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Post-traumatic Stress Disorder

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
  • Natural disaster such as earthquakes, hurricanes, or fires
  • Sexual abuse
  • Motor vehicle accidents
  • Animal attack

Researchers are studying how problems with synapses in the brain may be linked to PTSD.

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 history of mental health problems

Symptoms

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

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

People with PTSD may also:

Diagnosis

You will be asked about your symptoms and medical history. This may be done by using a structured interview and/or a questionnaire. You will also likely be given a psychological assessment. PTSD will be diagnosed if you have:

  • Symptoms of PTSD, which have lasted for more than one month
  • Both emotional distress and disturbed functioning (eg, problems at school, work, or home) due to the symptoms

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 3 months after the event
  • Delayed onset—symptoms do not appear until at least 6 months after the event

Treatment

There are many treatments available to help manage PTSD. Treatment will not only focus on treating PTSD, but will also focus on any other conditions you may have, such as depression, alcohol abuse, and drug abuse. The length of treatment will depend on the individual but can range from a few months to a few years. Treatment can often include a combination of approaches.

Cognitive-Behavior Therapy (CBT)

There are various forms of therapy and each person will have their own goals for therapy. General goals may include learning how to cope with symptoms, reducing symptoms, and strategies to improve relationships with family or friends.

Cognitive-behavior therapy (CBT) is a very effective type of counseling for PTSD. Therapy focuses on:

  • Learning about your current PTSD symptoms.
  • Better awareness of thoughts, feelings, and negative patterns.
  • Learning coping skills to manage thoughts about the trauma and current day challenges.
  • Understand and find the balance between your beliefs before the trauma and beliefs after the trauma.

There are a few different types of CBT including:

  • Cognitive Processing Therapy (CPT)—focuses on better understanding and management of distressing thoughts. The therapy focuses on the changes to your thought pattern since the trauma and how this change affects how you act and feel.
  • Exposure Therapy—uses repeated discussion of the trauma with a therapist. The goal is to decrease negative feelings from the trauma, help you develop relaxation skills during stressful times, and eventually decrease the influence of the memory. Though it sounds basic, this process should be done with a therapist to help introduce traumatic memories in a safe method and safe place.

Eye Movement Desensitization and Reprocessing (EMDR)

During this type of therapy, you are asked to talk about the traumatic event, including your memories, feelings, and sensations. While talking, you will be asked to do simple tasks like tapping hand, following therapist's hand with your eyes or listening to tones through headphones. The reason why is not clear, but repeating the story with the physical distraction allows your brain to process the trauma in a different way. In effect the process overwrites some of the negative thought processes related to the trauma.

Other Therapy

Other therapeutic options that may help include:

  • Group meetings—Meeting in a group with other survivors of trauma can be an effective form of therapy for people with PTSD.
  • Family therapy—may improve relationships between family members, give family members support, and help family understand your PTSD challenges.

Medication

Medication can help manage some symptoms while you go through counseling or during a crisis period. They may help manage anxiety, depression, and insomnia. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are also often prescribed.

Prevention

The events that trigger PTSD cannot be predicted or prevented. But there are some factors that might prevent PTSD from developing after a traumatic event, such as:

  • Working with a cognitive-behavioral therapist
  • Having a strong network of social support

Revision Information

  • Anxiety and Depression Association of America

    http://www.adaa.org

  • National Center for PTSD—US Department of Veterans Affairs

    http://www.ptsd.va.gov

  • Canadian Psychiatric Association

    http://www.cpa-apc.org

  • Canadian Psychological Association

    http://www.cpa.ca

  • Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Updated August 12, 2010. Accessed November 11, 2014.

  • Benedek DM, Friedman MJ, Zatzick D. Guideline watch: practice guideline for the treatment of patients with acute stress disorder and posttraumatic dtress disorder. Focus. 2009;7:204-213.

  • Jeffereys M. Clinician's guide to medications for PTSD. United States Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/professional/pages/clinicians-guide-to-medications-for-ptsd.asp. Updated July 28, 2014. Accessed November 11, 2014.

  • Treatment of PTSD. US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp. Accessed April 7, 2015.

  • Post-traumatic stress disorder. American Psychiatric Association website. Available at: http://www.apa.org/topics/ptsd/index.aspx. Accessed November 11, 2014.

  • Post-traumatic stress disorder (PTSD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 29, 2014. Accessed November 11, 2014.

  • Treatment of PTSD. US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp. Updated February 27, 2014. Accessed November 11, 2014.

  • What is PTSD? US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp. Updated January 17, 2014. Accessed November 11, 2014.

  • 3/16/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: 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.

  • 11/19/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Ji L, Xiaowei Z, Chuanlin W, Wei L. Investigation of posttraumatic stress disorder in children after animal-induced injury in China. Pediatrics. 2010;126(2):e320-324.