POST-TRAUMATIC STRESS DISORDER
Post-traumatic stress disorder (PTSD) is a reaction that often occurs when a person has been exposed to extreme trauma. In other words, the person has experienced or witnessed actual or threatened bodily injury or death or some other extreme situation. The stressor may be a one-time event, such as a car accident or a natural disaster, or it may be a long-term situation, such as being raised in a home where there is physical abuse.
A person with PTSD has been exposed to a severe traumatic experience that caused feelings of intense fear, helplessness or horror at the time. Later - usually shortly after the event, but sometimes even decades later - this person may begin to experi ence the several of the following types of symptoms:
- Re-experiencing the trauma in flashbacks, nightmares or unwelcome memories which intrude on everyday life.
- Having daydreams, nigh tmar es, illusion s, or hallucinations that the event is happening again.
- Feeling great anxiety and psychological distr ess when exposed to person s, objects, or situations that trigger memories of the trauma.
- Avoiding activities, conversation s, places, persons, or objects that are related to the trauma.
- Being unable to remember important details about the trauma.
- Feeling emotionally numb (unable to experience normal emotions, such as love).
- Feeling deta ched or disconnected from other people.
- Believing th at his or her life will be shorter than originally expected.
- Losing interest in activities th at were once enjoyable.
- Diminish ed interest in or par ticipation in life activities.
- Showing signs of increased arousal: Being unusually irritable, having outbursts of anger, having trouble sleeping and difficulty concentrating, being hyper-vigilant (always "on guard" against danger), and startling very easily.
These symptoms would be labeled Acute Stress Disorder [ASD] if they occur right after the event and for the next month. After a month, the diagnosis of PTSD is made. If the symptoms are not severe enough to seriously affect an individual's ability to function normally at home, at work or in social situations, it is called an Adjustment Reaction.
Some common PTSD stressors include:
- Serious motor vehicle accidents, plane crashes and boating accidents
- Industrial accidents
- Natural disasters (tornadoes, hurricanes, floods)
- Robberies, muggings, and shootings
- Military combat
(in fact, PTSD was formerly known as "shell shock" or "war neurosis")
- Rape, incest, and child sexual or physical abuse
- Hostage situations and kidnapings
- Imprisonment in a concentration camp or being forced to flee as a refugee
Assault and rape are the most common trauma in women.
There three kinds of symptoms in PTSD:
- Re-living: flashbacks, nightmares, or intrusive thoughts of the event. It may seem quite vivid, like it just happened. Expecting danger, being hyperaroused and alert for danger.
- Avoidance: avoiding places, persons, and conversations that trigger memories of the event
- Numbing: seeming to have no feelings, feeling distant PTSD is associated with an increased risk of depression, panic attacks, phobia, and substance abuse. PTSD can occur rapidly after the trauma. It can be DELAYED, meaning the symptoms do not occur until some reminder of the trauma occurs, sometimes years later! COMPLEX PTSD occurs when the traumata are numerous, change what a person thinks of herself, and create prolonged depressed mood.
At any one time, an estimated one percent to three percent of all Americans suffer from full-fledged PTSD, with an additional five percent to fifteen percent having milder forms of the illness. Although PTSD can develop in trauma victims of any age, the disorder tends to strike young adults more often than any other group. PTSD is common in people who use drugs or drink excessively.
Untreated PTSD can be a chronic condition which gets more severe or less severe at different times over the years. It is not unusual for a rape victim, for example, to still feel emotional pain two-to-three decades after the event.
If you experience a distressing event, talking to a therapist afterwards may prevent the development of PTSD. For that reason, trauma and grief counselors are sent to the site of industrial accidents, school shootings, and other such events. Critical Incident Stress Debriefing [CISD] is a form of prevention counseling which occurs at the site of a trauma which affects a large number of people, in the day or two right afterwards. CISD helps prevent the development of PTSD.
Medication can reduce the severity of the symptoms. We no longer sedate people after a trauma. Certain antidepressants which increase the brain chemical serotonin may reduce symptoms of PTSD. These include sertraline (Zoloft), which is approved for PTSD, paroxetine (Paxil), fluoxetine (Prozac), fluvoxamine (Luvox) and citalopram (Celexa). Antianxiety drugs, such as buspirone (BuSpar), diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan), may relieve the anxiety component of PTSD.
Psychotherapy can help you see how reliving the trauma is structuring your life. It can help restore a sense of control in your life. You can learn new coping skills. Psychological procedures can help desensitize stimuli that were reminding you of the trauma so you won t be sensitive to them anymore. Because the trauma can alter one s identity and self-worth, it may take considerable time to repair the psychic damage, including any associated depression. But often, the effects of a single traumatic event can be resolved quickly using EMDR.
The psychotherapies for PTSD include:
Behavior Therapy - changing the symptoms by using Relaxation therapy to reduce anxiety, Breath Training to prevent arousal of anxiety, and Thought Stopping to interrupt the disturbing thoughts.
Cognitive Behavioral Therapy - changing the thought patterns which have been produced by coping with the trauma.
Exposure therapy - Concentrating on the memories and stimuli associated with the trauma until the anxiety is reduced.
Eye Movement Desensitization and Reprocessing [EMDR] - The memories, thoughts, and emotions associated with the trauma are brought to mind, and, while you concentrate on the experience, the therapist will have stimulate the left and right sides of your brain by having you move your eyes. This activity stimulates the brain to change the emotions associated with the memory, so that the distress connected with it stops.
EMDR resolves symptoms of PTSD nearly completely in eighty to eighty-five percent of patients in about two-to-eight weeks.
Other therapies reduce symptoms completely or to a mild level in seventy percent of patients.
Sertraline (Zoloft) reduces symptoms by about 50% in 3 months, and many symptoms are resolved by 9 months.
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