Also called: Shell Shock, PTSS, PTSD, Combat Fatigue, Post Traumatic Stress Syndrome
Post-traumatic stress disorder (PTSD) is an anxiety disorder that involves feelings of intense fear, helplessness or horror brought on by experiencing or witnessing an especially traumatic or terrifying event. About 5 million adult Americans suffer from PTSD, according to the National Institute of Mental Health(NIMH).
In some cases, a trauma that directly impacts a person’s life may cause PTSD. Examples include military combat, rape or an automobile accident. In other cases, a person may develop PTSD after witnessing a trauma, such as seeing a plane crash or the physical abuse or torture of others.
Many patients with PTSD repeatedly re-experience the traumatic event in the form of flashback episodes, nightmares or frightening thoughts. Therefore, they try to avoid any reminders or thoughts of the traumatic event. Feelings of intense guilt, emotional numbness, sleep disturbances, depression, anxiety, irritability and substance abuse are also common, which makes it difficult for patients to maintain close relationships with others.
For many, PTSD can become so debilitating that patients have difficulty maintaining a job or socializing. Patients may not be aware that they have the condition, but may instead seek care when they find themselves overwhelmed by feelings related to a traumatic event or series of events. Before diagnosing PTSD, a physician will likely ask the patient about the event that triggered symptoms and how it affected the patient. The patient will also be asked to describe the nature of symptoms, when they occur, how intense they are and how long they last. A combination of psychotherapy and medications such as antidepressants may be used to treat post-traumatic stress disorder.
About post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is an anxiety disorder that may follow an especially traumatic or terrifying event in a person’s life. In severe cases, PTSD can become so debilitating that a patient’s quality of life suffers. For instance, they may have difficulty maintaining a job or socializing.
Many different types of events can cause PTSD. In some cases, the trauma that causes this disorder directly impacts the person’s life, such as being shot or having an automobile accident. In other cases, the person witnesses the trauma, such as witnessing an accident or terrorist incident.
Some examples of trauma that may cause PTSD include:
- Military combat
- Rape, mugging or torture
- Being kidnapped or held hostage
- Child abuse
- Serious accidents, such as automobile accidents
- Natural disasters such as floods, earthquakes or hurricanes
Traumatic events do not necessarily have to be related to accidents, disasters or violence. Research has indicated that parents of children undergoing chemotherapy demonstrate symptoms related to PTSD.
Risk factors and causes of PTSD
It is not completely understood what causes post-traumatic stress disorder (PTSD). However, more is being learned about how changes in the brain after trauma contribute to this disorder. Research has revealed that people with PTSD experience several altered brain mechanisms. This causes abnormalities in brain chemicals that mediate coping behavior, learning and memory, leading to symptoms of PTSD.
Recent research into causes of PTSD has focused on the specific brain areas involved in anxiety and fear, which are important for understanding anxiety disorders such as PTSD. Findings suggest that different anxiety disorders may be associated with abnormal activation of the amygdala, a small structure deep inside the brain which controls the fear response to deal with danger.
It has been shown that the hippocampus, another area in the brain that encodes information into memories and helps process threatening or traumatic stimuli, is often smaller in patients who have experienced severe stress through traumas such as child abuse or military combat. The smaller hippocampus may be responsible for some symptoms associated with PTSD, including flashbacks and reduced memory.
Additionally, people with PTSD tend to have abnormal regulation of stress hormones including natural opiates, cortisol and norepinephrine.
The Anxiety Disorders Association of America (ADAA) lists three major types of stress that usually cause PTSD. They are:
- The threat of death or serious injury to an individual
- Learning about the death, near death or serious injury of a family member or other loved one
- Witnessing the death, near death or serious injury of another person
People who are exposed to multiple traumas, rape or trauma early in life are at greater risk for suffering from PTSD. In addition, some forms of trauma are especially likely to trigger PTSD. For example, more than half of people exposed to mass violence are likely to develop the disorder, according to the ADAA.
Other factors that may increase the risk of developing PTSD include:
- History of depression or other emotional disorder
- History of physical or sexual abuse
- Early separation from parents (e.g., orphan or losing one parent to death)
- History of substance abuse
There is some evidence that PTSD may have a genetic component and that people may be more susceptible to the disorder if there is a family history of PTSD. This genetic link may help explain why some people who experience substantial trauma develop PTSD and others do not.
Signs and symptoms of PTSD
Symptoms of post-traumatic stress disorder (PTSD) often involve reexperiencing the traumatic ordeal through memories, flashbacks, frightening thoughts or nightmares. These are most likely to occur when patients come into contact with events or objects that remind them of the initial trauma, or on anniversaries related to the traumatic event.
PTSD can also cause patients to experience emotional numbness, particularly in regard to people with whom they were once close. They may stop enjoying certain activities (anhedonia), and may avoid people or places that remind them of the traumatic event. Their memory may suffer, especially when attempting to recall details of the trauma that caused the PTSD. Depression is also commonly associated with the disorder.
At the same time that patients become numb to certain feelings, they may show increased arousal in other ways. For example, they may be prone to feelings of intense guilt (if they survived a trauma in which others perished, or based on what they had to do to survive). Patients may also have sudden angry outbursts. They may become jumpy and have trouble concentrating. Other symptoms include sleep disturbances, anxiety and irritability.
Physical symptoms may include headaches, gastrointestinal disorders, immune system problems, dizziness, chest pain or discomfort in other parts of the body. Recent research also indicates that patients with PTSD may have a diminished sensitivity to physical pain.
PTSD symptoms usually begin within three months of a traumatic event. However, in some cases symptoms are delayed for months or even years. Symptoms will sometimes begin to dissipate within six months. In other cases, patients may experience symptoms for months or years longer. Symptoms tend to be worse when the patient is the victim of or witness to an intentional act caused by another person, rather than by nature or chance.
Patients with PTSD are often diagnosed with other associated mental disorders, including depression, substance abuse, eating disorders and other anxiety disorders. They also have a greater risk of committing suicide. Children who experience PTSD may display slightly different symptoms than adults. They may have nightmares of monsters or of threats to themselves or others. They also may re-enact the trauma through repetitive play – such as re-enacting crashes with toy cars. In addition, children who experience PTSD may show delayed or developmental regression in terms of toilet training, motor skills or language.
Diagnosis methods for PTSD
Patients who find themselves overwhelmed by feelings related to a traumatic event or series of events are encouraged to visit a physician. Early diagnosis of post-traumatic stress disorder (PTSD) can help a patient recover more quickly. Some studies have indicated that people who are encouraged to talk about their experiences very soon after a traumatic event are less likely to suffer lasting symptoms associated with PTSD.
Before diagnosing PTSD, a physician will perform a complete physical examination and compile a thorough medical history. The physician will likely ask about the event that triggered symptoms and how it affected the patient. The patient will also be asked to describe the nature of symptoms, when they occur, how intense they are and how long they last. Other questions that a physician may ask patients include:
- Are they having flashbacks or nightmares?
- Do they avoid people or places that remind them of the traumatic event?
- Are they having trouble sleeping?
- Do they feel emotionally numb?
- Are they having memory problems?
The diagnostic criteria for PTSD as outlined in the Diagnostic and Statistical Manual of Mental Disorders involves reports by a patient of intense fear, helplessness or horror after experiencing or witnessing events that were potentially life-threatening or that involved the threat of serious injury. Symptoms must last for more than one month and involve one or more of the following:
- Persistent reliving of the traumatic event
- Persistent avoidance of people, places or activities associated with the trauma
- Numbing of general responsiveness to life events
- Persistent symptoms of increased arousal, such as emotional outbursts or insomnia
If a physician suspects that PTSD is present, the patient may be referred to a psychiatrist, psychologist or other mental health professional for further evaluation, treatment and follow up.
Treatment options for PTSD
A combination of psychotherapy and medications may be used to treat post-traumatic stress disorder (PTSD). Psychotherapy may take place in a one-on-one or group setting. Cognitive behavior therapy (CBT) helps patients learn new skills to change reaction patterns to situations that typically trigger anxiety. Patients also learn about methods to redirect negative thought patterns that increase anxiety.
In addition, patients may be asked to intentionally relive their trauma in safe and controlled settings that allow them to gradually work through the trauma. This method of gradually exposing the patient to potentially traumatic stimuli and encouraging them to test new coping skills is known as exposure therapy. Some patients may also benefit from using certain types of medication. Antidepressants,such as selective serotonin reuptake inhibitors (SSRIs), are sometimes used to treat PTSD. Anti-anxiety drugs are also sometimes used to relieve a patient’s symptoms while increasing relaxation and helping the patient to sleep better. Patients should be aware that a physician may need to adjust the dosage or change medications to achieve the best results with minimal side effects. In addition, the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some patients and all people being treated with them should be monitored closely for unusual changes in behavior.
Questions for your doctor regarding PTSD
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to post-traumatic stress disorder (PTSD):
- I have been through or witnessed a traumatic event. What is my risk of developing PTSD? How can I reduce that risk?
- How can I tell if I am developing PTSD? What signs should I watch for?
- What should I tell my friends and family about my risk for PTSD? Should they also be on the lookout for signs and symptoms?
- My traumatic event was very recent and I am showing some signs of PTSD. Is that possible?
- How will a diagnosis of PTSD be made? Will I need to see a mental health professional? Can you recommend one?
- Do I have any conditions that are associated with PTSD? How will that affect my treatment?
- What are my treatment options?
- Are there medications that may be helpful? Which do you recommend and what are their potential side effects?
- What types of therapy should I consider? Can you recommend a qualified therapist?
- Does PTSD make me dangerous to myself or others? What steps can I take to minimize this risk?
- Might my close friends and family benefit from counseling regarding my PTSD? Can you recommend any support groups?