Weatherly's Woes

TRAUMA

POST-TRAUMATIC STRESS DISORDER - occurs following a LIFE-THREATENING stressor. PTSD is typically the most severe for the person who experienced the stressor (rape victim) but it can happen indirectly too (your neighbor was raped) with symptoms typically becoming progressively less impairing the more removed from the stressor person was. Recognize the A-G criteria below. Early group therapy is the best treatment, but since this is a chronic anxiety disorder, SSRIs (especially Sertraline) are helpful for maintenance, and Benzos are helpful for panic attacks. Alpha-blockers (Prazosin) help with nightmares and daymares, but beware of orthostasis.

A. Intrusive - Recurring nightmares, flashbacks or memories.

B. Avoidance - Literally avoiding. Avoiding the place where it happened, or not talking about it.

C. Mood - Negative mostly. Sadness, anhedonia, self-loathing, spacing out or dulling affect

D. Arousal - Hypervigilance. Easily startled, sits with back to a wall, trouble sleeping

E. Duration - >1 month

F. Functional significance

G. Ruled out everything else

ACUTE STRESS DISORDER - PTSD that has been going on for less than 1 month

ADJUSTMENT DISORDER - occurs following a NON-LIFE-THREATENING stressor, in other words a LIFE-CHANGING event (a divorce or firing). The patient will have trouble adapting to the new change, and will develop a mild depression or mild anxiety. They may even engage in some unusual behaviors, like skydiving. By definition, AD starts within 3 months of the event, and wears off after 6 months. If it goes on longer than that, the diagnosis progresses into MDD or GAD. Treatment usually consists of therapy alone, but sometimes supplemental medications are sprinkled on top, like something for sleep. If AD sounds frustrating and vague to you, here’s why that is:

“An editorial in the British Journal of Psychiatry described adjustment disorder as being so ‘vague and all-encompassing… as to be useless,’ but it has been retained in the DSM-5 because of the belief that it serves a useful clinical purpose for clinicians seeking a temporary, mild, non-stigmatizing label, particularly for patients who need a diagnosis for insurance coverage of therapy.”