Post-Traumatic Stress Disorder

Definition

Post-traumatic stress disorder (PTSD) is a debilitating condition that affects people who have been exposed to a major traumatic event. PTSD is characterized by upsetting memories or thoughts of the ordeal, "blunting" of emotions, increased arousal, and sometimes severe personality changes.
Description
Once called "shell shock" or battle fatigue, PTSD is most well known as a problem of war veterans returning from the battlefield. However, it can affect anyone who has experienced a traumatic event, such as rape, robbery, a natural disaster, or a serious accident. A diagnosis of a serious disease can trigger PTSD in some people. Considered to be one of a group of conditions known as "anxiety disorders," it can affect people of all ages who have experienced severe trauma. Children who have experienced severe trauma, such as war, a natural disaster, sexual or physical abuse, or the death of a parent, are also prone to PTSD.
Causes and symptoms
PTSD is a response to a profoundly disturbing event. It isn't clear why some people develop PTSD following a trauma and others do not, although experts suspect it may be influenced both by the severity of the event, by the person's personality and genetic makeup, and by whether or not the trauma was expected. As the individual struggles to cope with life after the event, ordinary events or situations reminiscent of the trauma often trigger frightening and vivid memories or "flashbacks." Symptoms usually begin within three months of the trauma, although sometimes PTSD doesn't develop until years after the initial trauma occurred. Once the symptoms begin, they may fade away again within six months. Others suffer with the symptoms for far longer and in some cases, the problem may become chronic. Some untreated Vietnam veterans with PTSD, for example, spent decades living alone in rural areas of the country, struggling to come to grips with the horror of war.
Among the most troubling symptoms of PTSD are flashbacks, which can be triggered by sounds, smells, feelings, or images. During a flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that it is actually happening all over again
A variety of other symptoms may arise following the traumatic event. Sleep disorders such as nightmares or night terrors, or difficulty falling asleep may occur. Intense distress may be experienced when exposed to events that are associated with the trauma. Avoidance of thoughts surrounding the trauma or inability to remember the event and the accompanying emotions may also arise. Loss of interest in former pleasures (psychic numbing or blunting) or a sense of a shortened future may also be present. Startle reactions (hyper-alertness and strong reactions to unexpected noises), memory and concentration problems, moodiness, and violence may also be symptomatic. Children with PTSD may experience learning disabilities and memory or attention problems. They may become more dependent, anxious, or even self-abusing. Major depression, anxiety disorders, substance abuse, adjustment disorder, development of hypochondria disorders, and organic brain disorders may be some of the psychiatric manifestations of exposure to traumatic stress. Recovery may be slowed by injuries, damage to property, loss of employment, or other major problems in the community due to disaster.
Diagnosis
Not every person who experiences a traumatic event will experience PTSD. A mental health professional will diagnose the condition if the symptoms of stress last for more than a month after a traumatic event. While a formal diagnosis of PTSD is made only in the wake of a severe trauma, it is possible to have a mild PTSD-like reaction following less severe stress.
Treatment
Several factors have been shown to be important in the treatment of post-traumatic stress. These include proximity of the treatment to the site of the event, immediate intervention of therapy as soon as possible, and the expectation that the individual will eventually return to more normal functions. The most helpful treatment appears to be a combination of medication along with supportive and cognitive-behavioral therapies.Medications
Medications used to reduce the symptoms of PTSD include anxiety-reducing medications and antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). Sleep problems can be lessened with brief treatment with an anti-anxiety drug, such as a benzodiazepine like alprazolam (Xanax), but long-term usage can lead to disturbing side effects, such as increased anger, drug tolerance, dependency, and abuse.Therapy
Several types of therapy may be useful and they are often combined in a multi-faceted approach to understand and treat this condition.
Psychological debriefing may be used as facts are recounted. Impressions, thoughts, and emotions are expressed. These responses are then validated and confirmed to be normal in response to an abnormal situation. The therapist conducting the debriefing may recommend coping skills.
Psychotherapy can help reduce negative thought patterns and self talk. This can be done on an individual basis or in groups with other PTSD sufferers. Family therapy can also be helpful.
Cognitive-behavioral therapy focuses on changing specific actions and thoughts.
Spiritual healing may also be employed and has been useful in some cases.
Alternative treatment
Several means of alternative treatment may be helpful in combination with conventional therapy for reduction of the symptoms of post-traumatic stress disorder. These include relaxation training, breathing techniques, spiritual treatment, and drama therapy, in which the event is re-enacted.
Prognosis
The severity of the illness depends in part on whether the trauma was unexpected, the severity of the trauma, how chronic the trauma was (such as for victims of sexual abuse), and the person's inherent personality and genetic make-up. With appropriate medication, emotional support, and counseling, most people show significant improvement. However, prolonged exposure to severe trauma, such as experienced by victims of prolonged physical or sexual abuse and survivors of the Holocaust, may cause permanent psychological scars.
Prevention
More studies are needed to determine if PTSD can actually be prevented. Some measures that have been explored include controlling exposure to traumatic events through safety and security measures, psychological preparation for individuals who will be exposed to traumatic events (i.e. policemen, paramedics, soldiers), stress inoculation training (rehearsal of the event with small doses of the stressful situation), and psychological debriefing.

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