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.
Treatment
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.
References:
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.
I am very grateful for this article on PSTD. I have had so many life trauma's and my last trauma lead me to feel all the past trama's and the new one all together. I wanted to no longer live. I had tried very hard to redirect my past trauma's into a productive business where I gave pony rides and riding lessons and it involved my whole family. I was having difficulty with PSTD from past experiences but found that by concentrating on my postive experiences in my business I could manage the feelings of loss and move towards feelings of achievement. However, I was constantly concerned that my therapudic program, if distroyed, would destroy me. Unfortunately, my neighbor was negelegent and even though he knew his electric dog fence was not working, let his dogs out at night and one of the dogs ran hot laps around all my ponies and horses causing them to panic and run around frantically causing almost all of them to suffer career ending injuries and even death. My worst nightmare happened and it cause me to have an unbelievable episode of PSTD and I ended up in a psycward that caused even further trauma as they did not treat my cries for grief counciling. Instead I was thrust into the presence of people who exhibited sucidal behavior and an array of mental disturbances that included bipolar and other outburst behavior that I could not relate to.
ReplyDeleteTo make matters worse, I was misdiagnosed with narrcisitic behavior because my family told the doctors that they could reach me and I was in my own little world. And I have been trying to sue my neighbors but now cannot include my therapy because they will see not only the misdiagnosis and past abuse but they will gain the opportunity to further contribute to my PSTD by using my past to incriminate me.
This is causing me to further sink into dispair because I cannot protect myself against their lawyers who will jump at the opportunity to deem me as emotionally disturbed. This will in turn take my opportunity to recieve the therapy that I truely need to recover from the multiple loss of my animals and watching one of my dearest ponies die at my feet.
I have been using all my financial resources just keep paying on the numerous vet bills that have accumulated due to the care of these injured animals and cannot afford to get the therapy I truely need.
I wish I could get help instead of trying to fight this on my own.
Can emotional abuse be considered domestic violence, too
ReplyDelete?
Very good article on PTSD, a good book that talks a little bit about the effects of war on human beings is called "Will War Ever End" by Captain Paul Chappell.
ReplyDeleteI have suffered severe unresolved ptsd for 45+ years...and I'm only 50. I believe that sometimes and other times I attribute it to simply being "no fucking good for nothing". Those are words my mother used to describe me once when I went to her and school counsellors for help with addiction to drugs and alcohol. I was 15. Why the drugs and alcohol? Severe sexual abuse at the hands of uncles, aunts, friends, even a brother and sister. I still disassociate so often according to others who know me well(yeah, right) and it's so bad that I simply find it easier to attribute these 'blackouts' to seizures, which I also have. My life is such a mishmash of violence, rape, child abuse, drug and alcohol abuse, legal trouble, divorces, financial problems, self-hate, flashbacks, nightmares so bad that I don't sleep for days and when I do, it's night terrors, night freezes, panic attacks, somnambulism to the degree I sleepwalk outside, fuck, I even dream when I'm awake because my sleep usually comes from exhaustion. I sometimes go all night trying to escape a nightmare and when I do, I end up realizing I am still in the middle of it. The nightmares are so fucking bad that they make Stephen King's horror stories look like Mother Goose Nursery Rhymes. I was a logistics and weapons systems expert during Desert Storm. In one recurrant night attack, my bed becomes a pool of blood that I can't get out of. It's filled with guts and body parts and in it I'm screaming and throwing parts out of the pool as if trying to find survivors while faceless Iragi people use shovels to throw parts back in. I'm approached by a woman, no face, just a hole left with her tongue sticking out and she's carrying a baby with one arm and no head, and this tongue is licking me all over while she begs me to save her child that one of my programmed weapons killed. I try to back away but this limbless baby grabs me with it's only arm and where its head was, a huge set of huge male genitals comes out of the neck cavity. I partly wake up tearing at my chest and screaming and I literally pull handfulls of chest hair out of my body trying to get its fucking hand off me and this set of genitals starts talking to me saying,"You made me. Now you kill me. So you sick prick, why aren't you gonna save me?" By then I'm running into doors and walls and furniture and screaming like a banshee. After an unknown amount of time passes, I find myself back in bed(I think) and in the middle of another nightmare where I'm trying to convince a judge in front of thousands of disfigured people that "if the Nazis can call it their job, why can't I?"...and on and on and on until I finally wake up, sometimes lying in my own piss.
ReplyDeleteHelp me somebody, please? My son is all that is keeping me alive, but that source is running out and nothing is taking its place. Despite being in mental therapy and pharmaceutical rehab and psych hospitals and drug rehab programs for 30+ years, this is an area that doesn't have people or facilities to help in the way I need. Fucking know it all assholes just keep "reminding" me that I need to stop venting and go on. YA FIGURE? I keep going cuz there's nothing else and nobody who gets me at all but I'm on the verge of mashing their fucking faces in next time they say "venting". I keep getting followed by people who are going to kill me or injure me it seems. I don't even believe God made a hell the way man describes it, but I know I'm going there because I am already in it. I'm lost, desperate, exhausted, and my wife has kicked me out, I'm alone, and even have leukocytic leukemia and/or anemia, liver cancer, destroyed spine, 30 years of diabetes, ocd of the psychogenic excoriation type, and I'm so covered with scars everywhere that people think I'm either a meth addict, or dieing with aids. It's not a matter of IF I'm going to kill myself, it's only a matter of WHEN if I don't get help now.