|
|
|
|
Post-Traumatic Stress Disorder |
Overcoming Anxiety (Home) > Post-Traumatic Stress Disorder > Lifetime Development Lifetime DevelopmentIn retrospect, the long-term development of PTSD may show several patterns. An acute PTSD may gradually develop into a chronic condition. A delayed form may manifest itself clinically after a considerable number of years up to three or four decades . A first and early manifestation may be followed by a symptom-free interval of years to decades and then relapse. A study in Dutch resistance veterans has revealed no differences at all between veterans who had or had not been in German concentration camps . It is clinical experience, also of my own, that PTSD of substantial duration is not the immediate consequence of one single event. If that would appear to be the case, it usually becomes clear after some time that significant earlier traumatisation has occurred. The said single event, then, will probably have triggered memories that had been unconscious (‘‘forgotten’’) for a longer time. Any individual who has significantly been traumatised may and almost certainly will meet circumstances or events during later life that symbolise the trauma and trigger the syndrome . Conditions that can trigger or exacerbate PTSD more or less acutely are intrusive medical treatments or other medical illness (e.g. with a stay in hospital acting as a memory of the concentration camp sick barrack), retirement or other reasons for drop-out from work (ending workaholism as a defence mechanism), general anaesthesia (an accidental, unwanted narco-analysis procedure), trains (association with the concentration camp transports), etc. Before the manifestation of their PTSD such patients may have had precursors of an aspecific type like surme´nage or ‘‘exhaustion’’ syndromes (adjustment disorders in DSM-IV terminology), functional syndromes (which are probably best described as undifferentiated somatoform disorders) or unspecified psychiatric syndromes. They also may have been given entirely different psychiatric diagnoses because the trauma criterion had not been recognised or because the flashbacks had been taken for delusions or hallucinations , a problem that is also known in dissociative identity disorder. A retrospective attempt to follow the longitudinal course of chronic PTSD showed that hyperarousal symptoms developed first, followed by avoidance symptoms, and finally by symptoms of the intrusive cluster. Symptoms plateaued within a few years after the Vietnam War, which was the stressor under study. Recording of alcohol and substance abuse revealed a course grossly parallel to PTSD symptoms . Prospectively, it has been confirmed that it takes some time for the consequences of traumatic exposure to become apparent. During a two-year followup of veterans after Operation Desert Storm (the Gulf War), hyperarousal symptoms were more severe than symptoms of re-experiencing or avoidance. Only two years after exposure to combat, its level was significantly associated with the score on the Mississippi trauma scale .
|
Bookmark This Page: Add to Favorites Add to Del.icio.us Send to a Friend Resources: |
|||||||||||||||||
