Hello and welcome back to module four stress and trauma related disorders, this is lecture 2. In this lecture, we will be taking a closer look at acute stress disorder and post traumatic stress disorder, or PTSD. In the first lecture of this module, we talked about the impact of stressors, including traumatic stressors on the brain and body recall that the cascade of activity in the autonomic nervous system and endocrine system initiated by the hypothalamus is referred to as the fight or flight response. The fight or flight response, is entirely normal, predictable response to the presence of danger in the environment, it causes people to feel physically and psychologically tense and alert, ready to respond to the danger by either fighting back against it or running away. When the danger passes, this state of readiness fades and the brain and body returned to the baseline level of alertness, sometimes, however, people do not return to the relaxed baseline after the danger is gone. Instead, their brains and bodies remain stuck in this heightened level of physiological hyper arousal, they're struggling with acute stress disorder or post traumatic stress disorder, or PTSD. The symptoms of these two illnesses are essentially the same, so we will be considering them together ,it is instead the timing of the onset and remission of the symptoms that determine which disorder a person has. If the symptoms begin within four weeks of experiencing a traumatic event and they go away less than a month after they begin, the person is diagnosed with acute stress disorder. If the symptoms persist for longer than a month, the person is diagnosed with PTSD, it's symptoms may begin soon after the traumatic event, or they may begin months or even years afterward. About one in four people with PTSD do not experience a full onset of symptoms until six months after the traumatic event, before we look more closely at the symptoms of these disorders, let's briefly discuss the concept of trauma. We define trauma as an event in which a person is exposed to actual or threatened death, serious injury or sexual violation. While any traumatic event can lead to the development of acute stress disorder or PTSD, research indicates that certain types of traumas have a particularly high likelihood of activating these disorders. Let's consider them, now researchers have identified a strong link between military combat experience and these disorders, after World War One, these symptoms were referred to a shell shock after World War Two. The term combat fatigue was employed in the years following the Vietnam War, there was an explosion of research into the lingering psychological symptoms of veterans. It is estimated that about 29% of all Vietnam war veterans struggled with an acute stress disorder or post traumatic stress disorder and that even today, 10% of surviving veterans continue to struggle with symptoms of PTSD. Current research reveals that 20 percent of the veterans of the wars in Iraq and Afghanistan have PTSD. Natural disasters and accidents often lead to stress and trauma related disorders, such events as fires, hurricanes, tornadoes, earthquakes, traffic accidents and airplane crashes are all strongly linked to these disorders. For example, U S research indicates that anywhere from 12 to 40% of people involved in car accidents go on to develop PTSD in the year following the accident, experiencing any type of victimization creates a high likelihood of developing PTSD. Sexual assault is defined as a sexual act committed against a person without their consent, research shows that most people who perpetrate sexual assaults are male and most people who are victimized by sexual assault are female. Studies have found that about one in six women will be sexually assaulted in their lifetime, sexual assault has been linked to high levels of stress and trauma related disorders. In fact, one study found that 94% of women who have been sexually assaulted will develop acute stress disorder after the event, people who have been victimized by terrorism have a high likelihood of developing PTSD. For example, following the terrorist attacks in New York City on September 11, the rate of PTSD among New Yorkers was found to be 9%, while the prevalence within the US is estimated at about 3.5%. Similar studies conducted after other large scale terrorist attacks around the world have reported similar results, finally, torture has been strongly linked to PTSD, torture has been defined as the use of brutal, degrading and disorienting strategies in order to reduce victims to a state of utter helplessness. While torture can be the act of an individual perpetrator toward an individual victim, it's commonly used throughout the world by governments and other powerful entities for the purpose of forcing people to give confessions or share information. Torture has also been used toward members of ethnic and religious groups, research estimates show that 30-50% of torture victims develop PTSD. Now let's take a closer look at the symptoms of these disorders and the impact they have on the people who struggle with them, we generally group the symptoms of these disorders into four categories or domains. First, people experience increased arousal and negative emotions, they feel extremely alert or hypervigilant, they startle very easily, they have insomnia, they cannot concentrate emotionally ,they experience high levels of anxiety, depression, anger and or guilt. Next people have various experiences related to re experiencing the traumatic event, they may have frequent nightmares, intrusive memories of the trauma or in other words, remembering the trauma at times they do not want to be thinking of it. And they may even have such vivid, intrusive memory experiences that they actually believe they are experiencing the traumatic event again, this last experience is called a flashback. Third, people with these disorders demonstrate avoidance in various ways, they may go far out of their way to avoid places, people objects and situations that remind them of the traumatic event. They may even have memory loss for part or all of the traumatic event, lastly, people struggling with these disorders demonstrate reduced responsiveness and association. They may feel very distant and detached from other people and their surroundings, they may have little or no interest in their jobs relationships, pastimes and they may feel no internal response to events going on around them. Additionally, they may have the feeling their mind or body are not real and experience called depersonalization or they may feel that their surroundings are not real and experience called de realization. As I'm sure you can imagine this collection of symptoms and experiences creates enormous distress for people and can have a devastating impact on their ability to function in their lives and maintain their relationships. Generally speaking, people who experience on responsiveness and association tend to have more severe forms of the disorders and are more distressed and impaired in their functioning. These symptoms are common in people whose PTSD has developed from military combat or chronic childhood, sexual and or physical abuse, acute stress disorder and PTSD can develop at any age, including childhood. Research has found these disorders to be quite common In North America, where 3.5-6 percent are estimated to struggle with one of these disorders, in a given year, lifetime prevalence in North America is estimated between 7-12%. At least 50% of the people with these disorders do not receive any treatment, co occurring psychological disorders such as anxiety and depression are common, and people often abuse alcohol and or substances. In an effort to manage their symptoms, about one in 5 people make a suicide attempt, there is increased risk of developing medical problems, including asthma, liver disease and heart disease.
