Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a specific form of anxiety that comes on after a stressful or frightening event.
While some stressors are a predictable part of most people's lives - for example, bereavement or chronic illness - others lie outside the range of these common experiences. These include hurricanes, floods and other natural disasters; airplane accidents and car crashes where considerable injury occurs; rape and assault; and armed combat, torture, and existence in a death camp. Such traumatic events would produce distress in almost everyone at any age. In some, they give rise to PTSD.
PTSD is one of the few psychological disorders with a clear point of origin. Although there are some people who have been exposed to trauma and do not develop PTSD, there are certain susceptibility characteristics in people who develop PTSD. These susceptibility factors include the following:
Previous chronic exposure to stress. Susceptibility depends primarily on the survivor's interpretation of the event. Thus, an event that is merely troublesome to one person can be devastating to another. Moreover, each of us may have a stress threshold, so that those who have endured more stress in life are considered more susceptible to PTSD.
Preexisting psychological disorders. People who suffer from depression or anxiety or have a family history of anxiety are more likely to develop PTSD.
Inadequate support systems. A failure by loved ones to acknowledge the trauma, or loved ones who downplay its importance and place blame on the victim, increase the risk of PTSD.
Recent (acute) stressful life changes.
Feeling of lack of control. The state of having "learned helplessness" or giving total control to another individual can give rise to PTSD.
Recent excessive alcohol intake.
The post-traumatic reaction often begins immediately but may emerge after days, weeks, months or even years after the event. There are three kinds of symptoms, hyperalertness/hyperarousal, intrusion and emotional constriction or numbing.
1. Hyperalertness/hyperarousal. People are often edgy, irritable, easily startled, constantly on guard, have poor sleep habits, are agitated and find it difficult to concentrate.
2. Intrusion. People tend to re-experience the event in painful memories, flashbacks, dreams or nightmares. People with PTSD also may experience a worsening of their symptoms when they find themselves in situations that resemble the original trauma or that may be taken as symbols of it - for example, a spell of hot, humid weather for a Vietnam veteran, or a dark street for a woman who has been raped. In avoiding, or attempting to avoid, such situations, an individual's ability to function socially and at work may be severely impaired.
3. Emotional constriction or numbing. Another symptom is called "psychic numbing" or "emotional anesthesia." Sufferers exhibit a pervasive feeling of being detached from other people, from the outside world, and from activities that used to be enjoyable.
They also have a greatly diminished ability to experience emotion, especially tenderness and the feelings associated with intimacy and sex. Other symptoms reflect an over-aroused autonomic nervous system. Sufferers have difficulty falling asleep or staying asleep; they are keyed up and their startle response is heightened.
Anxiety and depression are common in those with PTSD. Irritability is a further problem. Guilt about surviving when others did not, and about the behavior that was necessary for survival, may be constant and painful. Some of those with this disorder turn to alcohol or drugs for escape, others may become self-defeating or suicidal.
According the Diagnostic and Statistical Manual of Mental Disorders the following symptoms must be present for a diagnosis of PTSD:
Recurrent and intrusive distressing recollections or dreams about the event
Feeling as if the traumatic event were recurring, such as through hallucinations and flashbacks
Intense psychological distress at cues that symbolize the event
Additionally, these symptoms must endure for more than a month and must cause clinically significant distress or functional impairment.
As with many other psychiatric disorders, the most effective treatments are psychotherapy and drug treatment.
If functional impairment occurs, or if the symptoms are severe and prolonged, some form of psychotherapeutic treatment is indicated.
With psychodynamic psychotherapy, the individual has the opportunity to discuss the event, relive it, and achieve a better understanding of why it has triggered so severe a psychological and physiological reaction. Cognitive-behavioral techniques may be used to reduce anxiety and depression, aid with insomnia, and treat any phobic symptoms that may have developed.
Psychotherapists treating PTSD try to provide a way for the patient to feel safe in confronting the traumatic event and linking it emotionally as well as intellectually to the symptoms. Patients must learn to think about the trauma without intrusive reliving and exercise self-control without avoidance and emotional numbing.
Some patients are reluctant to talk because they believe the therapist cannot possibly understand what they have been through. Some resist any suggestion that the traumatic event is related to their symptoms. Their helplessness is confirmed by nightmares and flashbacks that remind them of their inability to protect themselves during the trauma. Some have become convinced that the world is hopelessly unjust, others that they themselves are defective or evil. Some patients make emotional demands and direct their accumulated anger at the therapist, they may quit therapy because they can no longer tolerate being exposed to their feelings about the trauma.
Drug treatment is aimed at relieving fear and anxiety and restoring normal sleep patterns. Tricyclic antidepressants, such as Tofranil and Elavil, or SSRIs such as Prozac or Zoloft, are helpful. Additionally, Catapres and Inderal are known to relieve agitation, while Xanax may help some people sleep.