Watch for an increase in stress-related disorders
Americans still affected by events of Sept. 11
As a result of the Sept. 11 terrorist attacks, case managers may be more likely to see people with post-traumatic stress disorder (PTSD) and other stress-related illnesses, says Mark Raderstorf, MA, LP, CCM, CRC, president of Behavioral Management Inc., a Minneapolis-based behavioral health management firm.
"We have come across cases where people in various parts of the country have developed a tremendous fear of flying. If they have a job where their major responsibilities involve flying, it can be a major issue because they won’t be able to complete their duties," Raderstorf says.
Another example of people who are suffering trauma as a result of the terrorist attacks may be people who are reluctant to go into tall buildings.
Although PTSD requires direct exposure to trauma, some people who were not directly exposed to a life-threatening event may develop symptoms that affect their ability to function, he adds. For instance, postal workers across the country may develop anxiety after becoming alarmed about news stories of anthrax.
PTSD is an anxiety disorder that affects people who witness or are a victim of an event that seriously threatens their well-being.
Symptoms include recurring recollections of the event and a persistent avoidance of surroundings or sensations associated with the event. People with PTSD often sleep poorly, have decreased concentration, irritability, and increased vigilance.
Although some initial symptoms are normal following a traumatic event, they are considered a significant mental health concern if they continue more than 30 days after the event, Raderstorf adds.
"To meet the diagnostic criteria for PTSD, an individual must witness or be a victim of an event that seriously threatens their physical well-being or livelihood and which also is outside the normal experience of most individuals. Clearly, using this definition, the catastrophic events of Sept. 11 left an unusually large number of Americans susceptible to PTSD," Raderstorf says.
Some people will seek access to care and treatment on their own. Others will just white-knuckle it and say they will get over it on their own until they have a strong overreaction to a minor incident, Raderstorf says.
In the aftermath of Sept. 11, many employers are trying to be flexible and set up video conferencing so employees who are fearful of flying won’t have to travel. "When individuals are experiencing these intense emotional states, their functioning is quite often impaired. But at some point, the employer is no longer going to be able to be flexible and they will have to determine if that individual can perform his duties, then take appropriate steps," Raderstorf adds.
In the case of clients who are suffering from acute stress, case managers should step in and make sure they are getting good treatment, Raderstorf advises.
Not only will a treatment regime help the patient start functioning normally, but it is likely to save money in the long run, he points out.
"Like any emotional disorder, research shows that the quicker access to good treatment people with PTSD have, the quicker they’ll recover and move back to normal function in their lives. People who receive appropriate intervention early on are more likely to recover quickly and have lower overall medical costs," Raderstorf says.
Patients with PTSD should not have a prolonged recovery whether their condition was caused by the events of Sept. 11, a workplace robbery, or an industrial accident, Raderstorf asserts.
"But they should be receiving specialized treatment. They should not just be left in the hands of their family practitioner who gives them a refill of Prozac each month," he says.
People who are experiencing PTSD are most likely to seek medical assistance for sleep deprivation or general irritability, Raderstorf says. He suggests that health plans refer to mental health professionals when members are experiencing symptoms of PTSD that linger more than a few weeks.
"A primary care physician can competently prescribe medications to relieve these symptoms which should improve an individual’s ability to maintain a normal daily routine. Most return to full function over a period of a week," he says.
However, if a patient doesn’t show significant improvement after two or three months, the individual should be referred to a psychiatrist for further treatment, he adds.
Raderstorf cited three therapies that have been helpful in treatment of PTSD:
- Exposure-based treatment: Patients are exposed to stimuli related to the traumatic event. For instance, a therapist dealing with someone who was fearful of returning to tall buildings as a result of Sept. 11 would take the patients step-by-step into a skyscraper environment.
- Cognitive behavior therapy: The therapist challenges a patient’s irrational thoughts. For instance, if someone has developed a fear of flying in airplanes, the therapist works to reintegrate the patient’s prior beliefs that flying is safe and practical.
- Eye movement desensitization response: A specially trained therapist uses hypnosis-related techniques to help the patient process the traumatic events so they are no longer overwhelming.
PTSD Symptom Development: Nine Risk Factors
- Female gender
- Age 40 to 60
- Poor coping skills
- Poverty or low socioeconomic status
- Presence of children in the home
- For women, presence of a spouse, especially if he is significantly distressed
- Living in a disrupted or traumatized community
- Secondary stress and loss of resources
Four Factors That Predict the Severity of PTSD:
- Intensity: people who are exposed to severe trauma have more intense symptoms than those who have witnessed less severe events
- Duration: People who experience repeated exposures (recurring abuse, multiple attacks) are more likely to be affected than those who have witnessed one event.
- Proximity: Those who are closer to the event are likely to have more significant symptoms than those further removed.
- History: People who have experienced previous personal trauma are at a higher risk for negative symptoms.
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