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Breaking the Stigma: Defining Post-Traumatic Stress Injury (PTSI)

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When some think of post-traumatic stress disorder (PTSD), the first thing that may come to mind is American military veterans. The U.S. Department of Veterans Affairs recently reported that approximately 23% of veterans receiving healthcare services from the VA have been diagnosed with PTSD.

However, the incidence of post-traumatic stress disorder diagnoses extends beyond the military community in the United States. The National Center for PTSD has reported as many as 5 out of 100 non-military citizens have diagnosed (or undiagnosed) traumatic stress injury, or approximately 13 million Americans.

Post-traumatic stress disorder is a debilitating mental health condition that impacts all areas of life. The incidence rate of traumatic injury is higher among women (8%) compared to men (4%) in the United States.

Despite increased awareness about mental health conditions, some prevailing negative stereotypes exist about PTSD. The stigmas and overall perception of the mental health condition may be an obstacle that prevents patients from seeking treatment.

Some mental health providers would like to improve the perceptions of PTSD by creating a new name for the diagnosis: post-traumatic stress injury or PTSI. Let’s explore the health condition and benefits of creating a new narrative that can improve trauma-informed care.

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Unraveling the Complexity of PTSD Symptoms

PTSD is a clinically recognized mental health condition characterized by distressing emotional reactions and persisting symptoms that have a detrimental impact on the quality of life for people diagnosed with the condition.

Unlike biological injury, which can heal with medical care, complex psychological injuries from traumatic events can linger, necessitating mental health support and treatment. However, some patients may not pursue treatment options because of misconceptions about trauma care and self-stigmatization.

The healthcare community wants to reduce stigma and create a new narrative that PTSD is not a disorder but rather an emotional injury that can improve and heal with the right mental healthcare support. This may increase the number of patients who seek treatment options.

The Four Common Symptoms of PTSD

Patients living with post-traumatic stress disorder (PTSD) can experience a variety of symptoms and ongoing emotional trauma. According to the diagnostic and statistical manual of mental health conditions, there are four symptoms that are common among people diagnosed with a post-traumatic stress injury.

  1. Intrusive Thoughts and Flashback Memories: Intrusive thoughts can manifest as vivid flashbacks, causing emotional and physical reactions akin to reliving the traumatic event. Contrary to media portrayals, patients often withdraw into their thoughts, experiencing symptoms like shaking, sweating, and heightened anxiety.
  2. Avoidance of Trauma-Related Stimuli: people living with PTSD may avoid situations reminiscent of their trauma, attempting to reduce exposure and potential embarrassment. In severe cases, self-isolation becomes a coping mechanism, providing control over the environment to minimize triggering stimuli and exposure to people who may visibly witness a traumatic stress episode.
  3. Changes in Mood and Cognition: Chronic insomnia and anxiety-related nightmares can lead to mood variability. Irritability, low mood, and clinical depression may further contribute to self-isolation, hindering discussions about symptoms and treatment.
  4. Emotional Hypervigilance: Trauma-induced hypervigilance causes patients to be alert for any signs of recurrence, leading to heightened anxiety triggered by stimuli resembling the traumatic event. Because trauma is an operational stress injury, PTSI can impact mood, sociability, employment, cognition and memory, and relationships due to a persistent state of moderate to severe anxiety.

Some people living with traumatic stress injury may not experience the common symptoms. Suppose there are other underlying mental health conditions. In that case, the symptoms can be more complex or mistaken for other diagnoses, such as clinical depression or other stressor-related disorders, including moderate to severe anxiety.

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What Are Treatment Options for Patients With PTSI?

Depending on the severity of symptoms, there are several treatment options for patients living with post-traumatic stress injury (PTSI). Talk therapy is used to identify the source of the emotional trauma and understand the stimuli that trigger flashbacks, anxiety, and feelings of depression.

Mental health treatment for PTSI may also include psychotropic medications. Most states that have legalized medical cannabis accept a diagnosis of PTSD as a qualifying health condition. That is because patients may find relief from symptoms of anxiety and stress, depression, and insomnia when using doctor-supervised cannabis.

The most common treatment plans for patients with traumatic stress injury include:

Cognitive Processing Therapy  (CPT)

This treatment focuses on helping the individual understand and process the thoughts and emotions associated with the initial trauma. The goal is to help the individual learn new ways of thinking about the event. By reframing thoughts and receiving emotional support to process the psychological impact of the event, some patients can reduce the intensity of their emotional reactions.

Prolonged Exposure Therapy (PET)

One way to resolve a traumatic fear is to confront it with prolonged exposure therapy or PET. This cognitive behavioral treatment involves gradually exposing the individual to memories and situations associated with the trauma.

PET aims to help the individual become desensitized to certain stimuli, so they will no longer trigger a traumatic response. This therapy may also help patients reduce the number of stimuli that may cause extreme anxiety over time and reduce the need to avoid certain situations in daily life.

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Eye Movement Desensitization and Reprocessing (EMDR)

The EDMR psychotherapeutic approach can reduce the distress that patients with PTSD experience when they have flashbacks or recall the memory of a traumatic event. Since this therapy was developed in the 1980s, it has become globally recognized as one of the most effective treatments for PTSD or PTSI.

There are four key components of EMDR therapy:

1. Patient Desensitization Phase

The licensed therapist helps the patient discover what specific memories or events may have caused traumatic stress. The patient explores the disturbing memories and how they felt physically and emotionally when they experienced the trauma.

2. Bilateral Stimulation and Tapping Therapy

One of the symptoms of traumatic stress is rapid eye movements. This is related to emotional hypervigilance or trying to observe all possible threats to safety. Bilateral stimulation therapy works with auditory tones, hand taps, and other methods to slow down visual surveillance and help promote relaxation.

3. Processing Talk Therapy

When someone has sustained an emotional trauma, they may bury it deep inside their memory. Some people may have difficulty remembering what specific event caused their trauma. Processing therapy gently guides patients with PTSI to process the traumatic memory and understand triggers that may cause emotional reactivity.

4. Integration

This therapeutic step helps patients reduce emotional distress that is associated with one or more traumatic memories. Patients are guided to replace former negative associations with positive cognitive thoughts and self-confidence.

The EMDR therapeutic method addresses both hemispheres of the brain with bilateral stimulation, and processing treatments are often repeated until the traumatic stress symptoms are greatly improved or resolved.

Stress Inoculation Training (SIT)

This method of cognitive behavioral therapy helps people with PTSI develop better-coping mechanisms. By learning new ways to process stress with relaxation and emotional grounding techniques, patients can reframe negative emotional responses and reduce the impact of traumatic triggers.

Narrative Exposure Therapy (NET)

If something very upsetting has happened to you, talking to someone about it can make you feel better. The more you discuss the event or experience, the more comfortable you can become and less likely to remain upset over the memory of the incident.

Narrative exposure therapy (NET) does precisely that. It can be very effective in treating patients with PTSI or PTSD, and it may be done privately with a therapist or in a group support setting with family or friends. The end goal of NET is to reduce the impact of traumatic stress by helping patients vent, explain, and receive emotional support that may help resolve PTSI symptoms.

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Psychotropic Medications

There are a variety of medications that can be used to treat PTSD. Antidepressants, anti-anxiety medications, and antipsychotics are all commonly prescribed and are the first treatment approaches to help patients manage PTSD symptoms.

Medications commonly prescribed for patients include:

  • Antidepressants to help moderate mood and reduce insomnia or sleep disruption.
  • Anti-anxiety medications to help lower traumatic stress responses.
  • Antipsychotic medications may be prescribed to patients who have other underlying mental health conditions, such as schizophrenia.

The side effects of many psychotropic medications can be challenging for patients. That is why many people diagnosed with PTSI seek out other treatment options, including doctor-supervised medical cannabis.

Acute Stress Disorder (ASD) vs. PTSD

While ASD and PTSD share similar symptoms, ASD typically occurs in the first few weeks after a traumatic event and lasts up to one month. If symptoms persist beyond one month or emerge later, a diagnosis of PTSD may be more appropriate.

One of the critical differences between acute stress disorder and post-traumatic stress disorder is the onset of symptoms. Some patients with PTSD can take months or several years before symptoms begin to emerge. When a traumatic event occurs, the human brain can try to bury what it cannot heal alone, and it is part of the way our bodies process trauma.

Why The Change in Diagnosis Name?

The American Psychiatric Association has a publication that lists all the mental health disorders and symptoms, and it functions as the authority resource for healthcare providers. Currently, PTSI is not included in the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5).

To foster a more accurate understanding of trauma, some healthcare professionals propose renaming PTSD to post-traumatic stress Injury (PTSI). This allows both patients and practitioners to view psychological trauma as an injury, not a disease or disorder.

Shifting the focus to injury may help reduce the stigmas that surround a PTSD diagnosis. Changing the narrative from a disorder to an injury may offer hope for recovery through treatment and support.

Three names refer to patients experiencing traumatic stress symptoms:

  1. Post-Traumatic Stress Disorder (PTSD): Recognized by the DSM-5-TR, focusing on diagnosing mental illness and guiding treatment.
  2. Post-Traumatic Stress (PTS): Emphasizes symptoms over categorization as a disorder, contributing to a healthier narrative about those suffering from emotional injuries.
  3. Post-Traumatic Stress Injury (PTSI): Positions trauma as a treatable condition, encouraging a focus on the impact of trauma and the biological changes survivors experience.

As perspectives on trauma continue to evolve, embracing terms like PTSI may pave the way for reduced stigma and a more supportive approach to treating the lingering effects of severe emotional injuries. Patients who view trauma as an emotional injury rather than a disorder may be more proactive in seeking treatment for quality care.

By fostering awareness, understanding, and empathy, we can collectively work towards improving the quality of life for those navigating the complexities of traumatic stress.


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