POSTTRAUMATIC STRESS DISORDER

DEFINITION

Posttraumatic stress disorder (PTSD) is a condition that affects people who have gone through a major traumatic (shocking) event. PTSD is characterized by repeated thoughts about the ordeal, a dulling of emotions, an increased tendency to become excited and aroused, and, sometimes, dramatic personality changes.

DESCRIPTION

At one time, a condition known as "shell shock" was common among men and women who had been through battle. The condition was also known as battle fatigue. These individuals experienced flashbacks of battle. Memories of the event could totally disrupt their lives. In some cases, they were affected so severely that they were unable to function in everyday life.

Today, we know that this condition is caused by a number of factors, including rape, robbery, a natural disaster, or a serious accident. People who are diagnosed with a serious disease often have the same symptoms. A better name for the condition, then, is posttraumatic stress disorder. That is, a person experiences severe feelings of anxiety following some major disruption in his or her life.

People of all ages can be affected by PTSD. Even children who experience sexual or physical abuse or who lose a parent to death may develop PTSD.

CAUSES

No one knows what causes PTSD. Two people may go through the same traumatic experience. But only one may experience PTSD. It may be that people differ in their genetic makeup. Or their personalities and upbringing may differ. Or they may experience the same event in two different ways.

SYMPTOMS

The appearance of symptoms varies widely among individuals. In some cases, symptoms appear a few months after the event. In other cases, it may be years before symptoms occur. Sometimes symptoms fade away after a short period of time. In other cases, they last for many years. Some veterans of the Vietnam War, for example, spent decades living alone in rural areas trying to deal with their memories of the horrors of that war.

Among the most troubling symptoms of PTSD are flashbacks. A flashback is a sudden memory of an event that occurred months or years earlier. Flashbacks may be triggered by certain sights, sounds, smells, or feelings. A flashback may cause a person to lose touch with the real world for a short time. The person goes back in his or her mind to the traumatic event and lives it over again.

DIAGNOSIS

Mental-health professionals use a number of standards to diagnose PTSD. These standards fall into three general categories: intrusive symptoms, avoidance symptoms, and arousal symptoms. Intrusive symptoms are experiences that interrupt and interfere with a person's normal life. They include:

• Flashbacks
• Sleep disorders, such as nightmares
• Intense distress when there is mention of the original event

Avoidance symptoms involve attempts by the patient to refrain from dealing with the original event. They include:

• Trying to avoid thinking or feeling anything about the trauma
• Inability to remember the event
• Loss of ability to feel and express emotions
• A sense that the past is approaching very quickly

Arousal symptoms are obvious changes in a person's mental state. They include:

• Problems falling asleep
• Sudden and extreme reactions to unexpected noises
• Memory problems
• Concentration problems
• Moodiness
• Violence

PTSD in children can also be diagnosed based on other symptoms. These include:

• Learning disabilities
• Memory or attention problems
• Increased dependency on other people
• Increased anxiety
• Self-abuse

Huseuin Gusic (right), a veteran of the Bosnian war, talking with Dr. Avdo Sakusic (left) about war related nightmares. (Reproduced by permission of

AP/Wide World Photos

)

TREATMENT

Posttraumatic stress disorder is usually treated with a combination of medications and counseling. The medications are designed to reduce anxiety and to help patients overcome depression. The most common drugs used are the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (pronounced floo-OC-suh-teen; trade name Prozac). Sleep problems may be treated with an antianxiety drug such as benzodiazepine (pronounced BEN-zoh-die-AZ-uh-peen). Drugs of this type have serious long-term side effects, however.

A common form of counseling is called cognitive-behavioral therapy. The purpose of cognitive-behavioral therapy is to help patients understand the basic nature of their disorder and to find ways of confronting and dealing with the disorder. Group therapy and family therapy can also be helpful. In group therapy, a number of individuals with similar problems meet and discuss common issues and ways of solving their problems. In family therapy, family members of the patient are helped to understand the nature of his or her disorder and to learn ways in which they can work together to support the patient.

PROGNOSIS

The prognosis for PTSD differs widely depending on a number of factors. Those factors include:

• Whether the original trauma was expected
• How severe the trauma was
• How long the trauma lasted
• The patient's genetic makeup and personality

When treated, many patients experience significant improvement. However, some individuals never recover fully from a terrible event. Some survivors of the Holocaust, for example, experienced permanent psychological scars as a result of that event.

FOR MORE INFORMATION

Books

Allen, Jon. Coping with Trauma: A Guide to Self-Understanding. Washington, DC: 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. New York: HarperCollins, 1995.

Bemis, Judith, and Amr Barrada. Embracing the Fear: Learning to Manage Anxiety and Panic Attacks. Center City, MN: Hazelden, 1994.

Kulka, Richard A. Trauma and the Vietnam War Generation: A 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. Oakland, CA: New Harbinger Publications, 1996.

Shengold, Leonard. Soul Murder: The Effects of Childhood Abuse and Deprivation. New Haven, CT: Yale University Press, 1989.

Organizations

American Psychiatric Association. 1400 K St., N.W., Washington, DC 20005. (202) 682–6000; (888) 357–7924.

Anxiety Disorders Association of America. 11900 Parklawn Dr., Suite 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., #302, Arlington, VA 22201. (703) 524–7600.

National Anxiety Foundation. 3135 Custer Dr., Lexington, KY 40517. (606) 272–7166. http://lexington-on-line.com/nafdefault.html.

National Institute of Mental Health. Panic Campaign. Rm. 15C-05, 5600 Fishers Lane, Rockville, MD 20857. (800) 64–PANIC. http://www.nimh.nih.gov/publicat.index.htm.

National Mental Health Association. 1021 Prince St., Alexandria, VA 22314. (703) 684–7722. http://www.mediconsult.com/noframes/associations/NMHA/content.html.

Society for Traumatic Stress Studies. 60 Revere Dr., Suite 500, Northbrook, IL 60062. (708) 480–9080.

Web sites

Anxiety and Panic International Net Resources. [Online] http://www.algy.com/anxiety/index.shtml (accessed on November 23, 1999).

Anxiety Network Homepage. [Online] http://www.anxietynetwork.com.

"Ask NOAH About: Mental Health." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/mentalhealth/mental.html#PTS (accessed on October 28, 1999).

Ford, Julian. "Managing Stress and Recovering from Trauma: Facts and Resources for Veterans and Families." [Online] http://www.dartmouth.edu/dms/ptsd. (accessed March 19, 1997).