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  1. #1

    What is Posttraumatic Stress Disorder?

    What is Posttraumatic Stress Disorder?
    Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.

    PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

    Understanding PTSD
    PTSD is not a new disorder. There are written accounts of similar symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome." There are particularly good descriptions of posttraumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.

    Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.

    PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, Korean conflict, and Persian Gulf populations, and in United Nations peacekeeping forces deployed to other war zones around the world. There are remarkably similar findings of PTSD in military veterans in other countries. For example, Australian Vietnam veterans experience many of the same symptoms that American Vietnam veterans experience.

    PTSD is not only a problem for veterans, however. Although there are unique cultural- and gender-based aspects of the disorder, it occurs in men and women, adults and children, Western and non-Western cultural groups, and all socioeconomic strata. A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5% in men and 10% in women.

    How does PTSD develop?
    Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure. Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes.

    The course of chronic PTSD usually involves periods of symptom increase followed by remission or decrease, although some individuals may experience symptoms that are unremitting and severe. Some older veterans, who report a lifetime of only mild symptoms, experience significant increases in symptoms following retirement, severe medical illness in themselves or their spouses, or reminders of their military service (such as reunions or media broadcasts of the anniversaries of war events).

    How is PTSD assessed?
    In recent years, a great deal of research has been aimed at developing and testing reliable assessment tools. It is generally thought that the best way to diagnose PTSD-or any psychiatric disorder, for that matter-is to combine findings from structured interviews and questionnaires with physiological assessments. A multi-method approach especially helps address concerns that some patients might be either denying or exaggerating their symptoms.

    How common is PTSD?
    An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

    About 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20 to 25 percent have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced "clinically serious stress reaction symptoms." PTSD has also been detected among veterans of the Gulf War, with some estimates running as high as 8 percent.

    Who is most likely to develop PTSD?
    1. Those who experience greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual (as opposed to nonsexual) victimization, real or perceived responsibility, and betrayal

    2. Those with prior vulnerability factors such as genetics, early age of onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events

    3. Those who report greater perceived threat or danger, suffering, upset, terror, and horror or fear

    4. Those with a social environment that produces shame, guilt, stigmatization, or self-hatred

    What are the consequences associated with PTSD?
    PTSD is associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with stable neurobiological alterations in both the central and autonomic nervous systems, such as altered brainwave activity, decreased volume of the hippocampus, and abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response.

    Psychophysiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.

    People with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress. Thyroid function also seems to be enhanced in people with PTSD. Some studies have shown that cortisol levels in those with PTSD are lower than normal and epinephrine and norepinephrine levels are higher than normal. People with PTSD also continue to produce higher than normal levels of natural opiates after the trauma has passed. An important finding is that the neurohormonal changes seen in PTSD are distinct from, and actually opposite to, those seen in major depression. The distinctive profile associated with PTSD is also seen in individuals who have both PTSD and depression.

    PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. In a large-scale study, 88 percent of men and 79 percent of women with PTSD met criteria for another psychiatric disorder. The co-occurring disorders most prevalent for men with PTSD were alcohol abuse or dependence (51.9 percent), major depressive episodes (47.9 percent), conduct disorders (43.3 percent), and drug abuse and dependence (34.5 percent). The disorders most frequently comorbid with PTSD among women were major depressive disorders (48.5 percent), simple phobias (29 percent), social phobias (28.4 percent), and alcohol abuse/dependence (27.9 percent).

    PTSD also significantly impacts psychosocial functioning, independent of comorbid conditions. For instance, Vietnam veterans with PTSD were found to have profound and pervasive problems in their daily lives. These included problems in family and other interpersonal relationships, problems with employment, and involvement with the criminal justice system.

    Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common in people with PTSD. Often, medical doctors treat the symptoms without being aware that they stem from PTSD.

    How is PTSD treated?
    PTSD is treated by a variety of forms of psychotherapy and drug therapy. There is no definitive treatment, and no cure, but some treatments appear to be quite promising, especially cognitive-behavioral therapy, group therapy, and exposure therapy. Exposure therapy involves having the patient repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help with sleep. The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft. At present, cognitive-behavioral therapy appears to be somewhat more effective than drug therapy. However, it would be premature to conclude that drug therapy is less effective overall since drug trials for PTSD are at a very early stage. Drug therapy appears to be highly effective for some individuals and is helpful for many more. In addition, the recent findings on the biological changes associated with PTSD have spurred new research into drugs that target these biological changes, which may lead to much increased efficacy.

    Note: More recently, a technique known as eye movement desensitization and processing (EMDR) has been used in the treatment of PTSD. EMDR is a form of exposure therapy that in part involves moving your eyes eyes back and forth while re-imagining the source of the trauma, or using other means to stimulate certain brain areas while visualizing the traumatic experience.

  2. #2

    PTSD

    I was diagnosed with PTSD and take zoloft.......I've tried going off it numerous times but feel myself slipping down the sides of this dark black well.........it doesn't fix the problems/issues but they don't seem so over whelming to where I just want to stay in bed and not deal with anything.

  3. #3

    What is Posttraumatic Stress Disorder?

    Have you tried therapy? My understanding was that therapy is needed, in addition to any medication you might be prescribed.

  4. #4

    What is Posttraumatic Stress Disorder?

    Quote Originally Posted by Ash
    Have you tried therapy? My understanding was that therapy is needed, in addition to any medication you might be prescribed.
    I would certainly agree with that. So would the published research.

  5. #5

    I see too many of these in myself

    I have a hard time coping with my childhood and adolence. I had everything when I was little; but the important things. These things don't matter to me, I am a modest person. Its the fact that my mom could not deal with our lives, my father. She sunk herself into her job and we were left with our drunk father.

    The memories of this man make it hard to even look at him. The anger is the worst part for me. I don't know how to express to him as I am afraid of him. Violent memories I suppose. The parties, the fighting, the constant reasurrance that I am nothing and always will be, followed by a reminder of bruises. I think the yelling was the part where I play back over and over again in my mind.

    I too became a drinker, but can say I have defeated that part of my life. I don't like alcohol, and what it does. The gambling part of my dad, this one I do struggle with. When I hear my mind, this voice telling me how useless I am, the words from him are so clear in my head.

    When I became a teenager, I looked for caring in the wrong way. I got involved in guys that were just the same as my dad. I have never told many about this, but I was rapped. This plays back in my dreams. What I could have, and should have done. Sometimes the simplest touch from anyone makes my body shudder.

    Then my ex-husband. He yelled and screamed at a drop of a dime. I lived in constant fear of what he was going to do next. The welts he left, the marks on my neck from strangling me. I wonder why he never finished what he started. The "wife duties" that were expected. I hated that man touching me, yet I had no choice. He is one that did know about my experience as a teenager, only to throw it in my face. He reminded me that he too had this power, which made me become a depressed pathetic woman who just did not care anymore.

    This is what I dream about. Constant fighting in my face. I wake up with the want to die. I ask myself, "Why did I have to wake up, could I not just stay asleep forever?" Everyone that has affected my life, they are in my dreams. My cousin who killed himself a few years ago, my dear sweet friend only a day older than me. But its not good dreams about him, the memories I want to remember. Its hate, violence, fighting. Why?

    So much easier to deal with being awake, I don't like going to bed. I live on wake up pills, appetite suppressants, coffee, cigs, laxatives. These things make me feel better. And I don't understand why. Sometimes I think, "Well ha, so there, this is who you said I am so this is who I will give you."

    Haunting

  6. #6

    What is Posttraumatic Stress Disorder?

    As you post more, Haunting, the reasons for your current feelings and behaviors are becoming more clear -- do you see that?

    "this is who you said I am so this is who I will give you"
    Or of course it could be, "This is who you said I am -- I will show you that you are wrong!"

  7. #7

    Yes, I do

    Yes, I do see this Dr. Baxter, I have always in my heart known this.

    But no, I will not show them that they are wrong. I used to think this way, and I fought so hard. Its never enough, I am never good enough.

    All I know, this pain, despair, it is me. Why change what is meant to be? Things are the way they are for the reasons that they are. (wasn't that quite a sentence).

    So yes, "this is who you said I am so this is who I will give you."

    Thanks Dr. Baxter,

    Haunting

  8. #8

    Re: Yes, I do

    Quote Originally Posted by haunting
    But no, I will not show them that they are wrong. I used to think this way, and I fought so hard. Its never enough, I am never good enough.
    Sweetie, I understand this all too well. I have this issue with my family, that I contact as little as possible. I never, ever felt good enough for them. Especially compared to my over-achieving sister. So, I stopped trying to show them that they are wrong. People will see what they want to see. Sometimes it's not worth the effort.

    Anyway...

    Living well is the best revenge. ;-)

  9. #9

    What is Posttraumatic Stress Disorder?

    Yes, I see your point. Some people you just can't do enough for, or do the right things. I also contact my family as little as possible. It's the fact that my mom is dying from cancer, I can't just turn away from her. If anyone, she tries to be supportive. She counts on me to talk to everyday, as everyone else judges her when she is feeling down. She knows she can say anything to me, cry, yell, get as angry as she wants to what she is going through; I always do my best to validate her feelings, just listen, and reasure her how much we love her.

    I have held her hand every step of the way through her battle with cancer. I find it hard because being with her means being around my dad. I have forgiven my mom, she did not know how to deal with the stress while us kids were growing up. She has always loved us. And now, well she is out of treatment options. My dad leaves her at home in the evenings to go drinking across the way with his friends. My mom does not like going over as they are heavy smokers, my dad included. So she is left alone, totally alone with nobody to talk too. I wish I could be with her. Its heart breaking.
    "why do people ignore the ones whom are dying inside?"

    Haunting

  10. #10

    What is Posttraumatic Stress Disorder?

    What you are doing for your mother is incredible. I'm glad that you are able to be there for her in her time of need.

    It sounds like your dad isn't handling the situation very well. It must be easy to get mad at him but you have to remind yourself that everyone deals with these situations differently. So he goes out every night? There's no one else who could take over in the evenings?

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