Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is in the Trauma Stressor-Related Disorder section of the DSM-5.

The etiology of simple posttraumatic stress disorder (PTSD) has not yet been determined, but oddly enough the more complex version has, or at least has enough that it can be explained in great detail and understood. Complex posttraumatic stress disorder is thought to be caused by childhood "trauma" that was never moved from the mind to the hippocampus of the brain where it should have been processed. When unprocessed trauma events build up and reach a certain point, then the individual's mind, followed by the the brain become overwhelmed due to the lack of communication between them. When all communication stops them the person becomes overwhelmed. This results in a barrier dividing the ganglia of the personality that are affected by the unprocessed events and the part that the mind attempts to keep from being affected by it. This process is known as structural dissociation of the personality. At this point the person then has posttraumatic stress disorder. It's unknown if childhood abuse plays a role, but it is well accepted that "childhood neglect" (which can be unintentional) is critical to the formation of this disorder. Some older ideas are that the cause could have been when a child is subjected to loss, constant pain or some other emotional distress that is not inflicted upon them. When structural dissociation takes place, one distinct state and one less than distinct state are created, which along with other factors cause the disturbing symptoms experienced in those with posttraumatic stress disorder. After an individual already has posttraumatic stress disorder and unprocessed trauma events continue to build up in the mind, and are not processed into memory, then a second less than distinct state can be created. At this point, the individual will experience far greater symptoms than they did before the extra state was made. Once an person has created their second less than distinct state, this disorder is hard to ignore. The less than distinct states will wreck havoc in an individuals life. Less than distinct states are parts of the personality that react and interact with unprocessed trauma events.

fMRI scans
When a fMRI scan is performed on an individual with posttraumatic stress disorder their distinct state is brightly lit up, and as soon as a "trigger" is introduced to the individual, that distinct state is immediately replaced by a small, dimly lit spot, which is the less than distinct state. This state responds to the trigger by causing undesirable symptoms such as flashbacks, exaggerated startle response, hyperarousal, anxiety, anger and so on. As the individual calms, the less than distinct state is replaced by the distinct state. What is happening is the brain and mind are miscommunicating back and forth. (See Structural Dissociation for in-depth information) It's the miscomunication between the mind and brain that are causing the symptoms. The brain can't understand what the mind is trying to say, so it sends out a signal, and depending on what that signal is, the person feels an array of symptoms. If the individual has complex-posttraumatic stress disorder, their two less than distinct states will show up on the fMRI scan in unison, and they confuse the brain even more, and in response to that confusion, the brain sends out signals causing enhanced symptoms. The individual is now highly distressed, with symptoms that are probably overwhelming, leaving the person unable to function well while the less than distinct states are in control.

Dissociative boundaries and elaboration of states
The less than distinct states in posttraumatic stress disorder are basic and primitive when compared to the less than distinct states in the complex Dissociative Disorders: other specified dissociative disorder and dissociative identity disorder. In addition, the dissociative boundaries that are associated with each of the disorders are highly specific to the disorder and to each state they are associated with. At the most extreme end of the spectrum is dissociative identity disorder with states so elaborated they have their own way of being, and can even have different physiological characteristics. In this disorder you will find an individual who's dissociative boundaries are so phobic of each other that each of the states are isolated from the others in a number of ways that are not found in posttraumatic stress disorder. In dissociative identity disorder, one state could be literally blind, another deaf, another with an IQ of 70 and another could be a genius and none have any idea of what is going on. Posttraumatic stress disorder does not have the advantage of the highly dissociated boundaries, and so the symptoms are glaringly painful and obvious to the person with them.

History of posttraumatic stress disorder
Posttraumatic stress disorder first become an official diagnosis in the DSM-III, which was published in 1980. Prior to this the experience of posttraumatic stress was represented in both the DSM-I, published in 1952, and the DSM-II, published in 1968. Another diagnostic manual, the International Classification of Diseases (ICD) is produced by the World Health Organization, and originally focused on physical illness only, first including a section of mental disorders in the ICD-6 version, published in 1948.

Diagnostic manuals
'''Diagnostic manuals like the DSM and ICD are not meant to be used to understand any mental disorder. Their intent is to give the minimum criteria needed to diagnose a disorder. The criteria listed here is paraphrased, as proper etiquette demands.'''

PTSD preSchool subtype
For children 6 years and younger the criteria is slightly different. This is included in the DSM-5 manual for children younger than six years. The criteria for posttraumatic stress disorder needed to be slightly different from those for older children and adults because young children their cognitive and verbal expression capacities as still forming, so the criteria are more "developmentally sensitive" for preschool children. Some of these changes in wording include:
 * constricted play is an example of "diminished interest in significant activities"
 * social withdrawal or behavioral changes can indicate "feelings of detachment or estrangement"
 * extreme temper tantrums are now included with "irritability or outbursts of anger"
 * intrusive symptoms such as flashbacks and intrusive thoughts do not always manifest overt distress in preschool children, Scheeringa (2013) states that "while distressed reactions are common, parents also commonly reported no affect or what appeared to be excitement"
 * fewer avoidance symptoms are included because avoidance is internalized, and harder to detect by observation, for example in pre-verbal children

Research has shown preschool children with posttraumatic stress disorder do have impaired functioning across a range of domains, and both the diagnosis and impairment are stable over the longer-term. Scheeringa and Zeanah (2008) studied posttraumatic stress disorder in 70 three to six-year old's directly effected by Hurricane Katrina. They found that children who stayed in New Orleans had significantly higher rates of posttraumatic stress disorder than children who were evacuated (62.5%, in comparison to 43.5%); of the children who did not develop posttraumatic stress disorder, none of them developed other mental disorders as a result of the trauma. The children had significantly higher rates of posttraumatic stress disorder than their caregivers, Scheeringa and Zeanah (2008) stated that "caregivers' rate of posttraumatic stress disorder was 35.6%, of which 47.6% was new post-Katrina". Caregivers' rate of posttraumatic stress disorderwas 35.6%, of which 47.6% was new post-Katrina.

Meiser-Stedman et al. (2008) studied children aged 2–6 years old, and aged 7–10 years old, after traumatic motor vehicle accidents. They found that parent's and children's reports of the traumatic experience had "poor agreement" between them, reflecting the fact that relying only on parent's reports of the trauma would lead to a lack of information for clinicians when assessing posttraumatic stress disorder, given the subjective nature of the experience. Effective treatment for posttraumatic stress disorder in very young children includes cognitive behavioral therapy, long-term, relationally-based treatment (in cases of interpersonal violence), play therapy, eye movement desensitization and reprocessing (EMDR), and other forms of therapy, however, the methods of addressing trauma need to be developmentally-appropriate methods for the child's age.