Post-Traumatic Stress Disorder (PTSD)
Basic Information
Post-Traumatic Stress Disorder (PTSD) develops from circumstances in which a patient has experienced a psychological trauma or catastrophic event in his or her life that would be overwhelming or incredibly stressful to anyone. Examples of these events could be combat experiences, terrorism, physical or sexual abuse, rape, violent street crime, family alcoholism, car, train or plane accidents, unexpected life-threatening illnesses and natural disasters, although man-made disasters cause more extreme reactions than natural disasters. After experiencing or witnessing a potentially life-threatening situation during which the patient felt horrified and helpless, it is not unusual for the patient to be in an acute crisis mode of up to a month, re-experiencing memories of the frightening event and having deep feelings of anger and fear, withdrawal from others, and experiencing sleep disorders. Within a month or so in 50% of patients readjustment occurs, the anxiety and terror recedes, relationships are re-established with loved ones and recovery begins. But in the other 50% of patients, recovery does not occur, especially if the patient did not experience an acute stress disorder immediately following the traumatic incident, and the patient continues to suffer the recurrent events of the psychological trauma. This condition is known as Post-Traumatic Stress Disorder (PTSD).
For half of patients diagnosed with PTSD, spontaneous remission can occur within 6 months to a year. But left untreated in patients who do not make a spontaneous recovery during this acute/protest phase (feeling righteous anger and seeking comfort and sharing their pain with others), the patient will enter the chronic/numbing phase which is characterized by a possibly debilitating state of depression, isolation, loss of interest in life's previous goals and pleasures and a view of the world as a dangerous, fearful place.
During the span of a lifetime it is estimated that from 1% to 15% of the U.S. population is diagnosed with PTSD, spread evenly between males and females, with all age groups affected.
Symptoms
The patient may have symptoms of:
- hyper vigilance -- a state of full alertness in the lack of danger
- flashbacks -- having no control over re-experiencing the trauma
- exaggerated startle -- jumping when there is no loud noise
- sleep disturbance often with nightmares
- extreme irritability
- grief -- continual, intrusively reminding the patient of the loss
- survivor guilt
- avoidance of feelings, thoughts or places that recall the traumatic event
- avoidance of friends , enjoyment of life's pleasures
- hallucinations
Diagnosis/Treatment
A health care provider who has experience in diagnosing PTSD will look for the symptoms listed above as well as be on the alert for signs of the four "D"s:
- detachment
- depersonalization
- disassociation
- dazed state
Also a careful evaluation of the patient's history before the traumatic event (alcoholism, drug abuse, personality disorder) will help the health care provider to make a professional assessment regarding possible increased difficulty in aiding the patient's recovery because of dysfunctional factors already in existence. In fact, PTSD can often be diagnosed when the patient exhibits a dysfunctional response to any stress.
Left untreated any of the above symptoms may be disabling to the patient. And if there is a delayed onset of specific symptoms -- just a dull, generalized expression -- diagnosis may be more difficult to make. Likewise patients who have been diagnosed with acute stress disorder (occurring within four weeks of the stress) may actually have PTSD, especially if the acute stress disorder lasts longer than one month.
Three major important disruptions occur in PTSD -- mastery, attachment and meaning, each very important to the meaning and value of each human being.
Stress-resistant persons are able to have reasonable mastery over life's complexities, make appropriate lifestyle choices and retain a sense of humor. They seek social support, have a sense of ethics and exhibit compassion for others. In other words there is a purposeful meaning in life, one than transcends terrible loss, violence or evil perpetrated by others. Usually the PTSD has lost this sense of purpose, exhibits faulty mastery skills, retains few caring attachments.
Mastery, attachment and meaning to life are goals of recovery for the patient diagnosed with PTSD -- or chronic debilitating symptoms previously described may continue unabated.
It is not surprising that untreated sufferers of PTSD engage in the repetition compulsion, seeking to reenact or repeat the initial trauma. This seems to be an attempt to regain the mastery interrupted by the original event -- to learn how to cope should a horrible event occur again -- and to keep trying to make meaning of the inexplicable catastrophe. It also brings physical relief from the pain of the traumatic event.
Endorphins -- chemicals in the brain -- are enhanced by this repetition compulsion -- and a feeling of calm ensues. Recent medical evidence shows that sex addictions, physical fights, accident-proneness, cocaine and crack addictions also release these endorphins and it is not unusual to find that patients with a history of traumatic abuse have these addictions. In these cases both problems require treatment: the untreated past abuse and the addictive behavior. If an addicted patient is treated only for PTSD, the addictive behavior will continue and complicate recovery for the initial trauma. Conversely, if the addictive behavior is treated by itself, the symptoms of untreated trauma will make recovery from addiction more difficult, as the patient will usually continue to try to self-medicate that initial psychological pain.
Treatment with experienced psychotherapists are usually effective in reducing severity of the symptoms and in referring the patient to appropriate groups for recovery.
Group therapy seems to be one of the most important tools for recovery, especially if they are composed of other PTSD patients. Here, in an atmosphere of acceptance, the patient's sense of mastery can slowly be restored, caring attachments can be made and compassion for an interest in other members can renew the sense of meaning in life that has been lost. There are 6--8 million Americans in self-help recovery groups and they have proven effective in dealing with addiction issues, life threatening illnesses and psychological trauma.
Professionally led groups, usually lasting around 10--12 weeks, are also successful. They offer short-term intervention, providing PTSD patients with information, education and support. Here consequences of untreated PTSD are brought to the fore.
Families and friends, with the help of experienced counselors, can learn about PTSD and be beneficial in their loved one's recovery. The patient may also wish to utilize the help of a counselor, for practical reasons as well as for help in recovery. If applicable to the case of the individual PTSD patient, a counselor can be helpful in maneuvering the recovering patient through the maze of the legal system, hospital bills, victim assistance programs, etc.
Sometimes your health care provider will find it necessary to augment your recovery with pharmacological treatment including prescribing antidepressants or sedating or anxiety reducing medications. Your health care provider will want to make a full evaluation of your personal and medical history before prescribing an appropriate drug for treatment.
Relaxation exercises including the use of deep breathing, muscle relaxation, peaceful imaging and even aerobics have shown proven benefits. But the PTSD patient has suffered a trauma and before any physical exercise is attempted, a physical exam must be taken to see that there are no medical consequences from the initial trauma. Do not undertake exercising on your own without having had a physical exam and a clearance from your health care provider.
Remember the treatment goals for recovery from PTSD are to regain a physical and emotional sense of well-being and to slowly develop a greater stress resistance. The goals include reducing physiological arousal -- (restoring your body chemistry to near normal) -- being able to exhibit reasonable mastery by having some personal control over events in your life in order to form caring attachments and regain a meaningful purpose in life.
If you or someone you know may be suffering from PTSD, please see your health care provider promptly.
Additional Resource