The given case illustrates the Posttraumatic Stress Disorder (PTSD) of a 65-years-old Elaine. Elaine is a former professor who enjoyed a busy and active lifestyle. The woman is described as an energetic and outgoing individual, a “social butterfly” who values good friendship and good meals. Elaine was a frequent subway commuter, going to different parts of the city to visit her favorite stores, cafes, exhibitions, and seminars, as well as to see her countless university acquaintances. Elaine attended a Northeastern university after graduating high school. Consequently, she received a bachelor’s degree in social work. Elaine finally acquired a Ph.D. and a position on the faculty of a large institution in the Northeast, wherein she stayed for 30 years. The woman started struggling with PTSD after an accident in the subway, a train collision. The accident caused her and other passengers multiple injuries, necessitating the hospitalization.
As for the DSM-5 evaluation, the patient does not have a factitious disorder due to a strong correlation between her behavior and traumatic experience. As seen above, Elaine was an active and cheerful person, and after being exposed to a traumatic event, she sought the help of professionals. Considering her history, Elaine had no motives to feign a disorder. Moreover, Elaine did not have substance abuse issues that could contribute to the disorder. Furthermore, the woman did not have any other mental conditions that could influence her well-being. The primary disorder of the patient is PTSD, which can be corroborated by numerous symptoms.
After being exposed to such a traumatic event, Elaine started experiencing several symptoms that resemble common symptoms of PTSD. For example, the most obvious symptoms of Elaine are “avoiding trauma-linked stimuli” and being distressed “when exposed to trauma-linked cues.” In this case, the woman was frightened to leave her house due to the fear of being the victim of the same stressful situation. Still, when confronted with the reality and necessity to go outside, in her case, it was a hospital visit, Elaine experienced panic attacks. She was breathing heavily, both from running and from fear of the road and vehicles. When Elaine first entered the building, she did not talk to anyone. Rather, she sat on the closest chair, closed her eyes, and gasped for oxygen, collapsing due to the reminder of a traumatic experience.
Additionally, Elaine experienced significant distress and became more isolated, avoiding her acquaintances and being constantly upset and inactive. Her outside activities were limited to what she deemed safe conditions, albeit nothing felt fully secure. Lastly, Elaine displayed “conspicuous changes in arousal and reactivity,” struggling with her sleep habits. She had previously been a good sleeper, but she suddenly found herself waking up regularly from nightmares that included flashbacks of her subway or emergency hospital experiences. As a result, the patient’s symptoms correlate with PTSD, the anxiety syndrome.
Among the possible treatments of posttraumatic stress disorder are cognitive-behavioral therapies (evidence-based) and non-trauma-focused treatment, such as relaxation (non-evidence-based). According to American Psychological Association (2017), the former, cognitive behavioral therapy, emphasizes the connection between thoughts, emotions, and actions. This treatment addresses present issues and symptoms and concentrates on modifying behavioral patterns, thinking, and emotions that contribute to daily limitations. According to Watkins et al. (2018), the latter attempts to eliminate posttraumatic stress disorder symptoms, but not by directly targeting distressing emotions, images, and experiences. In reality, the mentioned sources claim that cognitive therapy is proven to be more helpful than relaxing in lowering PTSD symptoms.
Lastly, based on a historical perspective, Elaine could develop the symptoms of anxiety syndrome due to a set of traumatizing experiences in her childhood. It is said that “she certainly had her share of trauma earlier in her life.” It is further described that Elaine witnessed protests and was exposed to hatred by her community. Moreover, in retrospect, it could also be assumed that Elaine’s PTSD could result from the fear of loss of independence and loneliness. It was described that the woman had “emotional and physical strength.” However, due to the accident, Elaine felt sudden weakness and helplessness, which could induce anxiety and panic attacks.
As for the theoretical orientations, one of the ways the patient could develop symptoms and current problems can be explained through a psychoanalytic perspective. In this sense, a series of ongoing bullying events at school made Elaine believe that everything could bring her pain. For example, when being cared for by the healthcare professionals, she thought she could be “raped or killed.” Similarly, sociocultural perspective and Elaine’s constant exposure to violence and hatred toward people of color could manifest into anxiety syndrome.
Hence, Elaine, a 65-year-old woman, experienced posttraumatic stress disorder due to an accident involving a subway train collision. The patient, who was once considered a cheerful and outgoing individual, became an avoiding person. Elain experienced a series of symptoms that are common in PTSD patients. Among such symptoms is avoidance of stress-inducing stimuli, changes in sleeping habits, experiencing flashbacks, and being distressed when exposed to trauma-linked cues. Considering no signs of substance abuse, malingering condition, or other mental health issues, the patient can be regarded as struggling with PTSD.
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258.
American Psychological Association. (2017). Cognitive Behavioral Therapy (CBT). APA. Web.