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| Division of Occupational Therapy - OT Connect Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event of ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include:
(Levitt, 1998; MIM, 2001; NIMH, 2001) Common Symptoms/Course of Disease Many sufferers of PTSD repeatedly re-experience the trauma in different ways. The symptoms most often occur in close proximity to the traumatic event, but they may also develop in the months or years that follow it. Anniversaries of the event or exposure to events or objects reminiscent of the trauma may trigger symptoms. People with PTSD may experience:
PTSD is diagnosed when symptoms last more than 1 month. (Levitt, 1998; MIM, 2001; NIMH, 2001) How Common is PTDS? About 3.6 percent of U.S. adults ages 18 to 54 (5.2 million people) have PTSD during the course of a given year. About 30 percent of the men and women who have spent time in war zones experience PTSD. One million war veterans developed PTSD after serving in Vietnam. PTSD has also been detected among veterans of the Persian Gulf War, with some estimates running as high as 8 percent. (NIMH, 2001) Age of Onset: PTSD can develop at any age, including in childhood. Symptoms typically begin within 3 months of a traumatic event, although occasionally they do not begin until years later. Once PTSD occurs, the severity and duration of the illness varies. Some people recover within 6 months, while others continue to suffer for extended periods of time. (NIMH, 2001) Who is Most Likely to Develop PTSD? People who have suffered abuse as children or who have had other previous traumatic experiences are more likely to develop the disorder. While research is continuing to pinpoint other factors that may lead to PTSD, it is suspected that people who tend to be emotionally numb or emotionally distant after a trauma may be more prone to PTSD. (NIMH, 2001) Occupational Therapy Involvement Occupational Therapy Assessment:
(Asher, 1996; Levitt, 1998) Occupational Therapy Treatment:
(Levitt, 1998) Resources
How OT Makes a Difference: Evidence-Based Practice Current Medical Management: As of December 2001, two medications are approved by the U.S. Food and Drug Administration (FDA) for treating PTSD. These medications are both serotonin reuptake inhibitors (SSRIs):
In addition to proven effectiveness, SSRIs are considered the first-line medication treatment for PTSD because there are fewer, less severe side effects. Tricyclic antidepressants can also be employed as second-line treatment if SSRIs prove ineffective or are not tolerated.
Anti-anxiety medications may also be used only briefly and intermittently to suppress acute and severe anxiety symptoms. While they reduce anxiety rapidly, they also may induce sedation, impaired coordination, and physical dependency.
In addition, a class of medications called monoamine oxidase inhibitors (MAOIs) has also been shown to be helpful in PTSD. However, MAOIs are rarely used because of more frequent side effects than found with SSRIs and because a careful diet must be followed to prevent dangerous increases in blood pressure. (MIM, 2001; NCPTSD, 2003) A young single woman reported problems in job performance following the development of several flashback episodes with subsequent depression. Her usual route to work included driving on a particularly busy street where she had witnessed a catastrophic car accident. Shortly after the accident, she developed acute anxiety when driving on this street, so she began to take a more indirect route, which invariably made her late for work. She also became highly irritable and distractible, especially during the last hour of the workday. After being reprimanded several time by her employer, she decided to take a leave of absence from work in order to attend a partial hospitalization program. (Levitt, 1998) Occupational Therapy Assessment: The Role Checklist indicated difficulty in performing the worker role and the high value placed on it. The Function Questionnaire indicated moderate to severe impairment in work because of anxiety. The Self-Assessment of Activity reported problems in concentration, job insecurity, excessive worry, poor coping strategies, and problem solving. Goals:
(Levitt, 1998)
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