PTSD is far more than a combat veteran’s malady. It affects Americans in every walk of life. It is a mental health disorder that may develop following any frightening event in which a person is exposed to actual or threatened harm, serious injury, sexual assault, or fear of death. It can include situations such as wildfires, home or office fires, tornados, hurricanes, earthquakes, home break-ins, transportation accidents, abuse or sexual abuse by known persons, friends, family members, assailants, and even reading the headlines of our free press. No one is excluded; no one can predict the event or can avoid it.
Who can suffer from PTSD?
Strangely, not everyone has suffered from one of the events that I have enumerated, and it has much to do with how hard-wired people are.. I am a combat veteran of Vietnam and have experienced many of the scenarios of warfare that most Americans have seen on TV or in the movies, but I have not been debilitated by PTSD. People who are far more intelligent or braver than I and were exposed to threats of possibility or probability do have PTSD. This is not a diagnosis that we wear on our shirtsleeves; it may not be obvious to others. But do not be mistaken: it is indelibly etched into their memories. It is our responsibility as health care providers to communicate that PTSD is treatable. It is normal to experience disturbances and anxiety. These responses can present and occur long after the initial event. These patients present with nightmares, flashbacks, fear of flying, or walking down a dark street. It is a known fact that with effective treatments, many patients recover. Women suffer from this disorder twice as often as men, partly do to sexual assault. Police officers, firefighters, EMT’s, First Responders, and war veterans are all higher on the list.
What are the symptoms?
According to the Diagnostic and Statistical Manual of Medical Disorders, Fifth Edition, to meet the criteria for PTSD a person most have symptoms for longer than thirty days. Additionally, their symptoms must interfere with daily tasks either at home or in the workplace. Symptoms such as nightmares and flashbacks create a re-experiencing of the associated trauma. Some engage in avoidance activities, such as using alternate means of transportation or avoiding certain streets that may seem ominous, or events that have large crowds such as stadiums and convention centers. They may have a decrease in interest in many things that were once pleasurable and find it difficult to experience feelings of happiness such as birthdays or weddings, and even the Macy’s Christmas Parade. Some become aggressive at the slightest provocation. Some engage in risky behaviors including sexual experiences. Insomnia is plentiful, concentration is a task, they are hyper-vigilant in scenarios where there is a perceived risk to themselves or a loved one, such as I had when walking with my fiancée forty-eight years ago in downtown Manhattan, NYC.
What can we do as a HCP?
Primary Care professionals are more apt to be exposed to this issue, but what can or should they do in the ongoing treatment of these unfortunate patients? First and foremost is the essential relationship of trust that you must build with the patient. Most PTSD individuals feel shame and self-reproach, as if their suffering is their fault. Most will be quick to deny the relationship between their symptoms and the diagnosis of PTSD. Build trust. Your encounter should feel safe and reassuring. One tip: if you spend more time looking at the computer screen than at your patient, you may miss the opportunity to intervene meaningfully. If you have documented the symptomology and I hope you have: a few words of encouragement fall short of a good clinical session. These patients, IMHO, need a referral to a mental health professional to afford the patient the greatest opportunity to have targeted therapy and, possibly, be cured. What are some of these therapies? CPT or Cognitive Processing Therapy. The female or the male who has suffered from sexual assault will sometimes, if not always, feel guilt or shame and feel that they may have avoided the assault by some inconclusive rationale. CPT will give them a new and different script that can be a means of healing. EMDR (Eye Movement Desensitization and Reprocessing or PE (Prolonged Exposure) which teaches the patient to gradually approach their trauma-related memories or feelings.
Lastly, why do I need to refer? Some PTSD patients are vulnerable to suicidal ideation as they feel as if there is no hope to change their life. Some commit homicide as a revenge tactic against a certain group or culture or race. There will be those that engage in risk-taking that effects their own life or that of other citizens. It is incumbent on all HCP to prevent possible tragedies and ultimately be named in a litigation for failure to diagnose or treat appropriately. There are acts of omission and acts of commission and both entities may be involved in a lawsuit. More importantly is the nagging self-condemnation that, by our actions, this entire situation may have been resolved. Remember, it is not only the family member that can target a clinician, but also the victim’s family. In a situation such as this, we need to have the best malpractice insurance available and this will usually be a Personal Liability Policy with not just any insurance company but with one of the best. Hopefully, by following what a good medical encounter produces, this will be mute. Until next month. Bob
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
