Transcript jfk-lecture-092016

PTSD, Terror and Trauma
A Holistic Approach
Finding help for Trauma-Related
Illness and PTSD by early recognition
and treatment
RONALD R. PARKS, MPH, MD
Integrative Medicine and Psychiatry
1070-1 Tunnel Road, Ste. 10, #274
Asheville, NC 28805
ronparksmd.com
(828) 333-7282
Disclosure Statement
No relevant financial relationships to disclose
 All of the information on the following slides and
references can be found in the article by Dr.
Parks at:
http://ronparksmd.com/ptsd-terror-traumaholistic-approach/
PTSD, terror, trauma – how common?
• An estimated seventy percent of adults in the U.S.
have experienced a traumatic event at least once in
their lifetime
• An estimated ten percent of the above will develop
Post Traumatic Stress Disorder (PTSD)
• Women are about twice as likely as men to develop
PTSD (one out of nine women)
• An estimated eight percent of the population will
have PTSD at some point in their lives - about eight
million adults during any given year
The onset of trauma-related
symptoms or illness
1. Can be delayed and emerge months after the
traumatizing event
2. May appear, earlier, be more subtle and
difficult to recognize, or be ignored
3. 50% of children who lost parents in the 9/11
attack developed anxiety and PTSD *reported
on CBS “Sixty Minutes” - 9/11/16 special
Trauma related illness (TRI) can occur
at any life stage as a result of:
• Exposure to threatened death, serious injury, auto
accidents, violence, or major emotional losses
• Feeling helpless during a trauma as childhood sexual
abuse, rape, physical assaults
• Overwhelming adverse life threatening events or
poly-trauma (i.e., series of traumatic events: as a job
loss, divorce, death of a significant other)
• Witnessing domestic violence, death or injury to
others
• Natural disasters or mass causality event as a
terrorist attack
Vulnerability factors for TRI & PTSD
1. Lack of social support
2. Co-occurring physical or mental health
problem such as a substance use disorder,
TBI, depression, or anxiety
3. Single or compounded losses
4. Contributing genetic factors
5. Early life ordeals or upheavals (parents
divorce, abandonment, abuse, neglect, &
bullying)
Cost of TRI and PTSD
 The cost to our medical care system for PTSD
and TRI is in the billions of dollars annually,
and is compounded by misdiagnosis and
improper treatment
 Beyond treatment costs, there are the related
workplace, drug, associated illness,
disabilities, and mortality costs
 Fortunately, an estimated 80%-90% of
persons exposed to the various types of severe
trauma will not develop PTSD
“Traumatic experience can have a
profound effect on one person and
very little impact on another”
 Predisposing — vulnerability factors — are
important deciders
 Where there is more exposure to traumatic
experiences, there is a greater chance of TRI
 Most people won't develop TRI, but instead
enhance their resilience
Intermittent or chronic emotional or
physical symptoms of TRI or PTSD #1
o Re-living: relive the ordeal through thoughts
and intrusive memories of the trauma —
including flashbacks, hallucinations,
nightmares, feeling great distress when
reminded of the trauma, acting and feeling as
if the trauma were recurring
o Feeling numb: avoiding people, places,
thoughts or situations that are reminders of
the trauma, inability to recall aspects of the
trauma; feeling of detachment or
estrangement from others; isolation and
withdrawal (freeze response)
Intermittent or chronic emotional or
physical symptoms of TRI or PTSD #2
o Loss of interest in once enjoyed activities,
difficulty relating to others, experiencing love,
joy, or intimacy – a restricted range of
feelings, interest, and activities
o Sense of a foreshortened future
o Increased arousal as: excessive emotions,
worry and guilt, difficulty falling or staying
asleep, feeling nervous, fearful, increased
irritability, outbursts of anger, agitation, and
difficulty concentrating (flight, fight response)
Intermittent or chronic emotional or
physical symptoms of TRI or PTSD #3
o Hypervigilant, guarded, and constantly
alert; physiologic reactivity upon exposure to
trauma cues and having exaggerated startled
responses – being jumpy, panic attacks
o Experiencing worsening physical symptoms
and medical problems, e.g., increased blood
pressure, heart rate, fatigue, rapid breathing,
muscle tension, headaches, sweating, digestive
problems as poor appetite, and diarrhea
Intermittent or chronic emotional or
physical symptoms of TRI or PTSD #4
 Feelings of hopelessness, helplessness,
shame, despair or sadness
 Self-blame, negative views of oneself or the
world and distrust of others
 Family, employment or school problems
 Relationship problems including conflicts,
being over-controlling, violence, and divorce
 Failure to engage in exercise, diet, safe sex,
or regular health care
 Excess smoking, alcohol and drugs problems
Recognition, then a
comprehensive approach
including:
 Prevention and avoidance of re-traumatization
 Earlier recognition of the acute and lingering effects
of trauma and timely interventions
 Assessment, diagnosis, and investigation into
contributing factors, as TBI or developmental issues
 Application of holistic, integrative and innovative
treatments
 Restoration of health, well-being, sleep, autonomic
regulation, interpersonal and daily functioning
Role of Integrative Medicine &
Psychiatry
 A caring and holistic approach with an integration of
environmental, functional medicine, traditional
psychiatry, nutrition and evidenced based alternatives
 Attention to: physical, psychological, emotional,
behavioural, biochemical, genetic, nutritional,
environmental, interpersonal, developmental, family
history, spiritual, and lifestyle issues
Assessment and treatment of malfunction in complex
integrated biologic systems
Goal of restoring functionality, health, & well-being
The tools of integrated psychiatry,
medicine, and psychology
 In-depth clinical history
 Psycho-social assessment
 Physical examination and laboratory testing
 Psychological testing
 Consulting with significant others – treatment
team, family members and friends when
possible
 Comprehensive treatment programs
Treatment considerations for TRI and
PTSD
 Lifestyle and nutritional modifications
 Reduction in psycho-social stressors
 Individual and group psychotherapies that
address current, past, developmental, and
trauma issues
 Interventions as suggested by clinical finding,
treatment team and lab testing
 Medication use after other contributing
factors have been addressed, and when nonmedication interventions have failed
Team or network approach for TRI
would include:
• Health care practitioners and therapists experienced
and trained in trauma work
• Individual, group, behavioral or cognitive
behavioral therapy (CBT) psychotherapies
• Exposure therapy, trauma-focused cognitive
behavioral therapy, trauma systems therapy
• Somatic experiencing, Eye Movement
Desensitization and Reprocessing (EMDR),
Emotional Freedom Technique, Reset, BAUD
• Transpersonal, Spiritual Emergence Therapies, and
other natural alternatives or medication
Medications commonly considered:
o Selective serotonin re-uptake inhibitors for
depression and anxiety (SSRIs; e.g.,
fluoxetine, sertraline)
o Symptomatic treatments with sleep agents or
more helpful for trauma-related nightmares
in adults — Prazosin — an anti-hypertensive
o Benzodiazepines (tranquilizers)— long-term
use does not appear beneficial and difficult to
wean and stop
o β-blockers — used to reduce arousal but of
questionable benefit
Simple vs complex trauma
a. Simple trauma – one incident without
compounding or related problems
b. Complex trauma – multiple layering on of
traumatic experiences and associated
problems
c. Corrective interventions to alleviate
compounding issues as: infections, digestive
disturbance, nutritional, metabolic, or
hormonal imbalances, allergies, drug, alcohol
addictions, emotional, mood, pain, sleep
problems, personal, or family stressors
Emerging Therapies
 Symptoms or crisis become the doorway to
growth, change in personal and spiritual life
 New paradigm, as Spiritual Emergence,
Transpersonal Psychology, where
presentation is not seen as pathology, but as a
gateways to healing and transformation
 Emphasis on resolution of core issues,
underlying problems and dynamics,
 Assisting positive change in personality,
development of compassion, openness,
flexibility, insightfulness, and resilience
References
 All of the information on the following
slides and references can be found in
article by Dr. Parks at:
http://ronparksmd.com/ptsd-terror-traumaholistic-approach/
 Also review other relevant articles on Dr.
Parks’ blog http://ronparksmd.com/
 For information on Center for Spiritual
Emergence in Asheville, NC
http://www.centerforspiritualemergence.com/
“The Truth”
۞
"Don't seek the truth. Just cease to
cherish opinions." -- Zen saying
"Old School"