The document outlines the nature, symptoms, and treatment of post-traumatic stress disorder (PTSD), emphasizing its impact beyond just veterans to include crime victims and various traumatic events. It discusses PTSD's prevalence, particularly among vulnerable populations like children and survivors of violence, along with its psychological consequences and complex connections to brain chemistry. Treatment options such as therapy, medication, and Eye Movement Desensitization and Reprocessing (EMDR) are highlighted as essential for recovery.

1. Presented by
Posttraumatic Stress Disorder Research Institute
Director Victoria Hargan, MA
Masters Degree Forensic Psychology
2010

2. Table of Contents
I. Introduction
 What is Post traumatic stress disorder?
 DSM-IV- TR
 Symptoms of post traumatic stress disorder
II. A Growing Problem
 PTSD not only a Veterans Condition
 PTSD Statistics
 A community health problem
 Crime Victimization and PTSD
 Psychological consequences of crime
 Crisis reaction and equilibrium
 Trigger events for crime related PTSD
 Risk factors
 Recovery Process
 Treatment for PTSD
 Medications for PTSD patients
 III. Conclusion

3. What is Post-traumatic Stress Disorder?
 According to the National Institute of Mental Health:
 “Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop
after exposure to a terrifying event or ordeal in which grave physical harm
occurred or was threatened. Traumatic events that may trigger PTSD include
violent personal assaults, natural or human-caused disasters, accidents, or
military combat”(NIMH, 2009).
 Post traumatic stress disorder or “PTSD”, was once called shell shock, battle
fatigue syndrome during WW II.
 PTSD got it’s name during the Vietnam war.
 PTSD is also known as “battered woman’s syndrome”. The name derived
from battered women victimized by domestic violence.

4. DSMI-IV-TR
PTSD Criterion- A.
A. Exposure to a traumatic event
 The person experienced, witnessed, or was confronted with an event/s
that involved actual or threatened death or serious injury, or a threat to
the physical integrity of self or others.
 Response involves intense fear, helplessness, or horror

5. DSMI-IV-TR
PTSD Criterion- B.
B. Traumatic event is persistently re-experienced in at least one
of the following ways:
 Recurrent and intrusive thoughts or images
 Recurrent distressing dreams
 Acting or feeling as if the event were recurring
 Psychological distress upon exposure to reminders of event
 Physiological reactions upon exposure to reminders of event.

6. DSMI-IV-TR
PTSD Criterion-C
C. Avoidance of stimuli associated with the event and numbing of
general response, occurring in at least three of the following
ways:
 Efforts to avoid thoughts, feelings, or conversations about the
event
 Efforts to avoid activities, places, or people that remind person
of the event
 Inability to remember an important aspect of the event
 Significantly diminished interest or participation in activities
 Feeling of being detached or estranged from others
 Restricted range of affect
 Speaks or thinks of not having a future

7. DSMI-IV-TR
PTSD Criterion-D
D. Increased arousal not present before traumatic event, presenting in
at least two of the following ways:
 Trouble falling or staying asleep
 Irritability or outbursts of anger
 Difficulty concentrating
 Hyper-vigilance
 Exaggerated startle response
E. Symptoms last at least one month
F. Symptoms listed above cause significant impairment in daily life

8. Symptoms Grouped into Three Categories
According to The National Institute on Mental Health:
 Re-experiencing symptoms:
 Flashbacks—reliving the trauma over and over, including physical symptoms like a
racing heart or sweating
 Bad dreams
 Frightening thoughts.
 Re-experiencing symptoms may cause problems in a person’s everyday routine. They
can start from the person’s own thoughts and feelings. Words, objects, or situations
that are reminders of the event can also trigger re-experiencing.
 Avoidance symptoms:
 Staying away from places, events, or objects that are reminders of the experience
 Feeling emotionally numb
 Feeling strong guilt, depression, or worry
 Losing interest in activities that were enjoyable in the past
 Having trouble remembering the dangerous event.
 Things that remind a person of the traumatic event can trigger avoidance symptoms.
These symptoms may cause a person to change his or her personal routine. For
example, after a bad car accident, a person who usually drives may avoid driving or
riding in a car.
 Hyperarousal symptoms:
 Being easily startled
 Feeling tense or “on edge”
 Having difficulty sleeping, and/or having angry outbursts.

9. Symptoms
 Depression
 Anxiety
 Panic Attacks
 Anger Outbursts
 Hyper-startle response
 Disturbed Sleep Pattern
 Nightmares
 Excessive sleep
 Insomnia
 Self medication
 Drugs
 Alcohol

10. Symptoms
 Hyper-vigilance
 Constantly looking out for
danger
 Weight loss or weight gain
 Disturbed eating pattern
 Eating too much
 Not eating enough
 Trouble concentrating
 Agoraphobia
 Afraid to leave the house
 A result of feeling that the world
is an unsafe place
 Problems with memory
 Short Term Memory loss
 Difficulty recalling details of the
event.

11. Symptoms and Complications
 Symptoms can be debilitating, complicating the condition
 Symptoms can interfere with ADL’s (activities of daily living.
 Many suffers develop substance abuse problems and
addictions
 PTSD suffers have a high rate of absenteeism
 often times lose their jobs
 leading to economic deprivation
 Suffers may fail in their academic studies and goals.
(Salvatore, R., 2009).
 High rate of suicide

12. Avoidance
 A major symptom that is presented in PTSD is persistent avoidance of
anything that is associated with the trauma, or crime.
 Usually begin soon after the traumatic event
 Referred to as psychic numbing.
 Psychic numbing is an automatic reflex reaction in which the mind
virtually shuts down to protect the survivor's psyche from further trauma,
allowing the victim to do what is necessary in order to function” (NCVC
2009).

13. Avoidance
 Examples of avoidance include:
 Efforts to avoid thoughts, feelings or conversations associated with
the trauma
 Efforts to avoid activities, places or people that arouse recollections
of the trauma; this is one reason why many victims will not leave
their homes.
 Inability to recall an important aspect of the trauma
 Diminished response to the external world, or “emotional amnesia.”
 Markedly diminished interest or participation in significant
activities; with children, they may regress developmentally and may
begin bedwetting, or talking like a baby.
 Feelings of detachment or estrangement from others;
 Restricted range of affect or reduced ability to feel emotions such as
feeling or giving love (NCPTSD 2009).

14. Triggers and Flashbacks
 A trigger is a sound or sight that
causes the survivor to relive the
event.
 Triggers may be exhibited by :
 Hearing a firework go off- may
trigger memories to a gunshot
victim or war veteran; may think
of memories of gunfire, or war;
 Seeing a car accident, may
remind a crash survivor of their
own accident
 Watching a rape survivor on the
news may bring back memories
of her/his assault
 A smell of cologne that was worn
by the perpetrator during a
sexual assault.

15. A Growing Epidemic
Crime victim’s and others
who have experienced
traumatic events are
vulnerable to PTSD.
PTSD is not just a
veterans condition.
Secondary symptoms
such as depression, and
substance abuse are
making this a National
health problem.

16. Crisis Reaction
 Victims will react differently to traumatic events
 Depending on the level of personal violation, their personality,
experiences, and support systems, their state of equilibrium at their
victimization” (NCVC 2009).
 All people have a normal state of equilibrium called homeostasis.
 It is influenced by everyday stressors such as:
 illness, moving, changes in employment, and family issues.
 If a person’s equilibrium is disrupted our bodies react, however they
return to previous functioning levels.
 The combination of everyday stressors, in addition to being
victimized, a person’s equilibrium becomes overloaded making the
person vulnerable to developing PTSD.

17. Victims of Crime
 Victims of crime may self medication with drugs or alcohol.
 In an attempt to psychologically numb
 Or block out the memories of the event.
 Family and friends are often confused and do not understand the
condition.
 May feel helpless and frustrated
 Survivor may further deteriorate as a result.
 May become more depressed
 Isolated
 Suicidal
 Survivors often feel
 alone
 Afraid
 Feel shame
 May feel like it’s their fault.

18. Crime Victimization and PTSD
Trigger events for crime-related PTSD
 Events may re-victimize the survivor and their families by:
 Identification of the perpetrator
 Hearings
 Trials
 Attending or hearing about other criminal justice
proceedings
 Anniversaries of the event
 Holidays and other important family life events; such as
birthdays.

19. Re-Victimizing the Victim
Court Proceeding can
bring on strong
emotions and the
victim will relive the
traumatic event all
over again.
Survivors may trigger
or flashback during
this time.
Survivors are often
revictimized by the
defense.

20. Crime Victimization and PTSD
Triggers may be internal or external.
 Internal may be a result of the intrusive memories of the
event
 External triggers may include seeing something on TV
that reminded the victim of the event.
 “People with PTSD will avoid things or situations that
trigger memories or flashbacks of the traumatic event. If
the condition is left untreated, the victim's life may
become dominated by attempts to avoid situations that
remind him or her of the event” (NCPTSD 2009).

21. Crime Victimization and PTSD
 Survivor may experience a flashbacks.
 May feel intense emotions
 May feel like the event is happening all over again
 May lead to physical symptoms
 Fast Heart beat
 Nausea
 Vomiting
 Headache
 Dry mouth
 Panic attacks
 Crying
 Fear

22. PTSD and Brain Chemistry
 Researchers have found a connection between PTSD and brain
chemistry.
 What happens to the brain during and immediately after the
critical, traumatic event will determine how each unique
individual will respond, develop, or recover from PTSD.
 Fight, Flight, or Freeze: The chemicals that flood the brain
during trauma is a natural response in order to help the person
to survive the event by:
 Either by running away
 Fighting furiously.
 Or submit to the trauma
 In some individuals, once the brain goes through this chemical
‘rewiring’ to survive the trauma, the wiring stays that way”. (Briere,
J., 2009).

23. PTSD and Brain Chemistry
 We are all born with an innate response to crisis called “the fight
or flight response”.
 The fight and flight response is a natural response that is
produced when our bodies are feeling threatened, or in a high
state of stress.
 Stressful situations produce a variety of body changes:
 Changes associated with the "fight or flight" response:
 increased blood levels of the hormone, adrenaline (a.k.a. epinephrine).
 This chemical messenger produces several body changes including
elevated blood pressure and increased pulse rate.
 These actions increase blood flow and, along with increased circulation
to arms and legs, allow an animal to increase appropriate physical
exertion capabilities” (PBS 2009).
 This is what allows us to run quickly in order to escape an attack from
the tiger.

24. PTSD and Brain Chemistry
 Not everyone develops PTSD after a traumatic event
 Depending on the unique brain chemistry of each person
will determine development, symptoms and behavioral
signs.
 Two people can experience the same trauma, and one may
come out with PTSD, and the other will not” (Briere, 2009).
 Research has also suggested that the hippocampus may
shrink and kill neurons.
 This may slow down the growth of new neurons.
 This has lead to understanding why individuals with PTSD
have a hard time concentrating or remembering things.

25. PTSD and Brain Chemistry
 “The ‘wiring’ of the brain’s neurochemical systems become over
sensitized. Resulting in the symptoms seen in PTSD.
 The complex chemical-neurological reactivity affects parts of the brain
that are all about learning, memory, and fear conditioning” (Briere,
2009).
 A neurochemical that plays a role in chronic stress is cortisol.
 “Cortisol is a hormone that is produced in the adrenal gland, producing
adrenaline. Also called the “stress hormone” because it tends to increase
blood pressure, blood sugar levels, and has an immunosuppressive effect”
(Briere, 209).
 Secretion of cortisol is prolonged during chronic stress or a traumatic
event.
This begins a viscous cycle of symptoms.
 Cortisol levels highest in the morning, lowest a few hours after sleep begins
in the average person.
 This helps explains the disturbed sleep and nightmares many PTSD suffers
experience.

26. PTSD and Brain Chemistry
Parts of the brain most involved in PTSD
 amygdala
 hippocampus
 medial front cortex
 thalamus
 hypothalamus
Hypothalamic-pituitary-adrenal axis.
 Along with these, chemicals in the brain
such as
 Noradrenalin
 Dopamine
 Serotonin
 the opiod systems, insulin, and cortisol
all play complex roles in the PTSD
symptom producing process” (Briere,
2009).
Since so many structures, hormones
and neurotransmitters are involved in
PTSD; the complex nature of PTSD has
made it difficult in treating patients
with one specific medication.
Instead a combination of medications
tends to work in concert with one
another in order to relieve patient
symptoms.

28. Statistics
 Families of homicide victims–the impact of homicide on surviving family
members (Kilpatrick, Amick & Resnick, 1990) indicated that, almost 1 in 4
victims (23.4%) develop PTSD after the death of their loved one.
 It is estimated that the prevalence of PTSD among adult Americans is:
 7.8%, with women (10.4%) twice as likely as men (5%) to have PTSD at some
point in their lives.
 Children who are at high risk for developing PTSD include:
 Survivors of childhood sexual assault
 Incest
 children who witness or are exposed to violence or abuse in the home.

29. The Silent Victims-Our Children
Children who witness or are exposed to violence or abuse
in the home are at high risk of developing PTSD.

30. Statistics
 Rape victims
 Are 13.4 times more likely to have two or more major alcohol problems.
 Are 26 times more likely to have two or more major serious drug abuse
problems.
 The National Institute of Justice surveyed adolescents for victimization, mental
health, and substance abuse issues.
 A survey of 4,023 adolescents ages 12 to 17, 1.8 million adolescents have been
sexually assaulted
 3.9 million have been physically assaulted
 2.1 million have been subjected to physically abusive punishment
 8.8 million have witnessed violence” (National Institute of Justice, 1995).

31. Substance Abuse and PTSD
Secondary symptoms and conditions may develop with PTSD. Co-occurring
conditions may exist with PTSD, such as depression, anxiety disorders, and
alcohol or other substance use disorders.

32. Treatment and Recovery Process
 A therapist or counselor can:
 Help the victim restructure the fragments of their lives
 Understand and accept some irreversible changes brought about by
the trauma.
 Reopen channels of feeling that may have been repressed.
 Learn to manage the impact of distressing, invasive thoughts or
flashbacks (NVPTSD 2009).
 As survivors begin to heal, they will regain control,
empowerment and a sense of confidence.
 The recovery process can be long and difficult.
 Crisis intervention should be implemented as soon as possible.
Counseling and Psychotherapy

33. Counseling and Psychotherapy
Treatment and the Recovery Process
 Therapists need to be honest with their clients.
 They need to inform survivors that although effects of a trauma can be
alleviated, they may not always go away (Young, 1992).
 Therapists should inform their clients that life’s events, holidays, anniversary
dates of the crime, or other potential triggers may trigger memories and cause
them to re-experience the stress reactions in the future.
 With effective treatment, survivors can learn to cope with symptoms and help
to control symptoms of anxiety and depression.
 Cognitive behavioral therapy and an integrated approach to therapy has proven
effective
 Medication may be needed for some survivors.

34. Medication s and PTSD
Treatment and the Recovery Process
 Medications that have proven successful in treating patients with PSTD
include:
 Anti-depressants-Help with depression, mood swings and irritability
experienced by sufferers
 Benzodiazepines- Help with panic attacks and anxiety
 Sleep aids- prescribed sleep aids such as Desyrl (Trazadone), aid in
sleep, and insomnia exhibited by suffers.
 Beta blockers-help in the reduction of the “fight and flight” response.
 A problem with medication regimens is that they may lead to
additional symptoms due to medication side effects.

35. EMDR and PTSD
Treatment and the Recovery Process
 EMDR- Eye movement desensitization reprocessing is an intervention that is
being used in clients with PTSD.
 Simple, and non-invasive patient
 EMDR-helps in the recovery of:
 PTSD
 Depression
 Anxiety
 Nightmares
 Distressing nightmares
 Insomnia
 Traumatic events and abuse
 Research shows that EMDR is rapid, safe and effective.
 EMDR does not involve the use of drugs or hypnosis.

36. Treatment and Referrals
 Family of homicide victims, especially those having
contact with the criminal justice system, should be
screened for the presence of PTSD and provided with
counseling referrals.
 “Due to the high risk for victims and survivors of
developing crime-related PTSD, mental health
referrals and services for crime victims should be
provided to all victims” (NCPTSD 2009).

37. Conclusion
 Crime does not discriminate and it can happen to anyone at anytime.
 The consequences of crime are devastating and can lead to post
traumatic stress disorder.
 Early intervention can help reduce the potential of developing PTSD,
and reduce symptoms.
 Early intervention is vital and has resulted in a better success rate than
those who do not seek treatment or seek treatment long after the event.
 The connection:
 PTSD , trauma, crime victimization, brain chemistry, the
development of secondary symptoms such as:
 depression, anxiety, and substance abuse disorders are becoming
more and more recognized as key components related to the
condition making this a National Health Issue.

38. Conclusion
 PTSD was first given its name during the Vietnam war; however
researchers and mental health professionals recognized the
cluster of symptoms much earlier; specifically during earlier
wars.
 We now know that there is a biological connection between
PTSD and brain chemistry.
 Crime prevention, education and community awareness should
begin as early as preschool.
 By reducing crime, its impact upon victims will also reduce.

39. Conclusion
 With extensive research on PTSD, suffers can be treated and lead
relatively normal lives.
 Psychotherapy, medication regimens, EMDR-eye movement
desensitization reprocessing, and support systems are some
interventions being used to help treat PTSD.
 Research on PTSD and technology are advancing; there is hope that the
rewired bio-chemical system can be rewired one more time through
therapy to help people regain the life they had before their traumatic
event”(Briere, 2009).
 The statistics of “crime victims with major crime-related mental health
problems make this a major health issue for communities and the
nation” (NCPTSD 2009).

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