Coming to Grips with Post-Traumatic Stress Disorder

A nurse manager was shot leaving work by an employee who she recently terminated for repeated absences and multiple warnings for subpar performance. She recovered physically, but over the course of months the patient found herself unable to move forward in her life for fear that the man would come back despite knowing that he was in jail. She visits her doctor in hope of finding out why she is irritable with her family, afraid to go back to a job she loved, fearful to go out of the house and tired of reliving the incident day and night.

This scenario describes a patient who is experiencing post-traumatic stress disorder, or PTSD, as it is commonly called. PTSD typically follows a terrifying ordeal that involved physical harm or the threat of physical harm. The condition was first brought to the public’s attention in relation to war veterans who brought the horrors and tragedy of war home with them in their embattled minds. In studying the disorder, health care professionals have learned that anyone is at risk for PTSD who experiences a traumatic event or witnesses a traumatic event. As such, the condition is not relegated to war. It has been associated, for instance, with stays in intensive care units.

According to the National Institute of Mental Health, about 7.7 million Americans are affected by PTSD. The condition can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families.

PTSD is characterized by a specific group of symptoms that set it apart from other types of reactions to trauma. Four major types of symptoms characterize the disorder:
• Re-experiencing.
• Avoidance.
• Numbing.
• Increased arousal.

A person with PTSD may startle easily or become emotionally numb, especially with people with whom they are close. A patient will report losing interest in things they used to enjoy and want to be alone. They have trouble feeling affectionate, are irritable, and can become aggressive or even violent. Most will avoid situations that remind them of the original event, and anniversary of the trauma is often a difficult times. Most will repeatedly re-experience the event, a sort of mental replay or flashback of the trauma, in their thoughts during the day and in nightmares when they sleep.

What is difficult for health care professionals is determining whether those reacting to traumatic events are demonstrating normal reactions or symptoms of something more serious. PTSD is only one of many possible reactions to traumatic experiences. After a trauma, most people experience anxiety or depression and may find they are not able to deal with their responsibilities. Over a period of time, with support from family and friends, most find that their upsets lessen and they are better able to function. Someone who continues to be profoundly affected by their experiences several months or even years later may be struggling with PTSD.

Case managers are usually called on to work with patients who experience traumatic events, so understanding how to identify PTSD and how the disorder can progress is essential to being effective. To assist you, we have complied a list of resources you can review and incorporate into your practice.

Staying Connected

MENTAL HEALTH AMERICA

The primary goal of Mental Health America is to educate the general public about the realities of mental health and mental illness.
www.nmha.org

NATIONAL ASSOCIATION OF SOCIAL WORKERS

Mental-health workers often assist patients with PTSD, in particular those working with returning members of the armed forces.
www.socialworkers.org

NATIONAL CENTER FOR POST-TRAUMATIC STRESS DISORDER

The PTSD information center contains in-depth information on PTSD and traumatic stress for a general audience, with specific sections for children and adolescents. It also presents The Iraq War Clinician Guide, 2nd Edition for those treating veterans.
www.ncptsd.va.gov

SIDRAN TRAUMATIC STRESS INSTITUTE INC.

The Sidran Institute provides information for survivors, professionals and students, with a recommended reading list.
www.sidran.org

THE NATIONAL WOMEN’S HEALTH INFORMATION CENTER

Women’s mental health topics and issues covered by the federal government.
www.womenshealth.gov

VETERANS’ FAMILIES UNITED FOUNDATION

Connecting veterans and their families to care resources, including those involving PTSD, readjustment and war-related illnesses.
www.veteransfamiliesunited.org