Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can cause significant disruption to a person's life. It is a biological response of the human brain to stress from an intense event or period, in which a person's life or safety (or those of their loved ones) was in danger.

The symptoms of PTSD were originally recognized and studied in soldiers. The definition has expanded in recent times to include the many people influenced by other traumatizing events. PTSD is a condition shared by millions of people worldwide, with 5-10% of the population estimated to experience PTSD at some point in their lives. PTSD can happen to anyone, including children.

The duration of PTSD varies between people. For some, it will be a temporary condition, the effects of which will wane and pass within weeks or months. For others, PTSD may carry on for years, or be a lifelong challenge.

Causes

The trigger for PTSD is a traumatic event experienced by the person. Events that can cause PTSD can include:

• Rape and sexual abuse;
• Wartime and combat experiences (for both soldiers and civilians);
• Natural disasters;
• Violent assault, terrorist attacks, hostage situations, domestic violence;
• Accidents (car accidents, plane crashes, industrial accidents);
• Imprisonment and torture, experiences in detention camps or concentration camps;
• Severe neglect in childhood, and;
• The sudden, unexpected death of a loved one.

In some cases, a person can develop PTSD despite not having experienced the trauma directly, but through learning of a horrific event happening to a loved one.

Types

PTSD is currently divided into three categories, based on when it appears:

• Acute PTSD (sometimes known as acute stress disorder) occurs less than three months after the event;
• Chronic PTSD occurs more than three months after the event, and;
• Delayed expression PTSD symptoms begin more than six months after the event.

Signs and symptoms

Nearly every person who has gone through an intense, stressful event will experience a short-term stress response to it. This will often pass within days or a few weeks. PTSD is diagnosed when the stress response to the event carries on beyond that initial period.

PTSD shows up differently in different people. Some will be moody and withdrawn, others may be more outwardly emotional; still others will become detached and emotionally numb.

Symptoms can be divided into four categories:

Persistent re-experiencing of the event

• Intrusive flashbacks, often with physical signs of stress (racing pulse, sweating);
• Distressing memories, and;
• Recurring nightmares related to the event.

Mood and cognitive problems

• Experiencing negative moods and guilt;
• Dissociation - shutting down emotionally, feeling emotionally numb, becoming incapable of exhibiting or accepting affection or tenderness, not enjoying activities that were enjoyable before the event;
• Loss of memory about the event, or parts of it;
• Developing depression or anxiety, and;
• New, negative thoughts or beliefs about oneself, others, or the world.

Post-traumatic stress disorder can cause feelings of dissociation, depression and guilt. 

Persistent avoidance of stimuli

• Avoiding physical locations and situations related to the traumatic event;
• Avoiding people, conversations and social situations related to the traumatic event, and;
• An increase in alcohol and/or drug consumption.

Persistent hypervigilance and hyperarousal

• Sleep problems such as insomnia;
• Being constantly alert to the possibility of threat;
• Concentration problems;
• Being angry, irritable, hostile and aggressive, and;
• Being reckless or self-destructive.

Many people with PTSD may not recognize their condition, or may be unwilling to receive help.

Methods for diagnosis

The doctor may diagnose PTSD based on a description of the person's history and symptoms. They will attempt to ascertain whether the person is suffering from PTSD, or from a similar anxiety disorder. The doctor may refer the person to a specialist (psychiatrist) for formal diagnosis.

Types of treatment

A person with PTSD may not ask for treatment, or want it when offered. It is not helpful to pressure a PTSD sufferer into receiving treatment against their will. Treatment can take a long time and there is a danger of the person dropping out due to lack of improvement over time. Treatment is different for every person.

Psychotherapy is the preferred treatment for PTSD. Medications can also be used in the short-term with symptoms, while individuals receive psychotherapy.

Psychotherapy

There are several psychotherapeutic approaches and techniques for treating PTSD. They include:

Exposure therapy

Exposure therapy helps the person re-live their experience in a safe way and learn to control their response to the memory.

Cognitive therapy

This type of therapy is directed at changing how a person thinks about their condition and how they respond to it. Types of cognitive therapy include:

• Cognitive behavioral therapy - guiding the person through their memories of the traumatic event and helping them to challenge their existing perception of the event, make sense of what happened and reshape their memories in a way that will not trigger anxiety;
• Stress reduction techniques - helping a person manage their anxiety through relaxation techniques, and;
• Cognitive processing therapy - a type of therapy developed especially for treating PTSD. It helps people with PTSD identify and overcome the sticking points in their thoughts and memories of the traumatic event.

Psychodynamic therapy

Psychodynamic therapy focuses on relating the person's past and present experiences to their PTSD symptoms. The act of bringing past life events and present situations to the surface is meant to help in dealing with PTSD.

Psychological first aid

This psychological intervention is employed a short time after the traumatizing event, usually after large-scale disasters or violent attacks.

First-response mental health workers go out to survivors of these events, assess their mental condition and offer information, support and compassion. They try to give a sense of safety and security, help with immediate needs and reduce or prevent PTSD symptoms.

Debriefing

A technique wherein the person experiencing a traumatic event is asked, shortly after the event, to describe and relive it in detail.

Psychotherapy provides many techniques for coping with a trauma. 

Medication

Antidepressants

Selective serotonin reuptake inhibitor (SSRI) antidepressants are the preferred medication for treating PTSD symptoms in adults. They help treat depression, anxiety and irritability in people with PTSD. Sertraline, paroxetine and fluoxetine are examples of antidepressants used in the treatment of PTSD.

Anti-anxiety

Anti-anxiety medications, such as benzodiazepines, can help people with PTSD in the short-term with their anxiety and sleep problems. They cannot cure PTSD.

Mood stabilizers

These are medications that can counter the negative moods experienced by PTSD sufferers and help them function in their daily lives.

Potential complications

PTSD can have a significant effect on a person's well-being, and interfere with their daily lives. Complications associated with PTSD include:

• Depression;
• Personality disorders;
• Substance abuse (alcohol, prescription drugs, illegal drugs), and;
• Heart disease.

Prognosis

The outlook for PTSD is different for every person. PTSD can, in many people, gradually fade. In about half of PTSD sufferers, the condition goes away within three months.

For others, treatment can help reduce the impact of PTSD or cure it completely. Some PTSD sufferers may have to live with the condition long-term. However, for them too, treatment and support can also make a significant difference.

Prevention

PTSD cannot be completely prevented. Effective treatment, support and counselling in the time after the traumatic event can help reduce the chance of PTSD and its length and severity.

Family, friends, support groups and healthcare professionals can all be sources of support. A person who has a supportive social environment and a trusting relationship with their healthcare professionals is at less risk of developing serious, long-term PTSD.

For people whose occupations put them at risk of PTSD, factors that can help lower the risk of PTSD include:

• A general level of professional training, preparedness and physical fitness;
• Stress management training;
• A solid, supportive work environment, and;
• An organizational response plan that can identify and help workers who need it.

Support services

The National Institute of Mental Health Information Resource Center

Hours: 8:30 a.m. to 5 p.m. eastern time, M-F

Phone: 1-866-615-6464
TTY: 1-301-443-8431
TTY (toll-free): 1-866-415-8051

Available in English and Spanish