Issue

Post-Traumatic Stress Disorder

Background

Post-Traumatic Stress Disorder (PTSD) is most likely to occur following exposure to any traumatic event involving intense fear or helplessness in which the individual experienced or witnessed actual or threatened death or serious injury of oneself or others. PTSD used to be considered a disorder that primarily affected war veterans, who had witnessed military combat, but we now understand that any traumatic event can lead to PTSD. PTSD affects hundreds of thousands of people who have survived or witnessed violent personal assault, terrorist attack, torture, incarceration as a prisoner of war, natural disasters (e.g., hurricanes, earthquakes), severe automobile accidents, or being diagnosed with a life threatening illness. The likelihood and severity of PTSD are correlated with the degree of the traumatic stressor. Repeated or prolonged trauma tends to cause additional vulnerability. There is a growing body of research, for example, which suggests that symptoms consistent with PTSD are common among mothers of children who have had bone marrow transplants. Additionally, patients who have been hospitalized for prolonged periods of times with complicated medical courses, are at considerable risk for developing symptoms of PTSD.

Three cluster of symptoms are characteristic of PTSD:
1) re-experiencing of the traumatic event (e.g., recurrent and intrusive thoughts, nightmares, flashbacks)
2) avoiding reminders of the trauma
3) experiencing persistant symptoms of increased arousal (e.g., exaggerated startle response, hypervigilance).

Individuals with PTSD may feel numb, and their emotions may be blunted. They may have feelings of anger, irritability, anxiety, and detachment. Some people develop feelings of guilt over having survived a disaster or tragic loss that others did not. This is called “survivor guilt” and may leave the person with feelings of unworthiness. Depression commonly results, if anger and grief are not successfully resolved. Individuals with PTSD may alternate between flooding of emotions (caused by re-experiencing the incident) and difficulty feeling or expressing emotions at all, even with those with whom they are close. Activities may be performed in a mechanical detached way. It may appear that individuals with PTSD are bored or preoccupied. They may exhibit loss of interest in previously enjoyed activities and may avoid accepting responsibility for others and for themselves at work or in their interpersonal relationships.

Efforts to avoid activities, places or people that arouse recollections of the trauma may have a significant impact on the daily lives of individuals with PTSD. These individuals may have a sense of foreshortened future, not expecting success or fearing the worst. Memories accompanied by the painful emotions of the experience may also intrude into their present lives. Some people re-experience the event so vividly, that they are unaware of what they are doing in the present and may feel like the trauma is actually happening all over again. Children may re-experience the trauma by acting out aspects of it in their play. Nightmares are another way people may re-experience the event.

People with PTSD may also act like they are under threat, becoming suddenly irritable or explosive even when not provoked. Memory problems, trouble concentrating and sleep disturbances (e.g., difficulty falling or staying asleep) may develop. The constant sense that danger is near can cause individuals with PTSD to have an exaggerated startle response. When the extreme fear reaction felt during the trauma goes unresolved, panic attacks commonly ensue. Symptoms of panic attacks can include tightness in the chest or throat, feelings of fear, increased breathing and heart rate, stomach-aches, headaches, dizziness, and nausea.

Information

PTSD usually appears within three months of the trauma, but it can surface months or years later. Psychiatrists estimate that up to 10 percent of the population has been affected by the clinically diagnosable symptoms of PTSD. PTSD occurs in both children and adults, but the symptoms may vary developmentally. In some cases the symptoms of PTSD disappear with time, but the symptoms can persist for many years. Many who suffer from PTSD may turn to medication, drugs, alcohol, or other behaviors which temporarily help them escape their pain. Many individuals recover with the help of family and friends. However, some people may require professional help in order to recover from the psychological damage that can result from experiencing or witnessing a traumatic event. Therapy is often helpful in assisting individuals with PTSD to work through their trauma and grief. Behavioral therapy, for example, can help people learn new coping techniques to manage anxiety, such as relaxation. A highly effective treatment intervention involves the use of imagery to work through the traumatic experience. Medication may be helpful in treating PTSD, but generally is most effective when used in conjunction with individual therapy.

Individuals who return to normal life patterns as soon after the trauma as possible tend to do better, especially if they have an adequate social support network (e.g., family, friends). It is crucial that individuals who have experienced or witnessed trauma have the opportunity to talk openly about their experiences. Developing a close alliance with someone with whom the person can talk soon after the traumatic event, is one of the most critical factors in helping avoid or diminish the symptoms of PTSD.

For help in dealing with PTSD, contact a mental health professional.