Post-traumatic stress disorder

Answer 1

Definition

Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.

Alternative Names

PTSD

Causes, incidence, and risk factors

Post-traumatic stress disorder (PTSD) may occur soon after a major trauma, or it can be delayed for more than 6 months after the event. When it occurs soon after the trauma, it usually gets better after 3 months. However, some people have a longer-term form of PTSD, which can last for many years.

PTSD can occur at any age and can follow a natural disaster such as a flood or fire, or events such as war, a prison stay, assault, domestic abuse, or rape. The terrorist attacks of September 11, 2001, in the United States may have caused PTSD in some people who were involved, in people who saw the disaster, and in people who lost relatives and friends. These kinds of events can produce stress in anyone, but not everyone develops PTSD.

The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD.

Having good social support helps to protect against PTSD. In studies of Vietnam veterans, those with strong support systems were less likely to get PTSD than those without social support.

People with PTSD re-experience the event again and again in at least one of several ways. They may have frightening dreams and memories of the event, feel as though they are going through the experience again (flashbacks), or become upset during anniversaries of the event.

Symptoms

People with PTSD re-experience the event again and again in at least one of several ways. They may have frightening dreams and memories of the event, feel as though they are going through the experience again (flashbacks), or become upset during anniversaries of the event.

Symptoms of PTSD fall into three main categories:

1. Repeated "reliving" of the event, which disturbs day-to-day activity

• Flashback episodes, where the event seems to be happening again and again
• Recurrent distressing memories of the event
• Repeated dreams of the event
• Physical reactions to situations that remind you of the traumatic event

2. Avoidance

• Emotional "numbing," or feeling as though you don't care about anything
• Feelings of detachment
• Inability to remember important aspects of the trauma
• Lack of interest in normal activities
• Less expression of moods
• Staying away from places, people, or objects that remind you of the event
• Sense of having no future

3. Arousal

• Difficulty concentrating
• Exaggerated response to things that startle you
• Excess awareness (hypervigilance)
• Irritability or outbursts of anger
• Sleeping difficulties

You also might feel a sense of guilt about the event (including "Survivor guilt"), and the following symptoms, which are typical of anxiety, stress, and tension:

• Agitation, or excitability
• Dizziness
• Fainting
• Feeling your heart beat in your chest (palpitations)
• Fever
• Headache
• Paleness

Signs and tests

There are no tests that can be done to diagnose PTSD. The diagnosis is made based on a certain set of symptoms that continue after you've had extreme trauma. Your doctor will do psychiatric and physical exams to rule out other illnesses.

Treatment

Treatment aims to reduce symptoms by encouraging you to recall the event, express your feelings, and gain some sense of control over the experience. In some cases, expressing grief helps to complete the necessary mourning process. Support groups, where people who have had similar experiences can share their feelings, are helpful.

People with PTSD may need to treat depression, alcohol or substance abuse, or related medical conditions before addressing symptoms of PTSD. Behavioral therapy is used to treat avoidance symptoms. This can include being exposed to the object that triggers your symptoms until you become used to it and no longer avoid it (called graded exposure and flooding).

Medicines that act on the nervous system can help reduce anxiety and other symptoms of PTSD. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), can be effective in treating PTSD.

A number of other medicines used for mental health disorders may be prescribed. A doctor should monitor you if you take these drugs, because they can have side effects. Sedatives can help with sleep disturbance. Anti-anxiety medicines may be useful, but some types, such as benzodiazepines, can be addictive.

Support Groups

You can find more information about post-traumatic stress disorder and coping with a national tragedy from the American Psychiatric Association -- www.psych.org.

Expectations (prognosis)

The best outcome, or prognosis, depends on how soon the symptoms develop after the trauma, and on how quickly you get diagnosed and treated.

Complications

• Alcohol abuse
• Depression, anxiety, and fear of things that are not usually frightening to other people (phobia), may be part of this disorder
• Drug abuse

Calling your health care provider

Although traumatic events like the September 11 tragedy can cause distress, not all feelings of distress are symptoms of PTSD. Talk about your feelings with friends and relatives. If your symptoms last longer, or are worse, than those of your friends, contact your doctor.

Seek help immediately by going to the emergency room or calling the local emergency number (such as 911) if:

• You feel overwhelmed by guilt
• You are impulsive
• You are thinking of hurting yourself
• You are unable to contain your behavior
• You have other very distressing symptoms of PTSD

You can also contact your doctor for help with ongoing problems such as recurrent thoughts, irritability, and problems with sleep.

Prevention

Research into ways to prevent PTSD is ongoing.

References

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev.2007;3:CD003388.

Ipser JC, Carey P, Dhansay Y, Fakier N, Seedat S, Stein DJ. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Syst Rev. 2006;4:CD005473.

Answer 2

Definition

Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.

Alternative Names

PTSD

Causes, incidence, and risk factors

PTSD can occur at any age. It can follow a natural disaster such as a flood or fire, or events such as:

• Assault
• Domestic abuse
• Prison stay
• Rape
• Terrorism
• War

For example, the terrorist attacks of September 11, 2001 may have caused PTSD in some people who were involved, in people who saw the disaster, and in people who lost relatives and friends.

Veterans returning home from a war often have PTSD.

The cause of PTSD is unknown. Psychological, genetic, physical, and social factors are involved. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters).

It is not known why traumatic events cause PTSD in some people but not others. Having a history of trauma may increase your risk for getting PTSD after a recent traumatic event.

Symptoms

Symptoms of PTSD fall into three main categories:

1. "Reliving" the event, which disturbs day-to-day activity

• Flashback episodes, where the event seems to be happening again and again
• Repeated upsetting memories of the event
• Repeated nightmares of the event
• Strong, uncomfortable reactions to situations that remind you of the event

2. Avoidance

• Emotional "numbing," or feeling as though you don't care about anything
• Feeling detached
• Being unable to remember important aspects of the trauma
• Having a lack of interest in normal activities
• Showing less of your moods
• Avoiding places, people, or thoughts that remind you of the event
• Feeling like you have no future

3. Arousal

• Difficulty concentrating
• Startling easily
• Having an exaggerated response to things that startle you
• Feeling more aware (hypervigilance)
• Feeling irritable or having outbursts of anger
• Having trouble falling or staying asleep

You might feel guilt about the event (including "survivor guilt"). You might also have some of the following symptoms, which are typical of anxiety, stress, and tension:

• Agitation or excitability
• Dizziness
• Fainting
• Feeling your heart beat in your chest
• Headache

Signs and tests

There are no tests that can be done to diagnose PTSD. The diagnosis is made based on certain symptoms.

Your doctor may ask for how long you have had symptoms. This will help your doctor know if you have PTSD or a similar condition called Acute Stress Disorder (ASD).

• In PTSD, symptoms are present for at least 30 days.
• In ASD, symptoms will be present for a shorter period of time.

Your doctor may also do mental health exams, physical exams, and blood tests to rule out other illnesses that are similar to PTSD.

Treatment

Treatment can help prevent PTSD from developing after a trauma. A good social support system may also help protect against PTSD.

If PTSD does occur, a form of treatment called "desensitization" may be used.

• This treatment helps reduce symptoms by encouraging you to remember the traumatic event and express your feelings about it.
• Over time, memories of the event should become less frightening.

Support groups, where people who have had similar experiences share their feelings, may also be helpful.

People with PTSD may also have problems with:

• Alcohol or other substance abuse
• Depression
• Related medical conditions

In most cases, these problems should be treated before trying desensitization therapy.

Medicines that act on the nervous system can help reduce anxiety and other symptoms of PTSD. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), can be effective in treating PTSD. Other anti-anxiety and sleep medicines may also be helpful.

Support Groups

You can get more information about post-traumatic stress disorder from the American Psychiatric Association -- www.psych.org.

Expectations (prognosis)

You can increase the chance of a good outcome with:

• Early diagnosis
• Prompt treatment
• Strong social support

Complications

• Alcohol abuseor otherdrug abuse
• Depression
• Panic attacks

Calling your health care provider

Although traumatic events can cause distress, not all feelings of distress are symptoms of PTSD. Talk about your feelings with friends and relatives. If your symptoms do not improve soon or are making you very upset, contact your doctor.

Seek help right away if:

• You feel overwhelmed
• You are thinking of hurting yourself or anybody else
• You are unable to control your behavior
• You have other very upsetting symptoms of PTSD

You can also contact your doctor for help with problems such as repeated upsetting thoughts, irritability, and problems with sleep.

Prevention

Research into ways to prevent PTSD is ongoing.

References

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev.2007;3:CD003388.

Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2006, Issue 1. DOI: 10.1002/14651858.CD002795.pub2.

Reviewed By

Review Date: 03/05/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.