Post Traumatic Stress Disorder: Case Study
Part 1: Diagnosis
Post Traumatic Stress Disorder (PTSD) is characterized by stressor related outcomes associated with individual trauma experiences. The Diagnostic and Statistical Manual of Mental Disorders (DSM – 5) stipulates that the first diagnostic criterion for post-traumatic stress disorder is that the victim must have experienced a traumatic or stressful situation (Nuckols, 2013). The first criterion for consideration is that the victim must have been exposed to probable death, threatened or actual sexual violence and/ or the threat of severe injury. In some cases, the stressful event may not have happened directly to the victim of PSTD but rather to a close relative or friend. In such instances, the victim experiences trauma as a secondary event in that the feelings of loss are what contribute to the PSTD. In some cases, the condition heals faster, in less than 6 months while in other, it may extend beyond the six months (Nuckols, 2013). The condition may also be chronic in some victims. As with the healing process, the onset of PSTD may be immediate, about 3 months after the traumatic experience or even years afterward.
The second criterion for PTSD is that the victim re-experiences the traumatic event. This can be through flashbacks, nightmares, upsetting memories, physical reactivity, and emotional distress after traumatic reminders (U.S Department of Veterans Affairs, 2018). In this category, a victim may display at least one of the symptoms to be diagnosed with PTSD in case the other criteria are also fulfilled. The third criterion entails avoidance of trauma-related stimuli such as reminders and thoughts. The last two categories for PTSD diagnostic criteria include worsening negative thoughts after the trauma and trauma-related reactivity or arousal which continue to deteriorate after some time. In the third and fourth diagnostic criteria, a person with PTSD would show at least two symptoms in each category. In case the combination of symptoms from the five categories is experienced for more than one month consistently, an individual may be considered to be suffering from PTSD (Nuckols, 2013). However, the physician or practitioner addressing the needs of the patient must also establish that the symptoms displayed are not as a result of other medications or medical conditions. Only then can one be deduced to be suffering from PTSD.
Various symptoms are attributed to the condition under discussion. The symptoms are categorized into different aspects beginning with re-experiencing symptoms. Such symptoms include bad dreams and frightening thoughts which impact negatively on the victim’s daily routine. Words, objects, and situations which can be considered as reminders of the traumatic events act as triggers towards the re-experiencing symptoms (NIMH, 2016). Avoidance symptoms result in a change of daily routines as they make the victim relieve the negative experiences they had in the past. Reactive and arousal symptoms, on the other hand, include feelings of tension, difficulty sleeping, angry outbursts, and a shift in moods. These symptoms are attributed to reminders of the traumatic events and the impacts they have had on an individual’s life (U.S. Department of Veterans Affairs, 2018). As such, the victim feels angry about the turn of events and may in event find it difficult to sleep, eat, or even concentrate on other daily tasks. Similarly, mood symptoms may make a person feel alienated and low. Feelings of worthlessness, blames, and regrets characterize most of the daily lives of people living with PTSD.
The treatment for PTSD depends on the relationship between the victim and people around them. In cases where the victim does not get sufficient social support, they are prone to an escalation of the condition and eventual despair. However, where the victim receives adequate support from the social system, they can heal much faster as they recognize their strengths and discard their negative thoughts. Planning for an effective treatment approach, therefore, requires an understanding of the feelings of the victims and organization of the treatment goals and objectives in a manner that is acceptable to the victim and the social worker.
James, an 18-year-old boy, lives with his parents and his younger sister in their family home. On his 18th birthday, James’ parents got him a new car as a birthday present, and since he already had his driving license, he enjoyed driving his car. Five months ago, James was involved in a traumatic road accident while driving his car, during which he incurred a serious cranial injury. The accident had occurred on his way from a party where he had been drinking and thus was not in a condition suitable for driving. As it is now, his wound is already healed. However, James now portrays symptoms that show he has a post-traumatic stress disorder and thus should be assisted to make sense of his routine and his environment. Initially, James enjoyed playing soccer, but this has since changed as he feels dysfunctional and incapable of managing team dynamics. Most of his friends who used to visit him at home in the early days after his accident stopped visiting when they realized he was quite irritable and his moods would change unexpectedly.
Medically, James had been without any health challenges before the accident and was very active. As a soccer player, he had the determination to stay fit and always engaged in healthy eating and maintained his exercise routine. This has since changed as he views himself incapable of ever playing soccer and thus sees no need to keep fit.
The patient was assessed based on the DSM – V criteria for post-traumatic stress disorder that is based on five major criteria. The objective was to determine whether James satisfied the descriptions of the different criteria and whether his symptoms were in tandem with the DSM –V descriptions of PTSD. The first criterion was that of having been involved in a traumatic event. This criterion was satisfied since James himself had been his car’s driver during the accident. The second criterion is that he had to display at least one re-experiencing symptom. For James, he reported that he had often experienced nightmares in which he saw himself being killed during a car accident, with a disfigured face and body or even made invalid as a result of the accident. The experiences occurred at least twice a week and begun about 3 months after his accident. He also fulfilled the third criterion as he displayed avoidance symptoms for PTSD. In this regard, James had decided and would not have himself driven in a car. He destroyed his driving license claiming that he could not be in a death trap. He also avoids busy roads, especially where he had been involved in a car accident. For criterion D, the symptoms displayed included loss of interest in formerly interesting activities such as soccer and physical exercise, isolated feelings, and feelings of shame and guilt. He also displayed other symptoms such as hyper-vigilance, difficulty in sleeping and irritability, which are characteristic symptoms of PTSD.
Physically, James is not dysfunctional in any way. All his body organs have remained intact and fully functional. In terms of his social functionality, James has changed significantly. Once James’ friends lowered their frequency of visiting, he began showing withdrawal symptoms. Furthermore, changes in his emotional responses such as frequent display of irritability and solitude resulted in lower social interactions unlike what he had been prior to the accident. James’ engagement in leisure activities has also reduced as he feels unable to cope with the demands of his athletic activities such as soccer. Cognitively, James’ concentration was most affected by the accident. He also experiences frequent headaches which hinder performance in cognitive-related tasks. In terms of spirituality, James’ attitude to faith has changed slightly. In as much as he still believes there is God, his attitude towards religious activities has changed.
Goals and Objectives
Based on James’ condition, the treatment goals and objectives would be as shown in the table below.
|Self-perception.||James is capable of remembering some aspects of the accident.||To help James improve his perception of self by restructuring his thoughts concerning his role in the accident by the end of the next two months.||To eliminate feelings of blame and guilt.|
|Fear control||The patient is not physically afraid.||To assist the patient in working on controlling anxiety and reducing the recurrence of the re-experiencing events.||To reduce the recurrence of re-experiencing thoughts.|
|Cognitive functioning||He is mentally sound.||To enable the patient to make sense of his bad memories and hence address them better.||To make the patient understand that what he went through is a possible outcome in human life.|
The treatment plan for James is intended to move him from the recreation phase to the leisure phase. With his current functional capabilities, the patient does not need absolute care, and any therapeutic activities would have to be mutually participative. The overall objective is to have James experiencing optimal health in a favorable environment, where he would be self-directed in all his activities.
To accomplish this, James will be subjected to a combination of cognitive restructuring and exposure therapy as recommended by NIMH (2016). The treatment will begin with the exposure therapy, whose objective will be to help James make sense of the traumatic experiences through the use of imagination, writing, and visits to the accident scene. This will be conducted over a two month period. The cognitive restructuring will be conducted over a three month period and will entail stress management and relaxation activities. The therapeutic procedures will be facilitated by a social worker and will be conducted in a group setting comprising of other individuals experiencing PTSD and anxiety related disorders. Pharmacological procedures will be used to address the presenting pains such as the recurrent headaches.
NIMH (2016). Post-traumatic stress disorder. The National Institute of Mental Health. Retrieved from www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Nuckols, C.C. (2013). The diagnostic and statistical manual of mental disorders 5th Ed. (DSM-5). Delaware Department of Health. Retrieved from dhss.delaware.gov/dsamh/files/si2013_dsm5foraddictionsmhandcriminaljustice.pdf
U.S. Department of Veterans Affairs (2018). PTSD: National center for PTSD. U.S. Department of Veterans Affairs. Retrieved from www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp