Post-Traumatic Stress Syndrome (PTSD)

Over 5.2 million Americans suffer from PTSD, and about 7.8 million people in the US will suffer from PTDS at least once during the course of their lives.

Post-tramatic Stress Disorder (PTSD), is an anxiety disorder that can develop after an exposure to a severe traumatic event.

Some traumatic events include rape, military combat, abuse or accidents.

This condition may also involve the fear of death or harm, where the individual is overwhelmed and unable to cope normally. A person with PTSD can re-experience the original trauma months or years after it occurred through flashbacks or nightmares as well as experience increased arousal such as insomnia, anger or extreme paranoia.

PTSD can develop at any age, including childhood. However, this condition is more common in women. This can be due to the fact that females are more likely to become victims of physical violence, harm, and rape than men.

Symptoms

Symptoms of PTSD can be categorized into three primary classes:

• Re-living.

People with PTSD frequently re-experience the terrifying event through intrusive thoughts and recollections of the trauma. These can include frequent nightmares, out-of-the-blue flashbacks, and in some cases, hallucinations.

• Avoiding.

The person will gradually distance from others, places, or any circumstances that can bring back the memory of the trauma. Eventually this can result in depression and family and friends.

• Increased arousal.

This class is characterized by extreme emotions such as difficulties relating to other people, an inability to express closeness like before; insomnia; frequent anger outbursts; moments of rage; difficulty concentrating and restlessness.

Causes

As with many other mental conditions, PTSD is usually caused by a combination of the following:

• An existing predisposition to psychiatric illnesses such as anxiety or depression.

• Lifetime experiences that includes the amount and severity of trauma since early childhood.

• The distinctive traits of a person’s personality – often called the temperament.

• The way the brain controls the release of stress hormone, such as adrenaline, during the “flight-or-fight” response.

So who gets PTSD?

People respond to stress differently, and everyone is different in the manner they handle a stressful event. Also, the level of assistance and guidance a person gets may affect the severity of symptoms.

Did you know?

Although most individuals (50-90%) encounter trauma over a lifetime, only about 8% develop full symptoms of PTSD

Source: Arch Gen Psychiatry.

PTSD got the attention of the medical community by military personnel and war veterans. It has been called a number of different names such as battle fatigue or gross stress reaction for soldiers who returned from World War II.

However, PTSD can occur in anyone who has experienced a traumatic event. Individuals who have been abused as children or exposed to repeated life-threatening events are at high risk for PTSD. Victims of sexual abuse and physical trauma face the greatest risk for developing PTSD.

Treatment

The main treatment for PTSD generally consists of psychotherapy and medication management. Not everyone is the same, so some people might respond better with one type of treatment than another.

However, it is recommended that a person with PTSD seek a phsycian/clinician who is experienced with this condition. Some individuals with this disorder might have to try different treatments to find out what works for him or her.

A person with PTSD that is also going through ongoing trauma, such as being in a physically abusive relationship, would need assistance for both problems. Other ongoing problems that need to be addressed can include depression, panic attacks, substance abuse, and suicidal ideations.

Psychotherapy

Different types of therapy can be effective in treating PTSD. Some methods target the symptoms of PTSD directly, and others address the social, family or work related problems. A doctor/mental health therapist can use different therapies depending on the person.

A useful therapy in the treatment of PTSD is cognitive behavioral therapy (CBT). This type consists of three parts:

• Exposure Therapy.This part of CBT gradually exposes people to the trauma they experienced before in a safe environment. It consists of visual imagery, journaling, and it might include visits to the place where the trauma occurred. The therapist uses these techniques to help people better cope with their feelings.

• Cognitive restructuring. Here the therapist helps the person makes sense of traumatic memories. Sometimes, the individual might remember them different as how they happened. Hence, they will often feel guilt or shame for events that were not their fault. The therapist can help them visualize the memories in a more realistic way.

• Stress inoculation training. This part of CBT aims at reducing PTSD symptoms by coaching people how to control anxiety. It is intended to help patients mentally prepare for an upcoming stressor or recurrent memory. As with cognitive restructuring, this therapy helps individuals see traumatic events in healthier way.

There are other types of treatment available such as EMDR. People with PTSD should consult with his/her therapist about this and other treatment options as well.

EMDR: Eye movement desensitization and reprocessing

EMDR is a specialized form of treatment that is used exclusively for PTSD and related conditions. It is seldom used alone, and designed to be used as part of a conventional therapy regimen.

EMDR was first discovered in 1987 by Francine Shapiro. During a walk in a park, she observed that eye movements seemed to reduce the influence of distressing thoughts. Since then, she developed a set of standardized procedures and principles that help treat PTSD.

EMDR is best described as an information processing therapy with eight phases of treatment. It focuses on past experiences and the current situations that trigger the emotions associated with them.

One of the procedures is “dual simulation” which consists of bilateral eye movements or taps. During the eight phases of treatment, the person relives past traumatic experiences while at the same time focuses on a set of external stimuli. Throughout this time, people experience new insight, changes in memories, and new associations.

EMDR has been subjected to several scientific studies. There have been 13 controlled studies overall, and each yielded a range of results that varied across studies. In 1998, The Journal of Traumatic Stress published one of the most promising studies about the efficacy of EMDR. Sixty women with PTSD in Colorado Springs, Colorado, were randomly assigned to either “active-listening” or EMDR therapy. After just two sessions, the women in the EMDR group exhibited fewer symptoms of PTSD than the “active-listening” group.

Medications

Currently, the U.S. Food and Drug Administration (FDA) has approved two anti-depressants for the treatment of PTSD. These include:

• Sertraline (Zoloft)

• Paroxetine (Paxil)

Both can help control PTSD symptoms such as excessive worrying, irritability, feeling numb, and anger. Consuming these medications may help individuals follow through with therapy.

There are other types of medications that your doctor may prescribe.

• Benzodiazepines. These medications, like Alprazolam (Xanax) and Diazepam (Valium), can help relax and sleep better. Individuals who take these medications sometimes experience memory problems or dependency.

• Antipsychotics. Like Haloperidol (Haldol) and Aripiprazole (Abilify), antispsychotics are medications that are usually given to people with other mental conditions, like schizophrenia. Patients on them might experience weight gain and are at higher risk for developing diabetes.

• Other antidepressants. These can include Fluoxetine (Prozac) and Citalopram (Celexa) . Antidepressants can be useful in reducing the sympsoms of co-occuring conditions, such as anxiety or depression.

Stigma

People and war veterans with PTSD are often stigmatized by friends and employers, making it hard for them to find a job.

Even as the military continues to work on overcoming the stigma of seeking help for mental health issues, many active-duty service members still don't seek help because of the fear that they may be relieved from the service.

Recently, Carter Ham, a four star Army general who commands U.S. soldiers in Europe admitted to suffering from PTSD. This brave example is critical to changing the military's "macho" culture.

Coping and support

If you think that you might have problems caused by a past trauma, contact your health care provider or therapist. You can also take additional actions outside of conventional therapy to help yourself cope. Some of the things you can do include:

• Don't self medicate. These medications, like Alprazolam (Xanax) and Diazepam (Valium), can help relax and sleep better. Individuals who take these medications sometimes experience memory problems or dependency.

• Follow your health professional's instructions. Talk to someone. Keep in touch with loyal friends and loved ones. You dont have to talk about what happened, unless you choose to. Simply spending quality time with family and friends can be therapeutic and comforting.

• Look after yourself. Get enough rest, consume a well balanced eating plan, exercise and remember to relax. Stay away from caffeine and smoking, which often can aggravate nervousness.

• Stay active. Whenever you feel nervous, relax and take a short walk or explore a pastime acticity to refocus.

• Consider joining a support group. Most residential areas have support groups specifically created to help people. Talk to your health care consultant for help finding one, look in your local phone directory, or speak to your community's directory of social resources system.

When someone you love has PTSD

PTSD can significantly strain a marriage or a relationship. People close to them often get “compassion fatigue”, which is a term that describes the feelings of depression and helplessness that they go through.

Hearing about the trauma can be extremely difficult for a loved one. It might cause a person to remember difficult events from the past. The person that you thought you knew might seem like a completely different person - irritable and moody, or withdrawn and sad.

If your loved one has PTSD, you might find it hard to hear about their trauma. You might even feel powerless that you can’t cure their symptoms or speed up their recovery.

In order to take care of a family member, it's essential to make your mental health a priority. Exercise, socialize with friends or participate in any outgoing activities that may help you replenish. If you continue to have difficulty coping, don’t hesitate to seek for help. A doctor or mental health therapist can help you better work through your feelings and emotions.

Resources

DoD Military Family Support: http://www.nmfa.org

National Center for PTSD: http://www.ncptsd.org

Veterans Benefits Information: http://www.va.gov

Health Benefits Eligibility: http://www.va.gov/elig

Vocational Rehabilitation and Employment: http://www.vba.va.gov/bln/vre/index.htm

Military One Source: http://www.militaryonesource.mil or 800-342-9642

Women Veterans Health Strategic Health Care Group: http://www.va.gov/wvhp/

A Kids Website: http://www.va.gov/kids

VA Readjustment Counseling Service (Vet Centers): http://www.va.gov/rcs/

VA Health Benefits Call Center: 1-877-222-8387

Veterans Benefit Administration: 1-800-827-1000http://www.vba.va.gov

War Related Illness & Injury Study Center: http://www.warrelatedillness.va.gov/

Battle Mind Training: http://www.battlemind.org

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Online citations

EMDR. Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Post-traumatic Stress Disorder. Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Post-traumatic Stress Disorder. EMDR Institute, Inc.

Post-Traumatic Stress Disorder. Comprehensive overview covers symptoms, causes, treatment and coping with this brain disorder. The Mayo-Clinic.

EMDR-PTSD. Depression Guide.

EMDR-FAQ. EMDR-Therapy.

PTSD Resources for Survivors and Caregivers. Gift from Within.

Post-Traumatic Stress & Dissociative Conditions.Traumatic Stress Education & Advocacy. Sidran Institute.

Post Traumatic Stress Disorder.WebMD.

Citations

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association.

Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (December 1995). "Posttraumatic stress disorder in the National Comorbidity Survey". Arch Gen Psychiatry52 (12): 1048–60. PMID 7492257.

Article updated: October 14, 2012

Article created: April 24, 2011

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