Post Traumatic Stress Disorder

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Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop in response to a traumatic experience that caused intense fear, horror, or helplessness. PTSD can result from personally experienced traumas (rape, war, natural disasters, accidents, abuse, captivity) or from the witnessing of a violent or tragic event.

Most people commonly experience some degree of anxiety or depression after such occurrences, but people with PTSD continually re-experience the traumatic event and often avoid situations, other individuals, or thoughts associated with the trauma. People with PTSD have these symptoms for longer than one month and experience a severe disruption in their ability to function at home or at work. Symptoms normally appear within 3 months of the trauma, but can occur months or even years later.

Anyone can develop PTSD, though women appear to be more often affected than men. Studies suggest that anywhere from 2 to 9 percent of the population suffer from some degree of PTSD. The likelihood of developing the disorder is greater when someone is exposed to multiple traumas or traumatic events early in life (or both).

Symptoms of PTSD:

Symptoms of PTSD vary from person to person, but generally fall into three categories:

1. Re-experience - Intrusive recollections, nightmares, flashbacks, hallucinations, or other vivid feelings of the event happening again which may result in extreme emotional or physical reactions such as panic attacks.

2. Avoidance - Persistent avoidance of people, places, thoughts, or objects that are associated with the trauma, and/or detachment and withdrawal from family and friends.

3. Increased Emotional Arousal - A constant feeling of being on guard, irritability or sudden anger, difficulty falling or staying asleep, difficulty concentrating, jumpiness or being easily startled.

DSM-IV Diagnostic Criteria:

A. The person has been exposed to a traumatic event in which both of the following were present:

 (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
 (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

 (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
 (2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
 (3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).
Note: In young children, trauma-specific reenactment may occur.
 (4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
 (5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

 (1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
 (2) efforts to avoid activities, places, or people that arouse recollections of the trauma
 (3) inability to recall an important aspect of the trauma
 (4) markedly diminished interest or participation in significant activities
 (5) feeling of detachment or estrangement from others
 (6) restricted range of affect (e.g., unable to have loving feelings)
 (7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

 (1) difficulty falling or staying asleep
 (2) irritability or outbursts of anger
 (3) difficulty concentrating
 (4) hypervigilance
 (5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Treatment of PTSD:

There are a variety of effective treatment options for PTSD, and people respond to treatments differently. Treatment generally involves psychotherapy, medication or a combination of both.

Psychotherapy:
Therapy is often effective in treating PTSD. Cognitive therapy helps people with PTSD take a close look at their thought patterns and learn to do less negative and nonproductive thinking. Therapy usually involves helping the survivor learn skills to manage symptoms and to develop ways of coping with and working through the trauma. Behavior therapy focuses on learning relaxation and coping techniques, and often increases the person's exposure to a feared situation as a way of making him or her less sensitive to it.

Medication:
For some people, medication can significantly reduce symptoms of this disorder, enhance the effectiveness of psychotherapy and greatly improve the quality of life. Antidepressant and antianxiety medications may help lessen symptoms such as insomnia or nightmares, depression, and edginess.

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms

The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse

Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD