Posttraumatic stress disorder
What is PTSD?
PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent personal assault. PTSD is a real illness that causes real suffering.
PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II. But PTSD does not just happen to combat veterans. PTSD occurs in men and women, in people of any ethnicity, nationality, or culture, and at any age. PTSD affects approximately 3.5% of U.S. adults, and lifetime risk for PTSD is estimated at 8.7%.
Long after the traumatic event has ended, people with PTSD continue to have intense, disturbing thoughts and feelings related to their experience. They may relive the event through flashbacks or nightmares; they may feel sadness, fear, or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
Exposure to an upsetting traumatic event is necessary for a diagnosis of PTSD. However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual who learns that a close family member or friend has died accidentally or violently.
Symptoms and Diagnosis
According to DSM-5*, symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.
1. Intrusive symptoms such as repeated, involuntary memories, distressing dreams, or flashbacks of the traumatic event. Flashbacks may be so vivid that individuals feel they are re-living the traumatic experience or seeing it before their eyes.
2. Avoidance of reminders of the traumatic event may include avoidance of people, places, activities, objects, and situations that bring on distressing memories. Individuals may try to avoid remembering or thinking about the traumatic event. For example, they may resist talking about what happened or how they feel about it.
3. Negative thoughts and feelings may include persistent and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); persistent fear, horror, anger, guilt, or shame; markedly diminished interest in activities; or feeling detached or estranged from others.
4. Arousal and reactivity symptoms may include irritable behavior and angry outbursts; reckless or self-destructive behavior; exaggerated startle response; problems with concentration; or sleep problems.
Many people who are exposed to a traumatic event experience symptoms like those described above in the days or weeks following the event. In PTSD, however, symptoms last for at least a month and often persist for months and sometimes years. Many individuals develop symptoms within 3 months of the trauma, but other people’s symptoms appear later. A diagnosis of PTSD requires that symptoms cause significant distress or impaired functioning. PTSD often occurs with—or may contribute to—other related disorders, such as depression, substance use, difficulty with memory, and other problems of physical and mental health.
Not everyone who experiences trauma develops PTSD, and not everyone who develops either requires psychiatric treatment. For some people, symptoms of PTSD subside or disappear with time. Others get better with the help of family, friends, or clergy. But many people with PTSD need professional treatment to recover from psychological distress that can be intense and disabling. It is important to remember that trauma may lead to severe distress. That distress is not the individual’s fault, and PTSD is treatable.
Psychiatrists and other mental health professionals use various effective (research-proven) methods to help people recover from PTSD. Both psychotherapy and medication provide effective evidence-based treatments for PTSD.
Cognitive behavior therapies (CBT) are very effective. Cognitive processing therapy, prolonged exposure therapy, and stress inoculation therapy are among the types of CBT used to treat PTSD.
Cognitive Processing Therapy focuses on modifying painful negative emotions (e.g. shame, guilt, etc.) and beliefs (e.g. “I have failed”; “the world is dangerous”) due to the trauma. Therapists confront such distressing memories and distressful emotions.
Prolonged Exposure therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. For example, virtual reality programs have been used to help war veterans with PTSD re-experience the battlefield in a controlled, therapeutic way.
Stress Inoculation Therapy involves a variety of anxiety management techniques such as education, muscle relaxation training and biofeedback. This may include social skills training, role-playing, distraction techniques, positive thinking and self-talk.
Other psychotherapies such as interpersonal, supportive, and psychodynamic therapies focus on the emotional and interpersonal aspects of PTSD. These may be helpful for people who don’t want to expose themselves to reminders of their traumas.
Medication can help to control the symptoms of PTSD. In addition, the symptom relief that medication provides allows many people to participate more effectively in psychotherapy.
Some antidepressants such as SSRIs and SNRIs (selective serotonin re-uptake inhibitors and selective norepinephrine re-uptake inhibitors), are commonly used to treat the core symptoms of PTSD. They are used either alone or in combination with psychotherapy or other treatments. Other antidepressants, including tricyclic antidepressants, are also used.
Other medications may be used to lower anxiety and physical agitation, or treat the nightmares and sleep disturbances that trouble many people with PTSD.
Family therapy may also help because the behavior of spouse and children may result from and affect the symptoms of the individual with PTSD. PTSD affects the entire family.
Group therapy encourages survivors of similar traumatic events to share their experiences and reactions in a comfortable and non-judgmental setting. Group members help one another realize that many people would have responded the same way and felt the same emotions.
Complementary and alternative medicine therapies area also increasingly being used to help people with PTSD. These approaches provide treatment outside the conventional mental health clinic. They require less talking and disclosure than psychotherapy. They include acupuncture, animal-assisted therapy, virtual reality, stellate ganglion block technique, and others.
In addition to treatment, many people with PTSD find being able to share their experiences and feelings with others who have similar experiences, such as in peer support groups, very helpful. Peers can share ideas about effective coping strategies.
Acute Stress Disorder. With acute stress disorder, symptoms are similar to those for PTSD following a trauma. However, they don’t last longer than one month.
National Center for PTSD (Veteran's Administration)
Anxiety Disorders Association of America (ADAA)
*DSM-5 - Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing, 2013
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