Post Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition that is triggered by a terrifying event such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes. PTSD was first brought to public attention in relation to war veterans.

The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers. Many people who go through traumatic events have difficulty adjusting and coping for a while, but they do not have PTSD. With time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with daily functioning, they may have PTSD.

Symptoms of PTSD may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event. PTSD makes people feel stressed and afraid after the danger is over. It affects the life of the people around the person with PTSD. Symptoms of PTSD make it hard to go about daily life, go to school or work, be with friends, and take care of important tasks.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

PTSD starts at different times for different people. PTSD symptoms may start within months of a traumatic event, but sometimes symptoms may not appear until years after the event. The symptoms cause significant problems in social or work situations and in relationships. PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you are stressed in general, or when you have reminders of what you went through. For example, you may hear a car backfire and relive combat experiences, or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in emotional reactions.

Symptoms of intrusive memories include:

• recurrent, unwanted distressing memories of the traumatic event
• reliving the traumatic event as if it were happening again (flashbacks)
• upsetting dreams about the traumatic event
• severe emotional distress or physical reactions to something that reminds you of the event
• bad dreams
• frightening thoughts

Symptoms of avoidance include:

• trying to avoid thinking or talking about the traumatic event
• avoiding places, activities or people that remind you of the traumatic event

Symptoms of negative changes in thinking and mood include:

• negative feelings about yourself or other people
• inability to experience positive emotions
• feeling emotionally numb
• lack of interest in activities you once enjoyed
• hopelessness about the future
• memory problems, including not remembering important aspects of the traumatic event
• difficulty maintaining close relationships

Symptoms of changes in emotional reactions (also called arousal symptoms) include:

• irritability, angry outbursts or aggressive behavior
• always being on guard for danger
• being easily startled
• overwhelming guilt, depression, or shame
• self-destructive behavior, such as drinking too much or driving too fast
• trouble concentrating
• trouble sleeping
• being easily startled or frightened

You are more likely to develop PTSD if you:

• live through dangerous events and traumas
• have a history of mental illness
• get hurt
• see people hurt or killed
• feel horror, helplessness, or extreme fear
• have little or no social support after the event
• are dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home

You can develop PTSD when you go through, see, or learn about an event involving actual or threatened death, serious injury, or sexual violation.

It is not clear why some people get PTSD. As with most mental health conditions, PTSD is probably caused by a complex mix of genes and physical characteristics of the brain.

Inherited mental health risks, such as an increased risk of anxiety and depression, may play a role in the development of PTSD.

Life experiences, including the amount and severity of trauma you have gone through since early childhood, affect the risk of developing PTSD.

Inherited aspects of your personality (your temperament) also influence the development of PTSD.

The way your brain regulates the chemicals and hormones your body releases in response to stress have also been linked to PTSD.

Post-traumatic stress disorder is diagnosed on the basis of signs and symptoms and a thorough psychological evaluation. Your health care provider will likely ask you to describe your signs and symptoms and the event that led up to them. You may also have a physical exam to check for medical problems.

To be diagnosed with PTSD, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. To be diagnosed with PTSD, a person must have all of the following for at least 1 month:

• at least one re-experiencing symptom
• at least three avoidance symptoms
• at least two hyperarousal symptoms

With proper treatment, many people with PTSD lead normal, fulfilling lives. If stress and other problems caused by a traumatic event affect your life, see your health care professional. Several actions can also improve the chance for success with your treatment for PTSD.

• Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan will help move you forward.
• Learn about PTSD. This knowledge can help you understand what you are feeling, and then you can develop coping strategies to help you respond effectively.
• Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
• Do not self-medicate. Turning to alcohol or drugs to numb your feelings is not healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
• Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
• Talk to someone. Stay connected with supportive and caring people such as family, friends, and faith leaders. You do not need to talk about what happened if you do not want to. Just sharing time with loved ones can offer healing and comfort.
• Consider a support group. Ask your health professional for help finding a support group, or contact veterans' organizations or your community's social services system. Or look for local support groups in an online directory or in your phone book.

PTSD treatment can help you gain control of your symptoms and your life.

Psychotherapy is the primary treatment for PTSD, but medications can help reduce the symptoms of PTSD. Cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing are psychotherapy approaches that may be used individually or in group settings.

Medications that can improve symptoms of PTSD include:

• antidepressants and anti-anxiety medications to relieve symptoms of depression and anxiety. They can also help improve sleep problems and concentration. Sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
• prazosin (Minipress) can help with symptoms of insomnia or recurrent nightmares. Although not specifically FDA-approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.