Victims of violence and post-traumatic stress disorder

PTSD can occur in victims of violence. It is not known whether PTSD is caused by the psychological reaction of helplessness, shame, and guilt in the face of a traumatic stressor, whether there is some sort of fundamental psychobiologic change in the CNS in response to a stressor, or whether psychological reactions lead to biologic changes and both then coexist. PTSD after experiencing violence is characterized by re-experiencing phenomena, numbing or the avoidance of stimuli associated with the violent event, and symptoms of increased arousal. The disorder may begin immediately after the trauma or onset may be delayed for months or even years. Even after PTSD is resolved, it can return years later in response to an event that reminds the trauma victim of his earlier experience. Treatment consists of individual psychotherapy, family therapy, group therapy, and a range of pharmacotherapeutic interventions. Experimental therapies are being developed such as those that combine narcosynthesis and talking therapy, and descriptions of these appear in the literature. It is important for the psychiatrist attempting individual psychotherapy of a sufferer of PTSD for the first time to consider supervision with a colleague who possesses expertise in treating the disorder, for many treatment efforts fail because of countertransference reactions. Similarly, those who employ other forms of talking therapy will benefit from supervision.