Sanctuary for the Abused
Tuesday, March 08, 2016
POST-TRAUMATIC STRESS DISORDER
What Is It?
Post Traumatic Stress Disorder (PTSD) is classified as a type of anxiety disorder, but is actually much more than that. It is a debilitating disorder that often develops after highly traumatizing events, such as natural disasters, personal assaults and combat. In fact, PTSD was first called "shell shock" or "battle fatigue" because it was noticed primarily in combat veterans. Over the years, however, professionals have recognized that PTSD often develops in people who experience a wide variety of traumatizing events. These include car and plane wrecks, earthquakes and floods, rape and other assaults, abuse or being held captive. The person experiencing PTSD may have felt personally threatened or may have felt that the life of someone close to him or her was threatened. It even occurs among professionals such as paramedics and firefighters who respond to plane crashes and natural disasters.
Typically, people experiencing PTSD report persistent and frightening memories of the event and feel emotionally numb and unresponsive. There is a mixture of anxiety related symptoms as well as depression and emotional numbing. Intrusive thoughts and memories of the event are hallmarks of this disorder. This combination of reactions is the key to PTSD.
The traumatic event is relived again and again. Nightmares are common. In some cases, the person suffering from PTSD will feel like he or she is reliving the event. This can include such extremes as illusions, hallucinations and dissociative flashbacks. One Vietnam veteran came to the emergency room of the base hospital, wearing jungle combat fatigues and carrying a rifle. He believed he was in Vietnam and that the year was 1968. In reality, it was Las Vegas in 1985. (No one was hurt in that incident and the veteran was sent for treatment of PTSD.) When the sufferer is exposed to things that remind them of the trauma, there is much distress and this may trigger the "flashback." The sound of helicopters often triggers reactions in Vietnam veterans.
The emotional numbing includes efforts to avoid thoughts, feelings and conversations related to the event. "I just don't want to think about it," is a common reaction and often extends to the avoidance of activities, places and people that might remind the sufferer of the trauma. This avoidance of the trauma may include actual "forgetting" of important aspects of the trauma. People with PTSD find it difficult to enjoy the things they used to find pleasurable. They feel detached from others ("No one can understand"). They find it difficult to experience positive feelings and often believe that their futures are limited.
The anxiety reactions include difficulty falling or staying asleep, irritability and outbursts of anger, difficulty concentrating, startle responses and being constantly on the look out for threats. Some people, including professionals, may interpret these behaviors as "paranoid," when in fact, they are symptoms of PTSD.
Who Experiences PTSD?
PTSD can strike anyone. Children also experience PTSD.3 People who experience PTSD do not have a history of emotional problems, nor are they from particularly "dysfunctional" families. It can happen to anyone, including professionals. The key is the experience of a traumatizing event, not some "predisposing" factor in the person. On the other hand, different people have differing abilities to cope with catastrophic events. Some people exposed to traumatic events do not develop PTSD.
PTSD typically develops shortly after the traumatizing event usually within three months, but it may be delayed for months or years. When it is delayed, there is often a triggering event that recalls the threat from long ago.
According to the National Institute of Mental Health approximately 3.6 percent of U.S. adults between the ages of 18 and 54 (5.2 million people) have PTSD during the course of a given year. About 30 percent of the men and women who have spent time in war zones experience PTSD. It is estimated that one million veterans of the Vietnam War developed PTSD. PTSD has also been detected among veterans of the Persian Gulf War, with some estimates running as high as 8 percent. 4
What is the Course of the Illness?
PTSD can become chronic, lasting for years or even decades. Sometimes it lasts a lifetime. In patients with chronic PTSD, there is often a waxing and waning of symptoms over the course of time. Even in cases where the PTSD seems to be resolved and no longer a problem, certain behaviors and reactions can persist. For example, a woman who was awoken with an intruder in her home in the middle of the night, even after nearly 20 years, can no longer sleep in a totally darkened room. This difficulty rarely causes problems in her daily life and is something she now accepts.
Other forms of mental illness often go along with PTSD. Substance abuse is common. It is possible that the substance abuse develops in an attempt to "self-medicate" for the distressing symptoms of PTSD. Major depression and various other anxiety disorders are often seen. The overlapping diagnostic criteria of the Diagnostic and Statistical Manual 4th edition (DSM-IV)1 may contribute to the multiple diagnoses of sufferers of PTSD.2 Misdiagnosis is also possible if the traumatized person fails to reveal the history of the traumatizing event.
The most successful interventions have been Cognitive/Behavioral therapy (CBT) and medications. "Exposure" through detailed recall of the traumatizing event and cognitive restructuring have been particularly helpful. This may be highly distressing to the patient, but in the long run, it is quite helpful in helping to diffuse the trauma of the event.
Various medications are often prescribed. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that has been approved by the FDA as an indicated treatment for PTSD.2 Psychiatrists often also prescribe a variety of tranquilizers as well as (in some cases) antipsychotic medications. The effectiveness of these medications is less clear.
Another form of treatment that has had some success is Eye Movement Desensitization and Reprocessing (EMDR), but it is not clear if this treatment is as effective as CBT.
Group therapy is probably the best approach for mild to moderate PTSD. This has been shown in studies of combat veterans as well as survivors of natural disasters. In these settings, the sufferers can share their memories and difficulties with others who have gone through the same thing. This helps break down the isolation experienced by many people with PTSD.
1. Diagnostic and Statistical Manual-IV, American Psychiatric Association, 1994.
2. National Center for PTSD..
3.National Institute of Mental Health, PTSD Info.
4. National Institute of Mental Health: Facts about PTSD.
Cathy A. Chance, Ph.D.