In medicine , traumatology (from Greek trauma , meaning injury or wound) is the study of wounds and injuries caused by accidents or violence to a person, and the surgical therapy and repair of the damage. Traumatology is a branch of medicine . It is often considered a subset of surgery and in countries without the specialty of trauma surgery it is most often a sub-specialty to orthopedic surgery . Traumatology may also be known as accident surgery .
61-410: Branches of traumatology include medical traumatology and psychological traumatology . Medical traumatology can be defined as the study of specializing in the treatment of wounds and injuries caused by violence or general accidents. This type of traumatology focuses on the surgical procedures and future physical therapy a patient needs to repair the damage and recover properly. Psychological traumatology
122-412: A norepinephrine /cortisol ratio consequently higher than comparable non-diagnosed individuals. This is in contrast to the normative fight-or-flight response , in which both catecholamine and cortisol levels are elevated after exposure to a stressor. Brain catecholamine levels are high, and corticotropin-releasing factor (CRF) concentrations are high. Together, these findings suggest abnormality in
183-636: A child with chronic illnesses. Research exists which demonstrates that survivors of psychotic episodes , which exist in diseases such as schizophrenia , schizoaffective disorder , bipolar I disorder , and others, are at greater risk for PTSD due to the experiences one may have during and after psychosis. Such traumatic experiences include, but are not limited to, the treatment patients experience in psychiatric hospitals , police interactions due to psychotic behavior, suicidal behavior and attempts, social stigma and embarrassment due to behavior while in psychosis, frequent terrifying experiences due to psychosis, and
244-537: A loved one accounts for approximately 20% of PTSD cases worldwide. Medical conditions associated with an increased risk of PTSD include cancer, heart attack, and stroke. 22% of cancer survivors present with lifelong PTSD like symptoms. Intensive-care unit (ICU) hospitalization is also a risk factor for PTSD. Some women experience PTSD from their experiences related to breast cancer and mastectomy . Loved ones of those who experience life-threatening illnesses are also at risk for developing PTSD, such as parents of
305-482: A loved one is the most common traumatic event type reported in cross-national studies. However, the majority of people who experience this type of event will not develop PTSD. An analysis from the WHO World Mental Health Surveys found a 5.2% risk of developing PTSD after learning of the unexpected death of a loved one. Because of the high prevalence of this type of traumatic event, unexpected death of
366-486: A maladaptive learning pathway to fear response through a hypersensitive, hyperreactive, and hyperresponsive HPA axis. Low cortisol levels may predispose individuals to PTSD: Following war trauma, Swedish soldiers serving in Bosnia and Herzegovina with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD symptoms, following war trauma, than soldiers with normal pre-service levels. Because cortisol
427-470: A marker of microglial activation ( 18-kDa translocator protein ) following lipopolysaccharide administration. This neuroimmune suppression is also associated with greater severity of anhedonic symptoms. Researchers suggest that treatments aimed at restoring neuroimmune function could be beneficial for alleviating PTSD symptoms. A meta-analysis of structural MRI studies found an association with reduced total brain volume, intracranial volume, and volumes of
488-463: A non-life-threatening traffic accident, and a similar proportion of children develop PTSD. Risk of PTSD almost doubles to 4.6% for life-threatening auto accidents. Females were more likely to be diagnosed with PTSD following a road traffic accident , whether the accident occurred during childhood or adulthood. Post-traumatic stress reactions have been studied in children and adolescents. The rate of PTSD might be lower in children than adults, but in
549-430: A smaller hippocampus might be more likely to develop PTSD following a traumatic event based on preliminary findings. Research has also found that PTSD shares many genetic influences common to other psychiatric disorders. Panic and generalized anxiety disorders and PTSD share 60% of the same genetic variance. Alcohol, nicotine, and drug dependence share greater than 40% genetic similarities. PTSD symptoms may result when
610-413: A state of fear and hyper-arousal. Exercising for thirty minutes a day facilitated the nervous system to "unfreeze" from a traumatic state. Being surrounded by a good support system is a powerful factor in treating psychological trauma. Participating in social activities, volunteering, and making new friends are all ways to help forget about or cope with traumatic events. Coming to terms with childhood trauma
671-437: A teenager in a car accident who broke his wrist and needed extensive surgery to save his arm may experience anxiety when driving in a car post-accident. PTSD can be diagnosed after a person experiences one or more intense and traumatic events and react with fear with complaints from three categorical symptoms lasting one month or longer. These categories are: re-experiencing the traumatic event, avoiding anything associated with
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#1732855033483732-457: A term that has at least two meanings. He urged clarity of communications as this new field expands; indeed, expansion is often built upon and facilitated by clarity of communications fostered by sematic precision. In a rebuttal of sorts, Donovan (1993) argued for a term broader in scope than traumatic stress studies, the phrase that has been used historically to unite the field. Clearly Schnitt's (1993) commentary offers insight to be considered. There
793-401: A traumatic event causes an over-reactive adrenaline response, which creates deep neurological patterns in the brain. These patterns can persist long after the event that triggered the fear, making an individual hyper-responsive to future fearful situations. During traumatic experiences, the high levels of stress hormones secreted suppress hypothalamic activity that may be a major factor toward
854-444: A traumatic event in adulthood. It has been difficult to find consistently aspects of the events that predict, but peritraumatic dissociation has been a fairly consistent predictive indicator of the development of PTSD. Proximity to, duration of, and severity of the trauma make an impact. It has been speculated that interpersonal traumas cause more problems than impersonal ones, but this is controversial. The risk of developing PTSD
915-747: A two-fold increased risk of death, with the leading causes of death being ischemic heart disease or cancers of the respiratory tract including lung cancer . Persons considered at risk for developing PTSD include combat military personnel, survivors of natural disasters, concentration camp survivors, and survivors of violent crime. Persons employed in occupations that expose them to violence (such as soldiers) or disasters (such as emergency service workers) are also at risk. Other occupations at an increased risk include police officers, firefighters, ambulance personnel, health care professionals, train drivers, divers, journalists, and sailors, as well as people who work at banks, post offices or in stores. The intensity of
976-597: A wide range of traumatic events. The risk of developing PTSD after a traumatic event varies by trauma type and is the highest following exposure to sexual violence (11.4%), particularly rape (19.0%). Men are more likely to experience a traumatic event (of any type), but women are more likely to experience the kind of high-impact traumatic event that can lead to PTSD, such as interpersonal violence and sexual assault . Motor vehicle collision survivors, both children and adults, are at an increased risk of PTSD. Globally, about 2.6% of adults are diagnosed with PTSD following
1037-440: Is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault , warfare , traffic collisions , child abuse , domestic violence , or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma -related cues, attempts to avoid trauma-related cues, alterations in
1098-442: Is a type of damage to one's mind due to a distressing event. This type of trauma can also be the result of overwhelming amounts of stress in one's life. Psychological trauma usually involves some type of physical trauma that poses as a threat to one's sense of security and survival. Psychological trauma often leaves people feeling overwhelmed, anxious , and threatened. Trauma can also be classified as: Secondary or vicarious trauma,
1159-501: Is also associated with PTSD. There is evidence that susceptibility to PTSD is hereditary . Approximately 30% of the variance in PTSD is caused from genetics alone. For twin pairs exposed to combat in Vietnam, having a monozygotic (identical) twin with PTSD was associated with an increased risk of the co-twin's having PTSD compared to twins that were dizygotic (non-identical twins). Women with
1220-501: Is also higher if people around the survivor ignore (or are ignorant of) the rape or blame the rape survivor. Military service in combat is a risk factor for developing PTSD. Around 22% of people exposed to combat develop PTSD; in about 25% of military personnel who develop PTSD, its appearance is delayed. Refugees are also at an increased risk for PTSD due to their exposure to war, hardships, and traumatic events. The rates for PTSD within refugee populations range from 4% to 86%. While
1281-418: Is another essential guideline when it comes to medical trauma care. Nurses are required to watch over patients and check blood pressure , heart rate , etc. to make sure that patients are doing well and are not crashing . When it comes to managing injuries, head and neck injuries require the most care post surgery. Head injuries are one of the major causes of trauma related death and disabilities worldwide. It
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#17328550334831342-468: Is another form of trauma in which a person develops trauma symptoms from close contact with someone who has experienced a traumatic event. When it comes to types of trauma, medical and psychological traumatology go hand in hand. Types of trauma include car accidents , gunshot wounds , concussions , PTSD from incidents, etc. Medical traumas are repaired with surgeries; however, they can still cause psychological trauma and other stress factors. For example,
1403-810: Is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder ). Some following a traumatic event experience post-traumatic growth . Trauma survivors often develop depression, anxiety disorders, and mood disorders in addition to PTSD. More than 50% of those with PTSD have co-morbid anxiety , mood or substance use disorders . Substance use disorder , such as alcohol use disorder , commonly co-occur with PTSD. Recovery from post-traumatic stress disorder or other anxiety disorders may be hindered, or
1464-429: Is especially challenging. Factors in the assessment of wounds are: Forensic physicians, as well as pathologists may also be required to examine ( traumatic ) wounds on people. Psychotraumatology Psychotraumatology is the study of psychological trauma . Specifically, this discipline is involved with researching, preventing, and treating traumatic situations and people's reactions to them. It focuses on
1525-428: Is important for patients of head trauma to get CT scans post surgery to insure that there are no problems. There is a range of approaches to assist victims to overcome the anxiety and stress that follows psychological trauma . Affected persons can also follow self-care such as exercise and socializing with familiar and safe associates and family members. Trauma disturbs the body's natural equilibrium by putting it in
1586-404: Is increased in individuals who are exposed to physical abuse , physical assault , or kidnapping . Women who experience physical violence are more likely to develop PTSD than men. An individual that has been exposed to domestic violence is predisposed to the development of PTSD. There is a strong association between the development of PTSD in mothers that experienced domestic violence during
1647-533: Is normally important in restoring homeostasis after the stress response, it is thought that trauma survivors with low cortisol experience a poorly contained—that is, longer and more distressing—response, setting the stage for PTSD. It is thought that the locus coeruleus-noradrenergic system mediates the over-consolidation of fear memory. High levels of cortisol reduce noradrenergic activity, and because people with PTSD tend to have reduced levels of cortisol, it has been proposed that individuals with PTSD cannot regulate
1708-418: Is significant potential for ambiguity in the use of traumatology as a unifying term for the field of psychological trauma. Donovan (1993) argues that the term is "socially influential as well as conceptually and pragmatically useful" (p. 41 0). The potential ambiguity serves to diminish the promised pragmatics, but the lack of sematic precision is easily corrected. In 1995, the addition of the prefix psycho- to
1769-423: Is similar to PTSD, but has a distinct effect on a person's emotional regulation and core identity. Prevention may be possible when counselling is targeted at those with early symptoms, but is not effective when provided to all trauma-exposed individuals regardless of whether symptoms are present. The main treatments for people with PTSD are counselling (psychotherapy) and medication. Antidepressants of
1830-406: Is used in the present context to define or order the conduct of inquiry and the categorization of information relevant to psychological trauma. Psychotraumatology may be defined as the study of psychological trauma; more specifically, the study of the processes and factors that lie (a) antecedent to, (b) concomitant with, and (c) subsequent to psychological traumatization (Everly, 1992; 1993). Since
1891-464: The SSRI or SNRI type are the first-line medications used for PTSD and are moderately beneficial for about half of people. Benefits from medication are less than those seen with counselling. It is not known whether using medications and counselling together has greater benefit than either method separately. Medications, other than some SSRIs or SNRIs, do not have enough evidence to support their use and, in
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1952-520: The hippocampus , insula cortex , and anterior cingulate . Much of this research stems from PTSD in those exposed to the Vietnam War. People with PTSD have decreased brain activity in the dorsal and rostral anterior cingulate cortices and the ventromedial prefrontal cortex , areas linked to the experience and regulation of emotion. The amygdala is strongly involved in forming emotional memories, especially fear-related memories. During high stress,
2013-421: The hippocampus , which is associated with placing memories in the correct context of space and time and memory recall, is suppressed. According to one theory, this suppression may be the cause of the flashbacks that can affect people with PTSD. When someone with PTSD undergoes stimuli similar to the traumatic event, the body perceives the event as occurring again because the memory was never properly recorded in
2074-512: The hypothalamic-pituitary-adrenal (HPA) axis . The maintenance of fear has been shown to include the HPA axis, the locus coeruleus - noradrenergic systems, and the connections between the limbic system and frontal cortex . The HPA axis that coordinates the hormonal response to stress, which activates the LC-noradrenergic system, is implicated in the over-consolidation of memories that occurs in
2135-432: The perinatal period of their pregnancy. Those who have experienced sexual assault or rape may develop symptoms of PTSD. The likelihood of sustained symptoms of PTSD is higher if the rapist confined or restrained the person, if the person being raped believed the rapist would kill them, the person who was raped was very young or very old, and if the rapist was someone they knew. The likelihood of sustained severe symptoms
2196-508: The thyroid hormone triiodothyronine in PTSD. This kind of type 2 allostatic adaptation may contribute to increased sensitivity to catecholamines and other stress mediators. Hyperresponsiveness in the norepinephrine system can also be caused by continued exposure to high stress. Overactivation of norepinephrine receptors in the prefrontal cortex can be connected to the flashbacks and nightmares frequently experienced by those with PTSD. A decrease in other norepinephrine functions (awareness of
2257-592: The 1970s, in large part due to the diagnoses of U.S. military veterans of the Vietnam War . It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). Symptoms of PTSD generally begin within the first three months after the inciting traumatic event, but may not begin until years later. In
2318-1008: The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV), revealed that 22% of cancer survivors present with lifetime cancer-related PTSD (CR-PTSD), endorsing cancer diagnosis and treatment as a traumatic stressor. Therefore, as the number of people diagnosed with cancer increases and cancer survivorship improves, cancer-related PTSD becomes a more prominent issue, and thus, providing for cancer patients' physical and psychological needs becomes increasingly important. Evidence‐based treatments such as eye movement desensitization and reprocessing (EMDR) therapy and cognitive-behavioral therapy (CBT) are available for PTSD, and indeed, there have been promising reports of their effectiveness in cancer patients. Women who experience miscarriage are at risk of PTSD. Those who experience subsequent miscarriages have an increased risk of PTSD compared to those experiencing only one. PTSD can also occur after childbirth and
2379-480: The HPA axis by dexamethasone . Studies on the peripheral immune have found dysfunction with elevated cytokine levels and a higher risk of immune-related chronic diseases among individuals with PTSD. Neuroimmune dysfunction has also been found in PTSD, raising the possibility of a suppressed central immune response due to reduced activity of microglia in the brain in response to immune challenges. Individuals with PTSD, compared to controls, have lower increase in
2440-769: The absence of therapy, symptoms may continue for decades. One estimate suggests that the proportion of children and adolescents having PTSD in a non-wartorn population in a developed country may be 1% compared to 1.5% to 3% of adults. On average, 16% of children exposed to a traumatic event develop PTSD, with the incidence varying according to type of exposure and gender. Similar to the adult population, risk factors for PTSD in children include: female gender , exposure to disasters (natural or man-made), negative coping behaviors, and/or lacking proper social support systems. Predictor models have consistently found that childhood trauma, chronic adversity, neurobiological differences, and familial stressors are associated with risk for PTSD after
2501-591: The adoption of new evidence based models in trauma treatment a new specialization in psychotherapy has emerged, the psychotraumatologist. According to the International Psychotraumatology Association a Psychotraumatologist standard of education and ethics: A Licensed Clinical Psychotherapist or Psychiatrist with knowledge and training: There are three main sub-specialization in the psychotraumatology field: Posttraumatic stress disorder Post-traumatic stress disorder ( PTSD )
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2562-610: The aftermath of trauma. This over-consolidation increases the likelihood of one's developing PTSD. The amygdala is responsible for threat detection and the conditioned and unconditioned fear responses that are carried out as a response to a threat. The HPA axis is responsible for coordinating the hormonal response to stress. Given the strong cortisol suppression to dexamethasone in PTSD, HPA axis abnormalities are likely predicated on strong negative feedback inhibition of cortisol, itself likely due to an increased sensitivity of glucocorticoid receptors . PTSD has been hypothesized to be
2623-502: The case of benzodiazepines , may worsen outcomes. In the United States, about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life. In much of the rest of the world, rates during a given year are between 0.5% and 1%. Higher rates may occur in regions of armed conflict . It is more common in women than men. Symptoms of trauma-related mental disorders have been documented since at least
2684-501: The commonly associated behavioral symptoms such as anxiety, ruminations, irritability, aggression, suicidality, and impulsivity. Serotonin also contributes to the stabilization of glucocorticoid production. Dopamine levels in a person with PTSD can contribute to symptoms: low levels can contribute to anhedonia , apathy , impaired attention , and motor deficits; high levels can contribute to psychosis , agitation , and restlessness. hasral studies described elevated concentrations of
2745-550: The condition worsened, when substance use disorders are comorbid with PTSD. Resolving these problems can bring about improvement in an individual's mental health status and anxiety levels. PTSD has a strong association with tinnitus , and can even possibly be the tinnitus' cause. In children and adolescents, there is a strong association between emotional regulation difficulties (e.g. mood swings, anger outbursts, temper tantrums ) and post-traumatic stress symptoms, independent of age, gender, or type of trauma. Moral injury ,
2806-573: The current environment) prevents the memory mechanisms in the brain from processing the experience, and emotions the person is experiencing during a flashback are not associated with the current environment. There is considerable controversy within the medical community regarding the neurobiology of PTSD. A 2012 review showed no clear relationship between cortisol levels and PTSD. The majority of reports indicate people with PTSD have elevated levels of corticotropin-releasing hormone , lower basal cortisol levels, and enhanced negative feedback suppression of
2867-422: The development of PTSD. PTSD causes biochemical changes in the brain and body, that differ from other psychiatric disorders such as major depression . Individuals diagnosed with PTSD respond more strongly to a dexamethasone suppression test than individuals diagnosed with clinical depression . Most people with PTSD show a low secretion of cortisol and high secretion of catecholamines in urine , with
2928-540: The fear of losing control or actual loss of control. The incidence of PTSD in survivors of psychosis may be as low as 11% and as high at 67%. Prevalence estimates of cancer‐related PTSD range between 7% and 14%, with an additional 10% to 20% of patients experiencing subsyndromal posttraumatic stress symptoms (ie, PTSS). Both PTSD and PTSS have been associated with increased distress and impaired quality of life, and have been reported in newly diagnosed patients as well as in long‐term survivors. The PTSD Field Trials for
2989-409: The feeling of moral distress such as a shame or guilt following a moral transgression, is associated with PTSD but is distinguished from it. Moral injury is associated with shame and guilt, while PTSD is associated with anxiety and fear. In a population based study examining veterans of the Vietnam War , the presence of PTSD and exposure to high level stressors on the battlefield were associated with
3050-502: The field of psychotraumatology. The term "psychotraumatology" was coined by George S. Everly, Jr. and Jeffrey M. Lating in the text entitled "Psychotraumatology" (1995). Donovan ( 1991) suggested that the term traumatology be used to unite the various endeavors within the field of traumatic stress studies. As Donovan notes, however, the term traumatology also denotes the branch of medicine that deals with wounds and serious injuries. Schnitt (1993) expressed concern over Donovan's choice of
3111-568: The increased noradrenergic response to traumatic stress. Intrusive memories and conditioned fear responses are thought to be a result of the response to associated triggers. Neuropeptide Y (NPY) has been reported to reduce the release of norepinephrine and has been demonstrated to have anxiolytic properties in animal models. Studies have shown people with PTSD demonstrate reduced levels of NPY, possibly indicating their increased anxiety levels. Other studies indicate that people with PTSD have chronically low levels of serotonin , which contributes to
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#17328550334833172-451: The risk increases if a woman has experienced trauma prior to the pregnancy. Prevalence of PTSD following normal childbirth (that is, excluding stillbirth or major complications) is estimated to be between 2.8 and 5.6% at six weeks postpartum, with rates dropping to 1.5% at six months postpartum. Symptoms of PTSD are common following childbirth, with prevalence of 24–30.1% at six weeks, dropping to 13.6% at six months. Emergency childbirth
3233-530: The root traumatology appears to clarify potential ambiguities and more clearly defines the conduct at hand. Such reasoning serves as the foundation for the choice of psychotraumatology as the title of this field published in the Volume of Psychotraumatology. There are three main categories that are looked at in psychotrauamatology: the factors before, during, and after a psychologically traumatizing event has occurred. Such factors include: The term psychotraumatology
3294-589: The stresses of war affect everyone involved, displaced persons have been shown to be more so than others. Challenges related to the overall psychosocial well-being of refugees are complex and individually nuanced. Refugees have reduced levels of well-being and a high rate of mental distress due to past and ongoing trauma. Groups that are particularly affected and whose needs often remain unmet are women, older people and unaccompanied minors. Post-traumatic stress and depression in refugee populations also tend to affect their educational success. Sudden, unexpected death of
3355-402: The study and treatment of post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) , but encompasses any adverse reaction after experiencing traumatic events, including dissociative disorders . Since 2021, Certified Trauma Professionals who have achieved a major level of training and clinical expertise can use the abbreviation PsyT after their names as a standard of recognition in
3416-495: The time of the ancient Greeks . A few instances of evidence of post-traumatic illness have been argued to exist from the seventeenth and eighteenth centuries, such as the diary of Samuel Pepys , who described intrusive and distressing symptoms following the 1666 Fire of London . During the world wars , the condition was known under various terms, including ' shell shock ', 'war nerves', neurasthenia and ' combat neurosis '. The term "post-traumatic stress disorder" came into use in
3477-489: The trauma field. The emergence of psychotraumatology as a field begins with the legitimization of PTSD as a psychological disorder. Symptoms of PTSD have been continuously reported in the context of war since the 6th century B.C., but it was not officially recognized as a valid disorder until it finally classified by the American Psychiatric Association (APA) in 1980. Once it was officially recognized as an issue, clinical research on PTSD increased dramatically, giving way to
3538-517: The trauma, and increased symptoms of increased psychological arousal . Airway management , monitoring, and management of injuries are all key guidelines when it comes to medical trauma care. Airway management is a key component of emergency on-scene care. Using a systematic approach, first responders must assess that a patient's airway is not blocked in order to ensure the patient gets enough circulation and remain as calm as they can. Monitoring patients and making sure their body does not go into shock
3599-442: The traumatic event is also associated with a subsequent risk of developing PTSD, with experiences related to witnessed death, or witnessed or experienced torture, injury, bodily disfigurement, traumatic brain injury being highly associated with the development of PTSD. Similarly, experiences that are unexpected or in which the victim cannot escape are also associated with a high risk of developing PTSD. PTSD has been associated with
3660-413: The typical case, the individual with PTSD persistently avoids either trauma-related thoughts and emotions or discussion of the traumatic event and may even have amnesia of the event ( dissociative amnesia ). However, the event is commonly relived by the individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma (" flashbacks "), and nightmares (50 to 70%). While it
3721-924: The way a person thinks and feels, and an increase in the fight-or-flight response . These symptoms last for more than a month after the event and can include triggers such as misophonia . Young children are less likely to show distress, but instead may express their memories through play . A person with PTSD is at a higher risk of suicide and intentional self-harm . Most people who experience traumatic events do not develop PTSD. People who experience interpersonal violence such as rape, other sexual assaults, being kidnapped, stalking, physical abuse by an intimate partner, and childhood abuse are more likely to develop PTSD than those who experience non- assault based trauma, such as accidents and natural disasters . Those who experience prolonged trauma, such as slavery, concentration camps, or chronic domestic abuse, may develop complex post-traumatic stress disorder (C-PTSD). C-PTSD
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