Post-traumatic Stress Disorder
What is post-traumatic stress disorder?
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.
While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions. People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event. PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later.
How common is PTSD?
Studies suggest that anywhere between 2 percent and 9 percent of the population has had some degree of PTSD. However, the likelihood of developing the disorder is greater when someone is exposed to multiple traumas or traumatic events early in life (or both), especially if the trauma is long term or repeated. More cases of this disorder are found among inner-city youths and people who have recently emigrated from troubled countries. And women seem to develop PTSD more often than men.
Veterans are perhaps the people most often associated with PTSD, or what was once referred to as "shell shock" or "battle fatigue." The Anxiety Disorders Association of America notes that an estimated 15 percent to 30 percent of the 3.5 million men and women who served in Vietnam have suffered from PTSD.
What are the symptoms of PTSD?
Although the symptoms for individuals with PTSD can vary considerably, they generally fall into three categories:
- Re-experience - Individuals with PTSD often experience recurrent and intrusive recollections of and/or nightmares about the stressful event. Some may experience flashbacks, hallucinations, or other vivid feelings of the event happening again. Others experience great psychological or physiological distress when certain things (objects, situations, etc.) remind them of the event.
- Avoidance - Many with PTSD will persistently avoid things that remind them of the traumatic event. This can result in avoiding everything from thoughts, feelings, or conversations associated with the incident to activities, places, or people that cause them to recall the event. In others there may be a general lack of responsiveness signaled by an inability to recall aspects of the trauma, a decreased interest in formerly important activities, a feeling of detachment from others, a limited range of emotion, and/or feelings of hopelessness about the future.
- Increased arousal - Symptoms in this area may include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, becoming very alert or watchful, and/or jumpiness or being easily startled.
It is important to note that those with PTSD often use alcohol or other drugs in an attempt to self-medicate. Individuals with this disorder may also be at an increased risk for suicide.
How is PTSD treated?
There are a variety of treatments for PTSD, and individuals respond to treatments differently. PTSD often can be treated effectively with psychotherapy or medication or both.
Behavior therapy focuses on learning relaxation and coping techniques. This therapy often increases the patient's exposure to a feared situation as a way of making him or her gradually less sensitive to it. Cognitive therapy is therapy that helps people with PTSD take a close look at their thought patterns and learn to do less negative and nonproductive thinking. Group therapy helps for many people with PTSD by having them get to know others who have had similar situations and learning that their fears and feelings are not uncommon.
Medication is often used along with psychotherapy. Antidepressant and anti-anxiety medications may help lessen symptoms of PTSD such as sleep problems (insomnia or nightmares), depression, and edginess.
Reviewed by Jack Gorman, MD May 2003