POST TRAUMATIC STRESS

Prepared by:
PERCY NARANJO MD MPH

ONE OF THE FEW CONDITIONS THAT

A DIFFERENCE FROM OTHERS
SUCH AS

- DEPRESSION

-SCHIZOPHRENIA

WE KNOW THE CAUSE:

TRAUMATIC EXPERIENCE

OR

“TRAUMA"
POST-TRAUMATIC STRESS
Is a serious psychological medical condition,
depression, anxiety insomnia and other medical
complications are highly prevalent and occur
concurrent as: unstable family life, divorce, affected
social and interpersonal relationships, suicidal
behaviors as well as violence, aggression, drug
abuse and criminal behavior.

THE OBJECTIVES of the training program are to

inform and educate on the latest strategies of
effective screening, diagnosis and treatment (social
psychotherapeutic and pharmacological
interventions) of post-traumatic stress and the
associated conditions (insomnia, anxiety,
depression).
 QUESTION TO THE AUDIENCE…
IF I ASK YOU, OR, TO THIS AUDITORY IF YOU CAN / REMEMBER
SOMETHING STRESSFUL THAT HAD HAPPENED TO YOU
OR THAT YOU WERE WITNESS; EVEN IF THEY WERE SO STRONG
AS THEY HAD CHARACTERISTICS OF A
PAINFUL-TRAUMATIC EVENT

AND IF I ASK YOU

HOW DID YOU FEEL?

YOU CAN DESCRIBE IT. AND REFLECT IN THE EXPERIENCE, AS

SUCH, WITHOUT FEELING ALL THE INTENSITY AND THE
REATIONS THAT, YOU CAN REMEMBER
THAT IN TRUTH
IT WAS TERRIBLE OR MAYBE HORRIBLE BUT WITHOUT FEELING
THE SAME EXPERIENCE AS SUCH
THAT IS WHAT IT REALLY
IS THE GOAL,
TO ACHIEVE WITH THE TREATMENT.

POST TRAUMATIC STRESS

IS
MEMORY OF THE EMOTIONAL REACTION
Associated with
ORIGINAL EVENT

RECOVERY
is
MEMORY OF THE PAINFUL EXPERIENCE WITHOUT THE
EMOTIONAL REACTION
Of the
"TRAUMA"
OR
TRAUMATIC EXPERIENCE
POST TRAUMATIC STRESS

LIFE PREVALENCE
IN GENERAL POPULATION
(9%)
HIDDEN CONDITION

OF THE
XXI
CENTURY
(Just began)
POST TRAUMATIC STRESS

FROM THE POINT OF VIEW OF

EXPERIMENTAL PSYCHOLOGY:

POST TRAUMATIC STRESS

IS, a BEHAVIORAL RESPONSE
BASED AND ORIGINATED
DUE TO
a
CONDITIONED STIMULUS
the
TRAUMA
OR
TRAUMATIC EXPERIENCE
 POST TRAUMATIC STRESS

INABILITY
OF
FORGET

(PHYSIOLOGICALLY
RELATED TO LEARNING AND
MEMORY)
 TREATMENT
of the

POST TRAUMATIC STRESS

BASIC STRATEGY:

EXTINGUISH THE RESPONSE OF

CONDITIONED FEAR
SO THAT
THE RESPONSE TO AVOID IS NO LONGER NECESSARY
OR USEFUL
AND
THE PERSON CAN
GET
AUTHORITY AND CONTROL
ABOUT THE TRAUMATIC MEMORY

"I AM IN CONTROL”

AND BECAUSE I AM IN CONTROL, I DO NOT HAVE TO

AVOID THESE OR THOSE THINGS OR SITUATIONS.
 TREATMENT
OF THE
POST TRAUMATIC STRESS

2 “EXPERTS”:
THE PATIENT:
EXPERT IN HIS SYMPTOMS

THE CLINIC:
EXPERT IN TREATMENT

NEGOTIATED TREATMENT THAT IS ACCEPTABLE

FOR BOTH
BASED

IN

MUTUAL RESPECT
COMMUNICATION and COLLABORATION
 POST TRAUMATIC STRESS

!IMPORTANT!
AFTER A TRAUMATIC EXPERIENCE YOU MUST, INITIALLY:

1) DECREASE NON SPECIFIC STIMULUS

2) DO NOT EXPOSE TO MEMORIES RELATED TO TRAUMA

PREVENTING NEW ASSOCIATIONS

AND
GENERALIZATION OF THE STIMULUS
(TRAUMATIC EXPERIENCE)
 PUBLIC MENTAL HEALTH
SECONDARY PREVENTION

RISK FACTORS OF DEVELOPING POSTRAUMATIC STRESS AFTER

A TRAUMATIC EXPERIENCE
GREATER IF

SEVERE, PROLONGED AND REPETITIVE THE EXPOSURE TO TRAUMA

INITIAL REACTION OF:

1. SEVERE PERSISTENT ANXIETY

2. PANIC ATTAC
3. ACUTE DISSOCIATION
• DEPERSONALIZATION
• DEREALIZATION
4.TO FEEL “OUT OF CONTROL”

CONTINUOUS SUBSEQUENT SYMPTOMS

STARTLE RESPONSE

5.PHYSIOLOGICAL CHANGES
• INITIAL AND CONTINUOUS TACHYCARDIA
(110-120.>)

HORMONAL REACTIONS
• HIGH RF VALUES
(CORTICOTROPIN RELEASE VALUES
• DST TEST
(SUPPRESSION OF CORTISOL AFTER ADMINISTERING DEXAMETHASONE)
DEPRESSION: NO SUPPRESSION "ESCAPE"
POSTRAUNATIC STRESS: HYPER SUPRESSION

NEED OF TRAINING PROGRAMS TO BE ABLE TO IDENTIFY PEOPLE AT A

HIGHER RISK
 OF DEVELOPING
POSTTRAUMATIC STRESS

REQUIRES PLANNING AND COORDINATED ACTION OF HEALTH AND SOCIAL

SERVICES AS WELL AS OTHER AGENCIES OR GOVERNMENT ENTITIES

POST TRAUMATIC STRESS

50%
RECOVER
WITH NO TREATMENT
IN 2- 3 MONTHS

IT DOES MEAN TO SAY, IS AN

EXCUSE
! NOT TO DO ANYTHING!
 THERE IS NO LIMIT DATE
(“STATUS OF LIMITATION”)

BETWEEN:

TRAUMA

AND
APPEARANCE
OF

POSTTRAUMATIC STRESS
THAT IS

MORE DISTANT OR FAR AWAY THE TRAUMATIC EXPERIENCE

LESS THE CONNECTION THAT THE PERSON MAKES WITH
HIS/HER SYMPTOMS OF THE PRESENT; ESPECIALLY
SOMATICOS:

(PAIN RELATED DISORDERS)

POSTTRAUMATIC STRESS

WHY IT SHOULD BE
TREATED?
Because
is
THE HUMANE

AND

THE

CORRECT THING TO DO
 COMORBIDITY
75%
OF THE AFFECTED PERSONS
WITH
POST TRAUMATIC STRESS

HAVE OTHER PROBLEMS OR CONDITIONS:

GENERALIZED ANXIETY

PANIC ATTACKS

DEPRESSION
ALCOHOL AND DRUG ABUSE
AND
PHARMACO DEPENDENCE

SOMATIZATION
(CHRONIC PAINS)
 HIGH RISK of DESTRUCTIVE BEHAVIORS
(AGGRESSIVE, SUICIDAL)

THE CLASIFICATIONS...
DSM (I, II, III, IV, V..)
THE QUESTIONS ARE ETERNAL
THE RESPONSES TRASIENT ...

DSM ....

Are CODES; IT USE HAS A VALIDITY TO THE EXTENT and, TILL

NEW EVIDENCE ALLOWS US A BETTER UNDERSTANDING OF
THE PROCESS AND DIATESIS.
 PERCENTAGES
40% OF THE GENERAL POPULATION WILL BE
EXPOSED DURING HIS LIFE AT LEAST TO A ONE
TRAUMATIC EXPERIENCE

30% OF THOSE EXPOSED TO A

TRAUMATIC EXPERIENCE WILL DEVELOP

POST TRAUMATIC STRESS

POST TRAUMATIC STRESS

NEW TRAUMAS
REACTIVATE

TRAUMAS OF THE PAST

 ! FLASHBACK!

IMAGES, EXPERIENCES, SUBIT AND

VIVID THAT FEELS LIKE IF THE
TRAUMATIC EVENT IS HAPPENING
AGAIN
IT IS "BACK" TO TRAUMA AGAIN

"PSYCHO- ANESTHESIA"

INABILITY

TO FEEL AND TO HAVE

ALL
THE VARIANTS AND
RANGES
 OF
HUMAN EMOTIONS

WHAT IS HELL?
THE INCAPACITY TO “FEEL” AND
“LOVE "

(DOSTOYESKI)

PSYCO ANESTHESIA,
EMOTIONAL ANESTHESIA
INABILITY TO FEEL, LOVE,

AND / OR
EXPRESS FEELINGS OF AFFECTION AND CARE

POST TRAUMATIC STRESS

“COPING AND ADAPTATION”
HAS TO DO
with the
CAPACITY
from
ADAPTATION
AND
SURVIVAL
of the
INDIVIDUAL
AND
 the
SPECIES

TRAUMA MYTH AND RITUAL

WE, CAN, FROM ANOTHER PERSPECTIVE, CONSIDER THE TRAUMATIC

EVENT AS THE MYTH THAT MUST BE UNDERSTOOD, ASSIMILATE AND
OVERCOME THROUGH THE:
TREATMENT
and
RITUAL

FOR EXAMPLE:

THE PERSON RELATES AND WRITES A COMPOSITION ABOUT THE TRAUMATIC

EVENT IN COMMUNICATION WITH THE THERAPIST THE ISSUES TO BE FOCUSED
ON EACH COMPOSITION

ARE ANALYZED

In this way after a series of sessions and compositions the person is going
progressively to FACE the traumatic experience, through this therapeutic ritual in
which the person can achieve and overcome the emotional painful experience that
represents the TRAUMA, exploring as the person perceived to himself and how
the world perceived before the trauma and how this change these perceptions and
mental schemes and can at the same time develop strategies that allow him/her to
pass from:
 VICTIM
TO

SURVIVOR
RECOVERING CONTROL

About his/her life and health and at the same time reevaluate principles on:
SAFETY TRUST, SELF-ESTEEM

And ability to relate with himself and with others. at the end of a series of
sessions you can symbolically "burn" bury "in a ritual” these compositions.

RESOLUTION AND RECOVERY

IS ACHIEVED

WHEN IS ABLE TO PASS

FROM

VICTIM
TO

SURVIVOR
WHEN IS ABLE TO GIVE A PERSONAL MEANING TO THE
EXPERIENCE AND AS AN OPPORTUNITY FOR A
GROWTH AND PERSONAL SUPERATION
(SALUDOGENIC ASPECT)

ABLE TO REORGANIZE MENTAL SCHEMES

ABOUT THYSELF AND THE WORLD
IN THEMES
OF
SECURITY, TRUST, CONTROL
AND
PERSONAL SELF-ESTEEM
ABILTY TO BE ABLE TO RESTORE INTIMACY WITH OTHERS AND HOW HE/HER WAS SEEN
THYSELF AND THE WORLD,
BEFORE AND AFTER TRAUMA

ABILTIES TO DEVELOP OF
SUPERATION AND RESILIENCE.
 Thank you for your interest and attention!
PERCY NARANJO MD

PTSD CheckList – Civilian Version (PCL-C)

https://www.mirecc.va.gov/docs/visn6/3_PTSD_Chec
kList_and_Scoring.pdf

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