Post-Traumatic Stress Disorder
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that may develop following exposure to any one of a variety of traumatic events that involve actual or threatened death, or serious injury. The event may be witnessed rather than directly experienced, and even learning about a specific event may be sufficient if the persons involved are family members or close friends. Sufferers may experience flashbacks, panic attacks and heightened awareness. PTSD is sometimes found in ex-military personnel who have been involved in conflict situations.
Causes and Risk Factors
PTSD is believed to be caused by the experience of a traumatic event. A person may experience or witness a stressful event involving death, serious injury or such threat to the individual or others in a situation in which the individual felt intense fear, horror, or powerlessness. PTSD can occur in individuals with no predisposing conditions; however persons considered at-risk include combat military personnel, rape survivors, victims of natural disasters, concentration camp survivors, and victims of violent crime such as domestic or sexual abuse.
More than half of all individuals will experience at least one traumatizing event in their lifetime; men are more likely to experience a traumatic event, but women are more likely to experience the kind of high impact traumatic event that can lead to PTSD, such as interpersonal violence and sexual assault. Only a minority of people who are traumatized will develop PTSD. The average risk of developing PTSD after trauma is around 8% for men and around 20% for women. Rates of PTSD are higher in combat veterans than than the average rate for men, with a rate estimated at up to 20% for veterans returning from Iraq and Afghanistan (Figure 1).
Symptoms and Diagnosis
The DSM indicates the following criteria for the diagnosis of PTSD:
A: Exposure to a traumatic event. This must have involved both (a) loss of physical integrity, or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror, or helplessness.
B: Persistent re-experiencing. One or more of the following must be present: persistent flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological responses to any reminder of the event(s).
C: Persistent avoidance and emotional numbing. This involves a high level of:
- avoidance of stimuli associated with the trauma, such as certain thoughts or feelings; talking about the event(s); or behaviors, places or people that may trigger unwanted memories.
- disturbing memories, dreams, flashbacks, and intense psychological or physiological distress;
- inability to recall major parts of the trauma
- decreased capacity (or inability) to feel certain feelings
- an expectation that one's future will be somehow constrained in ways not normal to other people.
D: Persistent symptoms of increased arousal not present before. Including difficulty falling or staying asleep, problems with anger or concentration, uncharacteristic irritability, angry outbursts, or heightened startle response.
E: Duration of symptoms for more than 1 month.
F: Significant impairment. Symptoms must lead to clinically significant distress or impairment, which means significant difficulty functioning in most domains of life, such as relationships, work or other daily functioning.
A number of psychotherapies have demonstrated usefulness in the treatment of PTSD and other trauma-related problems. The most helpful programs are cognitive-behavioral therapy (CBT), cognitive therapy (CT), exposure therapy, and stress inoculation training (SIT).
Cognitive behavioral therapy (CBT) seeks to change the way a trauma victim feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts. The goal is to understand how certain thoughts about events cause PTSD-related stress.
Exposure therapy is a type of cognitive-behavioral therapy that involves assisting trauma survivors to re-experience distressing trauma-related memories and reminders in order to facilitate habituation and successful emotional processing of the trauma memory.
A variety of medications have shown adjunctive benefit in reducing PTSD symptoms, but there is no clear drug treatment for PTSD. Positive symptoms (such as re-experiencing or increased arousal) generally respond better to medication than negative symptoms (when typical functions are no longer present in the individual, such as avoidance, withdrawal). Positive symptoms are those that most individuals do not normally experience but are present in people with PTSD, while negative symptoms are deficits of normal emotional responses or of other thought processes.