Post-traumatic stress disorder (PTSD)

Definition
Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that causes debilitating symptoms after experiencing, witnessing or learning about a traumatic event. PTSD is often characterized by intense fear, disorganization or agitation for more than one month in response to the traumatic event.

Overview
Post-traumatic stress disorder can develop at any age. The condition affects about 4 to 8 percent of American adults, but it may occur at higher rates -- between 33 and 50 percent -- in active combat veterans, rape survivors and other people at high risk. More than twice as many women as men experience PTSD after exposure to trauma. About 50 percent of people diagnosed with PTSD recover within three months, while some will have symptoms that last longer than 12 months. In other cases, PTSD may last for a lifetime with periods of remission or relapse. PTSD symptoms can also return under other kinds of stressors.
Traumatic events that lead to PTSD are typically severe, sudden and unexpected, but ongoing abuse or violence can have the same effect. Keeping in mind that not everyone who is exposed to a traumatic event develops post-traumatic stress disorder, the condition may occur after any of the following events:

violent acts, such as a mugging, rape, physical attack, or domestic, sexual or child abuse
forced separation, such as being kidnapped, held hostage, incarcerated, or taken to a prisoner of war or concentration camp
combat or other war-related events
political torture or emigration from areas of civil unrest
natural or man-made disasters
vehicle or other accidents
working with trauma victims
The most important factors influencing the likelihood of developing PTSD are the severity, duration and proximity of the person's exposure to the specific traumatic event. Family history, personality differences, childhood experiences, available social support and cultural variations will also influence how a person experiences and copes with traumatic events. In some cases, the extreme stress caused by the traumatic event may cause a change in the person's brain chemistry.


Characteristics
Symptoms often appear within three months of the traumatic event. The reaction may be delayed for months or even years, however. Symptoms may be acute (lasting for three months or less) or chronic (lasting for three months or more). Sometimes, symptoms are triggered by events that resemble or symbolize the traumatic event, such as anniversary dates, climatic conditions or specific odors.
Symptoms of post-traumatic stress disorder can resemble those of acute stress disorder, a related condition. Symptoms of acute stress disorder are not as lengthy, however, beginning and resolving within a four-week period following the traumatic event.

Physical characteristics
Physically, a person who has PTSD may experience sleep disturbances, including insomnia and night sweats. Physical problems such as tense muscles, stomachaches, headaches, gastrointestinal problems, dizziness, chest pain, immunity disorders or other physical conditions may develop.

Psychological characteristics
Psychologically, the person may have recurrent or intrusive, distressing recollections of the traumatic event. These recollections may include images, thoughts, perceptions or dreams. The person may feel intense fear, helplessness or horror. Irritability, hostility or outbursts of anger are common, as well as survivor guilt or shame. He or she may develop an exaggerated startle response. The person may have a sense of a shortened future, not expecting to have a family, a career and so on. There may be intense distress related to any cues of the event, such as odors or weather conditions. The person may think, "What did I do to deserve this?" or "What could I have done to prevent this?" Other common reactions include depression, emotional numbness, suspicion, anxiety or even panic.

Social characteristics
Socially, the person may withdraw from usual activities and avoid activities, places or people that lead to recollections of the trauma. The person may come and go without notice to others. He or she may also be unwilling to communicate with others and avoid thoughts, feelings or conversations about the trauma. Hypervigilance and compulsive behaviors such as overeating, compulsive gambling, acting out sexually or spending excessive amounts of money are common. The person may also lose interest in favorite or usual social activities.

Eventually, symptoms of PTSD can interfere with relationships and jobs -- even the ability to successfully function in society. Compounding the situation, people who have PTSD often have other conditions at the same time, such as alcoholism, drug abuse or other anxiety disorders.

Characteristics for children
Children affected by PTSD may become disorganized, anxious or agitated. Distressing dreams about the event may become generalized nightmares about monsters, other threatening figures or situations, or the child trying to rescue others. Children may also engage in repetitive play or daydreaming to relive the trauma. Withdrawal from usual activities, school phobia or poor academic performance may occur. A child may act younger than his or her age or show increased alertness to the environment. Children who have PTSD often have physical complaints, such as stomachaches and headaches.


Diagnosis
Post-traumatic stress disorder may be diagnosed when symptoms last more than a month. The health care provider will ask questions about your medical history, review current symptoms, and discuss stressful events you've experienced. A physical exam and other diagnostic tests can help the health care provider determine if the symptoms are related to a medical problem, mental health condition or both.

Coping
About half of the people diagnosed with post-traumatic stress disorder recover within three to six months. In some cases, however, the condition may last for decades or even a lifetime. Remissions, relapses or severe disability are possible. Fortunately, early treatment can help you regain a sense of control, decrease the power of past events, and keep the condition from becoming chronic.
Self-care strategies
If you have post-traumatic stress disorder, learn as much as you can about your condition and treatment options. It's also helpful to educate family, friends and other close contacts about the condition. Practice good physical and emotional self-care, maintain a positive attitude, and build a strong support network. Hone your skills in time management, communication, assertiveness and conflict management. Avoid caffeine, alcohol and illegal drugs, and make sure you comply with your treatment plan and keep all medical and therapy appointments. Finally, it may be helpful to attend stress management training courses and participate in activities that reduce stress, such as exercise, meditation or hobbies.

Psychological therapy
Individual, family or group counseling is often recommended to help you learn to confront and accept the trauma without being overwhelmed, as well as link the traumatic event to specific symptoms. Other types of psychological treatment may include behavioral therapy, stress management, relaxation training, hypnosis, self-help groups and support groups. Therapy groups involving people who share similar situations, such as Vietnam War veterans or rape survivors, are often helpful. Most therapy is done in outpatient settings. Brief inpatient treatment is sometimes necessary, however.

Drug therapy
Drug intervention may help calm you, ease symptoms of depression and anxiety, and facilitate therapy. The choice of medication depends on your symptoms and medical history. Although the U.S. Food and Drug Administration has not recommended any specific medications for the treatment of PTSD, antidepressants, beta blockers or antianxiety drugs may be recommended. Other drugs may be prescribed to manage coexisting conditions, such as withdrawal symptoms from drugs or alcohol.

Strategies for loved ones
If you have a loved one who has PTSD, educate yourself about the condition. Know that you may feel hurt, alienated, frustrated or discouraged if your loved one loses interest in the family or becomes emotionally detached. You may feel as if the trauma never stops if your loved one is excessively on guard, tense or enraged. It may be difficult to have a cooperative discussion about plans and decisions for the future if your loved one believes there is no future to be optimistic about. If you live in the same household, your own sleep may be disrupted due to your family member's sleep problems. Eventually, the trauma may take over the life of the family. Know that people who have PTSD may turn to addictions and domestic violence to mask their emotional pain. Keep in mind that family members of people who have post-traumatic stress disorder may also be at risk for depression, anxiety, alcoholism and drug abuse.

To help your loved one, encourage him or her to seek counseling. Be careful not to pressure the person into counseling, however. You may also want to seek counseling for yourself, your children, the two of you or as a family if your loved one is experiencing secondary trauma reactions, such as anxiety, fear, anger, addiction, school or work problems, or difficulties with intimacy. It may also help to take classes on stress and anger management, couples communication or parenting. Remember to stay involved in positive relationships, productive work and enjoyable activities.