Talk:Post-traumatic stress disorder

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[edit] Top

It makes me very sad that there isn't much discussed about refugees and rape/sexual assault/forced prostitution survivors. These are also very very important, and sadly very common members of the PTSD community. I do not have great official information on it, but I hope someone who does will add to the main article!!! - L (8Dec06) Lulashome 01:12, 9 December 2006 (UTC)

"TIR is derived from Scientology " - is this actually true? A therapy for treating PTSD is derived from a cult? This claim seems dubious.

I would like to see some evidence for that claim or that sentence amended.


Moved here. First of all, it's not certain that some people aren't predisposed to PTSD for organic reasons, and there has been a lot of research on how stress causes organic changes in the brain. Second, it's not true that behavioral drugs are of little value in long-term psychiatric care.

I left the part about drugs being generally ineffective in the article.

as the disorder does not arise from any organic cause and behavioral drugs are of little value in long-term psychiatric care.

Does anyone have any info on "triggers" in PTSD? The idea is that certain images, words, etc, may trigger PTSD victims into flashbacks, etc. I'd add something, but I've only heard about it from the satanic ritual abuse community, so I wonder on its wider prevalence... Martin 15:31 9 Jun 2003 (UTC)

"The idea is that certain images, words, etc, may trigger PTSD victims into flashbacks, etc." That's precisely it. Anything that reminds a victim of the trauma may lead to re-experiencing the trauma. It is this triggering that leads PTSD victims to avoid places/objects/people that remind them of the trauma. An example (from a documentary on PTSD I watched some time ago) would be a Vietnam war veteran having a flashback to a war experience triggered by the sound of a car door slamming closed (sounded somewhat like a gun shot). Or (making this one up) a rape victim flinching back from a harmless person who happens to share some facial features with her attacker. -- Kimiko 07:47 15 Jul 2003 (UTC)

AFAIK, EMDR is not (at the very least not yet) the treatment of choice for PTSD. Exposure and response prevention are still the most used treatment for PTSD, like they are for most anxiety disorders. Could whoever put that assertion there provide some data to back it up? -- Kimiko 07:47 15 Jul 2003 (UTC)

An anon user replaced:

Two of the most successful techniques for the treatment of trauma are EMDR and TIR:
EMDR(Eye Movement Desensitization and Reprogramming) is a technique developed by Dr Francine Shapiro in which the client uses the movement of his or her eyes to access the traumatic event and allow the integration of emotions and sensations that occurred during the traumatic event. Continued research has validated the success of this technique and it is becoming the treatment of choice for PTSD.

with:

Two of the most controversial techniques for the treatment of trauma are EMDR and TIR:
EMDR (Eye Movement Desensitization and Reprogramming) is a technique developed by Dr Francine Shapiro (Her doctorate was earned at the now defunct and never accredited Professional School of Psychological Studies. Her undergraduate degree is in English literature.) in which the client uses the movement of his or her eyes to access the traumatic event and allow the integration of emotions and sensations that occurred during the traumatic event. EMDR is controversial and not accepted practice by the American Psychological Association.

Some of this user's other edits have been slightly suspicious. Could someone who knows about this subject please check if this is accurate. - Efghij 03:11, 8 Aug 2003 (UTC)

EMDR (and probably TIR as well, although I hadn't heard of that before) is somewhat controversial still. It has been shown to have some effect, although it is still unclear how it works. The eye movements don't seem to be necessary, and the rest of it is simply imagined exposure, which is used in the treatment of most anxiety disorders.
So, there is some truth in the above text. However, calling EMDR on of 'the most controversial' techniques seems a bit too much. The remark about dr. Shapiro's credentials is irrelevant to this article, ad hominem regarding EMDR, and copied verbatim from the linked skepdic site.
I'll edit it a bit to tone it down. -- Kimiko 06:08, 8 Aug 2003 (UTC)

Hello!!

EMDR Is a very good treatment for PTSD, it seems to be one of the fastest and most effecient their is, ofcourse being treated by a good therapist... The eye movement isnt necessary there is also a technique where the therapist is touching the clients hands or legs. The important thing is to repeatedly touch the left and right side, its the same with the eye movement. A traumatic memory is just memorized in the right side of the brain,(a normal is memorized both in left and right side) and its surrounded with triggers that can cause a anxiety, flashbacks, panicattacks. So this techniqe simply puts the memory where it suppose to be. It does have a good survivalfunction, you react fast and like an animal, but its not good in the longterm.But still It do fill a function. I speak of experience, I have suffered from severe PTSD for 18 years, including nightmares. After 5 EMDR sessions last year 95 % of my nightmares disappeared, and alot of other sympthoms improved aswell,so I can RECOMMEND it!!!! cause I have tried it all.... H

I have added a reference to Spike Milligan in the reading section. Prune 22:43, 30 Nov 2003 (UTC)

Short comments that don't require extra explanation like this one (^) can be put in the Summary: field below the edit box. -- Kimiko 09:53, 1 Dec 2003 (UTC)

Hi, I added an external link to an article at eMedicine Health on Post-traumatic Stress Disorder for anyone interested in reading more about it. This is a great resource site for various conditions and diseases. All of the content is written and edited by real physicians.

[edit] A critique

Here are my thoughts on reading the article.

  • The name is not the accepted spelling used in DSM-IV, which is posttraumatic stress disorder.
  • PTSD is not the same as shell shock, battle fatigue or operational exhaustion. Combat stress reaction (CSR) is the generally accepted military psychiatry term for this nowadays. The DSM-IV nearest equivalent of this is acute stress disorder but they are not the same thing although there is overlap.
  • The stress does not have to be life threatening but can involve serious injury.
  • The symptom list is more complex and also includes things like avoidance and hyperarousal (although this latter may be covered by "extreme distress").
  • Brief reactive psychosis is not really related to PTSD but the sentence is correct otherwise but is more misleading than informative.
  • There is no mention of delayed onset PTSD.
  • Again "shell shock" is raised. The modern approach to (CSR) in the military is the PIES approach of proxity, immediacy, expectancy and simplicity. In the US other acronyms such as BICEPS are used but have basically the same approach. CSR is most definitely not treated as if it will lead to a more serious condition but the opposite is the case. Expectancy implies that everyone expects the soldier with CSR will get better soon. A few don't and they may go on to be diagnosed with ASR (and later possibly PTSD) or a brief reactive psychosis or even schizophrenia.
  • Comorbidity is high in PTSD with alcohol abuse and depression being the most common comorbid disorders.
  • The standard treatment for PTSD is a combination of antidepressants and cognitive behavioural therapy. EMDR was initially proposed as a cure but has now slipped back into being yet another useful treatment. I confess that I have not heard of TIR but then scores of new therapies have been suggested over the years as being effective in the treatment of PTSD.
  • More recently there has been promising work aimed at treating the nightmares by helping PTSD sufferers change the "script" so that there is a resolution to the nightmare. Studies have shown that this not only results in fewer nightmares but also a general reduction in symptoms.

OK folks. I propose a separate article on CSR and a clearer article on PTSD with DSM-IV criteria and the above included. Comments please --CloudSurfer 10:54, 25 Sep 2004 (UTC)

Below is the original opening before I changed it.

Post-traumatic stress disorder (PTSD), formerly and colloquially called shell shock (this is a World War One term), battle fatigue (World War II), and operational exhaustion (Korean War) during war, is a term for the psychological consequences of exposure to stressful, life-threatening and traumatic experiences. Symptoms include nightmares and flashbacks, sleep abnormalities, extreme distress resulting from personal "triggers", and emotional detachment with the possibility of simultaneous suffering of other psychiatric disorders. Experiences likely to induce the condition include rape, combat exposure, and childhood physical abuse. Unlike brief reactive psychosis, PTSD is a chronic condition.

PTSD is distinguished from normal grief and adjustment with traumatic events in that the normal emotional effects of traumatic events will tend to subside after several months or years, while in PTSD the emotional effects are ongoing. Most people who experience traumatic events will not have PTSD.

In earlier times and even today, "shell shock" among veterans has been regarded as simple cowardice, an unwillingness to put one's welfare at risk when danger is at hand. The modern psychological evaluation disagrees strongly. Shell shock is a mental condition in which the individual involved is perilously close to a break from reality, usually by succumbing to any of several neuroses or psychoses.

PTSD was first recognized in combat veterans following many historical conflicts; the term "shell shock" dates to World War I. At first, the medical community believed that shell shock resulted directly from the stress caused by the noise of repeated shell explosions. The modern understanding of the condition dates to shortly after the Vietnam War. PTSD may be experienced following any traumatic experience or series of experiences that do not allow the victim to readily recuperate from the detrimental effects of stress. It is believed that of those exposed to traumatic conditions, around 9% will experience some symptoms. In peacetime, 30% of those that suffer will go on to develop a chronic condition; in wartime, the levels of disorder are believed to be somewhat higher.

Above this is the original opening.

--CloudSurfer 12:57, 26 Sep 2004 (UTC)

I'd like to have more in the article on the script-changing-approach of nightmares that you mention. I think it can improve the condition.--Fenice 14:54, 26 Sep 2004 (UTC) I just found it - it is already in the text.--Fenice 15:14, 26 Sep 2004 (UTC)

[edit] I have doubts about

the following "synonym":

'PTSD is also known as NBD (No Backbone Disorder)"
This smacks of falsehood to me - even if this is a term for PTSD sufferers, isn't it somewhat derogatory and judgemental?

this sentence:
PTSD is distinguished from normal grief and adjustment with traumatic events in that the normal emotional effects of traumatic events will tend to subside after several months or years, while in PTSD the emotional effects are ongoing.
It makes it look like PTSD is just prolonged grief and an adjustment problem; I think it plays down the desease.--Fenice 14:54, 26 Sep 2004 (UTC)

Yes, I agree. PTSD is an anxiety disorder not a disorder of grief. It can have comorbid depression and some of the features of PTSD are similar to grief but that is not the core issue. Please see my changes. --CloudSurfer 02:06, 27 Sep 2004 (UTC)

[edit] Diary link removed

I have just removed this link:

While personal stories are sometimes helpful their role in an encyclopedia is limited. It would appear that this woman is suffering from more than a simple case of PTSD. Thus I felt it was a potentially confusing link. Please have a look at it and see if you agree or disagree. --CloudSurfer 08:45, 30 Sep 2004 (UTC)


[edit] Symptoms or Effects

I was wondering if somone could post some symptoms or effects to PSTD for a short story i'm writing. THNX --Jakob03 08:40, 23 March 2005

Dude, read the article. --Brasswatchman 00:13, August 14, 2005 (UTC)

[edit] Preparation therapy for PTSD?

Has anyone developed a preventative therapy for post-traumatic stress disorder - essentially, some sort of form of psychological education that might help individuals cope with PSTD, or make them less likely to contract it? For example, is there any content about PSTD during basic training in the United States military? Thank you. --Brasswatchman 00:13, August 14, 2005 (UTC)

Brasswatchman, Military organizations have surely been working on types of "preventative" approaches to PTSD for some time, and in a major way military training is already designed to minimize normal reactions to traumatizing events. I'm not sure, although, preventative training would be very appealing to know about... in that the general trend of military training is to dehumanize people, numb emotional reactions, and simplify thought processes. In the end I'm probably just as curious as you are, it would be good to expose whatever training solders are having to go through. I'm sure a lot of experimentation is going on in the U.S.'s current war in Iraq. Maxmiles 02:14, 19 September 2006 (UTC)

I don't have any statistics or hard information, but from my personal experience with military systems, their approach to PTSD seems to waver between wholesale denial and a "suck it up" attitude. I would be surprised to find out that the U.S. or any other military were preparing their soldiers for the psychological impact of battle situations (other than by desensitizing, as Maxmiles mentions above). - LeaHazel 10:21, 20 September 2006 (UTC)

[edit] Fiction and movie sections

What are the fiction and movie sections doing in this topic? I thought a list of technical references would be sufficient already. --MegaHasher 23:31, 6 February 2006 (UTC)

I didn't put them there (tho I may add some), but I'd say two reasons.
  1. Many articles have similar sections, sometimes called trivia: eg a town or historical event well-described in a movie.
  2. Many of the writings and films which involve the condition are deliberate attempts to describe and illustrate it to the lay-person, often written by or in consultation with sufferers.
But there is a glitch that most of these egs are about combat stress, which has its own article at Combat stress reaction. So perhaps this lot should be moved there. JackyR 21:15, 23 March 2006 (UTC)
I have a policy of forking off trivia from technical pages once a critical mass is achieved. If there are other established pages, move the material there with appropriate and prominent links. David91 02:42, 24 March 2006 (UTC)
I agree. Unless it really adds to the understanding of the subject, it's prey to removal when it starts to take over the page. --DanielCD 02:43, 24 March 2006 (UTC)
I'll get round to combing the egs and moving the combat stuff to Combat stress reaction, unless it's better to stick to David's policy (by "forking" here, you mean having a dedicated article like PTSD in film and fiction?). JackyR 18:39, 24 March 2006 (UTC)
If there is a dominant meaning for the term, that gets to be the "main page" as, say, PTSD. All other uses get their own dedicated pages as PTSD (film), PTSD (fiction), etc. where the subcategory goes into the brackets. Depending on how many pages are generated: for small number just link at top of page or as "see also", but for larger number create a dab page. David91 03:16, 25 March 2006 (UTC)

[edit] Law

Stop, stop! Enough! :-) Just wanted an idea of whether the legal stuff was internationally true or being written from a single-country viewpoint... In fact, I'm inclined to loose the "/diminished responsibility in English law", as "diminished responsibility" includes a lk there and the broader statement is better (if still true?). Many thanks for answering lots more than the Q! Cheers, JackyR 21:15, 23 March 2006 (UTC)

Sorry, I was simply repairing links having forked three law pages. I will remove the excessive material. David91 02:44, 24 March 2006 (UTC)

[edit] movie reference

In the bottom of the page it says that Captain Miller in Saving Private Ryan exhibits signs of PTSD such as his hand shaking. I was curious about this because no where in the rest of the article does it mention tremors or any kind of shaking as a symptom. 69.124.124.70 19:34, 6 April 2006 (UTC) -bob

Well, it's associated with stress and hyperarousal, both of which are associated with PTSD. --DanielCD 19:40, 6 April 2006 (UTC)

[edit] Ryan section

I removed this for now:

:Later in the film, Tom Hanks' character is killed when he is shell-shocked and walks out into the open during a period of heavy combat. He is shot in the chest by a German soldier credited by the film as 'Steamboat Willie'. Ironically, this German was a survivor of Miller's disastrous assault on the machine gun nest described above. Willie was allowed to go free and soon rejoined the German troops in the area. This decision was one also made by Miller, despite the objections of most of his squad. Miller's final and suicidal act is a fairly common occurrence with sufferers of PTSD, who tend to have a death wish and unnecessarily expose themselves to danger. At the end of the film the camera focuses on Miller's hand, which is (of course) no longer shaking.

He did not walk willingly out into the open, he wandered out there blindly. I don't see any argument that he intended to get himself killed. --DanielCD 19:40, 6 April 2006 (UTC)

[edit] citations need to be cleaned up

the citations in the beggining of the article need to be changed into footnotes.

[edit] Put People with PTSD, Movies, etc on Separate Page

The article is becoming quite cluttered and difficult to read. I propose that the article be limited to material about the psychiatric condition, PTSD: what it is, diagnosis, treatment and that fictional representations be placed in another article linked to this one. Please let me know your thoughts. If there is general consensus for this...or at least no vocal general opposition, I will do this some time in the next week or so when I get some time. RalphLendertalk 15:33, 21 August 2006 (UTC)

Agreed. From what I see, the WP standard would indicate List of people with post-traumatic stress disorder and/or List of fictional characters with post-traumatic stress disorder. I think it would be useful to separate the two from the get-go, since public figures and fictional portrayals are very different issues. However, if there are not enough references to support two list pages, the former title can/should be used, as it's more general. - LeaHazel 17:31, 21 August 2006 (UTC)
Agree, also. (I edited your note, RalphLender, to correct sp porpose to propose...if not ok, I appologize). I will be glad to help with the edit. I also agree with LeaHazel's suggestion to create 'two' pages with the titles as suggested. DPetersontalk 21:43, 21 August 2006 (UTC)
I've created the two pages but left the content on this page so that people can see how it looks and links. If there is concensus, maybe someone could then delete the content on this page that is now on those two new pages. DPetersontalk 21:59, 21 August 2006 (UTC)
Spelling isn't a strength of mine. I've gone a head and deleted the materials in the article since it is all on the two pages DPeterson made. RalphLendertalk 16:22, 23 August 2006 (UTC)

Moving that material to separate pages makes this article much more clear. Dr. Arthur Becker-Weidmantalk 22:28, 24 August 2006 (UTC)

[edit] Bad trips?

Bad drug trips are identified as things likely to cause PTSD. Are you sure this is right? As I understood it, the event must involve death or serious injury or threat thereof. I'm sure a person going through a bad trip might believe they were going to die, so that might qualify. But does anyone know if this is included in the DSM-IV criteria? Or verify with some other source? Thanks, delldot | talk 00:53, 5 September 2006 (UTC)

It can't possibly be confined only to near-death experiences, because rape and sexual assault are among the most common/most recognizable causes of PTSD. - LeaHazel 20:43, 5 September 2006 (UTC)

[edit] Flagged for cleanup

It is good to see that there is discussion behind the page, but it is just a mess of uncited facts. The opening sentence does not describe the disorder, but rather one person's uncited belief about the most common treatment.

The article needs first a description of the disorder by a TRULY knowledgable person (no intuition psychiatry). Then some description of the history of the disorder and it's discovery.

Information about causes (eg war, loss of loved one, illness etc...)

Then a list of symptoms (cited, of course) - summary of dagnostic criteria.

Followed by treatment options.

Controversy for you argumentative types.

Debate over the effectiveness of the treatment technique itself belongs in treatment's own article, unless it is specific to the treatment's applicability to PTSD.

Anyway, this article is messy in so many ways that it needs attention, and people need to know that it is no example of a good wikipedia article.


Thanks!

Please be sure to sign your comments. The opening sentence is congruent with and a decent summary of the DSM-IV description of PTSD. It could be cleaned up and reorganized, I agree. However, the wholesale deletion of the article is not acceptable. Work to improve the material is much more productive. DPetersontalk 11:28, 8 September 2006 (UTC)


My apologies about not signing. I didn't do any deletion - I came back today and it was a completely different article than what I saw yesterday. Most impressive :) Thanks for reverting it! 75.17.195.203 05:07, 9 September 2006 (UTC)

[edit] Merge with Combat stress reaction

No. From what I've read and heard, some combat stress reactions are cumulative conditions, whereas PTSD may occur after one event... ? During WWII, US military officers were warned to watch for the "2,000-yard stare" which all soldiers were expected to have after 200-250 days of intense combat (interestingly, Brit military soldiers were expected to reach the same point after 400-450 days because of the British use of front-lines rotation). --Renice 14:14, 27 October 2006 (UTC)

Some references: There is an article regarding Railway Spine now being the same condition as Fibromyalgia, both resulting from repetitive whiplash injuries from such jerky movements as railway cars, trampolines and sudden car stops. I will try to find it deep in my files and cite it. I think it was ALIVE magazine. Loss of muscle tone (note the blank stare refered to above- loss of tone happens to the eight muscles in the eyes too!) in PTSD may make a person more vulnerable to such injuries to the neck area- is this why it ends up being thought of as an "emotional" condition when the physical symptoms are real and an ongoing contributor to the condition. Has anyone else seen/heard about the documentary by Dini Petti on CBC about PTSD in Romanian orphans and children of drug addicts (essentially abandonment at early ages.)I saw it in 2001. The treatment proposed in this documentary was to return to the "triggers" and overlay them with a good memory rather than talk more about the traumatic event. I personally used this technique after a night attack on a dark road. I returned there with supportive friends, sang and prayed and find my physical reaction to thoughts of the incident are much reduced. Now when I "hear" the voice of my attacker I also hear the songs with my friends, see their faces, feel their hugs too, and their voices are stronger. In the documentary the children had been taken back to an apartment building and a park where horrific incidents had occurred. They went prepared to make new memories, had a picnic, went on the swings, sang songs and the (by then) teenagers stated they experienced some healing from the power of the memory triggers. user: Owlytoo, 27 October 2006

[edit] Diet paragraph; no citation

The following was added and a request for a citation was later put on

Another possible factor in PTSD is that a persistence of depressive symptoms may be caused by an underlying biochemical disorder, associated with insulin resistance (dysglycemia), that can be treated by a hypoglycemic diet

Unless someone can find a verifiable citation for this, I suggest it be deleted. DPetersontalk 13:22, 7 November 2006 (UTC)

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