Post Traumatic Stress Disorder (PTSD) is a mental and behavioral disorder that can

develop because of exposure to a traumatic event, such as sexual assault, warfare, abuse,
domestic violence, or other threats on a person's life.

The main features of PTSD may be described as follows:

1. Reexperiencing
The most dramatic form of reexperiencing is the flashback. Here the patient feels and acts as
if the trauma is recurring. Reexperiencing also includes distressing memories or dreams
(nightmares) when faced with stimuli linked to the traumatic event. There may be physiologic
or psychologic stress reactions, including full-blown panic attacks, associated with this
reexperiencing.

2. Avoidance/Numbing
Patients with PTSD may attempt to avoid thoughts or activities related to the trauma. They
try to stay away from places, events, or objects that are reminders of the traumatic
experience, and avoid thoughts or feelings related to the traumatic event.

3. Hyperarousal/Hypervigilance
People with PTSD often experience increased arousal which may disrupt sleep, contribute to
irritability and anger, and impair concentration. Hypervigilance may coexist with an
exaggerated startle response.

4. Cognition and mood:

People with PTSD often have negative thoughts about oneself or the world. Cognition and
mood symptoms can begin or worsen after the traumatic event, but are not due to injury or
substance use. These symptoms can make the person feel alienated or detached from friends
or family members. There may also be a markedly diminished capacity to experience
pleasure, difficulty in remembering aspects of the trauma, a feeling of detachment or
estrangement from others, and a perception of a foreshortened future.

It is natural to have some of these symptoms for a few weeks after a dangerous event.
When the symptoms last more than a month, seriously affect one’s ability to function, and are
not due to substance use, medical illness, or anything except the event itself, they might be
PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is
often accompanied by depression, substance abuse, or one or more of the other anxiety
disorders.

Causal Factors of PTSD:

1. Individual Risk Factors: Not everyone is at equal risk when it comes to the likelihood of
developing PTSD. Risk factors that increase the likelihood of developing PTSD include
being female, having higher levels of neuroticism, having pre-existing problems with
depression and anxiety, substance abuse, etc. Low levels of social support has also been
noted as a risk factor.

2. Biological Factors: Studies show that women with PTSD have higher baseline cortisol
levels than women who do not have PTSD. However, this is not the case for men with PTSD.
Under conditions of stress, people with PTSD show an exaggerated cortisol response. Having
the s/s genotype of the serotonin-transporter gene may increase the vulnerability to PTSD.
Smaller hippocampal volume is also a biological vulnerability factor.

3. Socio-cultural Factors: Being a member of a minority group seems to place people at

higher risk for developing PTSD. Returning to a negative and unsupportive social
environment can also increase the vulnerability to post-traumatic stress.

ACUTE STRESS DISORDER: Acute stress disorder (ASD) is an intense and unpleasant
reaction that typically occurs within one month of a traumatic event. People with ASD have
symptoms similar to those seen in post-traumatic stress disorder, however this disorder is
temporary. It lasts at least three days and can persist for up to one month. Some people with
this disorder can go on to develop PTSD. If symptoms persist beyond one month, affected
individuals are considered to have posttraumatic stress disorder (PTSD).

ADJUSTMENT DISORDER: Adjustment disorder is a psychological response to a

common stressor (eg., divorce, death of a loved one, loss of a job, etc.) that results in
clinically significant behavioral or emotional symptoms.
For the diagnosis to be given, symptoms must begin within 3 months of the onset of
the stressor, and the person must experience more distress than would be expected given the
circumstances or be able to function as usual. In adjustment disorder, the symptoms lessen or
disappear when the stressor ends or when the person learns to adapt to the stressor. In cases
where the symptoms continue beyond 6 months, the diagnosis is usually changed to some
other mental disorder.

DISSOCIATIVE DISORDERS: Dissociative disorders are a group of conditions involving

disruptions in a person's normally integrated functions of consciousness, memory, identity, or
perception.

1) Depersonalization/ Derealization Disorder: In DSM-IV derealization and

depersonalization were treated as two distinct conditions. However, in DSM-V, they have
been combined.
In derealization, a person's sense of reality of the outside world is temporarily lost,
and in depersonalization, a person's sense of his own-self and own reality is temporarily lost.
Many of us have such experiences in mild form at least once in our lives, usually
during the period of severe stress, sleep deprivation, etc. But when episodes of
depersonalization or derealization become persistent and recurrent and interfere with normal
functioning, depersonalization/derealization disorder may be diagnosed.
 In this disorder, people have persistent or recurrent experiences of feeling detached
from their own bodies and feel like an outside observer of their own bodies. They may even
feel like they are floating above their physical bodies, which may suddenly feel very
different, as if drastically changed or unreal. During periods of depersonalization, reality
testing remains intact.
Although the disorder can start In childhood, the mean age of the onset is around age
16. Moreover, in most of the cases, the disorder has a fairly chronic course with little to no
fluctuation in intensity. Although severe depersonalization/derealization symptoms can be
quite frightening, such fears are usually unfounded. Sometimes, however, feelings of
depersonalization can be early manifestations of the development of psychotic states.

2) Dissociative Amnesia: Retrograde amnesia is the partial or total inability to recall or

identify previously acquired information or past experiences. Anterograde amnesia, on the
other hand, is the partial or total inability to retain new information.
Dissociative amnesia is usually limited to a failure to recall previously stored personal
information (retrograde amnesia) when that failure cannot be accounted for by ordinary
forgetting. In this disorder, apparently forgotten personal information is still there beneath the
level of consciousness. It sometimes become apparent in interviews conducted under
hypnosis or narcosis. Individuals cannot remember certain aspects of their personal life
history or Important facts about their identity. Yet their basic habit patterns- such as their
abilities to read, talk, etc. remain intact, and they seem normal aside from memory deficit.
Thus, the only type of memory that is affected is episodic or autobiographical memory.
In rare cases, a person may retreat still further from real-life problems by going into
an amnesic state called a 'dissociative fugue', which is a defense by actual flight. This is
accompanied by confusion about personal identity or even the assumption of a new identity.
During the fugue, such individuals are unaware of memory loss of prior stages of their life,
but their memory of what happens during the fugue state itself remains intact. Their behavior
during the fugue state is usually quite normal and unlikely to arouse suspicion that something
is wrong. However, behavior during the fugue state often reflects a rather different lifestyle
from the previous one. Days, weeks, or even years later, such people may suddenly emerge
from the fugue state and find themselves in a strange place with no idea how they got there.
As the fugue state remits, their initial amnesia remits- but a new, apparently complete
amnesia for their fugue period occurs.

3. Dissociative Identity Disorder: Dissociative Identity Disorder (DID), formerly known as

Multiple personality disorder, is a dramatic dissociative disorder.
In this disorder, there are different personalities that emerge and are apparent to
an outside observer. Each identity may appear to have a different personal history, self-
image, and name, although there may be some identities that are only partially distinct and
independent from other identities. In most cases, the one Identity that is most frequently
encountered and carries the person's real name is the host identity. Also, in most cases, the
host is not the original identity and it may or may not be best-adjusted identity. The alter
Identities may differ in striking ways involving gender, sexual orientation, handwriting,
general knowledge, etc. For example, one alter may be carefree, fun, loving, etc. and the
other may be quiet, serious, hostile, etc. In sum, DID is a condition in which normally
integrated aspects of memory, identity and consciousness are no longer integrated. Additional
symptoms of DID include depression, self-injurious behavior, frequent suicidal ideation,
headaches, hallucinations, and other amnesic and fugue symptoms.
Causal Factors: In contemporary literature, the major theory of how DID
develops is the post-traumatic theory. The vast majority of patients with DID report
memories of severe and horrific childhood abuse. According to this theory, DID starts from
the child's attempt to cope with an overwhelming sense of hopelessness and powerlessness in
the face of repeated traumatic abuse. Lacking other resources or routes of escape, the child
may dissociate and escape into a fantasy, becoming someone else.
Another theory is the socio-cognitive theory. According to this theory, DID
develops when a highly suggestible person learns to adopt and enact the roles of multiple
identities, mostly because clinicians have suggested, legitimized and reinforced them and
because these different identities are geared to the individual's personal goals. This theory
does not regard this as being done intentionally or consciously by the person involved.
Rather, it occurs spontaneously with little or no awareness.

SOMATIC SYMPTOM AND RELATED DISORDERS:

1. Somatic Symptom Disorder: People with somatic symptom disorders experience bodily
symptoms that cause them significant psychological distress and impairment. For the
diagnosis of somatic symptom disorder to be made, individuals must be experiencing chronic
somatic symptoms that are distressing to them. They must also be experiencing dysfunctional
thoughts, feelings and behaviors.
DSM-5 criteria for somatic symptom disorder:
(i)One or more somatic symptoms that are distressing or result In significant disruption of
daily life.

(ii) Excessive thoughts, feelings or behaviors related to the somatic symptoms or health
concerns such as: disproportionate and persistent thoughts about the seriousness of one's
symptoms; persistently high level of anxiety about health; and excessive time and energy
devoted to these symptoms or health concerns.

(iii) Although any one somatic symptom may not be continuously present, the state of being
symptomatic Is persistent.

2. Illness Anxiety Disorder: This disorder is new to DSM-5. In this newly identified
disorder, people have high anxiety about having or developing a serious illness. This anxiety
is distressing and disruptive, but there are very few or very mild somatic symptoms.

3. Conversion Disorder: This disorder was one of several disorders that were grouped
together under the term hysteria. It is characterized by the presence of neurological symptoms
in the absence of neurological diagnosis. In other words, the patient has some symptoms or
deficits that affects the senses or motor activities that strongly suggest a medical condition.
However, the pattern of symptoms or deficits is not consistent with any medical problem. A
few examples Include partial blindness, deafness and partial paralysis. In such cases, the
person is not intentionally producing or faking the symptoms. Rather, psychological factors
are often judged to play an Important role because symptoms usually start by preceding
emotional or interpersonal conflicts or stressors.
OCD AND RELATED DISORDERS
1. OCD: OCD is defined by the occurrence of both obsessive thoughts and compulsive
behaviors performed In an attempt to neutralize such thoughts. A person with OCD usually
feels driven to perform this compulsive, ritualistic behavior in response to an obsession, and
there are often very rigid rules regarding exactly how the compulsive behavior should be
performed. Many obsessive thoughts include contamination fears, fear of harming oneself of
others, the need for symmetry, etc. These obsessions and compulsions interfere with daily
activities and cause significant distress.

For example, a person may try to ignore or stop his obsessions, but that only increases his
distress and anxiety. Ultimately, he feels driven to perform compulsive acts to try to ease his
stress. Despite efforts to ignore or get rid of bothersome thoughts or urges, they keep coming
back. This leads to more ritualistic behavior — the vicious cycle of OCD.

2. Body Dysmorphic Disorder: People with BDD are obsessed with some perceived or
imagined flaws in their appearance to the point they firmly believe they are disfigured or
ugly. The preoccupation is so intense that it causes clinically significant distress and
impairment in social or occupational functioning. Most people with BDD have compulsive
checking behaviors. Another very common symptom is avoidance of usual activities because
of fear that people will see their imaginary flaw and be repulsed. In severe cases, they may
become so Isolated that they lock themselves up in their houses and never go out.

3. Hoarding Disorder: People with hoarding disorder both acquire and fail to discard many
possessions that seem useless or of very limited value, in part because of the emotional
attachment they develop to their possessions. In addition, their living spaces are extremely
cluttered and disorganized to the point of interfering with normal activities that would
otherwise occur in those spaces, such as cleaning, cooking and walking through the house. In
severe cases, people have literally been buried alive in their own home by their hoarded
possessions.

4. Trichotillomania: Also known as hair pulling, it has at its primary symptom the urge to
pull out one's hair from anywhere on the body (most often the scalp, eyebrows, or arms),
resulting in noticeable hair loss. The hair pulling is usually preceded by an Increasing sense
of tension, followed by pleasure, gratification, or relief when the hair is pulled out. It usually
occurs when the person is alone and the person often examines the hair root, twirls it off, and
sometimes pulls the strand between their teeth and/or eats it. The onset can be in childhood or
later, with the onset of post-puberty being associated with a more severe course.
SPECIFIC PHOBIAS

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and

irrational fear associated with a specific object, situation, or concept which poses little or no
actual danger.[1][2] Specific phobia can lead to avoidance of the object or situation,
persistence of the fear, and significant distress or problems functioning associated with the
fear. A phobia can be the fear of anything.
Although fears are common and normal, a phobia is an extreme type of fear where great
lengths are taken to avoid being exposed to the particular danger.

Symptoms of specific phobias include:

1. Excessive or irrational fear of a specific object or situation

2. Avoiding the object or situation or enduring it with great distress
3. Physical symptoms of anxiety or a panic attack, such as a pounding heart, nausea or
diarrhea, sweating, trembling or shaking, numbness or tingling, problems with breathing
(shortness of breath), feeling dizzy or lightheaded, feeling like you are choking
4. Anticipatory anxiety, which involves becoming nervous ahead of time about being in
certain situations or coming into contact with the object of your phobia; for example, a person
with a fear of dogs may become anxious about going for a walk because they may see a dog
along the way.

Children with a specific phobia may express their anxiety by crying, clinging to a parent, or
throwing a tantrum.

There are different types of specific phobias, based on the object or situation feared,
including:

1. Animal phobias: Examples include the fear of dogs, snakes, insects, or mice. Animal
phobias are the most common specific phobias.
2. Situational phobias: These involve a fear of specific situations, such as flying, riding in a
car or on public transportation, driving, going over bridges or in tunnels, or of being in a
closed-in place, like an elevator.
3. Natural environment phobias: Examples include the fear of storms, heights, or water.
4. Blood-injection-injury phobias: These involve a fear of being injured, of seeing blood or of
invasive medical procedures, such as blood tests or injections
5. Other phobias: These include a fear of falling down, a fear of loud sounds, and a fear of
costumed characters, such as clowns.