WHAT IS PTSD?

Posttraumatic stress disorder (PTSD) is a potentially disabling anxiety disorder.  People who have PTSD have experienced intense fear, terror or hopelessness in response to a traumatic event that was life-threatening or that threatened their physical integrity (eg, war trauma, accidents, victimization from a crime, torture, rape, sexual molestation, severe emotional cruelty).  If you suffer from PTSD, you are not alone.  PTSD affects millions of people annually, with the lifetime prevalence of PTSD being 7.8% in the United States (Kessler et al 1995).

PTSD involves at least 1 month of symptoms characterized by (American Psychiatric Association, DSM-IV-TR, 2000):

• Emotional re-experiencing of the traumatic event, which triggers significant feelings of fear and anxiety.  This can include intrusive, recurrent thoughts, images, and/or nightmares of the trauma.  Sometimes, patients with PTSD experience flashbacks, which are periods of time when they relive the trauma while dissociating from reality, and can include hallucinations. These symptoms are usually triggered by traumatic reminders, which can be as obvious as encountering the assaulter or visiting the site of the trauma; sometimes, however, re-experiencing can be activated by more elusive associations with the trauma, such as smells, sounds, textures, subtle images, etc.
• Avoidant Behaviors.  Due to the extreme anxiety traumatic reminders can spark, instead of processing the trauma, often PTSD sufferers end up detaching from their friends and family, and avoid potential triggers.  All too often, this results in a very limited existence; especially if traumatic reminders include motor vehicles, crowded places, specific people, work, and even sleep.  Often family and friends see victims as being œchecked out and emotionally numb.
• Ongoing Symptoms of Hyper-Arousal.  This can include symptoms of:  Insomnia – Difficulties falling or staying asleep, either due to a fear of having a recurrent nightmare, or to being roused by a nightmare, is common in PTSD.  Insomnia can be a problem in PTSD even in the absence of nightmares.  Irritability, depression, anger or rage – Difficulties focusing, and impaired or fragmented memory.  Hypervigilance – PTSD sufferers commonly are on alert for another traumatic event and frequently expect to have a shortened lifespan.  Exaggerated Startle – Patients are often very œjumpy, especially if surprised by an unexpected pat on the back or approach from behind.

While most trauma sufferers develop PTSD soon after the trauma, it is possible to develop PTSD decades after the insult (Andrews et al; Smid et al 2009).  Interestingly, most people who experience a trauma do not develop PTSD. Only between 10-20% of trauma victims develop PTSD (Breslau N et al, 1998; Breslau N, 2009).

What makes someone more at risk for developing PTSD after a traumatic event? (Brewin, et al 2000)

• Female gender
• Limited emotional support
• Exposure particularly to violent trauma
• Witnessing the death of a family member or loved one
• History of a psychiatric diagnosis
• Family history of psychiatric illness, and
• History of early adversity (eg, death of a parent during childhood)

What makes people less vulnerable to PTSD after experiencing a trauma?

People who experience trauma and do not develop PTSD often reach out to a reliable support system of friends and family, and access trauma support groups, where they use the opportunity talk about — and process — their traumatic experiences. When reflecting on their actions during the trauma, they tend to be able to acknowledge their resilience in the face of trauma; this may  reaffirm their sense of being competent in an unpredictable world, rather than helpless.

There are many treatments for PTSD, including support groups, exposure therapy, EMDR, and medications.  Studies indicate that Transcranial magnetic stimulation, or TMS, a non-invasive outpatient treatment involving magnetic waves, is another promising non-drug approach to PTSD treatment.

If you found this post on PTSD interesting, check out our other posts on behavioral health, including one on protected time.