Analysis of Symptoms of Post Traumatic Stress Disorder - Assignment Example

?Analysis of Marla’s Symptoms and Disorder of College Analysis of Marla According to the synopsis, Marla is a 42-year-old Hispanic female who comes to the mental health clinic complaining of having trouble sleeping, feeling "jumpy all of the time," and experiencing an inability to concentrate. These symptoms are causing problems for her at work, where she is an accountant. At first there were several issues that came about for Marla which made the counselor ask more questions about her circumstances. Marla described herself as having many challenges throughout her day. As an example, she goes to work but always feels that she is looking over her shoulder because she is afraid that something will happen. Marla has had two major traumas in her life: She lost a very close friend in the bombing of the Trade Centers (9/11) and she thought she lost a family member in the aftermath of Hurricane Katrina. She eventually found her family member, but because of the loss of power and such in Louisiana it was several days before they could find out whether their family member was safe. Marla describes that she is having trouble sleeping because she is always thinking about what could happen to her and that life is not always promised. She feels that she has come to counseling because she needs to find a way to quiet these thoughts and she fears that something is very wrong with her. Diagnosis In the beginning of the discussion it seemed that she may have Attention Deficit Disorder with Hyperactivity (ADHD) but in looking at the symptoms, the diagnosis this counselor would suggest is 309.81 Post Traumatic Stress Disorder. In looking at the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV), Marla has the following symptoms: A. Marla was confronted with events that that both threatened and ended in death. She responded with “intense fear, helplessness [and] horror” (American Psychiatric Association,1994, p. 428). B. Marla talked about having dreams that were disturbing. Sometimes she dreamed of falling (and many people have told her that in a dream, if she falls she will die in real life), other times she dreamed that she was lost in the ocean and could not find anyone to save her); this is one of the reasons she feels she has trouble sleeping. C. Marla states that she has not been able to talk about these two issues because every time she approaches talking about them, she feels she will lose control of her emotions. She has cried many times about her friend, and when she knows other friends or family are going to fly, she has a fear that they will not return. She has never liked flying, but she will not fly unless she really has to; she prefers driving or other means of transportation. She says she sometimes feels her self feeling depressed, or not wanting to be around other people because they sometimes talk about these events and she does not want to talk about them, since they are too painful. D. She has difficulty falling asleep because of her thoughts and her dreams, she has difficulty concentrating at work and at home, and she does not like people coming up behind her because it startles her to the extent that she may begin to cry. She feels these symptoms began after her friend’s death and they have not stopped. In addition, Marla seems to have a chronic incidence of PTSD and this happened within the first week of finding out about her friend’s death. Suggested Treatment Generally speaking, PTSD is usually treated with medication and psychotherapy that is geared toward helping the individual gain control over their lives. In Marla’s case, psychotherapy would certainly be part of her treatment as well as an anti-anxiety medication may be the best way to treat her PTSD. Two different models of abnormality would be used: The biological model and the cognitive model. The biological model would show that medication was important to help Marla control her symptoms of PTSD. She would be referred to her primary care physician or to a psychiatrist who would prescribe anti-anxiety medicine( Mayo Clinic Staff, 2011). To date, she is not exhibiting problems with hallucinations or depression, but she may need depression medicine along with the anti-anxiety medicine in order to calm her body down. According to the National Center for PTSD, medication is used to “ameliorate posttraumatic reactions and to prevent the later development of PTSD” (par. 1). The body is exposed to a hyper-sensitivity in the brain to create an over-active amygdala in the brain, which stimulates the individual to react to the PTSD trigger. Because the amygdala has been impaired, the individual is unable to stop their reaction to the trigger, which creates a constant level of fear for the individual (National Center for PTSD, 2009, 2011). The challenge for doctors and/or psychiatrists is to locate the area in the brain that is giving the most problem and provide medication that will intervene when it is most necessary. The National Center for PTSD (2009, 2011) suggests that there are many areas of the body to consider when providing medication. Some of these are the adrenergic system, providing a way to decrease neurotoxicity, and providing a mood stabilizer in order to decrease the amount of glutamate in the system, which many doctors believe is one of the reasons that the amygdala is over stimulated. In PTSD, it is important to help the individual to become more functional in their daily life. By doing so, they are able to control their symptoms and develop a better understanding of how PTSD affects their daily lives. Another type of medication that is used to treat PTSD are the Serotonin Reuptake Inhibitors (SSRIs) which “raise the level of serotonin in the brain” (National Center for PTSD, 2007, 2011, par. 15). All prescriptions of medication must be given by either a medical doctor or a psychiatrist. Marla would benefit from medication because her symptoms are effecting her work and probably her family life. She needs to be able to stabilize the fears and anxiety in order to work on the causes of the PTSD in psychotherapy. The cognitive model is one that is used to work with people who have PTSD, and many people have benefited from using Cognitive Behavior Therapy (CBT) to help these individuals. According to Comer (2005) the two major names in this area were Albert Ellis and Aaron Beck. Ellis believed that the client brings with them the cause of their problems and they have created thinking around these problems that provide them with irrational beliefs and attitudes that stop them from moving forward with their lives. Beck believed that an individual had an activating event that created specific believes that created many consequences. In looking at Beck’s model (shown at left), and comparing it to Marla’s problems, the activating event would be her thinking of Hurricane Katrina or her friend’s death. These were actual events that made her feel that something terrible can happen to a person at any moment (irrational believes). The consequences of these beliefs bring about negative emotions that provide a misunderstanding of what is happening in her life . Because PTSD essentially deals with behavior, one method that has been shown to work well is Cognitive Behavior Therapy (CBT). According to The National Center for PTSD (2007, 2011) CBT helps the individual understand why they think the way they do about their specific trauma. In the counseling situation, Marla would be able to talk more freely with her therapist about what is going on and why she is creating the thinking that she has in the past. The therapist would help Marla find other ways to think about the traumas that will replace the way she has been thinking to keep the trauma going for her. Another treatment that is helpful in PTSD is exposure therapy. In this therapy, Marla would be asked to face the fear she is having so that she would find other ways to respond to the triggers that create the fear. The therapist would have as their goal to have Marla talk about the trauma repeatedly so she would change the way she looked at it (National Center for PTSD, 2007, 2011). The final treatment that might be helpful is the use of eye movement desensitization and reprocessing (EMDR). This method of therapy is useful in PTSD because it allows the client to focus on something other than what they are experiencing in the trauma. Many therapists use rapid eye movements, tapping or using sounds to help their client move forward (National Center for PTSD, 2007, 2011). Conclusion Working with Marla to change help her move past her trauma and PTSD would be very useful for her and this would allow her to find ways to put her friend’s death in the past and to take control of her life. The problems that she is having at work may be alleviated once she is on medication. Medication may help her to sleep and wake up more rested. The use of all three types of therapies that are mentioned here would be important towards helping her put the trauma into perspective. References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorder, Fourth Edition, (DSM-IV). Washington, DC: American Psychiatric Association. Comer, R. J. (2005). Fundamentals of abnormal psychology (4th ed.). New York, NY: Worth Mayo Clinic Staff. (2011). Post-traumatic stress disorder (PTSD): Treatments and drugs. Retrieved from http://www.mayoclinic.com/health/post-traumatic-stress- disorder/DS00246/DSECTION=treatments-and-drugs National Center for PTSD. (2007, 2011). Treatment for PTSD. Retrieved from http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp National Center for PTSD. (2009,2011). Biology of PTSD. Retrieved from http://www.ptsd.va.gov/professional/pages/fslist-biological.asp Clinical Interview Questions 1 Explain to me how you are feeling today. I am feeling tired but I feel hyper most of the time. 2 What are some of your interests or things you enjoy doing? I enjoy working out, reading books, going to movie. 3 How do you respond if something in your life is not going as planned? It makes me angry and anxious. I feel so overwhelmed sometimes that I don’t know what to do. I feel like I am always looking over my shoulder or waiting for the other shoe to drop. 4 Describe to me what your family life was like. I grew up with my mother, father and three other siblings. I have a brother and two sisters. 5 Is there any recent events that have been bothering you? 6 Yes. Well, I can’t say they are really recent. But, I had a family member become lost in Hurricane Katrina. It took us several days before we knew whether she was okay or whether something happened to her. 7 What are some things in your life that you are most proud of? I am proud of my family, my kids and the way that everyone has turned out. 8 What are some of your lifetime goals or things you hope to change in your life? Right now, I am not sure of my life goals. I haven’t really identified what I want to do with my life or where I am going. I am having so much trouble with not being able to sleep sometimes and feeling afraid all the time. I think this has to do with what happened at Katrina and other situations in my life. 9 Tell me about your personal attributes and personality characteristics. 10 Have you ever had a trauma or tragedy occur that you have difficulty dealing with? Yes. The entire situation with Katrina happened and I also lost a very close friend in 9/11. Ever since that time I haven’t been able to really get rested, I feel anxious a lot of the time and I am not sure what is going on with my job. Sometimes I am not able to listen to everything that is said—it’s like a blur to me. I just don’t know what is going on and it seems that it is getting worse as time goes on. 11 Does anyone in your immediate family have any psychological issues that you are aware of? Not that I know of. Read More