Causes and Risk Factors for Post-Traumatic Stress Disorder: The Importance of Right Diagnosis and Treatment

Abstract

Post-traumatic stress disorder (PTSD) is a serious debilitating syndrome with significant personal, social, and economic consequences. People with PTSD experience one or more major symptoms that include flashbacks and paranoia, difficulty in interpersonal relationships, and problems engaging in work and activities of daily living. In severe cases they can harm themselves or the others; but these events are preventable by appropriate therapies.PTSD is a well-characterized serious psychological and behavioural abnormality that occurs after exposure to one or more acute severe stressful events. It often occurs among soldiers returning from battlefields and the civilian victims of war. However, it also occurs in non-war situations, such as terrorist attacks or serious accidents; sexual abuse, rape, or other violent acts; and school or workplace bullying, harassment, or retaliation. Nevertheless, the diagnosis of PTSD is made too infrequently, particularly in the post-conflict periods in developing countries. This is in part because of inadequate awareness but also due to limited resources and expertise.Consequently, the resources for clinical care and research are diverted to other forms of behavioral issues, such as adjustment disorders. The treatment of PTSD needs to be well coordinated so that all stakeholders work synergistically using the resources necessary for the prolonged treatment and follow-ups. PTSD is underdiagnosed, and even misdiagnosed or mislabeled as depression or adjustment disorders. The failure to make a timely diagnosis or mislabeling of PTSD likely will harm victims and their families and may lead to negative outcomes, including suicide. The provision of appropriate, well organized, individualized, cost-effective treatment plans should alleviate PTSD symptoms and enable those with the disorder to return to their normal productive lives.

Endocrinological Mechanisms of Depressive Disorders and Ill Health

“…[22] It alters the memory and initiates a disruption of the hypothalamic-pituitary-adrenal (HPA) axis. [6] Similar to the responses in patients with acute medical or surgical illnesses, patients with PTSD have increased serum epinephrine and norepinephrine levels, pro-opiomelanocortin-derived peptides, thyroid hormones, in addition to other hormonal abnormalities [2,23] but having inappropriately low glucocorticoid levels. [6,[24][25][26] These sustained biochemical and hormonal abnormalities initiate and maintain PTSD.…”

“…In addition, the associated pathophysiological neurohormonal changes instigate maladaptive learning processes. [2,5,14] Inappropriately high levels of sustained anxiety and fear emerging through the impaired HPA axis lead to persistent elevation of circulatory norepinephrine and suboptimal circulatory glucocorticoid levels [16,27,28] that does not respond to the day-to-day stresses and needs.…”

“…[2] Previous experience and exposure, such as intrauterine (mal)nutrition and the environment, school or workplace bullying, discrimination, [4] abuse and neglect, and upbringing, influence how one handles and reacts to stressful situations. [2,5] Although many of these situations are beyond an individual's control, learning to handle and minimize stress is essential for balancing life. Unmanaged chronic stress can also lead to many other diseases, including eating disorders, smoking, alcohol and drug abuse, behavioral issues and addiction.…”

“…However, intense acute stress or frequent sustained stresses over a long period cause the negative biochemical and neurohormonal changes to become persistent, [2] these escalating stresses would lead to 'restructuring' of brain centers related to reasoning and behavior. [6] The adverse health issues of unmanaged stress and inappropriate or pathological responsiveness of the stress system affect and disrupt many bodily systems, including endocrine system; digestive system (stomachache, slow gastric emptying, enhanced colonic peristalsis leading to abdominal cramps and diarrhea); impairment of the immune system (frequent infections; chronic fatigue syndrome); changes in appetite and alteration of metabolism (weight gain or loss); cardiovascular dysfunction (hypertension, tachycardia, hyperlipidemia and hyperglycemia); nervous system manifestations (anxiety, depression, insomnia, lack of interest); and impaired memory.…”

“…The stress response causes immediate release of the stress hormones cortisol and adrenalin, which intensify mental concentration and enhance rapid reactions; survival mechanisms. [2] The associated neurohormonal secretions cause tachycardia and hypertension, and enhance immune responses and memory. These physiological systems have evolved to cope with day-to-day, short-term stresses and provide self-protection; however, the system is designed to return to baseline rapidly, after cessation of stress.…”