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Post-traumatic Stress Disorder

(PTSD)

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 (eg, earthquake, fire)
  • 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
    • Being easily startled
People with PTSD may also:

Diagnosis

The doctor will ask you 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 three months after the event
  • Delayed onset—symptoms do not appear until at least six months after the event

Treatment

There are many treatments available to help you. Treatment will not only focus on treating PTSD, but will also focus on any other conditions you have (eg, depression, alcohol abuse, drug abuse).

Cognitive-Behavior Therapy

Cognitive-behavior therapy (CBT) involves changing your thinking patterns to improve symptoms. Your therapist may teach you techniques to manage anxiety, stress, and anger.
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Exposure Therapy

In exposure therapy, the therapist brings back the imagery of the event in a safe place. You are gradually guided through a visualization. Re-experiencing the trauma in a controlled environment can help you let go of fear and gain control over anxiety.

Group Therapy

Meeting in a group with other survivors of trauma can be an effective and powerful form of therapy for people with PTSD.

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, the therapist has you move your eyes side-to-side following her hand movements. EMDR combines techniques from both CBT and exposure therapy. The goal is to allow the mind to process the trauma and to develop more positive beliefs about yourself.

Medication

Medicine may help with anxiety, depression, and insomnia . Usually, antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are prescribed.
The United States Food and Drug Administration (FDA) has approved these medicines to treat PTSD:
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
Your doctor may try these or other psychiatric medicines to help control your symptoms.

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

RESOURCES

Anxiety Disorders Association of America http://www.adaa.org/

Gift From Within http://www.giftfromwithin.org/

National Center for PTSD http://www.ptsd.va.gov/

CANADIAN RESOURCES

Canadian Psychiatric Association http://www.cpa-apc.org/

Canadian Psychological Association http://www.cpa.ca/

References

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed August 27, 2012.

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.

DSM criteria for PTSD. US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/professional/pages/dsm-iv-tr-ptsd.asp . Updated December 20, 2011. Accessed August 27, 2012.

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 September 12, 2011. Accessed August 27, 2012.

Post-traumatic stress disorder. American Psychiatric Association website. Available at: http://www.apa.org/topics/ptsd/index.aspx . Accessed August 27, 2012.

Post-traumatic stress disorder (PTSD). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated August 21, 2012. Accessed August 27, 2012.

Treatment of PTSD. US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp . Updated April 25, 2012. Accessed August 27, 2012

What is the actual EMDR session like? EMDR International Association website. Available at: http://emdria2.affiniscape.com/displaycommon.cfm?an=1&subarticlenbr=120 . Accessed August 27, 2012.

What is PTSD? US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp . Updated May 29, 2012. Accessed August 27, 2012.

3/16/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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 DynaMed's Systematic Literature Surveillance : 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.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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