Friday, 11 May 2012

Posttraumatic Stress Disorder or Injury?

This past week, American Psychiatric Association psychiatrists held a public hearing in Philadelphia to discuss reclassifying Posttraumatic Stress from a disorder to an injury.

Part of the motivation to consider this change is to lessen the stigma that comes with the word “disorder” - a stigma that prevents many people from seeking treatment.  As General Peter Chiarelli - who led the US Army’s effort to reduce suicide rates amongst combat veterans - put it: “No 19-year-old kid wants to be told he’s got a disorder.”

Posttraumatic stress is unique in that it is the only mental illness that is always caused by an outside force.  Symptoms can include; flashback memories; recurring nightmares; avoidance of certain places or people; decreased involvement in life activities.

Psychiatry professor Dr. Frank Ochberg, of Michigan State University, states; “There is a certain kind of shattering experience that changes the way our memory system works. One could have a clean bill of health prior to the trauma, and then afterward, there was a profound difference.”

Through modern brain imaging we can now see that the intensity of a trauma can be so overwhelming that it causes dramatic changes to the brain’s function and structure, so it then follows posttraumatic stress is more like a bullet wound or broken leg than a mental or emotional disorder.

PTSD was originally created to classify symptoms of some returning combat veterans, but over the years clinicians came to realize that these same symptoms were found in survivors of other traumas such as child abuse, sexual abuse, rape, witnessing murder or extreme violence.

Recent studies indicate that among children who have been sexually abused or who have witnessed the murder of a parent, the instances of posttraumatic symptoms are nearly 100% (Evans, 2008).  Coupled with the knowledge that one in four girls, and one in six boys will experience sexual abuse, the problem of posttraumatic stress in our community is staggering. People who experience posttraumatic stress often turn to alcohol or drugs and sometimes resort to suicide to stop the symptoms.  And it goes beyond individual suffering; the Mental Health Commission of Canada reports that 500,000 people miss work each day because of mental health issues and this costs Canadian business $50 billion in lost revenue each year.

As it stands right now, government administered universal health care and extended health providers either do not cover therapeutic counselling or have monetary caps on treatment. Including PTSI in the same classification as other injuries and providing coverage for treatment will alleviate prolonged suffering, reduce drug and alcohol dependence, and lower suicide rates.

Aaron D. McClelland, RPCc

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