Posttraumatic stress disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 26, 2016
StartDiseasesPosttraumatic stress disorder

Traumatic experiences like rape, violent assault, terrorist attacks, or war are terrifying for the individual(s) concerned. A fight-or-flight response is normal during the moment, but most people are able to recover from traumatic events. Some people develop what is called posttraumatic stress disorder (PTSD), with physical and mental effects that are long-lasting.

Contents

Definition & Facts

PTSD is a recognized mental health condition that results from a traumatic event. Many people with PTSD re-experience the trauma when faced with similar situations or when stressed by sudden noises or other triggers. PTSD includes arousal and reactivity (becoming agitated and upset by a trigger), hypervigilance (constantly scanning for threats even in safe situations) and other mental and physical symptoms. People with PTSD may have minor or severe symptoms that can affect their ability to work or develop relationships; some are completely incapacitated.

Symptoms & Complaints

Symptoms of PTSD include both mental and physical symptoms. Common mental or emotional symptoms are depression, anxiety, anger, irritability, and panic. Physical symptoms can include high blood pressure, a fast pulse, sweating and problems like gastric distress. Insomnia often occurs in people with PTSD.

The symptoms result from elevated levels of stress hormones like cortisol, epinephrine and norepinephrine. These hormones are released as part of the fight-or-flight syndrome. When faced with a real threat, fight-or-flight helps an individual by making them faster and stronger. In a safe situation that the person only perceives as threatening, fight-or-flight leads to physiological changes in the body and brain that can be damaging to health. Long-term health effects can include chronic high blood pressure, ulcers and other stress-related health problems.

Causes

Although the trigger for PTSD is a traumatic event, it is the individual's emotional and physical response to the event that causes PTSD. Some people are able to experience major trauma and effectively bounce back with little effort. In others, a single traumatic event to themselves or a loved one can trigger PTSD. Still others are able to handle several events, but eventually develop PTSD symptoms when traumatic experiences reoccur.

Women are more likely to develop PTSD than men, although it can occur in both sexes. No one one knows exactly why a person develops PTSD, but both risk factors and resilience play a part. Risk factors for PTSD include:

  • Getting hurt or seeing another person -- especially a loved one -- hurt
  • Childhood trauma, like physical, emotional or sexual abuse
  • Repeatedly living through dangerous events and traumatic experiences
  • Feeling horrified, helpless or extremely fearful
  • Experiencing a traumatic event with little or no social support afterward, or dealing with extra stress after the event
  • A history of mental illness.

Psychological resilience is the capacity to recover; a sense of emotional flexibility and toughness. People who are resilient are more likely to:

  • Have support from other people or a support group
  • Feel positive about their actions when faced with a traumatic event
  • Have positive coping strategies
  • Respond effectively even when frightened and upset.

Diagnosis & Tests

There are no lab or other diagnostic tests for PTSD. Diagnosis is based on symptoms and the clinician's observations of the patient's behavior. A traumatic event can cause what is called acute stress reaction, with symptoms very similar to PTSD. However, the symptoms begin immediately after the event and usually go away with a few weeks. PTSD is a more longstanding condition and can occur months or even years after the actual event. The official diagnosis of PTSD in an adult requires that he or she have symptoms for at least a month after the event. These include at least:

  • One re-experiencing symptom, like flashbacks, nightmares or frightening thoughts.
  • One avoidance symptom, like staying away from people, events or places that remind the person of the trauma, or having trouble remembering the traumatic event. For example, the patient who has PTSD because of an automobile accident might avoid driving or riding in a car.
  • Two arousal symptoms. These can included being easily startled, feeling tense, having insomnia or other sleep problems or having angry outbursts.
  • Two cognitive symptoms and mood symptoms. These might include memory loss, negative thoughts, feelings of guilt or blame, loss of interest in activities that were once pleasurable.

Young children -- up to the age of about six -- may regress (go back to an earlier level of development). For example, a toilet-trained child may start wetting the bed, forget how to talk or revert to baby talk. Young children may act out the event when playing, and some become very clingy and needy with parents and caregivers.

Older children and teens are more likely to have symptoms similar to those of adults. They may also engage in disruptive behavior or become destructive and disrespectful. Some may feel guilty if they survived when others didn't, or for not preventing a bad outcome.

Treatment & Therapy

Treating PTSD can be very difficult, especially if the traumatic event took place many years ago. Medications may be used to manage symptoms like depression and anxiety or to help people sleep. Psychotherapy, or talk therapy, is also used. Psychotherapy can occur one-on-one or in a group.

Cognitive behavioral therapy teaches patients to face and control their fears (exposure therapy) or to make sense of bad memories (cognitive restructuring). Treatment typically takes at least six to 12 weeks and may take longer. Some people may need to remain on medications for months or years.

Other treatment strategies that may be helpful include meditation and relaxation therapy or working with a support group. Family support is vitally important for a PTSD patient. Other experimental treatments include trigeminal nerve stimulation in the forehead.

Prevention & Prophylaxis

There is no known prevention for PTSD. However, certain events known to precipitate PTSD, like childhood abuse, rape, and war are larger social issues that may be dealt with by community education, legislation, law enforcement and mental health care. Readily available mental health treatment might help to promote community mental health and resilience.