Post-traumatic stress disorder

Definition

Post-traumatic stress disorder (PTSD) is a debilitating condition that affects people who have been exposed to a major traumatic event. PTSD is characterized by upsetting memories or thoughts of the ordeal, "blunting" of emotions, increased arousal, and sometimes severe personality changes.

Description

Once called "shell shock" or battle fatigue, PTSD is most well known as a problem of war veterans returning from the battlefield, and also civilians surviving the severe traumas of war, such as Holocaust survivors. However, it can affect anyone who has experienced a traumatic event, such as rape and other forms of sexual and physical abuse or torture, robbery, a natural disaster, death of loved ones, or a serious accident. A diagnosis of a serious disease can trigger PTSD in some people. Considered one of a group of conditions known as "anxiety disorders," it can affect people of all ages who have experienced severe trauma, including children.

Causes & symptoms

PTSD is a response to a profoundly disturbing event. It is not clear why some people develop PTSD following a trauma and others do not, although experts suspect it may be influenced both by the severity of the event, by the person's personality and genetic makeup, and by whether or not the trauma was expected. As the individual struggles to cope with life after the event, ordinary events or situations reminiscent of the trauma often trigger frightening and vivid memories or "flashbacks."

Symptoms usually begin within three months of the trauma, although sometimes PTSD does not develop until years after the initial trauma occurred. Once the symptoms begin, they may fade away again within six months. Others suffer with the symptoms far longer, and in some cases, the problem may become chronic. For example, some untreated Vietnam veterans with PTSD, spent decades living alone in rural areas of the country, struggling to come to grips with the horrors of war.

Flashbacks are among the most troubling symptoms of PTSD. These flashbacks can be triggered by sounds, smells, feelings, or images. During a flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again.

For a diagnosis of PTSD, symptoms must include at least one of the following so-called "intrusive" symptoms:

• flashbacks
• sleep disorders: nightmares or night terrors
• intense distress when exposed to events that are associated with the trauma

In addition, the person must have at least three of the following "avoidance" symptoms that affect interactions with others:

• trying to avoid thinking or feeling about the trauma
• inability to remember the event
• inability to experience emotion, as well as a loss of interest in former pleasures (psychic numbing or blunting)
• a sense of a shortened future

Finally, there must be evidence of increased arousal, including at least two of the following:

• problems falling asleep
• startle reactions: hyperalertness and strong reactions to unexpected noises
• memory problems
• concentration problems
• moodiness
• violence

In addition to the above symptoms, children with PTSD may experience learning disabilities and memory or attention problems. They may become more dependent, anxious, or even self-abusing.

Diagnosis

Not every person who experiences a traumatic event will experience PTSD. A mental health professional will diagnose the condition if the symptoms of stress last for more than a month after a traumatic event. While a formal diagnosis of PTSD is made only in the wake of a severe trauma, it is possible to have a mild PTSD-like reaction following less severe stress.

Treatment

Therapy can help reduce negative thought patterns and self talk. Cognitive-behavioral therapy focuses on changing specific actions and thoughts with the help of relaxation training and breathing techniques. Group therapy with other PTSD sufferers and family therapy can also be helpful.

A treatment technique known as eye movement desensitization and reprocessing (EMDR) has been employed to treat PTSD with some success. EMDR involves desensitizing the patient to his or her traumatic memories by associating a series of eye movements with both negative and positive events and emotions. The specific eye movements associated with the negative memories are thought to help the brain process the event and come to terms with the trauma. EMDR should only be performed by a healthcare practitioner, usually a clinical psychologist, certified in the technique.

When used in conjunction with therapies that address the underlying cause of PTSD, relaxation therapies, such as hydrotherapy, massage therapy , and aromatherapy are useful to some patients in easing stressful PTSD symptoms. Essential oils of lavender, chamomile, neroli, sweet marjoram, and ylang-ylang are commonly recommended by aromatherapists for stress relief and anxiety reduction.

Relaxation training, which is sometimes called anxiety management training, includes breathing exercises and similar techniques intended to help the patient prevent hyperventilation and relieve the muscle tension associated with the fight-or-flight reaction of anxiety. Yoga, aikido, t'ai chi , and dance therapy help patients work with the physical, as well as the emotional, tensions that either promote anxiety or are created by the anxiety.

There are other treatments or therapies available for PTSD, based on the physiological and/or energetic understanding of how the trauma is imprinted in the body. So-called alternative or complementary therapies are approaching PTSD differently to effect a release of stored emotions and resolution of them, by working with the body, rather than merely talking through the experience. One example of such a therapy is Somatic Experiencing (SE), developed by Dr. Peter Levine. SE is a short-term, biological, body-oriented approach to PTSD, or other trauma. This approach heal the person by emphasizing physiological and emotional responses, without retraumatizing the person, without placing the person on medication, and without the long hours of conventional therapy.

Allopathic treatment

The most helpful treatment appears to be a combination of medication along with supportive and cognitive-behavioral therapies. Effective medications include anxiety-reducing medications and antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). Sleep problems can be lessened with brief treatment with an anti-anxiety drug, such as a benzodiazepine like alprazolam (Xanax), but long-term usage can lead to disturbing side effects, such as increased anger.

Expected results

The severity of the illness depends in part on whether or not the trauma was unexpected, the severity of the trauma, if the trauma was chronic (such as for victims of sexual abuse), and the person's inherent personality and genetic makeup.

With appropriate medication, emotional support, and counseling, most people show significant improvement. However, prolonged exposure to severe trauma--such as experienced by victims of prolonged physical or sexual abuse and survivors of the Holocaust--may cause permanent psychological scars.

Key Terms

Benzodiazepine

A class of drugs that have a hypnotic and sedative action, used mainly as tranquilizers to control symptoms of anxiety.

Cognitive-behavioral therapy

A type of psychotherapy used to treat anxiety disorders (including PTSD) that emphasizes behavioral change, together with alteration of negative thought patterns.

Selective serotonin reuptake inhibitor (SSRI)

A class of antidepressants that work by blocking the reabsorption of serotonin in the brain, raising the levels of serotonin. SSRIs include Prozac, Zoloft, and Paxil.

Further Reading

For Your Information

Books

• Knaster, Mirka. Discovering the Body's Wisdom. New York: Bantam Books, 1996.
• Shapiro, Francine. EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma. Basic Books, 1997.

Periodicals

• Kessler, R., et al."Post-traumatic Stress Disorder in the National Comorbidity Survey." Archives of General Psychiatry 52 (1996): 1048-1060.

Organizations

• American Psychiatric Association. 1400 K St., NW, Washington, DC 20005.
• Anxiety Disorders Association of America. 11900 Parklawn Dr., Ste. 100, Rockville, MD 20852. (301) 231-9350.
• Freedom From Fear. 308 Seaview Ave., Staten Island, NY 10305. (718) 351-1717.
• National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272-7166.
• National Institute of Mental Health. Rm 15C-05, 5600 Fishers Lane, Rockville, MD 20857.
• Society for Traumatic Stress Studies, 60 Revere Dr., Ste. 500, Northbrook, IL 60062. (708) 480-9080.
• National Center for Post-Traumatic Stress Disorder. http://www.dartmouth.edu/dms/ptsd.

Other

• Ford, Julian. "Managing Stress and Recovering from Trauma: Facts and Resources for Veterans and Families." National Center for PTSD. http://www.dartmouth.edu/dms/ptsd (March 19, 1997).

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.