Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a debilitating condition
that follows a terrifying event. Often, people with PTSD have persistent
frightening thoughts and memories of their ordeal and feel emotionally
numb, especially with people they were once close to. PTSD, once
referred to as shell shock or battle fatigue, was first brought to
public attention by war veterans, but it can result from any number of
traumatic incidents. These include kidnapping, serious accidents such as
car or train wrecks, natural disasters such as floods or earthquakes,
violent attacks such as a mugging, rape, or torture, or being held
captive. The event that triggers it may be something that threatened the
person's life or the life of someone close to him or her. Or it could be
something witnessed, such as mass destruction after a plane crash.
Whatever the source of the problem, some people with PTSD repeatedly
relive the trauma in the form of nightmares and disturbing recollections
during the day. They may also experience sleep problems, depression,
feeling detached or numb, or being easily startled. They may lose
interest in things they used to enjoy and have trouble feeling
affectionate. They may feel irritable, more aggressive than before, or
even violent. Seeing things that remind them of the incident may be very
distressing, which could lead them to avoid certain places or situations
that bring back those memories. Anniversaries of the event are often
PTSD can occur at any age, including childhood. The disorder can be
accompanied by depression, substance abuse, or anxiety. Symptoms may be
mild or severe—people may become easily irritated or have violent
outbursts. In severe cases they may have trouble working or socializing.
In general, the symptoms seem to be worse if the event that triggered
them was initiated by a person—such as a rape, as opposed to a flood.
Ordinary events can serve as reminders of the trauma and trigger
flashbacks or intrusive images. A flashback may make the person lose
touch with reality and reenact the event for a period of seconds or
hours or, very rarely, days. A person having a flashback, which can come
in the form of images, sounds, smells, or feelings, usually believes
that the traumatic event is happening all over again.
Not every traumatized person gets full-blown PTSD, or experiences
PTSD at all. PTSD is diagnosed only if the symptoms last more than a
month. In those who do have PTSD, symptoms usually begin within 3 months
of the trauma, and the course of the illness varies. Some people recover
within 6 months, others have symptoms that last much longer. In some
cases, the condition may be chronic. Occasionally, the illness doesn't
show up until years after the traumatic event.
Post-traumatic stress disorder (PTSD) is an extremely debilitating
condition that can occur after exposure to a terrifying event or ordeal
in which grave physical harm was threatened or occurred. Traumatic
events that can trigger PTSD include violent personal assaults such as
rape or mugging, natural or manmade disasters, car accidents, or
Most people with PTSD try to avoid any reminders or thoughts of the
ordeal. Despite this avoidant behavior, many people with PTSD repeatedly
re-experience the ordeal in the form of flashback episodes, memories,
nightmares, or frightening thoughts, especially when they are exposed to
events or objects reminiscent of the trauma. Symptoms of PTSD also
include emotional numbness and sleep disturbances (including insomnia),
depression, and irritability or outbursts of anger. Feelings of intense
guilt are also common. PTSD is diagnosed only if these symptoms last
more than one month.
Fortunately, through research supported by the National Institute of
Mental Health (NIMH), effective treatments have been developed to help
people with PTSD.
How Common Is PTSD?
About 4% of the population will experience symptoms of PTSD in a given
When Does PTSD Strike?
PTSD can develop at any age, including childhood. Symptoms of PTSD
typically begin within 3 months following a traumatic event, although
occasionally symptoms do not begin until years later. Once PTSD
develops, the duration of the illness varies. Some people recover within
6 months while others may suffer much longer.
What Treatments Are Available for PTSD?
Treatment for PTSD includes cognitive-behavioral therapy, group
psychotherapy, and medications (including antidepressants). Various
forms of exposure therapy (such as systemic desensitization and imaginal
flooding) have all been used with PTSD patients. Exposure treatment for
PTSD involves repeated reliving of the trauma, under controlled
conditions, with the aim of facilitating the processing of the trauma.
Can People with PTSD Also Have Other Physical or Emotional
People with PTSD can also have other psychological difficulties,
particularly depression, substance abuse, or another anxiety disorder.
The likelihood of treatment success is increased when these other
conditions are appropriately diagnosed and treated, as well.
Many people with anxiety disorders can be helped with treatment. Therapy
for anxiety disorders often involves medication or specific forms of
Medications, although not cures, can be very effective at relieving
anxiety symptoms. Today, thanks to research by scientists at NIMH and
other research institutions, there are more medications available than
ever before to treat anxiety disorders. So if one drug is not
successful, there are usually others to try. In addition, new
medications to treat anxiety symptoms are under development.
For most of the medications that are prescribed to treat anxiety
disorders, the doctor usually starts the patient on a low dose and
gradually increases it to the full dose. Every medication has side
effects, but they usually become tolerated or diminish with time. If
side effects become a problem, the doctor may advise the patient to stop
taking the medication and to wait a week—or longer for certain
drugs—before trying another one. When treatment is near an end, the
doctor will taper the dosage gradually.
Research has also shown that behavioral therapy and
cognitive-behavioral therapy can be effective for treating several of
the anxiety disorders.
Behavioral therapy focuses on changing specific actions and uses
several techniques to decreases or stop unwanted behavior. For example,
one technique trains patients in diaphragmatic breathing, a special
breathing exercise involving slow, deep breaths to reduce anxiety. This
is necessary because people who are anxious often hyperventilate, taking
rapid shallow breaths that can trigger rapid heartbeat, lightheadedness,
and other symptoms. Another technique—exposure therapy—gradually
exposes patients to what frightens them and helps them cope with their
Like behavioral therapy, cognitive-behavioral therapy teaches
patients to react differently to the situations and bodily sensations
that trigger panic attacks and other anxiety symptoms. However, patients
also learn to understand how their thinking patterns contribute to their
symptoms and how to change their thoughts so that symptoms are less
likely to occur. This awareness of thinking patterns is combined with
exposure and other behavioral techniques to help people confront their
feared situations. For example, someone who becomes lightheaded during a
panic attack and fears he is going to die can be helped with the
following approach used in cognitive-behavioral therapy. The therapist
asks him to spin in a circle until he becomes dizzy. When he becomes
alarmed and starts thinking, "I'm going to die," he learns to
replace that thought with a more appropriate one, such as "It's
just a little dizziness—I can handle it."
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