Post-traumatic stress disorder
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. 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 aserious 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.
PTSD is a response to a profoundly disturbing event. It isn not clear why some people develop PTSD following a trauma and others do not, although expertssuspect 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, ordinaryevents or situations reminiscent of the trauma often trigger frightening andvivid memories or "flashbacks."
Symptoms usually begin within three months of the trauma, although sometimesPTSD does not develop until years after the initial trauma occurred. Once thesymptoms 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 followingso-called "intrusive" symptoms:
- 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 formerpleasures (psychic numbing or blunting)
- A sense of a shortened future.
Finally, there must be evidence of increased arousal, including at least twoof the following:
- Problems falling asleep
- Startle reactions:hyper-alertness and strong reactions to unexpected noises
- Memory problems
- Concentration problems
In addition to the above symptoms, children with PTSD may experience learningdisabilities and memory or attention problems. They may become more dependent, anxious, or even self-abusing.
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 havea mild PTSD-like reaction following less severe stress.
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 selectiveserotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). Sleep problems can be lessened with brief treatment with an anti-anxiety drug, such asa 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 otherPTSD sufferers and family therapy can also be helpful.
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.