ANZAC Day is a national day of remembrance in Australia and New Zealand that broadly commemorates all Australians and New Zealanders who served and died in all wars, conflicts, and peace keeping operations, and the contribution and suffering of all those who have served. It is a day of remembering that those who have (and do) serve our country, including our 80,000+ contingency of emergency service workers, put their lives at risk and are subsequently more vulnerable to developing trauma-related psychological disorders, such as posttraumatic stress disorder (PTSD).
PTSD is one of the most common psychological disorders, with a lifetime prevalence rate of 7.2%. This is why it is imperative that we strive to do all we can to help our local Wollongong and Illawarra community to access the psychological treatment they need in order to quickly overcome their trauma-related struggles.
The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has grouped all Trauma and Stressor-Related Disorders, which includes PTSD as well as Acute Stress Disorder, Reactive Attachment Disorder, and Adjustment Disorders. All of these disorders are the result of experiencing some form of traumatic stress (mild, moderate, or severe). For PTSD, this is the exposure to actual or threatened death, serious injury, or sexual violence through either direct experience, witnessing, or learning that the traumatic event occurred to a close family member or friend.
PTSD typically involved four clusters of symptoms including intrusive symptoms (e.g. memories of trauma), avoidance symptoms, negative alterations in cognitions and mood, and arousal and reactivity symptoms. The DSM 5 requires that at least one symptom in each of these clusters be present for at least one month and be associated with significant distress or impairment in social, occupational, or other important areas of functioning.
However, it is recommended that a thorough assessment of an individual’s functional (occupational and non-occupational) difficulties and comorbid mental and physical health conditions be identified as well. Comorbid symptoms may include interpersonal relationship breakdown, alcohol and drug abuse, anger difficulties, and depression. It is often common that veterans will present to their general practitioner with more generic complaints such as sleep disturbance, problematic anger, relationship problems or unexplained medical symptoms. This might also be true for emergency service workers and other vulnerable populations exposed to traumatic stress.
The role of GPs
The role of GPs in managing PTSD is central and the RACGP recommends this to include:
- provision of initial support and monitoring (eg psychological first aid)
- early detection, initial assessment and supportive management
- use of initial pharmacotherapy
- appropriate and timely referral for specialist treatment
- support of family and carers
- crisis assistance
- management of comorbid medical conditions
- maintenance treatment for chronic conditions
The K10 or the DASS21 are useful screening measures that are common in general practice and can help to identify general mental health difficulties. A simple screening measure that can be used for PTSD is called the Impact of Events Scale – Revised. A copy can be readily obtained with a simple google search but for sake of simplicity there is a copy available from this website: http://emdrresearchfoundation.org
You can also access an autoscorer from our website by clicking this link: IES-R Autoscorer.
Most PTSD guidelines emphasise careful diagnosis and treatment planning for PTSD, with the emphasis also being on early intervention. The role of psychotherapeutic treatment is highlighted and the limitations of the role of pharmacotherapy stressed (see the RANZCP for a review of PTSD guidelines).
There are various treatment models that have gained significant evidence base in the literature for the treatment of PTSD and other trauma and stress related disorders. Among these are trauma-focused CBT (including prolonged imaginal exposure) and Eye Movement Desensitisation and Reprocessing therapy (EMDR). These treatments are typically delivered in an outpatient setting and should be regular, i.e. at least once per week for 8-12 weeks. Treatment may be prolonged where PTSD is severe or multiple traumas are involved.
Marsden Clinical Psychology have numerous clinical psychologists that are trained in the delivery of trauma-focused CBT and EMDR and many years of experience in the treatment of PTSD and other trauma related disorders in Wollongong and the greater Illawarra region. For an appointment or to enquire about our services please do not hesitate to call 0411 542 624 or fax a referral to (02) 8322 8005. You may also submit an enquiry through our website by clicking this link: Website Enquiry.