Post-Traumatic Stress Disorder

What is "post-traumatic stress disorder"?

Post-traumatic stress disorder refers to a anxiety disorder that results from coming face to face with a traumatic event. PTSD is relatively new in terms of a diagnosis, however we know that people were aware of it many years ago.There was an accountant by the name of Samuel Pepys who lived through the great fire of London. He took some very good records and published a little account. You can read in his account typical symptoms of PTSD, such as nightmares and intrusive recollections. It was during the World Wars that we really started to recognize PTSD as a distinct entity. It went through a couple iterations in terms of nomenclature, it was called "combat fatigue", "shell shock", but it wasn't until 1980 that we really came up with a diagnosis of PTSD. A lot of people think of PTSD as a veterans disease because it was often very much associated with the Vietnam war, but in fact, there are many people in the civilian world that suffer from various violent crimes and other kinds of accidents, such as motor vehicle accidents, that develop PTSD; So it really does affect quite a few people.

What are the symptoms for post-traumatic stress disorder?

The typical symptoms of post traumatic stress disorder are classified into three general categories. One category includes arousal symptoms. This would be reflective of increased general activity of the norepinephrine or adrenaline system and can be manifested through irritability, problems with sleep, increased startle response, and just a general hypervigilance to the environment. Another category of symptoms are what we call the avoidance symptoms, and these include a feeling of estrangement from people, an emotional numbing, or an inability to really feel things or experience things in a normal way. People feel a detachment; they often feel that others can't really understand what they are going through. The final category of symptoms is the re-experiencing cluster and this would include intrusive recollections of the event. This is sort of akin to getting a melody in your mind which you just can't get out, and this can become very bothersome as inner fears of thinking about other things. Intrusive recollections can also occur as bad nightmares, and then in rare cases people can have flashbacks in which for a moment they relive the traumatic experience replete with a lot of sensory experiences. Patients with PTST can have other things such as anger outbursts, irritability, and it's not uncommon to have survivor guilt, especially if a traumatic event that they were involved with had resulted in death or serious injury to another person.

What are the most common causes of post-traumatic stress disorder?

The causes of post-traumatic stress disorder (PTSD) do center around a traumatic event. We do know that different types of trauma are associated with different risks for developing post-traumatic stress disorder (PTSD) in the future. So for example, if you are the victim of crime or held hostage or victim of a sexual assault thats associated with a very high risk of developing post-traumatic stress disorder (PTSD). If you've been involved in a natural disaster such as a hurricane or flood, that's something that probably isn't as likely to cause post-traumatic stress disorder compared to some of the earlier examples. We can actually construct a spectrum of various traumas and associate the relative risk for developing post-traumatic stress disorder (PTSD). In terms of the brain structures that are involved in developing post-traumatic stress disorder (PTSD) some research points to the amygdala and hippocampus. These structures are important because they are involved in memory. If you recall the diagnostic criteria for post-traumatic stress disorder (PTSD), one of the hallmarks is a real and intrusive recollection or reliving the events. So this points to something going on with memory circuits. So there's research that's going on right now that's trying to figure out whether there are ways to prevent or reverse this enhanced memory of a traumatic event. Some believe that if that can be understood, it might be possible to even prevent PTSD from developing in patients who, in people who've been traumatized. Or it might lead to other kinds of interventions for treating it.

What are the most common dangers associated with post-traumatic stress disorder?

Post-traumatic stress disorder or PTSD can really affect a lot of a person's areas of life. The dangers of post-traumatic stress disorder or PTSD are impairment in social and occupational functioning. If post-traumatic stress disorder or PTSD goes untreated, it's not uncommon for people to become estranged from their families; to lose those important relationships. If there's a lot of irritability and problems with concentration, this obviously will impact a person's ability to perform will at work. Other dangers of post-traumatic stress disorder or PTSD include development of other disorders such as major depression. This has its own set of dangers. People with post-traumatic stress disorder or PTSD are also more prone to develop substance abuse as they deal with problems with sleep, and will often turn to alcohol, or pot, or other kinds of sedatives to help them sleep or to help decrease the anxiety symptoms. This can just add together to create a downward spiral which can be very damaging.

How is post-traumatic stress disorder diagnosed?

Post-traumatic stress disorder is diagnosed according to some very specific criteria. If you're seeing a psychiatrist or mental health professional for post-traumatic stress disorder or PTSD, they'll be very interested in understanding what you're experiencing currently, what the nature of the trauma was, and looking at how it's impacted your functioning; both socially and occupationally. It'll also be important for them to have an idea of your past social and psychiatric history, as well as your family history. Once that's completed, they'll create what we call a differential diagnosis, or a list of the possible conditions that might explain your condition. These will then be eliminated, one by one, through further information-gathering, possibly medical tests, or a physical exam. They will then arrive at the diagnosis and be able to devise a specific treatment plan to help you.

What are the common treatments for post-traumatic stress disorder?

It is important to get treatment for post-traumatic stress disorder, and important, I think, that you are taking a comprehensive approach. This would often include medication and physcotherapy.

Is there anything I can do to avoid developing post-traumatic stress disorder?

It's difficult to say who is going to develop PTSD after a traumatic event. As we're seeing in combat experiences, there are individuals that are exposed to identical situations. Some develop PTSD, others don't. Hopefully, in the future we'll understand what some of those risk factors that predispose an individual to develop the disease are. However, what you can do is if you suspect you're having symptoms then get treatment as early as possible. What we really want to do is prevent the symptoms from becoming chronic to where they resolve in social isolation and impairment of job functioning or become complicated by substance abuse or other psychiatric disorders.