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PTSD

Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.  Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), 2013

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. PTSD is a real illness that causes real suffering.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II. But PTSD does not just happen to combat veterans. PTSD occurs in men and women, in people of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults, and lifetime risk for PTSD is estimated at 8.7 percent.

People with PTSD continue to have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual who learns that a close family member or friend has died accidentally or violently.

Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.

  1. Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
  2. Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that bring on distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
  3. Negative thoughts and feelings may include ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; or feeling detached or estranged from others.
  4. Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.

Many people who are exposed to a traumatic event experience symptoms like those described above in the days following the event. For a person with PTSD, however, symptoms last for at least a month and often persist for months and sometimes years. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later. For people with PTSD the symptoms cause significant distress or problems functioning. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

Not everyone who experiences trauma develops PTSD, and not everyone who develops either requires psychiatric treatment. For some people, symptoms of PTSD subside or disappear over time. Others get better with the help of family, friends or clergy. But many people with PTSD need professional treatment to recover from psychological distress that can be intense and disabling. It is important to remember that trauma may lead to severe distress. That distress is not the individual’s fault, and PTSD is treatable.

Psychiatrists and other mental health professionals use various effective (research-proven) methods to help people recover from PTSD. Both talk therapy (psychotherapy) and medication provide effective evidence-based treatments for PTSD. One category of psychotherapy, cognitive behavior therapies (CBT), is very effective. Cognitive processing therapy, prolonged exposure therapy and stress inoculation therapy (described below) are among the types of CBT used to treat PTSD.

Cognitive Processing Therapy focuses on modifying painful negative emotions (such as shame, guilt, etc.) and beliefs (such as “I have failed”; “the world is dangerous”) due to the trauma. Therapists help the person confront such distressing memories and emotions.

Prolonged Exposure Therapy uses repeated, detailed imagining of the trauma or progressive exposures to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. For example, virtual reality programs have been used to help war veterans with PTSD re-experience the battlefield in a controlled, therapeutic way.

Stress Inoculation Therapy involves a variety of ways to manage anxiety such as education, muscle relaxation training and biofeedback. This may include social skills training, role-playing, distraction techniques, positive thinking and self-talk.

Other psychotherapies such as interpersonal, supportive and psychodynamic therapies focus on the emotional and interpersonal aspects of PTSD. These may be helpful for people who don’t want to expose themselves to reminders of their traumas.

Medication can help to control the symptoms of PTSD. In addition, the symptom relief that medication provides allows many people to participate more effectively in psychotherapy.

Some antidepressants such as SSRIs and SNRIs (selective serotonin re-uptake inhibitors and selective norepinephrine re-uptake inhibitors), are commonly used to treat the core symptoms of PTSD. They are used either alone or along with psychotherapy or other treatments.

Other medications may be used to lower anxiety and physical agitation, or treat the nightmares and sleep problems that trouble many people with PTSD.

Group therapy encourages survivors of similar traumatic events to share their experiences and reactions in a comfortable and non-judgmental setting. Group members help one another realize that many people would have responded the same way and felt the same emotions. Family therapy may also help because the behavior and distress of the person with PTSD can affect the entire family.

Complementary and alternative therapies are also increasingly being used to help people with PTSD. These approaches provide treatment outside the conventional mental health clinic. They require less talking and disclosure than psychotherapy. They include acupuncture, animal-assisted therapy, virtual reality and stellate ganglion block technique (a procedure that anesthetizes nerves located in the neck).

In addition to treatment, many people with PTSD find being able to share their experiences and feelings with others who have similar experiences, such as in peer support groups, very helpful. Peers can share ideas about effective coping strategies.

Acute Stress Disorder

With acute stress disorder, symptoms are similar to those for PTSD following a trauma. However, they don’t last longer than one month.

Diagnostic and Statistical Manual of Mental Disorders, (DSM-5) American Psychiatric Publishing, 2013

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