Etiology and predisposing factors
The onset of the disorder is directly linked to the impact of emotionally destructive stress. Such situations include the loss of loved ones, violence, loss of home, or the global collapse of life ideals.
However, the disorder does not develop in everyone. The probability of development is influenced by predisposing factors:
- Increasing fatigue and asthenia.
- Chronic mental tension.
- Previous traumatic brain injury (TBI).
- Sleep deprivation.
- Intoxications (including alcohol abuse).
- Concomitant somatic pathologies.
The most crucial element is the social factor. The severity of the condition directly correlates with the lack of support and empathy in society. A classic example is Vietnam and Afghanistan veterans returning to an indifferent environment. If a person feels pride in their actions (e.g., defending the Motherland), the risk of developing pathology is minimal.
Clinical presentation
The symptoms of the disorder are largely typical of a depressive reaction. A key manifestation is anhedonia—the complete inability to derive pleasure from life.
The main clinical manifestations include:
- Intrusive memories of the experienced stress that constantly intrude into consciousness.
- Sleep disorders: patients are tormented by nightmares, and a persistent fear of seeing the tragedy in dreams develops.
- Personality changes: pronounced withdrawal and a persistent feeling of inner numbness.
Attitude toward the illness and social maladaptation
A specific feature is the distorted perception of one's condition. Victims extremely rarely consider themselves ill and actively refuse offered help.
They are characterized by an acute sense of total misunderstanding by others and deep distrust of doctors. Patients are convinced that only someone with a similar tragic experience can understand their feelings. This creates a serious compliance problem: patients sabotage medication intake, believing that drugs cannot bring back loved ones. In addition, they often experience guilt and believe they simply have no moral right to artificially dull their emotional pain.
Diagnostic criteria for reactive states
Since this pathology belongs to the group of psychogenic reactions, its diagnosis is based on general principles known as Jaspers' triad:
- A clear temporal link is traced between the psychological trauma and the onset of the disease.
- There is a clear correspondence between the essence of the traumatic event and the symptoms (the patient's thoughts constantly return to the disturbing topic).
- The ability to distract oneself from unpleasant memories brings at least temporary relief.
The appearance of any negative symptoms (e.g., intellectual-mnestic defect) is incompatible with the diagnosis of a reactive disorder.
Principles of treatment and physician tactics
Since victims rarely seek help on their own, physicians must take an active stance. In major disasters, it is necessary to proactively identify those in need of treatment, up to house-to-house visits.
In psychotherapeutic work, establishing trust is extremely important. The physician needs to show the talent of a listener and let the patient vent ("pour out their soul").
Pharmacotherapy is highly effective and includes:
- Tranquilizers to relieve anxiety.
- Antidepressants to combat the depressive background and anhedonia.
- Mild antipsychotic drugs.
Briefly: answers to topical questions
What specific psychotherapeutic techniques are used in the treatment of posttraumatic stress disorder?
In the treatment of posttraumatic stress disorder, general principles of psychotherapy aimed at establishing trust and cooperation with the patient are applied. Specific specialized techniques are not detailed in the source. The following general approaches are indicated:
- The physician needs to show the talent of a listener.
- The patient should be allowed to vent ("pour out their soul"), which helps gather important information for the treatment plan.
In major disasters, physicians need to actively identify those in need of treatment, as PTSD patients rarely seek help on their own.
What international classifications of diseases are used for the official diagnosis of posttraumatic stress disorder?
For the official diagnosis of posttraumatic stress disorder, the International Classification of Diseases, 10th Revision (ICD-10) is used. In this classification, the disease has the following code:
- Posttraumatic stress disorder (Posttraumatic Stress Disorder) — code F43.1.
The diagnosis in ICD-10 is presented as a special code, where the Latin letter F denotes the section of mental disorders, and the subsequent digits specify the exact nosology. Diagnosis is most often based on identifying the leading syndrome or symptom.
To remember Jaspers' triad, use the 3C rule: Connection to stress (in time), Correspondence to trauma (in thoughts), Cessation of anxiety (upon distraction).
Class and exam questions
Do patients with this pathology seek help on their own?
Extremely rarely. They do not consider themselves ill, refuse help, and distrust doctors, believing that only someone with the exact same experience can understand them.
What emotion or state underlies the clinical picture?
Symptoms are typical of a depressive reaction, the leading sign of which is anhedonia—the total inability to experience pleasure.
Why does the compliance problem arise during treatment?
Patients often experience guilt and believe they have no right to dull the pain with medications, and also argue their refusal by saying that pills "will not bring back the dead."
What else to study on this topic
- Affective-shock reactions (reactive stupor and agitation)
- Protracted reactive depressions and suicide risk
- Reactive paranoid under conditions of information isolation
- Differential diagnosis of psychogenic and endogenous psychoses
- Hysterical psychoses and anxiety conversion mechanisms
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