Post-Traumatic Stress Disorder

We’ve all known someone who suffers from PTSD; yet many of us have little understanding of the nature of the condition, its symptoms, and available treatments.   Post-traumatic stress disorder or PTSD is a psychiatric disorder that sometimes occurs in people who have experienced or witnessed a traumatic event.  Although, less commonly seen, PTSD can also be caused by the sudden death of a loved one.  Not everyone reacts in the same way to violence and trauma.

PTSD Has Been Recognized and Given Many Names Over the Years.

Accounts of PTSD type symptoms go back to ancient times and can be found in Assyrian writings from Mesopotamia dating back to 1300 BCE.  In 1761, an Austrian physician wrote about “nostalgia” among soldiers and described symptoms similar to PTSD.  The American Civil War was probably the first time PTSD symptoms were considered to be a medical problem requiring treatment.  In the 1860’s, doctors called the condition “soldiers’ heart.” They described symptoms of rapid pulse, anxiety and trouble breathing.  Civil War soldiers were generally given drugs to control symptoms and sent back into battle.

Another early example is the condition known as “railway spine.”  Rail travel was becoming common, especially in Europe, and train accidents caused death and horrific injuries.  Charles Dickens was involved in a bad rail accident in 1865, and he wrote about suffering anxiety and insomnia following the accident.  In World War I, doctors called it “shell shock” because they believed the frequent explosions of heavy artillery at the front affected the brain.  They used electric shock therapy as a treatment.

During World War II, the condition was known as “battle fatigue” or, less commonly, “combat stress disorder.”  Physicians thought the long surges with constant battles and skirmishes caused soldiers to become battle weary and mentally exhausted.  Up to half of military discharges during the Second World War were related to battle fatigue. 

In 1952, the American Psychiatric Association recognized something called “gross stress reaction,” and attached this diagnosis to people who were relatively normal but had symptoms related to traumatic events like disaster or combat.  This diagnosis was only used if the symptoms resolved within a few months.  There was still little understanding of the disorder.  Finally, in 1980, the American Psychiatric Association added the term “post-traumatic stress disorder” to its diagnostic manual.  The term “PTSD” had arrived.

The Difference Between PTSD and ASD.

Acute Stress Disorder (ASD) is a condition that is closely related to PTSD but of shorter duration.  ASD occurs in reaction to a traumatic event and the symptoms are quite similar.  ASD sufferers may relive the event, have flashbacks and nightmares, and experience depression and anxiety.  They may feel emotional detachment, just like PTSD sufferers.  However, the symptoms tend to ease off after a couple weeks and are usually gone in 1 – 2 months.  Some ASD patients can go on to develop PTSD, but the majority recover.  An estimated 13 to 21 percent of people surviving serious vehicle accidents have ASD, and 20 to 50 percent of those surviving assault, rape or mass shootings develop the disorder.

Causes, Symptoms, and Diagnosis of PTSD

Doctors don’t really know why some people get PTSD following a trauma and others do not.  The current belief is that PTSD is probably caused by a complex mix of factors, such as:

  • Stressful and traumatic experiences, including the amount of trauma you have experienced during your lifetime;
  • Inherited mental health risks – things like a family history of anxiety attacks and depression;
  • Your own personal temperament and how your mind interprets your experiences;
  • The way your brain regulates and controls the chemicals it releases in reaction to stressful situations.

You are more likely to develop PTSD following trauma if: (1) you experience intense and prolonged trauma; (2) you previously experienced trauma especially childhood trauma or abuse; (3) you have a job like military personnel or first responders who are frequently exposed to traumatic events; (4) you have other mental health issues like depression, anxiety or substance abuse; (5) you have no emotional support system of family and friends; (6) you have close family members with mental health issues like anxiety and depression.

PTSD is more common than you may think.  According to the National Center for PTSD, approximately 7 people out of every 100 will experience PTSD at some point in their lives. Sufferers may experience a variety of symptoms, most of which are included in the discussion of diagnostic criteria below.  In order to be diagnosed with PTSD, an adult must have all of the following symptoms for at least one month:

  • At least one re-experiencing symptom. Re-experiencing symptoms are things like flashbacks, bad dreams, and frightening thoughts.
  • At least one avoidance symptom. These include avoiding the location where the event happened; shying away from people or objects that are reminders of the trauma; and shutting down thoughts or feelings about the trauma.
  • At least two arousal and reactivity symptoms. These symptoms include being easily startled, feeling tense or edgy, insomnia, angry outbursts and sudden feelings of paranoia or fear.  This tense anxiety tends to be a constant feeling that makes it difficult to work or sleep.
  • At least two cognition and mood symptoms. Cognitive and mood symptoms include difficulty recalling details of the event, difficulty concentrating, negative thoughts about life and the world, feeling guilt or blame related to the event, and loss of interest in things you normally enjoy.

People with severe PTSD often find themselves unable to cope with the daily stresses of life and work.  They may alienate the people around them.  Sleeplessness, flashes of rage, paranoia and depression may push family members out of their lives. Isolated and without a social support system, the individual’s situation can rapidly worsen.

Children are different than adults.  While older children may exhibit similar symptoms to adults, they may also experience guilt and believe they are somehow to blame.  They often act out with disruptive behavior and have fantasies of revenge.  Children under the age of 6 tend to exhibit different symptoms and reactions.  They may:

  • Go back to bed wetting after being toilet trained;
  • Forget how to talk;
  • Act out the trauma during play;
  • Become unusually clingy with trusted adults;
  • Experience terrifying dreams that often have no resemblance to the event.

PTSD in Aging Veterans.

Some PTSD sufferers develop symptoms immediately after returning from a war zone or following a major trauma and continue to have those symptoms for the rest of their lives.  However, we also see older veterans who develop PTSD symptoms many years after their military service has ended.  These veterans or trauma survivors may have had mild, but manageable, symptoms throughout their adult lives, but they’ve always been able to cope and lived normal lives.  Now, in their 60’s and 70’s, they are having nightmares, reliving the experience, suffering from anxiety, unreasonable fear and paranoia, and irritability – classic PTSD symptoms.  Why would that happen?  The current theory is that life changes that come with aging trigger the symptoms.  Things like:

  • Retiring from work and having too much time on your hands;
  • Medical problems and loss of physical strength that make you feel weak and helpless;
  • Loss of friends and loved ones as people around you age and die;
  • Giving up smoking or drinking alcohol for health reasons;
  • Dwelling on TV news of tragic events and watching those news stories multiple times a day;
  • Less regular physical activity and fewer social contacts.

When veterans who have functioned well throughout their adult lives begin having PTSD symptoms with aging and illness, the VA calls the phenomena LOSS (late onset stress syndrome).  It is treated much the same as earlier onset PTSD.

Modern and Developing Treatments for PTSD.

The main treatments used for PTSD today are medications and psychotherapy.  Everyone is different, and the treatment must be tailored to the individual.  Therapy can be a very effective treatment, but only if the therapist has experience with PTSD patients.  Therapy focuses on a few key elements to treat the condition.  One is education.  The therapist and patient go over the symptoms, explore what triggers those symptoms, and work on skills to manage the symptoms when they arise.

In some cases, cognitive behavioral therapy is effective.  The therapist uses exposure therapy to help the patient confront the trauma in a safe setting.  Mental imaging, writing about the event, and revisiting the site of the trauma accompanied by a supportive person can be immensely helpful for some people.  Cognitive restructuring is also used.  Research shows that many trauma sufferers recall the event much differently than the way it actually happened.  The therapist helps the patient realize that feelings of guilt or blame are misplaced, that the event was not the patient’s fault.

Therapy can help in other ways.  Therapists provide relaxation techniques, anger management tools, help with sleep deprivation issues, and motivate the patient to exercise and develop social connections.  

Medication is also used in treating PTSD.  Antidepressants are prescribed to counter depression, anger, sadness, and feelings of isolation.  Drugs like Prazosin can be used to help with sleep issues and nightmares.

During the last 20 years, scientists have been making rapid strides in understanding the physiology of the human brain.   Researchers at the National Institute of Mental Health are conducting extensive studies into how trauma affects the brain.  With new advances in brain imaging and in genetic research, scientists hope to soon understand the mechanisms behind PTSD.    Once they understand what chemical and physical changes occur in the brain as a response to trauma, new and better treatments should follow.

Resources 

www.ptsd.va.gov/understand/what/aging_veterans.asp

www.ptsd.va.gov

www.psychiatry.org/patients-families/ptsd/what-is-ptsd

 

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