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. However, it can affect anyone who has experienced a traumatic event, such as rape, robbery, a natural disaster, or a serious accident. A diagnosis of a serious disease can trigger PTSD in some people. Considered to be one of a group of conditions known as "anxiety disorders," it can affect people of all ages who have experienced severe trauma. Children who have experienced severe trauma, such as war, a natural disaster, sexual or physical abuse, or the death of a parent, are also prone to PTSD.

Causes & symptoms

PTSD is a response to a profoundly disturbing event. It isn't 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 make-up, 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 doesn't 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 for far longer and in some cases, the problem may become chronic. Some untreated Vietnam veterans with PTSD, for example, spent decades living alone in rural areas of the country, struggling to come to grips with the horror of war.

Among the most troubling symptoms of PTSD are flashbacks, which 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: hyper-alertness 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

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.

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.

Prognosis

The severity of the illness depends in part on whether the trauma was unexpected, the severity of the trauma, how chronic the trauma was (such as for victims of sexual abuse), and the person's inherent personality and genetic make-up.

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

• Allen, Jon. Coping with Trauma: A Guide to Self-Understanding. American Psychiatric Press, 1995.
• Bassett, Lucinda. From Panic to Power: Proven Techniques to Calm Your Anxieties, Conquer your Fears and Put You In Control of Your Life. HarperCollins, 1995.
• Bemis, Judith and Amr Barrada. Embracing the Fear: Learning to Manage Anxiety and Panic Attacks. Hazelden, 1994.
• Greist, J. and James Jefferson. Anxiety and Its Treatment. New York: Warner Books, 1986.
• Herman, Judith. Trauma and Recovery. New York: Basic Books, 1992.
• Kulka, Richard A. Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel, 1990.
• Matsakis, Aphrodite. I Can't Get Over It: A Handbook for Trauma Survivors. New Harbinger Publications, 1992.
• Shengold, Leonard. Soul Murder: The Effects of Childhood Abuse and Deprivation. Yale University Press, 1989.

  Periodicals

• Bullman, Tim A. and Han K. Kang. "A Study of Suicide Among Vietnam Veterans." Federal Practitioner 12, no. 3 (March 1995): 9-13.
• Foa, E. "Uncontrollability and Unpredictability of Post-Traumatic Stress Disorder: an Animal Model." Psychological Bulletin 112 (1992): 218- 238.
• Ford, Julian. "Managing Stress and Recovering from Trauma: Facts and Resources for Veterans and Families." National Center for PTSD. website http://www.dartmouth.edu/dms/ptsd. (March 19, 1997).
• 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 Alliance for the Mentally Ill. 2101 Wilson Blvd. No. 302, Arlington, VA 22201. (703) 524-7600.
• 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.
• National Mental Health Association. 1021 Prince St., Alexandria, VA 22314. (703) 684-7722.
• Society for Traumatic Stress Studies, 60 Revere Dr., Ste. 500, Northbrook, IL 60062. (708) 480-9080.

  Other

• Anxiety Network Homepage. http://www.anxietynetwork.com.
• Anxiety and Panic International Net Resources. http://www.algy.com/anxiety.
• National Anxiety Foundation. http://lexington-on-line.com/nafdefault.html.
• National Center for Post-Traumatic Stress Disorder. http://www.dartmouth.edu/dms/ptsd.
• National Institute of Mental Health. http://www.nimh.nih.gov/publicat.index.htm.
• National Mental Health Association. http://www.mediconsult.com/noframes/associations/NMHA/content.html.

Gale Encyclopedia of Medicine. Gale Research, 1999.