Post-traumatic Stress Disorder
WHAT IS POST-TRAUMATIC STRESS DISORDER (PTSD)
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop from seeing or experiencing a terrifying event or ordeal in which there was the threat or actual occurrence of grave physical harm. PTSD was once associated primarily with war veterans who had difficulty adjusting to their experiences in combat and/or upon re-entering civilian life. But civilian PTSD can be triggered by serious accidents, natural or human-caused disasters, exposure to terrorist attacks, violent personal assaults or sexual abuse, or even sudden and major emotional losses. People with PTSD experience persistent symptoms that include strong and unwanted memories of the event, bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feelings of anxiety, and avoiding thoughts and situations that are reminders of the trauma.
HOW MANY PEOPLE SUFFER FROM THE DISORDER? WHAT IS THE INCIDENCE AMONG THE GENERAL POPULATION? ARE INDIVIDUALS OF CERTAIN DEMOGRAPHIC GROUPS MORE AT RISK FOR PTSD?
According to the 2005 National Comorbidity Survey-Replication study sponsored by the National Institute of Mental Health, PTSD affects about 6.8% of the American population or 7.7 million adults at some point during their lifetime, and about 3.5% of US adults have experienced some traumatic event in the prior 12 months. PTSD can develop at any age, including childhood. According to more recent NIMH research, among younger Americans aged 13-18, the lifetime prevalence of PTSD is approximately 4%.
WHAT CAUSES PTSD?
The cause of PTSD is unknown. Psychological, genetic, physical, and social factors are involved. PTSD is associated with changes in brain function and structure and these changes continue to provide researchers with clues to the origins, treatment, and prevention of PTSD. PTSD changes the body's response to stress, affecting the hormones and chemicals that carry information between nerves (neurotransmitters).
Doctors aren't sure why traumatic events cause PTSD in some people but not others. Having a history of trauma may increase your risk for getting PTSD after a recent traumatic event. As with most mental health problems, PTSD is probably caused by a complex mix of factors including:
- inherited mental health risks, such as an increased risk of anxiety and depression
- life experiences, including the amount and severity of trauma you've gone through since early childhood
- inherited aspects of your personality — often called your temperament
- The way your brain regulates the chemicals and hormones your body releases in response to stress
WHAT ARE THE MAJOR SYMPTOMS ASSOCIATED WITH PTSD?
Symptoms of PTSD are generally grouped into three types: intrusive memories or re-living the trauma itself; avoidance and numbing oneself to triggers that recall the trauma; and experiencing hyper-arousal (increased anxiety, excessive anger or aggression. While symptoms vary for individual patients, these clusters can overlap. Symptoms can persist for extended periods of time following the initial trauma, having a significant impact on the lives of patients and their families. Sleep disturbances are common symptoms of PTSD and include nightmares, nighttime anxiety attacks, and difficulty falling or staying asleep. Several lines of evidence link sleep disturbances to chronically perpetuating PTSD.
HOW CAN SOMEONE DETERMINE IF THEY ARE SUFFERING FROM PTSD?
Experiencing a wide range of feelings and emotions after a traumatic event is normal, such as heightened fear and anxiety, a lack of focus, sadness, changes in sleep or eating, nightmares or spontaneous crying spells. This doesn't necessarily indicate post-traumatic stress disorder. But if the disturbing thoughts and feelings persist for more than a month, if they are severe, or if an individual feels lack of control over his personal behavior, this could indicate PTSD.
HOW DOES A DOCTOR MAKE A DIAGNOSIS WHETHER SOMEONE SUFFERS FROM PTSD? WHAT MEDICAL CRITERIA MUST BE MET TO CONFIRM PTSD DIAGNOSIS?
There are no tests that can be done to diagnose PTSD, although mental health exams, physical exams, and blood tests are done to rule out other illnesses similar to PTSD. The diagnosis of PTSD is most often made by a mental health provider. The American Psychological Association suggests that only trained professionals (those who have experience with at least 10 trauma assessments) give tests to assess for PTSD.
A person who went through trauma might be given a very short list of screening questions just to see if further assessment for PTSD is needed. A positive screen does not mean a person has PTSD, but it does means that this person should probably be assessed further. The diagnosis is made based on certain symptoms, and how long a time period the patient has had them. In PTSD, symptoms are present for at least 30 days as opposed to a similar condition called Acute Stress Disorder (ASD), in which symptoms are present for a shorter period of time. While an interview may take as little as 15 minutes, the most common evaluation takes about one hour. Some PTSD assessments can take eight or more 1-hour sessions. This is more likely when information is needed for legal reasons or disability claims.
HOW IS PTSD TREATED?
Treatment can help prevent PTSD from developing after a trauma. Various forms of psychotherapy including talk therapy, cognitive behavior therapy, and exposure therapy or virtual reality exposure (VRE) are used to treat PTSD. Drugs that act on the nervous system, such as antidepressants including selective serotonin reuptake inhibitors (SSRIs), are prescribed to treat PTSD, and can help reduce anxiety, depression and hyper-excitability. Zoloft and Paxil are FDA approved for treating PTSD. While drugs may be effective at reducing PTSD symptoms in some patients, their use can be limited by side effects. Other anti-anxiety and sleep medicines are sometimes helpful, but prescription sleep medications are not ideal due to their short-term efficacy and safety concerns.
WHERE TO GET MORE INFORMATION ON PTSD
National Institute of Mental Health
http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
US Veterans Administration/National Center for PTSD
http://www.ptsd.va.gov/