Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Many people who go through traumatic events have difficulty adjusting and coping for a while. But with time and taking care of yourself, such traumatic reactions usually get better. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes they may completely shake up your life. In a case such as this, you may have post-traumatic stress disorder.

Getting treatment as soon as possible after post-traumatic stress disorder symptoms develop may prevent long-term post-traumatic stress disorder.

Symptoms

Post-traumatic stress disorder symptoms typically start within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not appear until years after the event.

Post-traumatic stress disorder symptoms are generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).

Symptoms of intrusive memories may include:

• Flashbacks, or reliving the traumatic event for minutes or even days at a time
• Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:

• Trying to avoid thinking or talking about the traumatic event
• Feeling emotionally numb
• Avoiding activities you once enjoyed
• Hopelessness about the future
• Memory problems
• Trouble concentrating
• Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:

• Irritability or anger
• Overwhelming guilt or shame
• Self-destructive behavior, such as drinking too much
• Trouble sleeping
• Being easily startled or frightened
• Hearing or seeing things that aren’t there

Post-traumatic stress disorder symptoms can come and go. You may have more post-traumatic stress disorder symptoms when things are stressful in general, or when you run into reminders of what you went through. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape and feel overcome by memories of your own assault.

Causes

You can develop post-traumatic stress disorder when you go through, see or learn about an event that causes intense fear, helplessness or horror.

Doctors aren’t sure why some people get post-traumatic stress disorder. As with most mental health problems, PTSD is probably caused by a complex mix of:

• Your inherited mental health risks, such as an increased risk of anxiety and depression
• Your life experiences, including the amount and severity of trauma you’ve gone through since early childhood
• The inherited aspects of your personality — often called your temperament
• The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, including:

• Being female
• Experiencing intense or long-lasting trauma
• Having experienced other trauma earlier in life
• Having other mental health problems, such as anxiety or depression
• Lacking a good support system of family and friends
• Having first-degree relatives with mental health problems, including PTSD
• Having first-degree relatives with depression
• Having been abused or neglected as a child

Women may be at increased risk of PTSD because they are more likely to experience the kinds of trauma that can trigger the condition.

Kinds of traumatic events
Post-traumatic stress disorder is especially common among those who have served in combat. It’s sometimes called “shell shock,” “battle fatigue” or “combat stress.”

The most common events leading to the development of PTSD include:

• Combat exposure
• Rape
• Childhood neglect and physical abuse
• Sexual molestation
• Physical attack
• Being threatened with a weapon

But many other traumatic events also can lead to post-traumatic stress disorder, including fire, natural disaster, mugging, robbery, assault, civil conflict, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack and other extreme or life-threatening events.

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what’s happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. Although you may not want to talk about it to anyone or you don’t want to even think about what’s happened, getting support can help you recover. This may mean turning to supportive family and friends who will listen and offer comfort. It may mean that you seek out a mental health professional for a brief course of therapy. Some people also may find it helpful to turn to their faith community or a pastoral crisis counselor.

However you choose to get support and help, doing so can help prevent normal stress reactions from getting worse and developing into post-traumatic stress disorder. Getting support may also help prevent you from turning to unhealthy coping methods, such as alcohol use.

How can I help a friend or relative who has PTSD?

If you know someone who has PTSD, it affects you too. The first and most important thing you can do to help a friend or relative is to help him or her get the right diagnosis and treatment. You may need to make an appointment for your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if his or her symptoms don’t get better after 6 to 8 weeks.

To help a friend or relative, you can:

• Offer emotional support, understanding, patience, and encouragement.
• Learn about PTSD so you can understand what your friend or relative is experiencing.
• Talk to your friend or relative, and listen carefully.
• Listen to feelings your friend or relative expresses and be understanding of situations that may trigger PTSD symptoms.
• Invite your friend or relative out for positive distractions such as walks, outings, and other activities.
• Remind your friend or relative that, with time and treatment, he or she can get better.

Never ignore comments about your friend or relative harming him or herself, and report such comments to your friend’s or relative’s therapist or doctor.

How can I help myself?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better.

To help yourself:

• Talk to your doctor about treatment options.
• Engage in mild activity or exercise to help reduce stress.
• Set realistic goals for yourself.
• Break up large tasks into small ones, set some priorities, and do what you can as you can.
• Try to spend time with other people and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
• Expect your symptoms to improve gradually, not immediately.
• Identify and seek out comforting situations, places, and people.

 

References:

1. Posttraumatic stress disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Jan. 5, 2011.
2. Posttraumatic stress disorder. In: Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. ArlingtonWashington, D.C.: American Psychiatric Publishing; 2008. http://www.psychiatryonline.com. Accessed Jan. 5, 2011.
3. Shalev AY. Posttraumatic stress disorder and stress-related disorders. Psychiatric Clinics of North America. 2009;32:687.
4. Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2010;4:414.
5. May AC, et al. Posttraumatic stress disorder In: Ferri FF. Ferri’s Clinical Advisor 2011: Instant Diagnosis and Treatment. Philadelphia, Pa.: Mosby Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05610-6..00025-1–sc30645&isbn=978-0-323-05610-6&type=bookPage&sectionEid=4-u1.0-B978-0-323-05610-6..00025-1–sc30645&uniqId=230982534-3. Accessed Jan. 5, 2011.
6. Holzer SR. Mediational significance of PTSD in the relationship of sexual trauma and eating disorders. Child Abuse & Neglect: The International Journal. 2008;32:561. http://www.mdconsult.com/das/citation/body/230982534-5/jorg=journal&source=MI&sp=20885418&sid=1101209736/N/20885418/1.html?issn=0145-2134. Accessed Jan. 5, 2011.
7. Understanding PTSD. National Center for PTSD. http://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf. Accessed Jan. 5, 2011.
8. Nakell L. Adult post-traumatic stress disorder: Screening and treating in primary care. Primary Care: Clinics in Office Practice. 2007;34:593.
9. Acupuncture may help symptoms of posttraumatic stress disorder. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/research/results/spotlight/092107.htm. Accessed Jan. 5, 2011.
10. Coping with traumatic stress reactions. National Center for PTSD. http://www.ptsd.va.gov/public/pages/coping-traumatic-stress.asp. Accessed Jan. 12, 2011.
11. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 11, 2011.
12. http://www.mayoclinic.com/
13. http://www.nimh.nih.gov/

Tags: causes, How can I help a friend or relative who has PTSD?, How can I help myself?, Post-traumatic stress disorder, prevention, PTSD, Risk factors, Symptoms

Share it.