Posttraumatic Stress Disorder (PTSD): Introduction (Nursing)

00:01 Now we're going to discuss Post-Traumatic Stress Disorder, or PTSD.

00:10 What do we mean when we're talking about Post-Traumatic Stress Disorder? It's actually a psychological sequelae.

00:18 That happens when a person has had an experience of a terrifying event, maybe a near death event, they've witnessed it, or they've experienced it.

00:30 They may even have seen it on television, or on social media.

00:35 But the effect of witnessing has given them a fear for their own life, or for the life of their loved ones.

00:45 PTSD can be acute, which is short term, or chronic, which is long term and lasting for years.

00:56 PTSD interferes with activities of daily living.

01:02 It can result in memories that come up and take over in a present moment experience.

01:11 It has the person suddenly re-experiencing that same level of fear or danger.

01:20 And their arousal rises up, almost making them incapable of dealing with what is actually going on in the present moment, even though the actual experience has passed and is over.

01:37 Severity of the trauma is going to be the determining factor when we look at the signs and symptoms that we see from PTSD, and it's important to recall that for PTSD, post-traumatic stress disorder, the signs and symptoms that we're going to see include things like anxiety, depression, insomnia, hypervigilance.

02:03 There's a whole constellation that is part of this umbrella of post-traumatic stress disorder.

02:13 And it's important for us when we're looking at someone to be able to find out whether or not there was an experience.

02:22 ACEs or Adverse Childhood Experiences, oftentimes gives rise to chronic PTSD as an adult.

02:33 People who have witnessed something, for example, 9/11, you didn't have to be in New York City to experience PTSD from 9/11.

02:44 You could have witnessed it.

02:46 You could have known someone who was in New York, or you could have just been watching it on television.

02:53 And the impact on your emotional central nervous system responses is going to be the same.

03:03 So, our body responds.

03:07 Our autonomic nervous system suddenly becomes aroused.

03:15 We find that persons will start doing impulsive movements, even though there's no danger.

03:21 For example, a person who has been in a car accident, which is a traumatic event.

03:27 They may be riding as a passenger in a car.

03:30 And when they get to a red light, they notice a car to the right, and they suddenly put their hand up, as though they're going to stop that car.

03:40 That kind of impulsive movement.

03:45 There's a sequencing of sensory motor experiences.

03:49 Meaning that your mind, your brain starts remembering in sequence as things happened.

03:57 And your body responds to that sequencing.

04:02 For example, you may have a startle response.

04:07 You might have that fight-or-flight response, where you suddenly either want to run away or stand up and fight.

04:17 We may seem sudden postural changes.

04:21 Meaning that a person might be talking to you about something and say, "Yeah, my, my, my brother died in 9/11.

04:32 I lost him." And you suddenly see this collapse of the body that would be the postural change.

04:41 There's an orienting response.

04:44 Oftentimes, when I'm working with a patient who has PTSD, and they start to tell me about how difficult their childhood was, and perhaps how their stepmother used to really like slap them or hit them.

05:02 They will say, "And my stepmother...

05:09 she used to hit me." Almost as though the stepmother is sitting right next to them still.

05:15 I will say to them, "And at your dinner table, where did your step mom sit?" And they will say, "She was right here." So that is an orienting response.

05:27 Orienting to where the trauma started.

05:30 Even though the person is no longer there, the person may not even be living.

05:36 They also have defensive responses.

05:39 Emotionally defensive.

05:41 They may immediately react to something you say.

05:45 It may not even be the words that you say.

05:48 I've worked with spouses who have been abused.

05:51 And we've done some experiences, experiential experiments, where I will say, "I'm going to say a word.

06:02 I'm going to say beautiful." And they say, okay. They say, okay.

06:06 "And I want you to tell me, what happens? Like drop inside.

06:11 And notice what happens when I say, "You're beautiful." And I say, "Oh, that feels nice." And I say, "You're beautiful." They go, "Oh, oh..." Well, this... "Ahh" this defensive response comes up immediately because they immediately hear a voice that is commanding voice, it doesn't matter what I'm saying.

06:34 It's the tone of voice that they hear that activates this defensive response.

06:42 Also, they have retraumatization.

06:45 If you have a child who is living through adverse childhood experiences, if you have that child, if you have a child of color, who is watching television, and seeing how people who look like him or her are being arrested or beaten, or in some cases killed, that is a constant retraumatization.

07:09 And there's not any way they can get away from that because they're seeing it on television.

07:16 Sometimes, like with 9/11 and with other problems that have come up that we have seen a mass event, that has caused emotional pain.

07:31 Each time the news decides to rerun it, that retraumatizes people again, having to see that those same images coming up again and again as though they are continuing to happen.