Post-Traumatic Stress Disorder (PTSD)
(from the National Library of Medicine)

Post-traumatic stress disorder (PTSD) can have an acute onset soon after the trauma, or a delayed onset in which the symptoms occur more than six months after the trauma. Acute PTSD resolves after three months, with a chronic form of the disorder persisting past that time.

PTSD can occur at any age and can follow a natural disaster such as flood or fire, a man-made disaster such as war or imprisonment, assault, domestic abuse or rape. Such events produce stress in anyone, but not everyone develops PTSD.

The causes of PTSD are not known, but psychological, genetic, physical, and social factors may contribute to its development. PTSD alters the body’s response to stress, effecting mediators such as stress hormones and neurotransmitters. Prior exposure to trauma may increase risk, suggesting a kind of learned response.

Social support appears to play a protective role. In studies of Vietnam veterans, those with strong support systems were less likely to develop PTSD than those without social support.

People with PTSD persistently re-experience the event in at least one of several ways: recurrent distressing dreams; recurrent recollections of the event, a sense of reliving the experience (flashbacks); and intense distress at events that symbolize an aspect of the event (such as anniversaries).

Prevention

Early counseling and crisis intervention are important for people who have experienced extremely stressful situations. These interventions may help prevent chronic forms of PTSD and should be part of public health responses to groups at risk such as disaster victims.

Symptoms

Symptoms of PTSD fall into three general categories:

1. Intrusive "reliving" of the event

• recurrent distressing memories of the event
• recurrent dreams of the event
• flashback episodes when the event seems to be re-occurring
• physiological reactions to situations involving "cues" to the traumatic event

2. Avoidance

• inability to recall important aspects of the trauma
• lack of interest in activities
• feelings of detachment
• sense of foreshortened future
• psychic or emotional "numbing"
• restricted range of affect

3. Arousal

• irritability or outbursts of anger
• sleeping difficulties
• difficulty concentrating
• exaggerated startle response
• hypervigilence

Additional symptoms that may be associated with this disease include a sense of guilt about the event (including "survivor guilt"), as well as the following symptoms, which are typical of anxiety, stress, and tension: paleness, heartbeat, sensations, headache, fever, fainting, dizziness, agitation.

Signs and tests

Characteristic symptoms that persist after a history of unusual trauma lead to the diagnosis. Psychiatric and physical examinations are completed to rule out other disorders.

Treatment

The aim of treatment is to reduce the symptoms by encouraging the affected person to recall the event, to express feelings, and to gain some sense of mastery over the experience. In some cases, the expression of grief helps to complete the necessary mourning process.

Support groups are effective at providing a setting where people who have had similar experiences can share feelings. Treatment for depression, alcohol or substance abuse, or associated medical conditions may need to take place before symptoms of PTSD can be effectively addressed.

Behavioral therapy can be used to treat avoidance symptoms. Behavior techniques used include the graded exposure and flooding technique (frequent exposure to an object that triggers symptoms).

Medications that act upon the central nervous system may be used to reduce feelings of anxiety and associated symptoms. Antidepressant medications have been proven effective in treating PTSD, including newer agents such as Prozac, Paxil and Zoloft. Sedating agents can help with sleep disturbance. Anti-anxiety agents may be useful, but the benzodiazepines, a common class of these medications, can potentially become addictive.

Complications

• depression, anxiety, and phobia may accompany this disorder
• alcohol abuse and/or drug abuse

For more on trauma, click here.

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