Respond to posting that used a different case from the one you chose in any of the following ways:
According to the DSM-5, the nature of the psychological distress that is exhibited symptomatically by individuals who develop trauma and stressor related disorders may not fit the pattern of an anxiety, or fear based phenotype (American Psychiatric Association, 2013). Some of the symptoms mentioned include anhedonia, dysphoria, anger, aggression, and dissociation. In addition, individuals may not exhibit any symptoms of an anxiety or fear based event at all. An adjustment disorder, unlike PTSD, is characterised by an outsized reaction to a particular stressor(s), which may not be outside of the realm of a normal human experience. The psychological reaction is generally less severe than in PTSD, and the length of time experiencing the problem are of much shorter duration. Similarly, anxiety is described as excessive fear and anxiousness relating to a real or perceived threat, or anticipation of a future threat. Unlike with PTSD, the key words with adjustment and anxiety disorders are â€œoutsizedâ€, or â€œexcessiveâ€ fear, and â€œanticipated threatâ€, as well as the inclusion of a possible perceived, rather than actual threat. There is likely not a specific identifiable triggering event for anxiety to take place, as there must be with PTSD. On the other hand, Hooley, Butcher, Nock, and Mineka (2017) describe PTSD as more of a normal reaction to abnormal situations that have already occurred. The abnormal situation is outside the bounds of regular human experience, with intense and potentially long-lasting psychological disturbance. It is aggravated by often multiple external stressors and particular internal dispositions. It is for these reasons above that PTSD has been classified as a trauma and stressor related disorder rather than an anxiety or adjustment disorder.
Hooley et al. (2017) discuss the key factors that increase the seriousness of a stressor, including the higher severity, longer duration, a number of stressors at once, closer proximity to the self, unpredictable or unanticipated events, especially with no experience of previous coping strategies, and lack of control over events. The factors that contributed to the overall stress in the case of Jennifer the military nurse and her development of PTSD directly apply to the above dynamics. Jennifer was serving in a war zone, and while she was not engaging in active combat, the threat of potential death or dismemberment would have been very present every day, in other words, her degree of direct exposure was very close. Potentially, friends of hers were in the direct line of fire and returning to the hospital dead or wounded. Her typical coping mechanisms would not have prepared her for this type of situation. As Hooley et al. (2017) state, â€œthe adequacy and security the person has known in the relatively safe and dependable civilian world are completely underminedâ€ (p. 160). The nature of a war zone is that the presence of the threat is ongoing for an extended duration, and incoming wounded and dead, as well as threat of bombs or shooting at her location would have no predictability, as Holley et al. (2017) state â€œdisaster was routineâ€ (p. 137), with no control over the situation or outcomes. This is a situation with multiple traumatic stressors. As with soldiers, Jennifer was separated from her loved ones, would have limited personal freedom, and be at risk for disease. She was working long shifts and was likely exhausted due to the combination of that and sleep deprivation. The high temperatures would have contributed to the extreme discomfort of the environment as well. The psychological shock of seeing â€œmangled bodiesâ€ (Hooley et al., 2017, p. 137) would have been tremendously traumatic. In addition, one particular incident clearly made a large impact on Jenniferâ€s level of trauma, when a dead soldier returned with the upper part of his body missing and she could smell burned flesh, this was a triggering event. Hooley et al. (2017) suggest that traumatic events caused by human intent tend to cause higher rates of PTSD, which is certainly the case with war, as it damages the sense of safety that one might derive from being a rule-abiding member of society.
Other risk factors that could have played a part in her development of PTSD include being female, having higher levels of neuroticism, being a member of a minority group, pre-existing or familial history of mental disorders such as depression or anxiety, low levels of social support, believing her symptoms are a weakness and other misaligned cognitive beliefs, an s/s genotype of the 5HTTLPR gene (increased sensitivity to negative stimuli in a war zone), reduced hippocampus size, lower socio-economic status, less social support, disagreement with the warâ€s purpose, disengagement from her unit and/or leaders, lack of counselling or debriefing, no break from being immersed in the trauma environment, more stressors present post-deployment, and no or inadequate advanced preparation for the combat environment (Hooley et al., 2017; Polusny, Erbes, Murdoch, Arbisi, Thuras, & Rath, 2011).
Treatment for removing or coping with stressors could include emphasis on creating a low-stress home and work environment for a prolonged period of time to allow for recovery, with encouragement to develop a strong support network of empathetic people. Providing a safe, empathetic space for Jennifer to talk about the trauma that she experienced at her pace, while normalizing reactions could be invaluable (Hooley et al., 2017). Medications could help to treat specific symptoms, however, effectiveness in treating PTSD has limited evidence (Hooley et al, 2017; Peterson, Luethcke, Borah, Borah, & Young-McCaughan, 2011). Peterson et al. (2011) found that only exposure-base therapies, such as prolonged exposure and cognitive processing therapy have enough empirical evidence to conclude efficacy for treating PTSD, other research tends to be inadequate for combat-based intervention and treatment logistics. Hooley et al., (2017) also suggest a newer form of therapy that seems to be widely accepted by military personnel which is virtual reality exposure treatment. The trauma related cues that Jennifer experienced could perhaps become minimized over time as she learns to cope with them in a safe environment. Various forms of relaxation therapies for any related anxiety may also be indicated. She should most definitely not be deployed again (if ever) until she has received a clean bill of mental health, and is provided with more advanced coping preparation strategies, increased support and better rest opportunities, at the very least.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Hooley, J. M.,Butcher, J. N., Nock, M. K. & Mineka, S. (2017). Abnormal psychology (17th ed.). Boston, MA: Pearson Publishing.
Peterson, A. L., Luethcke, C. A., Borah, E. V., Borah, A. M., & Young-McCaughan, S. (2011). Assessment and treatment of combat-related PTSD in returning war veterans. Journal of Clinical Psychology in Medical Settings, 18(2), 164-175. doi: 10.1007/s10880-011-9238-3
Polusny, M. A., Erbes, C. R., Murdoch, M., Arbisi, P. A., Thuras, P., & Rath, M. B. (2011). Prospective risk factors for new-onset post-traumatic stress disorder in National Guard soldiers deployed to Iraq. Psychological medicine, 41(4), 687-698.doi:10.1017/S0033291710002047
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