. They are irritated by large companies (the only exception being people who have suffered the same stress as the patient himself), they prefer to be alone. However, after a while, loneliness begins to oppress them, and they begin to express dissatisfaction with their loved ones, reproaching them for inattention and callousness. At the same time, a feeling of alienation and distance from other people arises.

Particular attention should be paid to increased suggestibility of victims. They are easily persuaded to try their luck at gambling. In some cases, the game is so exciting that the victims often lose everything.

Black and white world

The sharpening of the instinct of self-preservation leads to a change in everyday behavior.

Veterans and soldiers who participate in combat operations use one single psychological defense strategy for survival - splitting. Feelings are pushed aside and only rational thoughts remain - what needs to be done to survive. Observation and attention are sharpened, as well as the speed of reaction to a threat. The world is divided into “us” and “strangers”, since this is the only way to survive. Their behavior remains the same in conditions of peaceful life when they return home. If a veteran has diagnosed the aggressive behavior of those around him, he can quickly move into actions that are justified on the front line, but are not permissible in peacetime. The task of the environment is to understand the state of this person and help.

Earthquake survivors tend to sit close to a door or window so they can quickly leave the room if necessary. They often look at a chandelier or aquarium to determine if an earthquake is starting. At the same time, they choose a hard chair, since soft seats soften the shock and thereby make it difficult to catch the moment the earthquake begins.

Victims who have suffered bombings, upon entering the room, immediately curtain the windows, inspect the room, look under the bed, trying to determine whether it is possible to hide there during the bombing. People who took part in hostilities, upon entering a room, try not to sit with their backs to the door and choose a place from where they can observe everyone present.

Former hostages, if they were captured on the street, try not to go out alone and, conversely, if the seizure took place at home, do not stay alone at home.

Persons exposed to emergency situations may develop so-called acquired helplessness: the thoughts of victims are constantly occupied with the anxious anticipation of a recurrence of the emergency. experiences associated with that time and the feeling of helplessness that they experienced. This feeling of helplessness usually makes it difficult to modulate the depth of personal involvement in contact with others. Different sounds, smells, or situations can easily trigger memories of events related to the trauma. And this leads to memories of one’s helplessness. Thus, in victims of emergencies, there is a decrease in the overall level of personality functioning. However, a person who has experienced an emergency, in most cases, does not perceive the deviations and complaints he has as a whole, believing that they do not go beyond the norm and do not require contacting a doctor. Moreover, the majority of victims consider existing deviations and complaints as a natural reaction to everyday life and are not associated with the emergency that occurred. In the dynamics of the development of disorders at the first stage of PTSD, the individual is immersed in the world of experiences associated with emergency situations. A person seems to live in a world, situation, dimension that took place before the emergency. It’s as if he’s trying to bring back his past life (“return everything the way it was”), trying to understand what happened, looking for the culprits and trying to determine the degree of his guilt in what happened. If a person has come to the conclusion that an emergency is “the will of the Almighty,” then in these cases the formation of a feeling of guilt does not occur.

In addition to mental disorders, during emergencies there are also somatic abnormalities. In approximately half of the cases, an increase in both systolic and diastolic pressure is noted (by 20-40 mmHg). It should be emphasized that the observed hypertension is accompanied only by an increase in heart rate without deterioration in mental or physical condition. After an emergency, psychosomatic diseases often worsen (or are diagnosed for the first time) (peptic ulcer of the duodenum and stomach, cholecystitis, cholangitis, colitis, constipation, bronchial asthma, etc.) It should be especially noted that women of childbearing age quite often experience premature menstruation (less often, delayed ), miscarriages in early pregnancy. Among sexual disorders, there is a decrease in libido and erection. Often victims complain of coldness and a tingling feeling in the palms, feet, fingers and toes. excessive sweating of the extremities and deterioration of nail growth (flaking and brittleness). Deterioration in hair growth is noted. Another disorder that develops after the transition period is generalized anxiety disorder. In addition to an acute reaction to stress, which, as a rule, resolves within three days after an emergency, psychotic level disorders can develop, which are called reactive psychoses in the domestic literature.

If you observe these symptoms of PTSD (may not be all, but only some) in yourself or loved ones, take it carefully. This state is not only very painful, but also completely unhealthy and for the situation as a whole. Don’t tolerate or ignore the problem, ask for help and provide help. To put it very simply, PTSD is a consequence of poisoning the body with stress hormones, as well as overstrain of the entire nervous system and psychological defense mechanisms.

How to help?

For many years there has been a system of assistance to victims and their families. It is very important to help the family understand and realize the state of the veteran or soldier who has returned from the combat zone. Above I described the state of splitting and constant combat readiness. The veteran returns home in 1 day, but the psyche can return to normal functioning for years.

Give it time. Time heals and sometimes a person himself can cope with the transition to a peaceful life and activity. Helping people suffering from post-traumatic disorder consists primarily in creating a safe and calm atmosphere in the family, in accepting this condition.

It often happens that the trauma is conscious, but what is lost is not. It is necessary to understand what is lost. One of the initial concerns is taking care of the body. You need to rest, eat well and do something enjoyable for yourself. The second part of caring is caring for the soul. Allow space for trust and expression to be created. Warmth heals.

A person experiencing PTSD often feels like there is something wrong with the world, but everything is fine with him. This belief prevents you from asking for help. It is important to remember: post-traumatic syndrome is a normal mental reaction to abnormal circumstances, just as pain is a normal reaction to physical trauma. Trauma divides our lives into “before” and “after”. But life itself does not know about this and flows as it always has. The opportunity to talk about your feelings and experiences connects these events and makes it possible to continue. Take care of yourself and your loved ones.

Slobodyanyuk Elena Alexandrovna psychologist, analyst, group analyst

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What is Post Traumatic Stress Disorder?

Post-traumatic syndrome is characterized by a state of increased anxiety, against the background of which, from time to time, attacks of unusually vivid memories of the traumatic event occur.

Such attacks most often develop when encountering triggers (keys), which are irritants that are a fragment of a memory of a traumatic event (a child’s cry, squeaking brakes, the smell of gasoline, the hum of a flying airplane, etc.). On the other hand, PTSD is characterized by partial amnesia, so that the patient cannot remember all the details of the traumatic situation.

Due to constant nervous overstrain and characteristic sleep disorders (nightmares, insomnia), over time, patients with post-traumatic syndrome develop the so-called cerebrasthenic syndrome (a set of symptoms indicating depletion of the central nervous system), as well as disorders of the cardiovascular, endocrine, digestive and other leading systems of the body.

It is characteristic that the clinical symptoms of PTSD, as a rule, appear after a certain latent period after the traumatic event (from 3 to 18 weeks) and persist for quite a long time (months, years, and often decades).

Post-traumatic stress conditions: history of study
pathology

However, the first scientific developments of this problem appeared much later and at first also had a scattered and disordered nature. Only in the mid-nineteenth century was the first comprehensive study of clinical data carried out, which revealed increased excitability, fixation on difficult memories of the past, a tendency to escape reality and a predisposition to uncontrollable aggression in many former participants in military operations.

At the end of the nineteenth century, similar symptoms were described in patients who survived a train accident, as a result of which the term “traumatic neurosis” was introduced into psychiatric practice.

The twentieth century, filled with natural, social and political disasters, provided researchers of post-traumatic neurosis with a wealth of clinical material. Thus, German doctors, when treating patients who participated in the fighting of the First World War, found that the clinical signs of traumatic neurosis do not weaken, but intensify over the years.

A similar picture was discovered by scientists studying the “survivor syndrome” - pathological changes in the psyche of people who survived natural disasters - earthquakes, floods, tsunamis, etc. Dire memories and nightmares, bringing anxiety and fear into real life, tormented disaster victims for years and decades.

Thus, by the 80s, quite a lot of material had been accumulated about mental disorders developing in people who had experienced extreme situations. As a result, the modern concept of post-traumatic syndrome (PTSD) was formulated.

It should be noted that initially post-traumatic stress disorder was talked about in cases where severe emotional experiences were associated with extraordinary natural or social events (military actions, acts of terror, natural and man-made disasters, etc.).

Then the boundaries of use of the term were expanded and they began to be used to describe similar neurotic disorders in persons who have experienced domestic and social violence (rape, robbery, domestic violence, etc.).

How often does post-traumatic stress, which is a physiological reaction to extreme trauma, develop into severe pathology - post-traumatic syndrome?

It is known that post-traumatic stress, which is a physiological reaction to extreme trauma, does not always transform into the pathological state of PTRS. Much depends on the degree of a person’s involvement in an extreme situation: witness, active participant, victim (including those who have suffered severe trauma). For example, in the case of socio-political cataclysms (wars, revolutions, riots), the risk of developing post-traumatic syndrome ranges from 30% among witnesses to 95% among active participants in events who received severe physical injuries.

The risk of developing PTSD also depends on the nature of the external influence. Thus, certain manifestations of post-traumatic syndrome were found in 30% of Vietnam War veterans and in 80-95% of former concentration camp prisoners.

In addition, age and gender influence the risk of developing serious mental pathology. Children, women and the elderly are more susceptible to PTSD than adult men. Thus, when analyzing many clinical data, it was found that post-traumatic stress disorder develops within two years after a fire in 80% of children who suffered severe burns, while for burned adults this figure is only 30%.

The social conditions in which a person lives after experiencing a psychological shock are of great importance. It has been noted that the risk of developing PTRS is significantly reduced in cases where the patient is surrounded by people who have undergone similar trauma.

Of course, there are individual characteristics that increase the risk of developing post-traumatic syndrome, such as:

• family history (mental illness, suicide, alcohol, drug or other addiction in close relatives);
• psychological trauma suffered in childhood;
• concomitant nervous, mental or endocrine diseases;
• social loneliness (lack of family, close friends);
• difficult economic situation.

Causes of Post-Traumatic Stress Disorder

The most studied causative factor is military conflicts, causing PTSD with some characteristic features in active participants ("military neurosis", "Vietnamese syndrome", "Afghan syndrome", "Chechen syndrome").

The fact is that the symptoms of PTSD in war neurosis are aggravated by the difficulties of adaptation of former combatants to a peaceful existence. The experience of military psychologists shows that post-traumatic syndrome extremely rarely develops in people who quickly become involved in the life of society (work, family, friends, hobbies, etc.).

In peacetime, the most powerful stress factor, causing the development of post-traumatic syndrome in more than 60% of victims, is captivity (kidnapping, hostage taking). This type of PTSD also has its own distinctive features, which consist primarily in the fact that serious psychological disorders occur already during the period of exposure to a stress factor.

In particular, many hostages lose the ability to adequately perceive the situation and begin to experience sincere sympathy for the terrorists (Stockholm syndrome). It should be noted that this state is partly explained by objective reasons: the hostage understands that his life is valuable to the captors, while the state machine rarely makes concessions and carries out an anti-terrorist operation, putting the lives of the hostages in serious danger.

A long stay in a state of complete dependence on the actions of terrorists and the plans of security forces, a state of fear, anxiety and humiliation, as a rule, causes post-traumatic syndrome, which requires long-term rehabilitation by psychologists specializing in working with this category of patients.

There is also a very high risk of developing post-traumatic syndrome in victims of sexual violence(from 30 to 60%). This type of PTSD was described at the dawn of the last century under the name “rape syndrome.” Even then it was indicated that the likelihood of developing this pathology largely depends on the traditions of the social environment. Puritanical morals can aggravate the feeling of guilt characteristic of all post-traumatic stress disorders and contribute to the development of secondary depression.

The risk of developing PTSD is slightly lower in survivors of non-sexual criminal incidents. Yes, when brutal beating the probability of developing post-traumatic syndrome is about 30%, with robbery– 16%, y witnesses to murders– about 8%.

The likelihood of developing post-traumatic syndrome in people who have experienced natural or man-made disasters, including automobile and railway accidents, depends on the magnitude of personal losses (death of loved ones, serious injuries, loss of property) and can range from 3% (in the absence of severe losses) to 83% (in the event of an unfortunate combination of circumstances). At the same time, many patients with “survivor syndrome” develop a feeling of guilt (often completely unjustified) for the death of loved ones or strangers.

Recently, a lot of clinical data has appeared on post-traumatic stress syndrome in people who have experienced domestic violence(physical, moral, sexual). Since the victims, as a rule, are persons with a gender and age predisposition to the development of PTSD (children, women, old people), post-traumatic syndrome in such cases is especially difficult.

The condition of such patients is in many ways reminiscent of the condition of former concentration camp prisoners. Victims of domestic violence, as a rule, find it extremely difficult to adapt to normal life; they feel helpless, humiliated and inferior, and often develop an inferiority complex and severe depression.

Symptoms of Post-Traumatic Stress Disorder

Intrusive memories of a traumatic event are a specific system-forming symptom of post-traumatic stress disorder syndrome

At the same time the memories accompanied by a feeling of horror, anxiety, melancholy, helplessness, which are not inferior in strength to the emotional experiences suffered during the disaster.

As a rule, such an attack of experiences is combined with various disorders of the autonomic nervous system(increased blood pressure and heart rate, heart rhythm disturbances, palpitations, profuse cold sweat, increased diuresis, etc.).

Often there is a so-called flash back symptoms– the patient has a feeling that the past is bursting into real life. Most characteristic illusions, that is, pathological perceptions of real-life stimuli. So, for example, the patient can hear the screams of people in the sound of wheels, distinguish the silhouettes of enemies in the twilight shadows, etc.

In severe cases, possible episodes of visual and auditory hallucinations when a PTSD patient sees dead people, hears voices, feels the movement of a hot wind, etc. Flashback symptoms can cause inappropriate actions - impulsive movements, aggression, suicide attempts.

Influxes of illusions and hallucinations in patients with post-traumatic syndrome are most often provoked by nervous overstrain, prolonged insomnia, alcohol or drug use, although they can occur for no apparent reason, exacerbating one of the attacks of intrusive memories.

In the same way, attacks of intrusive memories themselves often arise spontaneously, although more often their development is provoked by a meeting with some stimulus (key, trigger) that reminds the patient of the catastrophe.

At the same time, the clues are diverse in nature and are represented by stimuli of all known senses (the appearance of an object familiar from the disaster, characteristic sounds, smells, taste and tactile sensations).

Avoiding anything that might remind you of the tragic situation

So, for example, patients with PTSD who have survived a train accident often try to avoid not only traveling by this type of transport, but also anything that reminds them.

Fear of memories is fixed at a subconscious level, so that patients with post-traumatic syndrome involuntarily “forget” many details of the tragic event.

Sleep disorders

In severe cases, frightening dreams may follow one another with a short period of awakening, so that the patient loses the ability to distinguish between dreams and reality. It is nightmares that, as a rule, force the patient to seek help from a doctor.

In addition, patients with post-traumatic syndrome experience nonspecific sleep disorders, that is, those observed in many other pathologies, such as sleep rhythm distortion (drowsiness during the day and insomnia at night), insomnia (difficulty falling asleep), and restless shallow sleep.

Guilt

Patients with the anxious type of PTSD suffer from a disorder of social adaptation, which, however, is not associated with pathological changes in character traits, but with a severe psychological state and increased irritability. Such patients easily make contact and often seek medical help on their own. They are ready to discuss their problems with a psychologist, although in everyday life they do their best to avoid situations that remind them of the trauma they received.

Asthenic type Post-traumatic stress disorder is characterized by the predominance of symptoms of exhaustion of the nervous system (asthenia means lack of tone) - symptoms such as weakness, lethargy, and a sharp decrease in mental and physical performance come to the fore.

Patients with the asthenic type of PTSD are characterized by a loss of interest in life and a feeling of personal inferiority. Attacks of intrusive memories are not so vivid, and therefore are not accompanied by a feeling of horror and symptoms of disruption of the autonomic nervous system.

Such patients, as a rule, do not complain of insomnia, but they find it difficult to get out of bed in the morning, and during the day they are often half asleep.

As a rule, patients with the asthenic type of post-traumatic syndrome do not avoid talking about their experiences and often seek medical help on their own.

Dysphoric type PTSD can be described as an angry and explosive state. Patients are constantly in a gloomy, depressed mood. At the same time, their internal dissatisfaction from time to time breaks out into outbursts of unmotivated or weakly motivated aggression.

Such patients are withdrawn and try to avoid others. They never make any complaints, so they come to the attention of doctors solely due to their inappropriate behavior.

Somatophoric type Post-traumatic syndrome, as a rule, develops with delayed PTSD and is characterized by the presence of a large number of heterogeneous complaints from the nervous and cardiovascular systems, as well as the gastrointestinal tract.

As a rule, such patients do not avoid communicating with others, but do not turn to a psychologist, but to doctors of other profiles (cardiologist, gastroenterologist, neurologist).

Diagnosis of Post-Traumatic Stress Disorder

1. The presence of a fact of varying degrees of involvement in an extreme situation of a catastrophic nature:

• the situation posed a real threat to the life, health and well-being of the patient and/or other people;
• stress reaction to the situation (horror, feeling of helplessness, moral distress from the suffering of others).

2. Intrusive memories of the experience:

• vivid intrusive memories;
• nightmares, the plot of which is a traumatic situation;
• signs of "flash back" syndrome;
• a pronounced psychological reaction to a reminder of the situation (horror, anxiety, feeling of helplessness);
• symptoms of the reaction of the autonomic nervous system in response to a reminder of the situation (increased heart rate, palpitations, cold sweat, etc.).

• avoiding talking about the situation, as well as thoughts related to the disaster;
• avoidance of everything that can somehow trigger a memory of the situation (places, people, actions, smells, sounds, etc.);
• disappearance from memory of many details about what happened.

• sleep disorders;
• increased irritability, outbursts of aggression;
• decreased attention function;
• general anxiety, state of hypervigilance;
• increased reaction to fear.

6. Social adaptation disorders:

• decreased interest in activities that previously brought pleasure (work, hobbies, communication);
• reduction of emotional contacts with others up to complete alienation;
• lack of plans for the long term.

Post-traumatic stress disorder in children

Reasons for the development of post-traumatic illness in children

In addition, many experts believe that the list of reasons for the development of post-traumatic stress disorders in children and adolescents should additionally include such extreme situations for them as:

• serious illness of one of the parents;
• death of one of the parents;
• placement in a boarding school.

Psychology of post-traumatic stress symptoms in children

Therefore, quite often young patients try to relive the situation again. They use scenes from traumatic situations for their drawings and games, which often become monotonous. Children and adolescents who have experienced physical violence often become aggressors in children's groups.

The most common sleep disorder in children is nightmares and daytime sleepiness, teenagers are often afraid to fall asleep and for this reason do not get enough sleep.

In preschool children, the psychology of post-traumatic stress includes such a feature as regression, when the child seems to go back in his development and begins to behave like a younger child(certain self-care skills are lost, speech becomes easier, etc.).

Disorders of social adaptation in children, in particular, are manifested in the fact that the child loses the opportunity to imagine himself as an adult, even in fantasy. Children with PTSD become withdrawn, capricious, irritable, and younger children are afraid to part with their mother.

How to Diagnose Post-Traumatic Stress Syndrome in Children

With a long course of PTSD, children are significantly behind in mental and physical development, they develop irreversible pathological deformation of character traits, and in adolescents, earlier than in adults, a tendency to antisocial behavior and the development of various kinds of addictions arises.

Meanwhile, some extreme situations, such as physical and/or sexual violence, may occur without the knowledge of the child’s parents or guardians. Therefore, you should urgently seek medical help if the following alarming symptoms occur:

• nightmares, development of enuresis;
• sleep and appetite disturbances;
• monotonous games or drawings with a strange repeating plot;
• inadequate behavioral reaction to certain stimuli (fear, crying, aggressive actions);
• loss of some self-care skills, the appearance of lisping or other behavioral traits characteristic of young children;
• unexpectedly arising or renewed fear of separation from mother;
• refusal to attend kindergarten (school);
• decreased academic performance in school-age children;
• constant complaints from teachers (educators) about attacks of aggression in the child;
• increased anxiety, flinching when exposed to strong stimuli (loud sound, light, etc.), fearfulness;
• loss of interest in activities that previously brought pleasure;
• complaints of pain in the heart or epigastrium, unexpected migraine attacks;
• lethargy, weakness, drowsiness, avoidance of communication with peers and unfamiliar people;
• decreased ability to concentrate;
• prone to accidents.

Post-traumatic stress disorder: treatment and rehabilitation

Is there an effective drug therapy for post-traumatic stress disorder?

• constant nervous tension;
• anxiety with increased reaction to fear;
• a sharp decrease in general mood;
• frequent attacks of intrusive memories, accompanied by a feeling of horror and/or autonomic disorders (palpitations, a feeling of interruptions in the heart, cold sweat, etc.);
• influxes of illusions and hallucinations.

In case of mild post-traumatic syndrome with a predominance of symptoms of nervous overstrain, sedatives (sedatives) are prescribed, such as Corvalol, Validol, valerian tincture, etc.

However, the effect of sedatives is insufficient to relieve severe symptoms of PTSD. Recently, antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (fevarin), have become very popular.

These drugs are characterized by a wide range of effects, namely:

• increase the overall mood;
• restore the desire to live;
• relieve anxiety;
• stabilize the state of the autonomic nervous system;
• reduce the number of attacks of intrusive memories;
• reduce irritability and reduce the likelihood of outbreaks of aggression;
• reduce cravings for alcohol.

Basic drugs for the treatment of PTSD also include beta blockers (anaprilin, propranolol, atenolol), which are especially indicated for severe autonomic disorders.

In cases where outbreaks of aggression are combined with drug dependence, carbamazepine or lithium salts are prescribed.

For influxes of illusions and hallucinations against a background of constant anxiety, sedative antipsychotics (chlorprothixene, thioridazine, levomenromazine) are used in small doses.

In severe cases of PTSD in the absence of psychotic symptoms, it is preferable to prescribe tranquilizers from the benzodiazepine group. For anxiety combined with severe autonomic disorders, use Tranxen, Xanax or Seduxen, and for nighttime anxiety attacks and severe sleep disorders - Halcion or Dormikum.

For the asthenic type of post-traumatic syndrome, medications from the group of nootropics (Nootropil, etc.) are prescribed, which have a general stimulating effect on the central nervous system.

These are relatively harmless medications that do not have serious contraindications. However, it should be borne in mind that a side effect of stimulation of the nervous system can be insomnia, so nootropics should be taken in the first half of the day.

Psychotherapy for post-traumatic stress disorder

At the first, preparatory stage, a trusting relationship is established between the doctor and the patient, without which full treatment is impossible. Psychologist in an accessible form provides information about the essence of the disease and the main methods of therapy, setting the patient up for a positive outcome.

Then they begin the actual treatment of PTSD. Most psychologists believe that the basis for the development of post-traumatic syndrome is a violation of the processing of life experience in an extreme situation, so that instead of becoming a part of memory, the past continues to exist simultaneously with reality, preventing the patient from living and enjoying life.

Therefore, in order to get rid of intrusive memories, the patient should not avoid, but, on the contrary, accept and process this difficult life experience. There are many techniques to help the patient make peace with your past.

Psychotherapeutic sessions bring good results, during which the patient re-experiences an extreme situation, telling a professional psychologist about the details of the events.

In addition, methods of behavioral psychotherapy are quite popular, which aim to neutralize the trigger keys that initiate attacks, gradually “accustoming” the patient to them.

To do this, first, with the help of the patient, a kind of gradation of triggers is carried out according to the degree of impact on the psyche. And then, in the safe environment of a doctor's office, seizures are provoked, starting with the keys of the smallest initiating ability.

New promising methods for dealing with attacks of intrusive memories include a specially developed technique of rapid eye movements or the EMDR method (desensitization and processing by eye movements).

Conducted in parallel psychocorrection of feelings of guilt, attacks of aggression and self-aggression. In addition to the individual work of the patient with a psychologist, group psychotherapy sessions are successfully used, which are a therapeutic interaction between a doctor and a group of patients united by a common problem - the fight against post-traumatic stress disorder.

A variation of group psychotherapy is family psychotherapy, which is especially indicated for the youngest patients. In some cases, it is possible to achieve fairly rapid and lasting success in the treatment of PTSD in children with the help of neuro-linguistic programming.

The most commonly used auxiliary methods of psychotherapy are:

• hypnosis (suggestion);
• auto-training (self-hypnosis);
• relaxation methods (breathing exercises, oculomotor techniques, etc.);
• treatment with the help of fine arts (specialists believe that the positive effect of this method is due to the fact that patients get rid of their fears by depicting them on paper).

It should be noted that after the final stage, many patients continue to visit psychotherapy groups for patients with PTSD in order to consolidate the results of treatment and mutual assistance to fellow sufferers.

Treatment method for PTSD in a child - video

Does PTSD require long-term treatment?

Thus, in cases where a patient seeks medical help in the acute phase of PTSD, the period of treatment and rehabilitation is 6-12 months, in the case of a chronic type of course - 12-24 months, and in the case of delayed PTSD - more than 24 months.

If pathological changes in character traits have developed as a result of post-traumatic syndrome, there may be a need for lifelong support from a psychotherapist.

Consequences of post-traumatic stress

• psychopathization of the patient’s personality (an irreversible pathological change in character traits that makes it difficult for a person to adapt to society);
• development of secondary depression;
• the appearance of obsessions and phobias (fears), such as, for example, agorophobia (fear of open space (square, etc.)), claustrophobia (panic when entering a confined space (elevator, etc.)), fear of the dark, etc. ;
• the occurrence of unmotivated panic attacks;
• development of various kinds of psychological addictions (alcoholism, drug addiction, gaming addiction, etc.);
• antisocial behavior (aggression towards others, criminalization of lifestyle);
• suicide.

Is it possible to determine the chances of successful post-traumatic
rehabilitation

With a mild course of post-traumatic syndrome, spontaneous healing is possible. However, clinical studies have shown that patients with mild forms of PTSD undergoing rehabilitation courses recovered twice as quickly. In addition, specialized treatment significantly reduced the likelihood of developing negative consequences of post-traumatic syndrome.

In the case of severe symptoms of post-traumatic stress, spontaneous healing is not possible. About a third of patients with severe forms of PTSD commit suicide. The success of treatment and rehabilitation largely depends on the following factors:

• timeliness of seeking medical help;
• support from the immediate social environment;
• the patient’s mood for successful treatment;
• no additional psychological trauma during rehabilitation.

Is it possible for post-traumatic shock symptoms to return after
successful treatment and rehabilitation?

Relapses of post-traumatic stress disorder most often occur similar to the chronic or delayed form of PTSD and require long-term treatment.

To avoid the return of symptoms of post-traumatic shock, it is necessary to lead a healthy lifestyle, avoid stress, and when the first symptoms of psychological distress appear, seek help from a specialist.

Psychological assistance to survivors of extreme situations as
prevention of post-traumatic stress disorder

Therefore, preventing the development of post-traumatic stress disorder is counseling people who have experienced post-traumatic shock, even in cases where the patients feel quite well and do not make any complaints.

PTSD (Post-Traumatic Stress Disorder) is a special set of psychological problems or painful behavioral abnormalities dictated by a stressful situation. Synonyms for PTSD are PTSS (Post-traumatic stress syndrome), “Chechen syndrome”, “Vietnamese syndrome”, “Afghan syndrome”. This condition occurs after a single traumatic or multiple repeated situations, for example, physical trauma, participation in hostilities, sexual violence, threat of death.

Features of PTSD include the manifestation of characteristic symptoms for more than a month: involuntary recurrent memories, high levels of anxiety, avoidance or loss of memory of traumatic events. Statistics show that most people do not develop PTSD after traumatic situations.

PTSD is the most common psychological disorder in the world. Statistics say that up to 8% of all inhabitants of the planet experience this condition at least once during their lives. Women are susceptible to this disorder 2 times more often than men due to reactivity and physiological instability to a stressful situation.

Causes of PTSD

This condition is caused by the following traumatic influences: natural disasters, terrorist acts, military actions, which include violence, hostage taking, torture, as well as severe long-term illnesses or death of loved ones.

In many cases, if the psychological trauma is severe, it is expressed in feelings of helplessness, intense, extreme horror. Traumatic events include service in law enforcement agencies, domestic violence, where he witnesses serious crimes.

People develop post-traumatic stress disorder due to post-traumatic stress. The features of PTSD are expressed in the fact that the individual, having managed to adapt to various life circumstances, has changed internally. The changes that happen to him help him survive, no matter what conditions he finds himself in.

The degree of development of the pathological syndrome depends on the level of the individual’s participation in a stressful situation. Also, the development of PTSD can be influenced by the social and living conditions in which the individual finds himself after the trauma he has experienced. The risk of developing a disorder is greatly reduced when there are people around who have experienced a similar situation. Often, individuals with poor mental health and increased reactivity to environmental stimuli are susceptible to PTSD.

In addition, there are other individual characteristics that provoke the occurrence of the disorder:

— hereditary factors (mental illness, close relatives, alcoholism, drug addiction);

- childhood psychological trauma;

— nervous, concomitant mental pathologies, diseases of the endocrine system;

— difficult economic and political situation in the country;

- loneliness.

One of the most common causes of PTSD is participation in combat. A war situation develops in people a neutral mental attitude towards difficult situations, but these circumstances, remaining in memory and emerging in peacetime, cause a strong traumatic effect. The majority of participants in hostilities are characterized by disturbances of internal balance.

What are the signs of PTSD? The criteria for PTSD are events that go beyond normal human experience. For example, war horrors have an impact due to their intensity, as well as their frequent repetition, which does not help a person to come to his senses.

The other side of PTSD affects the inner world of the individual and is associated with his reaction to experienced events. All people react differently. A tragic incident may cause irreparable trauma to one person, but little to no impact on another.

If the injury is relatively minor, then increased anxiety and other signs will disappear within a few hours, days, weeks. If the trauma is severe or traumatic events are repeated many times, the painful reaction persists for many years. For example, for combat veterans, an explosion or the rumble of a low-flying helicopter can cause an acute stressful situation. At the same time, the individual strives to feel, think, and act in such a way as to avoid unpleasant memories. The human psyche with PTSD develops a special mechanism to protect itself from painful experiences. For example, an individual who has experienced the tragic death of loved ones will subconsciously avoid a close emotional connection with anyone in the future, or if a person believes that at a crucial moment he showed irresponsibility, then in the future he will not take responsibility for anything.

“Combat reflexes” do not seem unusual to a person until he finds himself in peacetime and makes a strange impression on people.

Help with PTSD for participants in tragic events includes creating an atmosphere so that people can rethink everything that is happening to them, analyze their feelings and internally accept and come to terms with the experience. This is necessary in order to continue to move forward in life and not get stuck on your experiences. It is very important for people who have experienced military events or violence that they are surrounded by love, harmony, and understanding at home, but often this is not the case and at home people are faced with misunderstanding, lack of a sense of security and emotional contact. Often people are forced to suppress their emotions, not allowing them to come out, at the risk of losing them. In these situations, nervous mental tension does not find a way out. When an individual for a long time does not have the opportunity to relieve internal tension, his psyche and body themselves find a way to get along with this state.

PTSD symptoms

The course of PTSD is expressed in repeated and obsessive reproductions of traumatic events in the mind. Often the stress experienced by the patient is expressed in extremely intense feelings, causing suicidal thoughts to stop the attack. Characteristic nightmares and recurring dreams and involuntary flashbacks are also noted.

Features of PTSD are expressed in increased avoidance of feelings, thoughts, conversations associated with traumatic events, as well as actions, people and places that initiate these memories.

Signs of PTSD include psychogenic amnesia, which is the inability to recall a traumatic event in detail. People have constant vigilance, as well as a constant state of anticipation of a threat. This condition is often complicated by diseases and somatic disorders of the endocrine, cardiovascular, nervous and digestive systems.

The “trigger” of PTSD is an event that causes an attack in the patient. Often the “trigger” is only part of a traumatic experience, for example, the noise of a car, a crying child, an image, being at a height, text, a TV show, etc.

Patients with PTSD usually do their best to avoid encounters with factors that provoke this disorder. They do this subconsciously or consciously, trying to avoid a new attack.

PTSD is diagnosed when the following symptoms are present:

- exacerbation of psychopathological experiences that cause serious harm through mental trauma;

- the desire to avoid situations reminiscent of the trauma experienced;

— loss of traumatic situations from memory (amnestic phenomena);

- a significant level of generalized anxiety during the 3rd - 18th week after the traumatic incident;

- manifestation of exacerbation attacks after meeting with factors that provoke the development of this disorder - anxiety triggers. Triggers are often auditory and visual stimuli - a gunshot, squeaking brakes, the smell of some substance, crying, the hum of an engine, etc.;

- dullness of emotions (a person partially loses the ability to express emotions - friendship, love, there is a lack of creative enthusiasm, spontaneity, playfulness);

- impaired memory, as well as concentration when a stress factor appears;

- with accompanying feelings, a negative attitude towards life and nervous exhaustion;

- general anxiety (concern, worry, fear of persecution, fear, guilt complex, lack of self-confidence);

— (explosions similar to a volcanic eruption, often associated with the influence of alcohol and drugs);

— abuse of medicinal and narcotic substances;

- uninvited memories that emerge in ugly, terrible scenes associated with traumatic events. Unbidden memories surface both while you are awake and while you sleep. In reality, they appear in cases where the environment resembles what happened during a traumatic situation. They are distinguished from ordinary memories by a feeling of fear and anxiety. Uninvited memories that come in a dream are classified as nightmares. The individual wakes up “broken,” wet with sweat, with tense muscles;

- hallucinatory experiences, which are characterized by behavior as if the person is reliving the traumatic event;

- insomnia (intermittent sleep, difficulty falling asleep);

- thoughts of suicide due to despair, lack of strength to live;

- a feeling of guilt due to the fact that he survived difficult trials, while others did not.

Treatment of PTSD

Therapy for this condition is complex; at the beginning of the disease, medication is provided, and then psychotherapeutic assistance.

All groups of psychotropic drugs are used in the treatment of PTSD: hypnotics, tranquilizers, antipsychotics, antidepressants, and in some cases, psychostimulants and anticonvulsants.

The most effective in treatment are antidepressants of the SSRI group, as well as tranquilizers and drugs that act on MT receptors.

An effective treatment technique is one in which the patient, at the beginning of an attack, concentrates attention on a distracting, vivid memory, which over time contributes to the formation of the habit of automatically moving to positive or neutral emotions, bypassing the traumatic experience when a trigger appears. A psychotherapeutic method in the treatment of PTSD is the method, as well as processing using eye movements.

For patients with severe symptoms, psychedelic psychotherapy is prescribed using serotonergic psychedelics and psychostimulants of the phenylethylamine group.

Psychological assistance for PTSD is aimed at teaching patients to accept the reality of their lives and create new cognitive models of life.

Correction of PTSD is expressed in gaining true mental and physical health, which does not consist of meeting someone else's standards and norms, but of coming to an agreement with oneself. To do this, on the path to true recovery, it is not so important to behave as is customary in society, but you need to be extremely honest with yourself, assessing what is currently happening in life. If life circumstances are influenced by: way of thinking, disturbing memories, behavior, it is important to honestly acknowledge their existence. Complete relief from PTSD can be obtained by seeking help from specialists (psychologist, psychotherapist).