Post-Traumatic Stress Disorder
Mark A. Shaffer, MSW, LCSW
Social Work Perspectives on Psychopathology
June 29, 2013
Post-traumatic stress disorder: the social worker perspective
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that occurs following a traumatic event and is characterized by re-experiencing the event, avoidance of key details and features of the event as well as a state of hyper-vigilance and arousal (Zlotnick et al., 2001). The condition is relatively common, with almost 8% of adults experiencing PTSD at one point in their life (Bisson & Andrew, 2007). PTSD is more common in populations likely to be exposed to traumatic events, including members of the armed forces or police force; combat experience increases the lifetime prevalence of PTSD to 49% in men (Bisson & Andrew, 2007). Women may also experience PTSD, an association that is noted with sexual assault, where the lifetime prevalence of PTSD is 29% (Zlotnick et al., 2001). The aetiology of the condition is unclear and may relate to susceptibility due to specific genes or neurodevelopmental characteristics of the individual (Cloitre et al., 2010).
Accurate diagnosis and intervention in PTSD is essential as symptoms have a severe impact on the life of the patient, becoming socially disabling (Stein, 2003). Furthermore, patients may demonstrate signs of depression or substance abuse, which could lead to poor outcomes and more severe psychological discomfort (Lukaschek et al., 2012). The aim of this paper is to provide an overview of the diagnostic criteria for PTSD, as detailed in the Diagnostic and Statistical Manual (DSM) of mental disorders, including recent changes to the diagnosis of the condition. These changes will be reviewed from a social worker perspective, in order to evaluate how practice, ethics and values should be applied to these patients. Comparison of DSM-5 and -IV
The diagnosis of PTSD has been controversial for a number of years, with authors suggesting that DSM-IV criteria relies too heavily on an association with ill-defined trauma, leading to an inaccurate pathologizing of normal distress (APA, 2000). A recent update of these criteria has thus been formulated in DSM-5 in order to improve on diagnostic clarity and guide evidence-based treatment based on patient presentation and circumstances (Pitman, 2013). These changes will be considered in the context of social work practice for patients with PTSD.
The updated diagnostic criteria for PTSD have favored the formation of four major symptom clusters, compared with three noted in the DSM-IV. The four clusters are: 1) re-experiencing the event, including flashbacks, recurrent dreams or prolonged psychological distress 2) heightened arousal, such as sleep disturbances or hyper-vigilance 3) avoidance and, 4) negative cognitions and mood (APA, 2013). Furthermore, the traumatic event that can lead to PTSD is defined in more explicit terms, including sexual assault and repeated exposure to trauma in police officers or first responders (APA, 2013). It is also worth noting that an individual’s response to the event is now considered less important (e.g. intense fear or helplessness) as such reactions are often poor predictors of PTSD development (APA, 2013).
The new criteria have also recognized a preschool subtype of PTSD, where symptoms are present in children under the age of six years, indicating that a developmental component of PTSD is now appreciated (APA, 2013). In addition, PTSD symptoms in association with dissociative symptoms, including feeling detached from one’s mind or body, can be classified as PTSD dissociative subtype. Hence, there is an increased appreciation that PTSD, while a clinical entity in itself, often presents with complex mood and psychological disorders that may benefit from further treatment (Brewin et al., 2009). Implications for...
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