Definition
Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops after a traumatic event. PTSD has also been called shell shock or battle fatigue.
Causes
The exact cause of PTSD is unknown. PTSD is triggered by exposure to a traumatic event. Situations in which a person feels intense fear, helplessness, or horror are considered traumatic. PTSD has been reported in people who experienced:
- War
- Rape
- Physical assault
- Earthquakes
- Fire
- Sexual abuse
- Motor vehicle accidents
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Not everyone who experiences a traumatic event will develop PTSD. Symptoms of PTSD are more likely to occur if the person has:
- Previous traumatic experiences
- A history of being physically abused
- Poor coping skills
- Lack of social support
- Existing ongoing stress
- A social environment that produces shame, guilt, stigmatization, or self-hatred
- Alcohol abuse
- Family psychiatric history
Symptoms
People with PTSD experience symptoms of anxiety. These symptoms fall into three categories:
- Re-experiencing of the event
- Dreams/nightmares
- Flashbacks
- Anxious reactions to reminders of the event
- Hallucinations
- Avoidance
- Avoiding close emotional contact with family and friends
- Avoiding people or places that are reminders of the event
- Loss of memory about the event
- Feelings of detachment, numbness
- Arousal
- Difficulty falling or staying asleep
- Anger and irritability
- Difficulty concentrating
- Being easily startled
Physical symptoms may also occur such as:
- Stomach and digestive problems
- Chest pain
- Headaches
- Dizziness
People with PTSD may also abuse alcohol or drugs.
Diagnosis
The doctor will ask you about your symptoms and medical history. This could be done by a structured interview and/or a questionnaire. You will also likely be given a psychological assessment. PTSD will be diagnosed if you have the specified symptoms, they last for more than one month, and they result in both emotional distress and disturbed functioning (problems at school, work, and/or in family and peer relationships).
PTSD is categorized according to when symptoms occur and how long they last. There are three types of PTSD:
- Acute—symptoms last between one and three months after the event
- Chronic—symptoms last more than three months after the event
- Delayed onset—symptoms don't appear until at least six months after the event
Treatment
There is no definitive treatment nor is there a cure for PTSD. A variety of therapies can help relieve symptoms. You will not begin treatment for PTSD until after you are completely removed from the traumatic event. You will first receive treatment forsevere depression, suicidal tendencies, drug or alcohol abuse.
Cognitive Behavior Therapy
Cognitive behavior therapy (CBT) involves changing your thinking patterns to improve symptoms. Your therapist may teach you techniques to manage anxiety, stress, and anger.
Exposure Therapy
In exposure therapy, the therapist brings back the imagery of the event in a safe place. He or she will gradually guide you through a visualization. Re-experiencing the trauma in a controlled environment can help you let go of fear and gain control over the anxiety.
In a recent randomized controlled study involving 288 female military personnel suffering from PTSD, prolong exposure was significantly more effective at relieving, and even resolving, PTSD symptoms than supportive (non-CBT) therapy after 10 weekly sessions. *
Group Therapy
Meeting in a group with other survivors of trauma can be an effective and powerful form of therapy for PTSD sufferers.
Medication
Medication may help with anxiety, depression, and insomnia. Usually antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are prescribed. Anti-anxiety medications may be used in the short term and/or beta-blockers in the long term to calm some of the physical symptoms of severe PTSD.
Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. Formore information, please visit http://www.fda.gov/cder/drug/antidepressants
Prevention
The events that trigger PTSD cannot be predicted or prevented. However, there are some factors that might prevent PTSD from developing after the event.
- Debriefing—a group meeting with trained facilitators. This allows those affected to talk about their thoughts, feelings, and reactions.
- Social support—A network of social support can make a difference in how people react to trauma.
RESOURCES:
American Psychiatric Association
http://www.psych.org
Anxiety Disorders Association of America
http://www.adaa.org
Gateway to Post-traumatic Stress Disorder Information
http://www.ptsdinfo.org
National Center for PTSD
http://www.ncptsd.org
CANADIAN RESOURCES:
Canadian Mental Health Center
http://www.cmha.ca
Canadian Psychological Association
http://www.cpa.ca
References:
American Psychiatric Association website. Available at: http://www.psych.org.
National Center for PTSD website. Available at: http://www.ncptsd.org.
National Institute of Mental Health website. Available at: http://www.nimh.nih.gov.
Updated Treatment section on 3/16/2007 according to the following study, as cited by DynaMed's Systematic Literature Surveillance: Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic str
ess disorder in women: a randomized controlled trial. JAMA. 2007 Feb 28;297(8):820-830.
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