Post Traumatic Stress Disorder and Crime Victimization

Post Traumatic Stress Disorder and Crime VictimizationPresented byPosttraumatic Stress Disorder Research InstituteDirector Victoria Hargan, MAMasters Degree Forensic Psychology2010

Table of ContentsI. IntroductionWhat is Post traumatic stress disorder?DSM-IV- TRSymptoms of post traumatic stress disorderII. A Growing ProblemPTSD not only a Veterans ConditionPTSD StatisticsA community health problemCrime Victimization and PTSDPsychological consequences of crimeCrisis reaction and equilibriumTrigger events for crime related PTSDRisk factors Recovery ProcessTreatment for PTSDMedications for PTSD patientsIII. Conclusion

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 its name during the Vietnam war.

PTSD is also known as battered womans syndrome. The name derived from battered women victimized by domestic violence.

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

DSMI-IV-TRPTSD Criterion- B.B.Traumatic event is persistently re-experienced in at least one of the following ways: Recurrent and intrusive thoughts or imagesRecurrent 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.

DSMI-IV-TRPTSD Criterion-CC.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 eventEfforts to avoid activities, places, or people that remind person of the eventInability to remember an important aspect of the eventSignificantly diminished interest or participation in activitiesFeeling of being detached or estranged from othersRestricted range of affectSpeaks or thinks of not having a future

DSMI-IV-TRPTSD Criterion-DD. 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 angerDifficulty concentratingHyper-vigilance Exaggerated startle response

E. Symptoms last at least one month

F. Symptoms listed above cause significant impairment in daily life

Symptoms Grouped into Three CategoriesAccording to The National Institute on Mental Health:Re-experiencing symptoms:Flashbacksreliving the trauma over and over, including physical symptoms like a racing heart or sweatingBad dreamsFrightening thoughts. Re-experiencing symptoms may cause problems in a persons everyday routine. They can start from the persons 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 experienceFeeling emotionally numb Feeling strong guilt, depression, or worryLosing interest in activities that were enjoyable in the pastHaving 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 startledFeeling tense or on edgeHaving difficulty sleeping, and/or having angry outbursts.

Symptoms DepressionAnxietyPanic AttacksAnger OutburstsHyper-startle responseDisturbed Sleep PatternNightmaresExcessive sleepInsomniaSelf medication DrugsAlcohol

SymptomsHyper-vigilanceConstantly looking out for dangerWeight loss or weight gainDisturbed eating patternEating too muchNot eating enoughTrouble concentratingAgoraphobiaAfraid to leave the houseA result of feeling that the world is an unsafe placeProblems with memoryShort Term Memory lossDifficulty recalling details of the event.

Symptoms and ComplicationsSymptoms can be debilitating, complicating the conditionSymptoms can interfere with ADLs (activities of daily living.Many suffers develop substance abuse problems and addictions PTSD suffers have a high rate of absenteeismoften times lose their jobsleading to economic deprivationSuffers may fail in their academic studies and goals. (Salvatore, R., 2009). High rate of suicide

AvoidanceA 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).

AvoidanceExamples of avoidance include: Efforts to avoid thoughts, feelings or conversations associated with the traumaEfforts 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 traumaDiminished 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).

Triggers and FlashbacksA 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 accidentWatching a rape survivor on the news may bring back memories of her/his assaultA smell of cologne that was worn by the perpetrator during a sexual assault.

A Growing Epidemic

Crime victims 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.

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 persons equilibrium is disrupted our bodies react, however they return to previous functioning levels. The combination of everyday stressors, in addition to being victimized, a persons equilibrium becomes overloaded making the person vulnerable to developing PTSD.

Victims of Crime Victims of crime may self medication with drugs or alcohol.In an attempt to psychologically numbOr block out the memories of the event.

Family and friends are often confused and do not understand the condition.May feel helpless and frustratedSurvivor may further deteriorate as a result.May become more depressedIsolatedSuicidalSurvivors often feel aloneAfraidFeel shameMay feel like its their fault.

Crime Victimization and PTSDTrigger events for crime-related PTSDEvents may re-victimize the survivor and their families by:Identification of the perpetratorHearingsTrialsAttending or hearing about other criminal justice proceedingsAnniversaries of the eventHolidays and other important family life events; such as birthdays.

Re-Victimizing the VictimCourt 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.

Crime Victimization and PTSDTriggers 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).

Crime Victimization and PTSDSurvivor may experience a flashbacks.May feel intense emotions May feel like the event is happening all over againMay lead to physical symptoms Fast Heart beatNausea VomitingHeadacheDry mouthPanic attacksCryingFear

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 awayFighting 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).

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.

PTSD and Brain ChemistryNot everyone develops PTSD after a traumatic eventDepending 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.

PTSD and Brain ChemistryThe wiring of the brains 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.

PTSD and Brain ChemistryParts 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 NoradrenalinDopamine 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.

Statistics

Families of homicide victimsthe 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 assaultIncest children who witness or are exposed to violence or abuse in the home.

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

StatisticsRape 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 assaulted3.9 million have been physically assaulted2.1 million have been subjected to physically abusive punishment8.8 million have witnessed violence (National Institute of Justice, 1995).

Substance Abuse and PTSDSecondary 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.

Treatment and Recovery ProcessA 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

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 lifes 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.

Medication s and PTSDTreatment 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.

EMDR and PTSDTreatment 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:PTSDDepressionAnxietyNightmaresDistressing nightmaresInsomniaTraumatic events and abuse

Research shows that EMDR is rapid, safe and effective.

EMDR does not involve the use of drugs or hypnosis.

Treatment and ReferralsFamily 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).

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.

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.

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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