1. Introduction
15 April 2013 runners and spectators took their places on the streets of Boston to take part in the very popular Boston marathon. Supporting friends and family across the finish line and running those last meters for a well deserved congratulations, not at all suspecting that close to where they were having an amazing time as families and friends were two pressure cooker bombs filled with ball bearings were about to explode leaving 170 injured and 3 dead, one of who was 8 year old Martin Richard. Whose mother and sister were severely injured in the explosion. (Hosken, 2013) This certainly was a horrible experience for the Richard family and for many others who were there in-between it all when it happened most likely having them develop PTSD. Traumatic experiences such as this one would often leave the people feeling shaken and disturbed and even though there would be numerous individuals with PTSD this essay will focus on the Richard family and how what they have gone through would be a great cause for them developing PTSD. (Train, 2009) This essay will discuss PTSD thoroughly looking at the following aspects. The clinical description, epidemiology, etiology, the diagnostic criteria according to the DSM-IV-TR and lastly the treatment and prognosis will all be discussed in this essay making reference to the Richard family for a clearer understanding of PTSD. 2. Clinical Description A traumatic experience can be described as exposure to an event where someone feels fear, helplessness or horror. (Barlow, 2012) Where victims such as the Richard family may experience some afterward effects of the bombing. First thing that people with PTSD may experience after a traumatic experience is flashbacks. (Barlow, 2012) The victims will reexperience the event through memories and nightmares. These memories and nightmares are usually accompanied by strong emotions and they would find themselves reliving the event. (Barlow, 2012) Flashbacks also occur suddenly and without warning as people with PTSD will avoid anything that reminds them of the trauma. Interpersonal relationships may also be disrupted by the victims displaying a characteristic restriction or numbering of emotional responsiveness. (Barlow, 2012) They may also develop a defence mechanism which is the unconscious protective process that protect us from being consciously aware of a thought or feeling which we cannot tolerate. In other words defence mechanisms allow thoughts and feelings to be expressed indirectly in a disguise form. (Barlow, 2012) Two most likely defence mechanisms that will occur in the case of the Richard family are denial, which is that they would at first completely reject what happened or suppression of the event where they only vaguely remember what happened and will be unable to remember some aspects of the event. (Barlow, 2012) Victims of a traumatic experience such as the Boston Marathon will possibly become on high alert and will be chronically overaroused and will be easily startled and even be quick to anger. (Barlow, 2012)
PTSD has three subdivisions namely acute PTSD which can be diagnosed 1 month after the event occurs. When it lasts longer than 3 months, is considered as chronic PTSD, and these individuals are usually associated with more prominent avoidance behaviours. (Barlow, 2012) Then there is PTSD with delayed onset which is when individuals show few or no symptoms immediately after trauma, but later, perhaps even years afterward, they develop full blown PTSD. (Barlow, 2012) Because PTSD cannot be diagnosed until a month after the trauma the DSM-IV-TR added a new disorder called acute stress disorder. (Barlow, 2012) This is really PTSD occurring within the first month after the trauma. Most of the victims of the Boston Marathon will go through the acute stress disorder, but some will probably develop acute PTSD and some even chronic PTSD if they do not get treatment immediately. (Barlow, 2012) 3. Epidemiology
First of all epidemiological studies have certain objectives, these objectives are: (Dohrenwend, 1981)The most compelling objective for an epidemiological study is to determine the rates of specific disorders so that society can properly analyze the parameters of a problem, establish an effective public policy regarding it, and, in the case of mental health disorders, provide the mechanisms for funding scientific study and the clinical services needed to treat disorders. (Dohrenwend, 1981) The second objective of epidemiological studies is to have a further understanding of the many factors that influence proper functioning in our society and culture. (Dohrenwend, 1981)The third objective of, epidemiological studies help us to understand more fully how our society and culture function, giving us normative information about the presence and absence of certain problems. (Dohrenwend, 1981)The range of issues examined can be health, mental health, opinions, occupation, habits, personal characteristics, etc. Data on these variables commonly appear in our scientific literature, but also appear regularly in the mass media. (Dohrenwend, 1981)Studies on health and behaviour, and the consequences of life experiences, are inherently interesting to members of Western societies. (Barlow. 2012.) Epidemiological studies provide this information and thereby afford us the opportunity to better understand ourselves and others, while providing the justification for societal action on specific issues. (Barlow. 2012.)
Rape has the most significant emotional impact. Compared to 2.2% of non-victims, 19.2% of rape victims had attempted suicide, and 44% reported suicidal ideation at some time following the rape. (Barlow. 2012.) It was found that 32% of rape victims met criteria for PTSD at some point in their lives. (Barlow. 2012.) Taylor and Koch (1995) found that 15% to 20% of people experiencing server auto accidents developed PTSD. (Barlow. 2012.) Other surveys indicated that among the population as a whole, 6.8% have experienced PTSD at some point in their life and 3.5% during the past year and combat and sexual assault are the most common precipitating traumas. (Barlow. 2012.) The fact that a diagnosis of PTSD predicts suicidal attempts independently of any other problem, such as alcohol abuse, has recently been confirmed. (Barlow. 2012.)
Close exposure to the trauma seems to be necessary to developing this disorder. But this is also evident among veterans, where 18.7% developed PTSD, with prevalence rates directly related to amount of combat exposure. The connection between proximity to traumatic event and the development of PTSD was starkly evident following the tragedy of 9/11. (Barlow. 2012.) People who were personally affected by the disaster were the ones that were that were mostly affected. It is also know that once it appears PTSD tends to last. (Barlow. 2012.) Although some people experience the most horrifying traumas imaginable they will emerge psychologically healthy. (Barlow. 2012.) For others, even relatively mild stressful events are sufficient to produce full blown PTSD. To understand how this can happen the etiology of PTSD should be looked at. (Barlow. 2012.)

4. Etiology
The real cause for someone developing PTSD is when he/she experiences a trauma and develops the disorder. (Barlow. 2012.) But like it has been mentioned before some people will have no PTSD after a traumatic experience while others will get full blown PTSD. So what is the reason behind that for happening? Well whether a person develops PTSD is a surprisingly complex issue involving biological, psychological or social factors. (Barlow. 2012.)
As with other disorders people bring their own biological and psychological vulnerabilities with them. (Barlow. 2012.) The greater the vulnerability, the more likely they are to develop PTSD. (Barlow. 2012.) If certain characteristics run in your family you have a greater chance of him/her to develop the disorder. (Barlow. 2012.) A family history of anxiety suggests a generalized biological vulnerability for PTSD. (Barlow. 2012.) Nevertheless, as with other disorders, there is little or no evidence that genes directly cause PTSD. (Barlow. 2012.) Rather, genetic factors predispose individuals to be easily stressed and anxious, which then may make it more likely that traumatic experience will result in PTSD. (Barlow. 2012.) Social factors play a major role in the development of PTSD. (Barlow. 2012.) The results from a number of studies are consistent in showing that, if someone has a strong and supportive group of people around them, it is less likely that, that person will develop PTSD after a trauma. (Barlow. 2012.)
For example the Richard family, had one of the greatest tragedies that day. Martin Richard being killed in the explosion, his sister losing her leg and his mother also being severely injured. (Hosken, 2013) The family members are going to have a very though time and whether they have a strong support group and predisposition within their family will determine whether they will develop PTSD. As it will not have been an easy thing to go through as a family. 5. Diagnostic criteria
DSM-IV-TR Criteria for Post-Traumatic Stress Disorder
How Psychiatrists and Psychologists diagnose and describe PTSD
A. The person has been exposed to a traumatic event in which both of the following were present: (1) The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. (2) The person’s response involved intense fear, helplessness, or horror.
Note: in children this may be expressed by disorganized or agitated behaviour.
B. The event is persistently re-experienced in one or more of the following ways: (1) Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. (2) Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content.
(3) Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).
Note: in young children, trauma-specific re-enactment may occur.
(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma) as indicated by three or more of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) Inability to recall an important aspect of the trauma
(4) Markedly diminished interest or participation in significant activities
(5) Feeling of detachment or estrangement from others
(6) Restricted range of affect (e.g. unable to have loving feelings)
(7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:
(1) Difficulty falling or staying asleep
(2) Irritability or bursts of anger
(3) Difficulty concentrating
(4) Hypervigilance
(5) Exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria A, B, C, & D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: 1. Acute: duration of symptoms less than 3 months 2. Chronic: duration of symptoms 3 months or more
Specify with:
With delayed onset: onset of symptoms is at least 6 months after the event.

6. Treatment and Prognosis

From the psychological point of view, most clinicians agree that victims of PTSD should face the original trauma, process the intense emotions, and develop effective coping procedures in order to overcome the debilitating effects of the disorder. (Barlow. 2012.) Available treatments of PTSD include the following: (Barlow. 2012.)

7.1. Psychotherapy
Some of the psychotherapy methods that can assist in helping someone with PTSD are. (Anon., 2011) Cognitive Behaviour therapy (CBT) which is the most effective to recovering from PTSD CBT usually involves meeting with your therapist once a week for up to four months. (Anon., 2011) There are different types of cognitive behavioural therapy. The two most-researched types of CBT for PTSD are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). (Anon., 2011)

CPT
CPT can give you skills to handle these distressing thoughts. (Anon., 2011) It helps you understand what you went through and how the trauma changed the way you look at the world, yourself, and others. (Anon., 2011) In CPT, you will focus on examining and challenging thoughts about the trauma. (Anon., 2011) By changing your thoughts, you can change the way you feel. (Anon., 2011)
CPT has four main parts: * Learning about your PTSD symptoms and how treatment can help (Anon., 2011) * Becoming aware of your thoughts and feelings (Anon., 2011) * Learning skills to challenge your thoughts and feelings (cognitive restructuring) (Anon., 2011) * Understanding the common changes in beliefs that occur after going through trauma (Anon., 2011)
In addition to regular meetings with your therapist, you will get practice assignments to help you use your new skills outside of therapy. (Friedman, 2012)

Prolong exposure therapy (PE)

Repeated exposure to thoughts, feelings, and situations that you have been avoiding helps you learn that reminders of the trauma do not have to be avoided. (Anon., 2011) In PE, you and your therapist will identify the situations you have been avoiding. (Anon., 2011) You will repeatedly confront those situations until your distress decreases. (Anon., 2011)
Here patients may go through systematic desensitization as a therapy to help them overcome PTSD. (Anon., 2011)
PE has four parts: * Education: to learn about your symptoms and how treatment can help (Anon., 2011) * Breathing retraining: to help you relax and manage distress (Anon., 2011) * Real world practice (• in vivo exposure): to reduce your distress in safe situations you have been avoiding (Anon., 2011) * Talking through the trauma (imaginal exposure): • to get control of your thoughts and feelings about the trauma (Anon., 2011)
PE usually involves 8–15 sessions with a therapist, plus practice assignments you will do on your own. With time and practice, you learn to manage your reactions to stressful memories. (Anon., 2011)

Eye Movement Desensitization and Reprocessing (EMDR)

In EMDR, you focus on hand movements or tapping while you talk about the traumatic event. (Anon., 2011)The idea is that the rapid eye movements make it easier for our brains to work through the traumatic memories. (Anon., 2011) Focusing on hand movements or sounds while you talk about the traumatic event may help change how you react to memories of your trauma over time. (Anon., 2011) You also learn skills to help you relax and handle emotional distress. (Anon., 2011) EMDR has four main parts: * Identification of a target memory, image, and belief about the trauma. (Anon., 2011) * Desensitization and reprocessing: focusing on mental images while doing eye movements that the therapist has taught you (Anon., 2011) * Installing positive thoughts and images, once the negative images are no longer distressing (Anon., 2011) * Body scan: focusing on tension or unusual sensations in the body, to identify additional issues you may need to address in later sessions. (Anon., 2011)
Over time, EMDR can change how your react to memories of your trauma. (Anon., 2011) A course of four to twelve sessions is common. (Anon., 2011)

7.2. Medication

Selective Serotonin reuptake inhibitors (SSRI’s)
They are the most popular medication when it comes to depression, because they increase the amount of serotonin. (Banich, 2012) The best know SSRI’s are fluoxetine, which is commercially known as Prozac. (Banich, 2012) They can be very helpful in reducing depression but they have many side effects such as they can interfere with sleep, reduce appetite, and have deleterious effects on sexual performance making an individual incapable of orgasm. (Banich, 2012)

7. Conclusion

Many of us have had a traumatic experience — the death of a loved one, serious illness, divorce. At the time, we may have been very upset, or frightened, or sad. But usually the grief passes, the pain lessens over time, and life eventually becomes more normal. But sometimes people experience life-threatening or life-changing situations that are so distressing or cruel that the memory doesn’t fade, not even slightly. For some people, the experience is so extreme that they find they cannot get passed it to move on with life. Someone who feels this way may be suffering from posttraumatic stress disorder, or PTSD, a very real and debilitating health condition.
Fortunately, a lot has been learned in the last several years about PTSD treatment and support. Understanding PTSD and seeking intervention is important to treating the persistent and overwhelming symptoms, and helping people to regain their lives. This essay took a deeper look at PTSD and all the different aspects, and what was discussed was that if someone is directly part of a traumatic experience they are more likely to develop PTSD but if they receive treatment either through psychotherapy or medication they will overcome the PTSD and carry on as they did before the traumatic experience.

Reference List
American Psychiatric Association (2000). Desk reference to the diagnostic criteria from DSM-IV-TR. Washington, DC: American Psychiatric Press.

Anonymous. (2011). Understanding PTSD treatment. National centre of PTSD. Retrieved 2013/04/15 from www.ptsd.va.gov
Banich, M.T., & Compton, R.J. (2011). Cognitive Neuroscience (3rd end) Wadsworth: Cengage Learning.
Barlow, D.H., & Durand, V.M. (2012). Abnormal psychology: an integrative approach. Wadsworth: Cengange Learning.
Dohrenwend, B.D. & Shrout, P.B. (1981). Toward the development of a two-stage procedure for case identification and classification in psychiatry epidemiology. Research in Community and Mental Health, 2, 295-323.
Friedman, H.S.,& Schustack, M.W. (2012). Personality: classic theories and modern research (5th end.). Boston: Pearson
Hosken, G. (2013). Tsunami of panic. The times Wendsday April 17 2013. P1
Train, B., Ahmed, R., Bandawe, C.,Cockcroft, K., Crafford, A., Greenop, K., Stacey, M., Tomilson, M., Tommy, J., Dale-Jones, B. (2009). Introduction to psychology: fresh perspectives. Cape Town: Pearson Education South Africa.