Post Traumatic Stress Disorder

Learn About Post Traumatic Stress Disorder

The experience of a severe trauma or life-threatening event may eventuate in the development of Posttraumatic Stress Disorder, or PTSD.  The immediate response to an event or stressor well outside of the realm of normal experience can include numbness, disbelief, or detachment; distortions of the experience of time, space, or perspective; amnesia for various aspects of the traumatic event or, to the contrary, their sudden spontaneous or cued recall (flashback); distressing dreams or nightmares related to the event; feeling or acting as if the traumatic event were recurring; anxiety or depressed mood together with physiologic signs or symptoms of psychic distress provoked by recollections of aspects of the event; efforts to avoid thoughts, conversations, feelings, activities, places or other stimuli that arouse or provoke recollections of the event; difficulty in falling asleep, restless sleep, or problems staying asleep; hypervigilence – an unusually acute awareness of the environment that can border on paranoia; irritable, angry or aggressive behavior; exaggerated startle response; and agitation or restlessness.  However, sometimes these symptoms don’t surface for months or years after the traumatic event.  At any rate, a minimum number of symptoms causing distress or impairment must be present for at least a month to qualify as PTSD.  Symptoms may persist for 6 months or more, in which case the condition is chronic.  

Fear is a natural and non-pathological response to danger.  The “fight or flight” reaction prepares the body for battle or flight, whichever is most likely to result in the preservation of life.  But in PTSD, this reaction is altered; people who have PTSD may feel stressed or frightened even when they’re no longer in danger.  PTSD affects about 7.7 million American adults, but anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events.  It is important to remember that not everyone who lives through a dangerous event gets PTSD.  In fact, most will not get the disorder.
Many factors play a part in whether a person will get PTSD. Some of these are risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event.  PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

The main treatments for people with PTSD are psychotherapy, medications, or both. Some people with PTSD need to try different treatments to find what works for their symptoms.  Psychotherapy can occur one-on-one or in a group. Psychotherapy for PTSD usually lasts 6 to 12 weeks, but can take more time.  Many types of psychotherapy can be helpful. Cognitive therapy involves recognizing and challenging established thought patterns that form the foundation of the PTSD signs and symptoms – for example, the tendency in PTSD to negative or inaccurate ways of perceiving otherwise perfectly normal situations.  Exposure therapy creates a safe interpersonal space to mobilize and confront that which is frightening in the traumatic event so that healthy coping strategies can be brought to bear on it.  Eye movement desensitization and reprocessing (EMDR) combines exposure therapy with a series of guided eye movements that help reprocess traumatic memories and change the reactive stance with respect to traumatic memories.

Medications for the management of PTSD involve primarily antidepressants.  In fact, the only two medications approved by the U.S. Food and Drug Administration (FDA) are the antidepressants sertraline (Zoloft) paroxetine (Paxil).  They help control PTSD symptoms such as sadness, worry, anger, and psychic numbing. Taking these medications along with psychotherapy can optimize the clinical response to each.  Other medications used to treat PTSD with at least some evidence for effectiveness include those that moderate the fight-or-flight reactivity of the sympathetic nervous system  (e.g., propranolol and other beta blockers, clonidine, prazosin and other alpha blockers); benzodiazepines (Klonopin, Xanax, others); certain drugs for psychosis (Abilify, Risperidone, others); and of course, any of the many antidepressants.

Thinking about the diagnosis of PTSD has evolved over time.  In the psychiatric classification of illnesses, PTSD was conceptualized as an anxiety disorder until the most recent re-categorization, in particular, in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V).  There, it is under the Trauma- and Stressor-Related Disorders heading.  The illness is defined by the presence of the traumatic event, followed upon by signs and symptoms gathered into four groupings:  Intrusion, Avoidance, changes in Cognition and Mood, and alterations in Arousal and Reactivity.  The older approach still has relevance, however, and was simpler, dividing the defining features of PTSD into four quadrants:  A traumatic event occurring, which is re-experienced in various ways, accompanied by avoidance of people and situations associated with the event or its recollection, and a state of heightened awareness of the environment and its attendant physiologic manifestations, or hyperarousal.  Either way of thinking about the illness will capture its essence for the purposes of diagnosis and treatment.  

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