Your Health - Post-traumatic Stress Disorder

Post-traumatic Stress Disorder

(PTSD)

Definition

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops after a traumatic event. PTSD has also been called shell shock or battle fatigue.

Causes

The exact cause of PTSD is unknown. PTSD is triggered by exposure to a traumatic event. Situations in which a person feels intense fear, helplessness, or horror are considered traumatic. PTSD has been reported in people who experienced:

War
Rape
Physical assault
Earthquakes
Fire
Sexual abuse
Motor vehicle accidents

Risk Factors

Not everyone who experiences a traumatic event will develop PTSD. Symptoms of PTSD are more likely to occur if the person has:

Previous traumatic experiences
A history of being physically abused
Poor coping skills
Lack of social support
Existing ongoing stress
A social environment that produces shame, guilt, stigmatization, or self-hatred
Alcohol abuse
Family psychiatric history

Symptoms

People with PTSD experience symptoms of anxiety. These symptoms fall into three categories:

Re-experiencing of the event
- Dreams/nightmares
- Flashbacks
- Anxious reactions to reminders of the event
- Hallucinations
Avoidance
- Avoiding close emotional contact with family and friends
- Avoiding people or places that are reminders of the event
- Loss of memory about the event
- Feelings of detachment, numbness
Arousal
- Difficulty falling or staying asleep
- Anger and irritability
- Difficulty concentrating
- Being easily startled

Physical symptoms may also occur such as:

Stomach and digestive problems
Chest pain
Headaches
Dizziness

People with PTSD may also abuse alcohol or drugs .

Diagnosis

The doctor will ask you about your symptoms and medical history. This could be done by a structured interview and/or a questionnaire. You will also likely be given a psychological assessment. PTSD will be diagnosed if you have the specified symptoms, they last for more than one month, and they result in both emotional distress and disturbed functioning (problems at school, work, and/or in family and peer relationships).

PTSD is categorized according to when symptoms occur and how long they last. There are three types of PTSD:

Acute—symptoms last between 1-3 months after the event
Chronic—symptoms last more than three months after the event
Delayed onset—symptoms don't appear until at least six months after the event

Treatment

There is no definitive treatment nor is there a cure for PTSD. A variety of therapies can help relieve symptoms. You will not begin treatment for PTSD until after you are completely removed from the traumatic event. You will first receive treatment for severe depression , suicidal tendencies, drug or alcohol abuse.

Cognitive-Behavior Therapy

Cognitive-behavior therapy involves changing your thinking patterns to improve symptoms. Your therapist may teach you techniques to manage anxiety, stress, and anger.

Managing Mental Health Concerns

Many mental health concerns are caused by a combination of physiological and emotional triggers. CBT can help patients cope by decreasing the effects of emotional triggers.

Exposure Therapy

In exposure therapy, the therapist brings back the imagery of the event in a safe place. You are gradually guided through a visualization. Re-experiencing the trauma in a controlled environment can help you let go of fear and gain control over the anxiety. For example, a study involving female military personnel found that exposure therapy was effective in relieving PTSD symptoms.

Group Therapy

Meeting in a group with other survivors of trauma can be an effective and powerful form of therapy for PTSD sufferers.

Medication

Medication may help with anxiety, depression, and insomnia . Usually antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are prescribed. Anti-anxiety medications may be used in the short term and/or beta-blockers in the long term to calm some of the physical symptoms of severe PTSD.

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

Prozac ( fluoxetine ), Zoloft ( sertraline ), Paxil ( paroxetine ), Luvox ( fluvoxamine ), Celexa ( citalopram ), Lexapro( escitalopram )

For more information, please visit: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273

Prevention

The events that trigger PTSD cannot be predicted or prevented. However, there are some factors that might prevent PTSD from developing after the event.

Cognitive behavioral therapy after an acute stressful episodes may help prevent PTSD
Social support —A network of social support can make a difference in how people react to trauma.

RESOURCES:

Anxiety Disorders Association of America
http://www.adaa.org/

National Center for PTSD
http://www.ncptsd.va.gov/

CANADIAN RESOURCES:

Canadian Mental Health Center
http://www.cmha.ca/

Canadian Psychological Association
http://www.cpa.ca/

References:

American Psychiatric Association website. Available at: http://www.psych.org . Accessed July 15, 2009.

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

National Center for PTSD website. Available at: http://www.ncptsd.va.gov/ncmain/index.jsp . Accessed July 15, 2009.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/index.shtml . Accessed July 15, 2009.

Post-traumatic stress disorder (PTSD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 10, 2009. Accessed November 12, 2009.

¹3/16/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297:820-830.

Last reviewed November 2009 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.