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Natural disasters acute stress disorder and posttraumatic stress disorder essay

This article has been cited by other articles in PMC. This is the first of two articles summarizing the nature and treatment of PTSD and the associated condition of acute stress disorder ASD.

A companion paper to be published in a future issue of Psychiatry 2005 will provide a summary of empirically supported treatments, both psychological and pharmacological, for PTSD and ASD. In the second paper, scheduled to appear in a subsequent issue of Psychiatry 2005, we will address issues related to the prevention and treatment of ASD and chronic PTSD.

Following exposure to a traumatic event, the person must also experience at least one of five Cluster B symptoms of reexperiencing the trauma recurrent and intrusive distressing recollections, nightmares, flashbacks, intense psychological distress in response to memories or reminders of the trauma, and physiological arousal cued by memories or reminders of the trauma ; three or more of seven Cluster C symptoms of persistent avoidance of memories or reminders of the trauma and emotional numbing dissociative or psychogenic amnesia for important parts of the trauma, loss of interest in important activities, feelings of detachment or estrangement from others, restricted range of affect, and a sense of a foreshortened future ; and two or more Cluster D symptoms of increased arousal sleep difficulties, irritability or outbursts of anger, concentration difficulties, hypervigilance, and an exaggerated startle response.

Essay on Natural Disasters Covering PTSD and Survivor Syndrome

The B, C, and D symptoms must develop in natural disasters acute stress disorder and posttraumatic stress disorder essay wake of the traumatic event, persist for at least one month Criterion Eand cause clinically significant distress or impairment Criterion F. By convention, PTSD with symptoms lasting 1 to 3 months is designated as acute, whereas PTSD with symptoms lasting more than three months is designated as chronic.

Technically, DSM-IV permits the specification of PTSD with delayed onset, in which symptoms do not develop until at least six months following exposure to the trauma, although such delayed onset is statistically quite rare. Epidemiology and the Natural History of Trauma Reactions Epidemiological studies indicate that exposure to potentially traumatic events i. Not only was exposure to potentially traumatic events common in the NCS sample, but among those participants who were exposed to at least one potentially traumatic event, 56.

Despite the higher rate of trauma exposure among men, lifetime PTSD was twice as common among women 10. The majority of individuals who experience a potentially traumatic event do not develop PTSD. In other words, while exposure to a potentially traumatic experience is necessary for the development of PTSD, it is not sufficient. One major reason is that not all potentially traumatic events are equally associated with the development of PTSD, with some of the most commonly experienced events being among the least likely to be associated with the development of PTSD.

However, among individuals experiencing these different events, prevalence of PTSD related to rape was 46 percent for men and 65 percent for women, compared to less than 10 percent for each of being in an accident, natural disaster or fire, and witnessing someone badly injured or killed for both men and women.

A second major reason is that most reactions to potentially traumatic events, even those most likely to be associated with PTSD, such as rape, are transient and resolve within 4 to 12 weeks after the event.

  1. Many people do not display chronic symptoms until well after the traumatic event, even the anniversary can be the first trigger. Acute stress disorder scale.
  2. A second major reason is that most reactions to potentially traumatic events, even those most likely to be associated with PTSD, such as rape, are transient and resolve within 4 to 12 weeks after the event. At present, perhaps the best candidate for that function is the diagnosis of acute stress disorder ASD.
  3. Negative predictive power was higher than positive predictive power for all symptom clusters, with values ranging between 0. Use these research information in order to write a proficient essay on natural disasters.
  4. Exposure therapy focusses on the memories and external reminders of the traumatic event. General Considerations The assessment of PTSD and ASD requires at minimum an assessment of the person's trauma history, obtaining information on both the objective features of the trauma s i.
  5. So, start writing right now! A current perspective is shown in a Queensland government publication where over 100,000 Queenslanders aged 18-64 are expected to experience a mental health problem in the 2 years following the 2010-2011 floods Bryant, 2009.

For example, Rothbaum, et al. At the first assessment, approximately 12 days after the assault, 94 percent met full symptom criteria, but not the duration criterion, for PTSD. By the fourth assessment occurring approximately one month after the assault, the point at which participants could natural disasters acute stress disorder and posttraumatic stress disorder essay be diagnosed with PTSD, 64 percent met full criteria for acute PTSD.

By the final assessment, approximately three months after the assault, 47 percent met criteria for chronic PTSD. Thus, the majority of people exposed to a traumatic event and who experience immediate symptoms of PTSD experience natural recovery from their symptoms within 1 to 3 months of the event, although the rate at which symptoms decline decreases over time so that by three-months post-trauma, individuals with PTSD are likely to remain symptomatic without appropriate treatment to be reviewed in a future companion article.

These and similar data provide support for the utility of the current convention of not diagnosing PTSD in the first month following the event, as high symptoms in the immediate aftermath of a potentially traumatic event can be normative, and for differentiating between acute and chronic PTSD, as those who still have PTSD three months after the trauma are not likely to experience recovery in the absence of treatment. In addition to the type of trauma and sex of the victim, several other factors have been identified as predictors of the development of PTSD.

In a recent meta-analysis of risk factors for PTSD, Brewin and colleagues 7 found the largest effect sizes for severity of the trauma, lack of social support following the trauma, and life stress following the trauma, although the magnitude of the effect sizes varied substantially across studies.

Smaller but more consistent effects were found for personal psychiatric history see also section below on comorbidityfamily psychiatric history, and personal history of abuse in childhood. Several recent investigations have attempted to identify biological markers or risk factors for the development of PTSD, with the two most promising being low cortisol levels in the acute aftermath of the trauma and elevated resting heart rate shortly after the trauma. Specifically, exposure to a stressful event results in activation of the hypothalamus, resulting in the release of corticotropine-releasing factor CRF that then stimulates the pituitary gland to release adrenocorticotrophic hormone ACTHwhich in turn stimulates the adrenal gland to release cortisol.

Cortisol then feeds back onto the hypothalamus and pituitary gland to inhibit further activity. Thus, cortisol serves to contain the H-P-A stress response. An implication of the theory is that low levels of cortisol at the time of a trauma will result in a stronger and more sustained stress reaction, which is hypothesized to contribute to the development of PTSD.

Consistent with this hypothesis, Delahanty and colleagues 9 found that urinary cortisol levels obtained upon admission to the hospital in motor vehicle accident survivors was significantly lower among subjects who were found to have PTSD one month after the trauma than among subjects who did not develop PTSD.

Hierarchical regression analyses further revealed a significant correlation between cortisol levels and PTSD symptom severity even after controlling for prior history of PTSD and injury severity caused by the recent accident. Additional evidence that intensity of the biological stress response to the traumatic event is predictive of the development of PTSD is provided by Shalev, et al.

This brief summary illustrates that there are a number of known predictors or risk factors for the development of PTSD.

However, to date, none of these factors, either alone or in combination, has emerged as a practical method with adequate sensitivity and specificity to serve as a guide to identify those individuals most in need of early intervention to prevent the development of chronic PTSD. At present, perhaps the best candidate for that function is the diagnosis of acute stress disorder ASD.

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An emphasis was placed on dissociative responses occurring at the time of the trauma or shortly thereafter based on the trauma survivors who restrict their awareness of the traumatic event and the resulting emotions actually impede their ability to process these emotions and thereby impede natural recovery. Also like PTSD, the diagnosis of ASD requires at least one symptom of reexperiencing the trauma, such as through recurring thoughts, images, nightmares, flashbacks, and intense emotional distress upon exposure to reminders of the trauma Criterion C ; that the person displays marked avoidance of trauma-related thoughts or reminders of the trauma Criterion D ; and that the person displays symptoms of anxiety or increased arousal, such as sleep problems, irritability, poor concentration, hypervigilance, and exaggerated startle Criterion E.

As with other DSM diagnoses, the disturbance must cause clinically significant distress or functional impairment Criterion F and the disturbance is not due to the effects of a physiological substance or general medical condition Criterion Gand not better accounted for by another disorder. For example, the question has been raised whether it is justifiable to distinguish between two diagnoses that share symptoms on the basis of duration of the symptoms.

On one hand, including the diagnosis would potentially facilitate patients with PTSD-like symptoms in receiving early interventions that may reduce the duration of those symptoms and prevent the development of chronic PTSD.

Post-Traumatic Stress Disorder and Acute Stress Disorder I

On the other hand, the symptom duration criterion was introduced in the PTSD diagnosis specifically to prevent the pathologizing of what may be normal and transient reactions. In one such study, Harvey and Bryant 14 assessed 92 consecutive motor vehicle accident victim admissions ages 16—65 to a major trauma hospital for ASD symptomology.

All initial assessments took place within four weeks of the accident and the average time between the accident and the initial assessment was 6. Seventy-one of the participants were also assessed for PTSD six months later. Full syndrome meets all criteria for ASD at the initial assessment or meets all criteria for PTSD at the follow-up assessmentsubclinical meets criteria for four of the five ASD symptom clusters, or two of the three PTSD symptom clusters at the corresponding time pointor no diagnosis.

Among participants with subclinical ASD, 78. The utility of the ASD diagnosis was strongest for the cases in which 1 full ASD criteria were met and 2 cases where the person did not meet criteria for even subclinical ASD.

Specifically, among participants meeting full ASD criteria at the initial assessment, 77. Among participants who did not meet criteria for even subclinical ASD at the initial assessment, 87. Of theoretical significance is the fact, reported above, that the majority of participants meeting criteria for subclinical ASD had failed to meet the dissociation criteria, raising into question the centrality of dissociation in the ASD construct.

Analyses conducted to evaluate the positive and negative predictive power for each of the ASD criteria A-E in predicting PTSD found strongest positive predictive power for the dissociative cluster 0. Negative predictive power was higher than positive predictive power for all symptom clusters, with values ranging between 0. In summary, individuals who meet full ASD criteria are highly likely, although not inevitably, to develop chronic PTSD in the absence of appropriate treatment; individuals who do not meet criteria for even subclinical ASD are highly unlikely, although not entirely, to develop chronic PTSD or even subclinical PTSD; and individuals meeting criteria for all ASD symptom clusters but one are somewhat more likely than not, but again not inevitably, to subsequently develop either chronic or subclinical PTSD.

Overall, there is greater negative predictive power for the ASD diagnosis than natural disasters acute stress disorder and posttraumatic stress disorder essay predictive power.

In other words, absence of significant symptoms of ASD in the aftermath of a traumatic event is a better predictor of subsequent outcome absence of PTSD than is their presence. In addition, while the dissociative symptom cluster may have higher positive predictive value than other symptom clusters, their presence is not necessary for the development of chronic PTSD.

Translating the above findings into clinical guidelines, it would seem appropriate that individuals meeting full criteria for ASD at least one week after the trauma be offered treatment if the appropriate services are available and that those not meeting criteria for even subclinical ASD be educated that treatment is probably unnecessary unless their symptoms worsen.

For individuals meeting criteria for subclinical ASD, it would seem reasonable to either offer treatment or recommend a series of follow-up visits to monitor the course of their symptoms so that treatment may be initiated for those who do not show a pattern of natural recovery.

In the NCS, 5 for example, 79.

Natural Disasters, Acute Stress Disorder and Posttraumatic Stress Disorder Essay

Additional analyses of the temporal order of exposure to trauma, developing PTSD, and developing other psychopathology suggests that non-PTSD psychopathology is a risk factor for both subsequent exposure to trauma and the development of PTSD in response to trauma and the greater number of prior disorders the greater the risk for both exposure to trauma and the development of PTSD.

Thus, an individual with an extensive prior history of psychiatric problems who then experiences a traumatic event may be particularly vulnerable to the development of PTSD. Prior trauma and the development of PTSD may also be risk factors for subsequent exposure to additional traumas as well as the development of other psychopathology, particularly in the case of the substance abuse disorders.

Thus, the combination of these two effects may serve to create a vicious cycle among exposure to trauma, development of PTSD, and substance use. Partial support for the vicious cycle hypothesis comes from the previously mentioned NWS survey. Similarly, even after controlling for the same demographic variables in the previous analysis age, race, and education as well as alcohol or drug use at the initial assessment, the occurrence of an assault during the follow-up period nearly tripled the use of alcohol at the follow-up assessment and nearly doubled the use of drugs.

Unfortunately, these authors did not investigate whether any of these reciprocal effects of alcohol and drug use with trauma exposure were mediated by the development of PTSD. Nonetheless, it is clinically relevant to be aware that alcohol and substance abusing patients are at elevated risk for exposure to trauma, and therefore at elevated risk for the development of PTSD, and patients with PTSD are at elevated risk for developing alcohol substance use problems. General Considerations The assessment of PTSD and ASD requires at minimum an assessment of the person's trauma history, obtaining information on both the objective features of the trauma s i.

In principle, each of these content areas can be assessed through clinician natural disasters acute stress disorder and posttraumatic stress disorder essay, self-report measures, or a combination of the two.

In part, this is because it is assumed that clinicians will have a better understanding of the diagnostic criteria and will better able to judge whether or not a particular patient complaint falls within the category.

  • In Australia natural disasters take the form of bushfires, floods, severe storms, earthquakes and landslides all which display their own various consequences;
  • Morphine has been shown in several studies of hospitalized patients to be an effective deterrent in developing PTSD;
  • A clinician rating scale for assessing current and lifetime PTSD;
  • Additional questions with a similar level of specificity were used to ask about non-sexual assault and other potentially traumatic events;
  • The Impact of Event Scale—revised;
  • With regard to offering patients information about prognosis, monitoring natural recovery, or evaluating treatment response, dimensional assessment utilizing reliable and valid assessment instruments is frequently more helpful than simple diagnostic decisions and clinician impressions of severity as they provide greater information, are more sensitive to change either worsening or improving , and treatment effects observed in the clinic can be compared with treatment effects reported in the research literature to help the clinician set reasonable expectations with the patient and for both the clinician and the patient to understand how their symptom level or treatment response compares to that of others.

For example, DSM differentiates recurrent, intrusive, distressing thoughts or recollections about the trauma Criterion B1 from flashbacks Criterion B3. The difference between these two symptoms is that flashbacks have a quality of feeling as though it is happening right now, whereas intrusive recollections are clearly recognized as a memory for a past event. Patients, however, may not make this differentiation and, as a result, may rate the same event as two separate symptoms and thereby elevate the overall severity score.

For example, patients who lose consciousness during the trauma or were under the influence of drugs or alcohol may have gaps in their knowledge for what happened, but such gaps may be due to either a failure to encode the relevant memory or normal sources of forgetting, rather than the kind of cognitive avoidance mechanism envisioned in the diagnostic criteria.

The primary disadvantage of clinician-administered measures is that they can be time consuming to administer. Self-report measures, which are often validated against interview measures, have the advantage that they can be mailed to patients ahead of time and filled out at their leisure or completed while waiting to see the clinician.

With regard to offering patients information about prognosis, monitoring natural recovery, or evaluating treatment response, dimensional assessment utilizing reliable and valid assessment instruments is frequently more helpful than simple diagnostic decisions and clinician impressions of severity as they provide greater natural disasters acute stress disorder and posttraumatic stress disorder essay, are more sensitive to change either worsening or improvingand treatment effects observed in the clinic can be compared with treatment effects reported in the research literature to help the clinician set reasonable expectations with the patient and for both the clinician and the patient to understand how their symptom level or treatment response compares to that of others.

Accordingly, we recommend clinicians incorporate the use of formal assessment instruments into their practice and, to this end we provide a brief review of commonly used assessment instruments. For even greater detail on the assessment of psychological trauma and PTSD, the interested reader is referred to Wilson and Keane.

Assessing Trauma Several instruments have been developed to assess for the experience of traumatic events that vary substantially in their level of specificity and comprehensiveness about various types of traumas. Note the following example: Sometimes things happen to people that are extremely upsetting—things like being in a life-threatening situation, such as a major disaster, a very serious accident or fire; being physically assaulted or raped; seeing another person killed or dead, or badly hurt; or hearing about something horrible that has happened to someone you are close to.

At any time during your life, have any of these kinds of things happened to you? The advantage of such an open-ended approach to assessing for potentially traumatic events is that it does not require the patient's experience to fit into a predetermined mold and instead permits the patient to report whatever experiences they have had and the interviewer, through follow-up questioning, can elicit information to determine if the event meets both of the objective threat and subjective reaction criteria to qualify as a traumatic event.

The disadvantages, however, are 1 such an approach provides little context for assessment by way of explaining the nature of traumatic events so that intent of the questions will be clear to the patient and help to focus the discussion on the kinds of events of interest; and 2 the range of examples cited fails to include several types of events that are potentially traumatic events but, for one reason or another, the patient may not report to the interviewer, such as sexual assaults that fall short of the patient's definition of rape because of who the perpetrator was e.

Contrast the approach taken by the SCID with that taken in the epidemiological NWS, in which the researchers were specifically interested in the prevalence of violent crime, which is illustrated by how they assessed for instances of rape.

Another type of stressful event that many women have experienced is unwanted sexual advances. Women do not always report such experiences to the police or other authorities or discuss them with family or friends. The person making the advances isn't always a stranger, but can be a friend, boyfriend, or even a family member. Such experiences can happen at any time in a woman's life—even as a child.

Regardless of how long ago it happened or who made the advances, has a man or boy ever made you have sex by using force or threatening to harm you or someone close to you? Just so there is no mistake, by sex we mean putting a penis in your vagina. Additional questions with a similar level of specificity were used to ask about non-sexual assault and other potentially traumatic events.

The key here is to ask clear operationally defined and, in the case of interpersonal violence, behaviorally specific questions instead of relying on the patient's implicit definitions of certain terms, such as rape and sex. Specific potentially traumatic events that are covered in most of the trauma-screening measures used in clinical research include rape; other forms of sexual assault e. Several treatment outcome studies that have used the CAPS as the primary outcome measure require a minimum score of 50 for entry into the study and a commonly agreed upon score reflecting a good outcome is a score less than 20.

This scale, called the Trauma Screening Questionnaire TSQconsists of 10 items from the PSS-SR that are rated by the patient in simple yes or no fashion natural disasters acute stress disorder and posttraumatic stress disorder essay on whether or not the patient experienced any of the items at least two times in the past week.

Using the cut-off score of 6 or greater, TSQ was found to have excellent sensitivity, specificity, and power index values ranging between 0.