CASOS DE USO GESTION DE RECAUDACIONES Y PAGOS

A number o f psychiatric disturbances have been associated with exposure to trauma and stressful events, including PTSD, which is considered as the most serious impact o f traumatic incidents that go beyond the ordinary or familiar life experience. The American Psychological Association (APA) identified it as a type o f anxiety disorder that manifests itself as an experience o f abnormal psychological and physical stress followed by distinctive symptoms. Gilliland and James (1993; pp. 179-181) asserted the significance o f emotional denial and numbing as well as intrusive- repetitive ideation relating to PTSD. Re-experiencing is the hallmark o f PTSD and the chief symptom that distinguishes it from other psychiatric disorders (March, 1993). It may include intrusive recollections, nightmares, flashbacks, or physiological reactivity. The event may be re-experienced in the form o f dreams while sleeping or painful remembrance when awake. The symptoms typically begin shortly after the trauma and may persist for months or years (Blank, 1993). Many individuals feel distressed and remember their experiences vividly.

Avoidance symptoms include fear or being involved in similar events and avoiding thoughts, feelings, people and anything, which might be reminders o f the

incident (Parkinson, 1995). An individual may complain o f having markedly

diminished usual activities, o f feeling detached or estranged from other people. The individual may have a feeling o f isolation, and inability to show and express the

feeling o f love towards others. There may be a sense o f danger or fear. The

individual may avoid thinking about the future because they think that they will not live long or that life is very dangerous and they cannot survive. He/she might forget some important elements o f the event and will not have the ability to recall the whole event.

Increased arousal includes difficulty in sleeping or concentrating, irritability, hyper-vigilance, and increased startle response. There can be an increased sensitivity to noise and the slightest sound may cause people to "jump" nervously in an exaggerated startle response. Some will become over vigilant. This can lead to an incapacity to accept normal reactions within work and family life. There can be sleep disturbances, dreams and nightmares and outbursts o f anger and frustration that may lead to violence. The result can be a retreat into isolation and loneliness. Symptoms o f PTSD sometimes appear following the occurrence o f the trauma either directly, or after one month or more.

1.4.1 Diagnostic criteria of PTSD

Diagnostic criteria of PTSD take into consideration the nature o f PTSD symptoms and the nature o f stressful experiences that cause these symptoms. Clinical Descriptions and Diagnostic Guidelines (ICD-10) provides diagnostic guidelines of PTSD. It mentions that this disorder should not be diagnosed unless there is evidence

“probable” diagnosis might still be possible if the delay between the event and the onset was longer than 6 months, provided that the clinical manifestations are typical and no alternative identification o f the disorder (e.g. as an anxiety or obsessive- compulsive disorder or depressive episode) is plausible. In addition to evidence of trauma, there must be a repetitive, intrusive recollection or re-enactment o f the event

in memories, daytime imagery, or dreams. Conspicuous emotional detachment,

numbing o f feeling and avoidance o f stimuli that might arouse recollection o f the

trauma are often present but are not essential for the diagnosis. The autonomic

disturbances, mood disorder, and behavioural abnormalities all contribute to the diagnosis but are not o f prime importance (WHO, 1992; pp. 148-149).

DSM-1Vdetermines the diagnostic criteria for PTSD as follows (APA, 1994; pp. 427-429);

“A. The person has been exposed to a traumatic event in which both o f 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 o f self or others.

(2) The person’s response involved intense fear, helplessness or horror.

B. The traumatic event is persistently re-experienced in one (or more) o f the

following ways:

(1) Recurrent and intensive distressing recollections o f the event,

including: images, thoughts or perceptions.

(2) Recurrent distressing dreams o f the event.

sense o f re-living the experience, illusions, hallucinations and disassociative flashback, episodes, including those that occur on awakening or when intoxicated).

(4) Intense psychological distress on exposure to internal or external cues that

symbolise or resemble an aspect o f the traumatic event.

(5) Physiological reactivity on exposure to internal or external cues that

symbolise or resemble an aspect o f the traumatic event.

C. Persistent avoidance o f stimuli associated with the trauma and numbing o f a

general responsiveness (not present before the trauma), as indicated by three (or more) o f 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 o f the

trauma.

(3) Inability to recall an important aspect o f the trauma.

(4) Markedly diminished interest or participation in significant activities.

(5) Feeling o f detachment or estrangement from others.

(6) Restricted range o f affections (e.g., unable to have loving feelings).

(7) Sense o f a foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span.

D. Persistent symptoms o f increased arousal (not present before the trauma) as

indicated by two (or more) o f the following: (1) Difficulty falling or staying asleep. (2) Irritability or outbursts o f anger. (3) Difficulty concentrating.

(4) Hypervigilance.

(5) Exaggerated startle response

E. Duration o f the disturbance (symptoms in Criteria B, C, and D) is more than one

month.

F. The disturbance causes clinically significant distress or impairment in social,

occupational, or rather important areas o f functioning. Specify if:

Acute: if duration o f symptoms is less than 3 months.

Chronic: if duration o f symptoms is 3 months or more Specify if:

With delayed onset: if onset of symptoms is at least 6 months after the

stressor.”