What Is Posttraumatic Stress Disorder (PTSD)?*

PTSD is a psychiatric disorder that occurs in individuals exposed to a traumatic event. The rates vary with the event and can be as few as 2% or as many as over 50% who are affected. PTSD follows exposure to a traumatic event involving death, serious injury, or a threat to the physical integrity of the self or others. The traumatic event must be persistently re-experienced in the form of distressing images, thoughts, perceptions, dreams, or reliving; intense psychological or physiological reactivity may also be present on being reminded of the event. Persistent symptoms of increased arousal should be present since the trauma and efforts to avoid stimuli associated with the trauma and numbing of responsiveness must be present following the trauma. The symptoms should be present for at least 1 month. Symptoms of PTSD include: nightmares, flashbacks, memory and concentration problems, intrusive memories, startle responses, hyperarousal, hypervigilance, avoidance, feeling worse with traumatic reminders, emotional numbing, dissociative and out-of-body experiences, derealization, amnesia, fragmented sense of self and identity, anxiety and panic attacks, and claustrophobia. Individuals with PTSD are vulnerable to high levels of anxiety, depression, substance abuse, phobias, personality disorders, flashbacks, emotional numbing, and nightmares. *adapted from DSM-IV, American Psychiatric Association

What Is Acute Stress Disorder (ASD)?*

ASD is a psychiatric disorder that occurs in individuals exposed to a traumatic event. ASD follows exposure to a traumatic event involving death, serious injury, or a threat to the physical integrity of the self or others. The traumatic event must be persistently re-experienced in the form of distressing images, thoughts, perceptions, dreams, or reliving; intense psychological or physiological reactivity may also be present on being reminded of the event. Persistent symptoms of increased arousal should be present since the trauma and efforts to avoid stimuli associated with the trauma and numbing of responsiveness must be present following the trauma. The symptoms should be present for at least 2 days and a maximum of 4 weeks and occur within 4 weeks of the traumatic event. Symptoms of ASD include: nightmares, flashbacks, memory and concentration problems, intrusive memories, startle responses, hyperarousal, hypervigilance, avoidance, feeling worse with traumatic reminders, emotional numbing, dissociative and out-of-body experiences, derealization, amnesia, fragmented sense of self and identity, anxiety and panic attacks, and claustrophobia. Individuals with PTSD are vulnerable to high levels of anxiety, depression, substance abuse, phobias, personality disorders, flashbacks, emotional numbing, and nightmares. *adapted from DSM-IV, American Psychiatric Association

Brain Areas Involved in PTSD

The amygdala is involved with fear response and the processing of environmental threats. As a threat is perceived, the amygdala triggers other brain areas to induce a physiological and cognitive response. In individuals with PTSD, a fear response may occur when there is no real threat in the environment or when memory triggers such a response. Also an exaggerated physiological response can occur from even minimal threats. The hippocampus is the part of the brain that is responsible for storage and retrieval of memories. In PTSD, the hippocampus may be smaller or less active. This may result in deficient cognitive processing of memories and, therefore, the individual is more inclined to act on emotional stimuli. The anterior cingulate is involved with memory, emotion, and selective attention. PTSD patients show an underactivation in this region. In PTSD, the anterior cingulate is hypoactive. The decreased activity results in failure of the cortex to modulate the responses of the amygdala and diminish cognitive control.

Principles of the Intervention by Mental Health Professionals (adapted from "Psychopathology of Disasters," Prof. Juan J. Lopez-Ibor, MD, PhD. XII World Psychiatric Congress, August 2002, Plenary Lecture 1)

1. Intervention needs to be as immediate as possible. 2. The intervention needs to be integrated -- near as possible to the site were the event took place and include individual and collective reactions. 3. Needs to assist the whole of the population (including staff), not only the immediate victims. 4. An important intervention is verbal -- debriefing, discussions, social support. Individually and group if possible. 5. Differential diagnosis is important to triage severe from mild cases. 6. Awareness of issues of stigma concerning mental health treatment and attempts to minimize this. 7. Minimizing or avoiding exaggerated news, rumors, or "information wars" by providing adequate information. 8. Training and preparation in anticipation are important to prevent disasters and maximize coordination. 9. Awareness of local, cultural, and situational needs in any intervention. 10. The role of the mental health professional or health professional is to integrate and organize the social and biological aspects of individuals and systems.