Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder, or PTSD, is a condition in which a person has longlasting psychological symptoms after experiencing an extremely stressful event. In PTSD, people who have survived a terrifying event relive their terror in nightmares, memories, and feelings of fear. It can be severe enough to interfere with everyday living and can occur after a natural disaster, military combat, rape, mugging, or other violent event. More than one-third of PTSD victims never fully recover.

PTSD is a condition that occurs among people who have lived through or seen a traumatic or very stressful event, such as war, natural disasters, serious accidents, child abuse, rape, or other threatening acts of violence. Psychological trauma refers to an emotional shock that leads to lasting psychological damage. The traumatic event may be any event that involves the threat of serious injury or death and to which the person responds with fear and helplessness. For some individuals with PTSD, the traumatic event involves a direct attack on them. For others, simply being a witness to a violent incident, such as a murder, can lead to PTSD. The condition is a problem particularly for people who engage in military combat or whose countries are the sites of such combat. People with this disorder often relive the terrifying events through nightmares and disturbing memories. They may have trouble sleeping and may feel emotionally numb or cut off from other people. The symptoms can be severe enough and last long enough to interfere with everyday activities. PTSD is considered acute if the symptoms last less than three months after the traumatic event and chronic if the symptoms last more then three months. Delayed onset PTSD occurs when the symptoms do not begin until six or more months after the traumatic experience.

Children and teenagers can show signs of PTSD. Researchers have found that the disorder is extremely common in young people who experience such violence as seeing a parent murdered or raped, witnessing a school shooting, or being the victim of sexual abuse. It is also common in young people who are exposed to a lot of violence in their community. While it is unclear why PTSD develops in some people but not in others, at least one factor, a high degree of family support, lowers the risk of PTSD in young people.

Victims of PTSD are at higher risk for alcohol or other substance abuse and suicide attempts. PTSD increases risk for other disorders such as clinical depression, panic disorders, and social phobias. Victims of PTSD are also more likely to engage in impulsive behaviors. Females have a higher risk for developing PTSD than males. Females are also more likely to develop PTSD as a result of a violent crime such as rape. Individuals with a prior history of trauma, preexisting anxiety disorders, or preexisting depression are at an increased risk for developing PTSD.

Traumatic events occur frequently. The National Center for Post Traumatic Stress Disorder estimates that just over 60 percent of men and 50 percent of women experience at least one traumatic incident at some point. Not all develop PTSD, but studies show that up to 14 percent of them do. The cause of PTSD can be any event that threatened serious physical harm. Such events include violent personal attacks, such as rape, sexual molestation, or mugging; natural disasters, such as hurricanes, tornadoes, or earthquakes; accidents, such as fires or car crashes; terrorist attacks, such as the 2001 World Trade Center bombing in New York City and at the Pentagon in Washington, DC; wartime suffering; or military combat. The common element in these events is that people lived through a period when they faced great harm and felt fearful and defenseless. Their situations were life threatening and overwhelming.

In 2015, doctors did not understand why some people respond to such experiences by developing PTSD while others do not. However, researchers have reported finding physical changes in some people who have survived traumatic events. Researchers investigated factors that may set apart people who experience PTSD after a very stressful event from those who do not. They have found that people with PTSD tend to have abnormal levels of key hormones * involved in the body's response to stress. In particular, levels of cortisol * are lower than normal, while levels of epinephrine * and norepinephrine * are higher. In addition, when people are in danger, they produce high levels of natural opiates * , body chemicals that temporarily block pain. Scientists have found that people with PTSD keep making higher levels of these substances even after the danger has passed, which may account in part for the emotional numbness often experienced in the disorder.

The symptoms of PTSD may be mild or severe. One person may become slightly cranky, for instance, while another may have violent outbursts. In general, the symptoms seem to be worse if another person caused the event that triggered PTSD. People may have more trouble with their feelings after a rape, for example, than after a flood. Common symptoms of PTSD include:

Most people who have been through a very frightening event will have a noticeable reaction in the days and weeks just afterward. The diagnosis of PTSD is considered only if the symptoms last more than a month. The course of the disorder varies. Some people with PTSD recover within months, whereas others have symptoms that last much longer. Occasionally, the onset of symptoms may not show up until years after the stressful event.

In severe PTSD, people can become overwhelmed by the feeling that nothing really matters. Because they almost lost their lives in an unexpected event, they may fear they are still at risk. This fear causes them to withdraw and become depressed. Depression, in turn, makes it hard for them to concentrate, learn, or perform a job. Students may experience falling grades. People with PTSD may also have difficulty sleeping, because they are trying to avoid nightmares. They may be overly protective of themselves and loved ones and avoid situations in which most people would say there is no danger. They may be easy to anger, or they may experience chest pains, rapid breathing, or dizziness for no apparent reason.

Young children with PTSD may experience less specific fears, such as being afraid of strangers. They may also avoid situations and become preoccupied with words or objects that may or may not be linked to the stressful event. They may have sleep problems, and they may lose previously learned skills, such as toilet training. In addition, they may act out parts of the distressing event in their play.

Older children may also reenact part of the event in play or drawings. They may remember details that happened during the event in the wrong order. In addition, they may believe that there were warning signs that predicted the event. As a result, they may think that they can avoid future problems by always staying alert for such signs. Teenagers show symptoms similar to those of adults, but they are more likely to become aggressive or to make poorly thought-out decisions they later regret.

Some studies show that counseling people soon after a disaster may prevent or relieve the symptoms of PTSD. For example, a study of 12,000 children who lived through a hurricane in Hawaii found that those who got counseling early were doing much better two years later than those who did not get counseling.

Cognitive behavioral (KOG-nihtiv bee-HAY-vyuh-rul) therapy helps people change specific, unwanted types of behavior and faulty thinking patterns. In one form of the therapy, people describe and mentally relive a stressful event under safe, controlled conditions. This lets them face and gain control of the fear that was overwhelming during the actual event. In most approaches, gradual exposure to the traumatic event is paired with relaxation in a supportive environment. With systematic desensitization, people start out with less upsetting events and work up to the most disturbing event, or they confront the stressful event one piece at a time.

Play therapy may help young children who are not able to talk about their feelings directly. The therapist uses play, games, and art to help children remember and describe the stressful event safely and express their feelings about it.

Medications may help reduce certain symptoms, such as sleep aids for those with PTSD who have trouble sleeping and antianxiety drugs for those who are easily startled. Antidepressants may improve conditions that often occur with PTSD, such as depression and panic disorder, in which repeated attacks of overwhelming fear strike often and without warning. Anticonvulsants * have also been used to control impulsive behavior and sudden emotional changes.

See also Anxiety and Anxiety Disorders: Overview • Child Abuse • Sexual Abuse • Stress and Stress-Related Illness • Substance Abuse • Suicide • Trauma

* hormones are chemical substances that are produced by various glands and sent into the bloodstream carrying messages that have certain effects on other parts of the body.

* cortisol (KOR-ti-sol) is a hormone that helps control blood pressure and metabolism, the process of converting food into energy and waste products. It plays a part in the stress response.

* epinephrine (eh-pih-NEH-frin) is a chemical substance produced by the body that can also be given as a medication to constrict, or narrow, small blood vessels, stimulate the heart, and cause other effects, such as helping to open narrowed airways in conditions like asthma and croup.

* norepinephrine (NOR-e-pi-nefrin) is a body chemical that can increase the arousal response, heart rate, and blood pressure.

* opiates (O-pea-aytz) are painkilling chemicals that can cause sleepiness and loss of sensation.

* anticonvulsants (an-tie-konVUL-sents) are medications that affect the electrical activity in the brain and are given to prevent or stop seizures.