Post-Traumatic Stress Disorder
Anxiety Disorders Association of America.
Everyone looks backwards at times. Sometimes we recollect a happy memory because it makes us feel good. Other times, we recall something we didn't handle so well and wish we could have a second chance. Following a death or other personal trauma, we may brood and ask why. Eventually, we put the past aside and get on with our lives. But, for some people, moving forward is not so easy. Some individuals who survive a traumatic event are affected so strongly by the experience that they are unable to live a normal life.
When a traumatic experience begins to interfere with normal activities, a person may be suffering from post-traumatic stress disorder or PTSD. This disorder may follow an unusually distressing experience such as a sexual or physical assault, war, natural disaster, fire, sexual abuse, car or plane crash, traumatic death, or captivity. For some people, witnessing a violent or tragic event is sufficient to cause PTSD, which is part of a larger group of health problems known as anxiety disorders.
Post-trauma symptoms can range from unrelenting and intrusive memories of the traumatic event to amnesia of all or parts of the event. Individuals with PTSD may be unable to concentrate on routine tasks and often report feelings of 'going crazy.' In many cases, people who have witnessed or experienced a trauma recover without treatment - often in a matter of months. But other victims will develop and be troubled by PTSD for several months or years and will not get better unless treated by a professional.
WHO GETS PTSD?
Women tend to report symptoms of PTSD more often than men and it seems to be less common in the elderly. The disorder has been familiar to soldiers over the years as "shell shock" or "battle fatigue". It has been estimated that between 15 and 30 percent of the 3.5 million men and women who served in Vietnam have suffered from PTSD.
PTSD can affect anybody at any age and recent studies show it is far more common among children than previously believed. The disorder tends to be more severe if the trauma was unanticipated or occurred over an extended period of time. Many children who have suffered childhood sexual abuse will grow into adult hood experiencing ongoing Post-traumatic related symptomatology. Estimates of the disorder’s frequency vary widely, but the best estimates say about 7-8 percent of the population will have a bout with PTSD.
WHAT ARE THE SYMPTOMS OF PTSD?
PTSD has a wide variety of symptoms. The specific symptoms, their number, and their intensity will vary with each individual, so it is possible for two people with PTSD to be affected in vastly different ways. The symptoms are divided into three different categories and a diagnosis of PTSD will rarely be made unless an individual has at least one to three elements from each group. Symptoms must be recurring, distressing, and significantly interfere with social or occupational functioning for this disorder to exist.
Intrusive and unwanted memories: People with PTSD have frequent episodes in which they relive the traumatic event. This experience can manifest itself as a nightmare, a flashback, or simply a sudden flood of emotions or images related to the trauma. A person having a flashback may think that he or she is actually experiencing or seeing the traumatic event again. Sometimes flashbacks can be so severe that individuals unconsciously begin acting as they did at the time of the trauma. A war veteran, for example, may take cover as if under bombardment.
Nightmares may be so intense that an individual will wake up screaming. They may be so terrifying that an individual may develop insomnia to avoid the dreams. Sudden memories of the distressing event, coming with or without warning, may be powerful enough to bring tears and physical distress such as sweating and/or rapid heartbeat.
Avoidance Behaviors: A second category of symptoms is characterized by an effort to avoid any situation or activity that might revive memories and subsequent distressing emotions related to the trauma. Consequently, trauma victims often shut down all emotions in order to avoid distressing trauma-related emotions. This numbing of emotions can cause a withdrawal from family and friends and can strain personal relationships by causing others to feel rejected or ignored. Avoidance behaviors may interfere with routine activities. An individual caught in a bank holdup, for example, may refuse to go to a bank. Someone with PTSD may become so wary and avoidant of certain situations that the thought of leaving their home becomes a frightening idea. Others with this disorder may avoid responsibility, lose interest in favorite activities, or feel hopeless about the future. Such responses can lead to poor work performance and cause family problems.
Arousal Symptoms: The third group includes symptoms of physiological arousal such as unprovoked anger, jumpiness, an extreme sense of being 'on guard," problems with concentration, and insomnia. Somebody who has been in a war situation may overreact to noises such as fireworks or a car backfire that are similar to the sounds of battle. Sometimes individuals with PTSD have panic attacks with such symptoms as chest pain, dizziness, rapid breathing, and the feeling they are dying or losing control.
WHEN DO SYMPTOMS APPEAR?
Symptoms typically appear within a few weeks of the trauma, but on rare occasions there can be a long gap between the triggering event and the beginning of PTSD. Some individuals may go months or years before having any PTSD symptoms. The diagnosis of PTSD may be difficult because the patient and the therapist may overlook a distant traumatic episode. Often, a patient has forgotten the incident or simply fails to tell the therapist about it in the belief that it is not important. It is essential that a person seeking help inform the therapist about any traumatic experience. This enables the therapist to consider whether that event may be related to the patient's difficulties. The potential PTSD patient may first be diagnosed with Acute Stress Disorder if the post-traumatic symptoms occur within the first month after the trauma. If, however, the symptoms persist for more than one month and meet the criteria for PTSD, the diagnosis is changed from Acute Stress Disorder to PTSD.
It is not unusual for individuals to have more than one problem at the same time. Individuals with PTSD or other mental health problems frequently turn to drugs or alcohol for comfort. One recent study by the National Institute of Mental Health found that half of the drug or alcohol abusers in the United States have a mental illness. Sometimes, the problems associated with substance abuse mask the symptoms of PTSD. In other instances, the most significant symptoms also may be characteristic of ailments other than PTSD. Temper tantrums, tension headaches, and despair are common characteristics of many disorders. For example, an individual with PTSD may also suffer from depression serious enough to benefit from treatment. In fact, persons with PTSD are often additionally diagnosed with a depressive disorder. Once the PTSD has been successfully treated, the depression often remits.
Fortunately, PTSD can be treated effectively. Behavior therapy can play a useful role by helping modify the way patients act and by reducing avoidance behavior. Behavior therapy often is combined with cognitive therapy, which is intended to change underlying thought patterns. These approaches may be used in a group or individual setting. Medication can be a valuable complement to other treatment by relieving many of the most debilitating symptoms and enabling other therapy to go for-ward. It is particularly helpful in controlling anger, jumpiness, insomnia, nightmares, flashbacks and depression. Medication usually is required for several months, but in severe cases it may be needed for several years.
Family therapy can help close relatives understand and cope with the illness. Through counseling, family members can learn that any apparent rejection by a relative with PTSD may be the result of the disorder. Family counseling can repair communications and help those close to the survivor learn appropriate and helpful responses in order to create an environment of support and healing for their loved one. Support groups of individuals who have experienced PTSD can show victims that their reactions to trauma are shared by many. By discussing common experiences and emotions, groups of survivors can help each other rebuild confidence.
A qualified psychiatrist, psychologist, social worker, or other mental health professional should be able to recognize and treat PTSD or make a referral to a specialist and/or a local support group.
The Anxiety Disorders Association of America (ADAA) publishes a list of therapists to help individuals locate specialists in their home area. Treatment of PTSD generally can be arranged on an outpatient basis. But some severe cases may require hospitalization or other intensive services, particularly if there are complications like suicidal depression or excessive use of drugs or alcohol.