reflection 1
Monday, October 25, 2021
Chapter 1 and 2 Lecture Notes
Subject Post-Traumatic Stress Disorder and Crime Victimization
Exposure to traumatic events is not a new phenomenon. We have been experiencing traumatic events since the beginning of time. We often hear of the ancient example of the saber tooth tiger that chases a person, and the person experiences what is called the “fight and flight” response. When a person has been exposed to a traumatic event a normal, natural reaction takes place in the brain. Not everyone develops PTSD when exposed to a traumatic event. Post-traumatic stress disorder is an anxiety disorder that develops when a person is exposed to a traumatic event and felt extreme terror, helplessness and fear.
According the DSM-IV-TR “the essential feature of Post-traumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury; or other threat to one’s physical integrity, or witnessing an event that involves death, injury; or a threat to the physical integrity of another person (Criterion A1). The person’s response to the event must involve intense fear, helplessness, or horror (Criterion A2) (DSM-IV- TR). “All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD” (National Center for Post-Traumatic Stress Disorder 2009). PTSD is often misdiagnosed and often overlooked by the medical community.
Symptoms of PTSD
A major symptom that is presented in PTSD is persistent avoidance of anything that is associated with the trauma, or crime. “PTSD is a disorder of avoidance and many survivors, especially those recently traumatized, will require extra support to engage fully in groups” (NCPTSD, 2009). This symptom makes it particularly difficult for clinicians to aid the client in recovery because the client has difficulty discussing the event due to the avoidance. One intervention that has worked is a medication regimen to help the client through therapy. Clients with PTSD often avoid therapy because it is too painful to talk about. “Most of the persistent avoidance of stimuli and diminished responsiveness to the outside world usually begin soon after the traumatic event and are referred to as psychic numbing. This is an automatic reflex reaction in which the mind
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Monday, October 25, 2021 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).
Some 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. More examples include: 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).
Additional symptoms of PTSD may include depression, anxiety, agoraphobia, self-medication, substance abuse, trouble concentrating, anger outbursts, disturbed sleep pattern-insomnia, or excessive sleeping, nightmares, avoidance, hyper-vigilance, hyper-startle response, disturbed eating pattern-cannot eat, or eating too much leading to weight loss or weight gain, panic attacks, looking out for danger, checking and locking doors and windows frequently. Survivors may not want to leave the house (a form of agoraphobia) as a result feeling as if the world is an unsafe place. All of these symptoms can disrupt the activity of daily living for the client and their family. Many PTSD suffers have a high rate of absenteeism and often times lose their jobs, leading to economic deprivation, again further complicating the condition. Suffers may fail in their academic studies and goals. (Salvatore, R., 2009).
The intrusive memories can be especially frustrating, for the survivor. Many survivors state “it’s like a movie that keeps rewinding, and it won’t go away”. “Triggers or flashbacks can occur at any time and the survivor may feel the same fear and horror they felt when the event took place; this is called a flashback” (NCPTSD 2009). A trigger is a sound or sight that causes the survivor to relive the event. Triggers may include: 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.
Family and friends are often confused and do not understand the condition. They may feel helpless and frustrated and say things like “just get over it, or it’ll go away soon” further debilitating the survivor. The survivor may become more depressed, isolated, and possibly suicidal as a result of not understanding what it is that s/he is experiencing. They often feel alone, afraid, feel shame, and may feel like it’s their fault. Victims of crime often begin self-medication with drugs or alcohol in an attempt to psychologically numb or block out the
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Monday, October 25, 2021 memories. According to the National Center for Victims of Crime, rape victims are 13.4 times more likely to have two or more major alcohol problems; and twenty-six times more likely to have two or more major serious drug abuse problems, again further complicating the victims condition, and overall well-being.
Post-traumatic stress disorder is becoming recognized more now than ever before. As science, technology and research emerge, the more we are learning about conditions such as PTSD. The prevalence of PTSD is alarming, and clinical social workers need to be aware of this growing problem; “It is suggested that the number of individuals experiencing potentially traumatic events (PTSD) is quite substantial, with estimates ranging from 40% to 80%” (Breslau, Davis, Andreski, & Peterson, 1991; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). In addition the link between exposure to traumatic events, the significance of substance abuse and posttraumatic stress disorder (PTSD) are among the more prominent sequelae (Breslau et al., 1991)”(Cougle, J.R., Resnick, H., Kilpatrick, D.G.”, ( 2009). The prevalence of PTSD is at epidemic levels making this condition a major health issue for communities and the nation; especially with the increase in military personnel being deployed.
Criminal victimization can result in short-term and long-term symptoms. “Trigger Events for Crime-Related PTSD may be brought on by being re-victimized by the criminal justice system through Identification of the assailant, hearings, trials, appeals and other criminal justice proceedings; Anniversaries of the event; Holidays and other important family life event;. During a flashback, the survivor may experience intense feelings of fear, or a panic attack, and they may feel as if the event is happening again. This can lead to physical symptoms such as tachycardia (rapid heart rate), the throat tightens, nausea, vomiting, headache, or the person may become physically ill” (NCPTSD 2009). 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).
Survivors of crime, whether they are direct victims or the family members of victims, will experience a variety of emotional consequences. “Dr. Morton Bard (1986) has described a victim's reaction to crime as the crisis reaction. Victims will react differently depending upon the level of personal violation, their personality, experiences, and support systems, and their state of equilibrium at their victimization” (NCVC 2009). All people have a normal state of equilibrium called homeostasis and it is influenced by everyday stressors such as illness, moving, changes in
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Monday, October 25, 2021 employment, and family issues and so forth. 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.
Statistics
The National Institute of Justice examined victimization, mental health, and substance abuse issues among teenagers. “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, and 8.8 million have witnessed violence” (National Institute of Justice, 1995). Another alarming study on homicide victims and their families reveals the following: “A 1990 study on the impact of homicide on surviving family members (Kilpatrick, Amick & Resnick, 1990) indicated that, regardless of the specific character of the crime, almost one in four victims (23.4%) develop PTSD after the death of their loved one. Researchers recommended that all homicide victims, especially those having contact with the criminal justice system, should be screened for the presence of PTSD and provided with counseling referrals. Lula Redmond (1989) found that homicide survivors may present symptomatic behaviors characteristic of PTSD for up to five years following the murder of a loved one” (NCPTSD 2009).
According to the National Center for Victims of Crime 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. Survivors of childhood sexual assault, incest or children who witness or are exposed to violence or abuse in the home are also at high risk for developing the condition.
Recovery Process
If PTSD is left untreated the client may further deteriorate. Crime victims are especially vulnerable to developing PTSD and it is vital to identify, and treat symptoms of PTSD as soon as possible. After experiencing initial reactions to victimization, many survivors say “they want the old me back”. What they are expressing is that they aren’t the same, and they are having difficulty identifying with and accepting “the new me”. However, as they 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. In addition, individual therapy is recommended. “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;
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Monday, October 25, 2021 reopen channels of feeling that may have been repressed; and learn to manage the impact of distressing, invasive thoughts or flashbacks” (NVPTSD 2009).
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 also 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, even after the client has developed some normalcy back in their lives. With effective treatment, survivors can learn to cope with symptoms and help to control symptoms of anxiety and depression. Medication may be needed for some survivors. There are many quality medications that are proving to help survivors manage their symptoms.
Current medications that have proven successful in assisting patients with PSTD include the use of anti-depressants, benzodiazepines, sleep aids, and beta blockers. Anti-depressants help with depression, mood swings, and the irritability that is experienced by suffers; benzodiazepines are used for panic attacks and anxiety; prescribed sleep aid such as Desyrl (Trazadone), aid in sleep due to the insomnia that suffers experiences, and beta blockers have recently shown that they 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.
Another intervention that is being used in clients with PTSD, depression, and anxiety is EMDR- eye movement desensitization repossessing. This is a new therapy for patients who have suffered for years from anxiety or distressing memories, nightmares, insomnia, abuse or other traumatic events. “Research shows that EMDR is rapid, safe and effective. EMDR does not involve the use of drugs or hypnosis. It is a simple, non-invasive patient-therapist collaboration in which healing can happen effectively” (EMDR-Therapy, 2009).
Crime does not discriminate and it can happen to anyone at any time. 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. “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).
The prevailing argument and current research on PTSD has come a long way in identifying symptoms, diagnosis and the treatment of PTSD. The connection between PTSD , trauma, crime victimization, the development of secondary symptoms, such as: depression, anxiety, and substance abuse disorders are becoming more and more recognized as key symptoms and factors related to the condition. Back in the 1960’s, during the Vietnam War when PTSD was first given
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Monday, October 25, 2021 its name; society thought that veterans were “messed up” from the war. They did not understand the dynamics of trauma and its consequences. 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. 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. 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 good news is that research on how PTSD works in the brain is moving forward, 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).
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