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Posttraumatic stress disorder (PTSD) is described by

the DSM-IV-TR as the

development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical integrity of others. Examples of some experiences that may produce this type of response include participation in military combat, experiencing violent personal assault, being kidnapped or taken hostage, being tortured, being incarcerated as a prisoner of war, experiencing natural or manmade disasters, surviving severe automobile accidents, or being diagnosed with a life threatening illness (APA, 2000). Characteristic symptoms include re-experiencing the traumatic event, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. Intrusive recollections or nightmares of the event are common. Some individuals may be unable to remember certain aspects of the trauma. Symptoms of depression are common with this disorder and may be severe enough to warrant a diagnosis of a depressive disorder. In the case of a life-threatening trauma shared with others, survivors often describe painful guilt feelings about surviving when others did not or about the things they had to do to survive (APA, 2000). Substance abuse is common. The full symptom picture must be present for more than 1 month and cause significant interference with social, occupational, and other areas of functioning. If the symptoms have not been present for more than 1 month, the diagnosis assigned is acute stress disorder

Psychosocial Theory One psychosocial model that has become widely accepted seeks to explain why certain persons exposed to massive trauma develop PTSD and others do not. Variables include characteristics that relate to (1) the traumatic experience, (2) the individual, and (3) the recovery environment.

THE TRAUMATIC EXPERIENCE. Specific characteristics relating to the trauma have been identified as crucial elements in the determination of an individuals long-term response to stress. They include: Severity and duration of the stressor Degree of anticipatory preparation for the event Exposure to death Numbers affected by life threat Amount of control over recurrence Location where the trauma was experienced (e.g., familiar surroundings, at home, in a foreign country) THE INDIVIDUAL. Variables that are considered important in determining an individuals response to trauma include: Degree of ego strength Effectiveness of coping resources

Presence of pre-existing psychopathology Outcomes of previous experiences with stress/ trauma Behavioral tendencies (temperament) Current psychosocial developmental stage Demographic factors (e.g., age, socioeconomic status, education) THE RECOVERY ENVIRONMENT. It has been suggested that the quality of the environment in which the individual attempts to work through the traumatic experience is correlated with the outcome. Environmental variables include: Availability of social supports The cohesiveness and protectiveness of family and friends The attitudes of society regarding the experience Cultural and sub cultural influences Nursing Actions: Accept client; establish trust Stay with client during flashbacks Encourage verbalization about the trauma when ready Discuss coping strategies Assist client to try to comprehend the trauma and how it will be assimilated into his or her persona