Post-traumatic stress disorder (PTSD) is a psychological condition that develops following an extremely stressful event or series of events that cause intense fear, particularly if feelings of helplessness accompany the experience. Those with PTSD are much more likely than others to have major depression, problems with substance abuse, or panic disorder sometime in their life, either before or after the development of PTSD. PTSD may be precipitated by war-related trauma, physical or sexual assault or abuse, an accident (such as an airplane crash or a serious motor vehicle accident), or a mass disaster. In PTSD, factors associated with the original event elicit the same stressful feelings later on, so the affected person often tries to avoid these stimuli. Feelings of stress in response to a trauma are normal; PTSD is characterized by the intensity of the feelings, how long they last, how one behaves in response to these feelings, and the presence of particular symptoms. Since exposure to at least one traumatic event is estimated to occur in 5% to 35% of the U.S. population every year, PTSD is a significant public health problem.
Signs and SymptomsSymptoms of PTSD may develop months or even years after the original trauma and may include the following:
- Intrusive thoughts recalling the traumatic event
- Efforts to avoid anything that either reminds the person of the traumatic event or that triggers similar feelings
- Flattened emotional response
- Lack of motivation
- Feelings of guilt (from the false belief that one was somehow responsible for the traumatic incident)
- Being easily startled
- Poor concentration
- Hypervigilance (excessive awareness of possible danger)
What Causes It?Normally, during a traumatic event, one's perceptions and thought processes change and serve to dissociate one from the extreme circumstance. This natural defense mechanism helps a person cope with the situation at hand and to separate from the trauma as a form of self-protection. With PTSD, these thought processes linger on and recur in response to any trigger that brings back thoughts of the trauma. This may be related to persistent elevations of a substance called glutamate in the brains of those with PTSD; glutamate generally rises in response to stress and returns to normal following the event. Ongoing trauma (as in the case of an abusive relationship) makes the persistence of dissociative thinking more likely as well.
Who's Most At Risk?These factors increase the risk for PTSD:
- An environment where trauma is likely, such as fighting in a battle, living in a high-crime area, or being in a physically or sexually abusive relationship
- Working in a high-risk occupation, such as fire-fighting or law enforcement
- Having a psychological diagnosis, such as depression, before being exposed to a traumatic event
- Not having adequate social support
- Women are twice as likely as men to show signs of PTSD.
What to Expect at Your Provider's OfficeThere are no laboratory tests to detect PTSD. To diagnose PTSD, a healthcare provider will consider your symptoms together with any history of trauma. He or she will likely also use psychological assessment tools to confirm the diagnosis and involve an appropriately trained specialist (such as a psychologist or psychiatrist) to participate in the evaluation and treatment.
PreventionEarly crisis intervention immediately after a traumatic event in the form of support groups, psychotherapy, and use of psychiatric drugs may help prevent PTSD. In addition, cultural or religious rituals such as prayer or healing ceremonies may be helpful in relieving stress and other effects of the trauma.
Treatment PlanThe treatment for PTSD includes the following:
- Behavior therapy — through specific processes that involve mental imagery of the traumatic event paired with relaxation techniques, one learns to no longer experience fear in response to triggers
- Cognitive therapy — coping skills are learned that change the thought process about the traumatic event
- Psychodynamic therapy — by re-experiencing the traumatic event in a supportive environment, one gains insight into the conscious and unconscious meaning of the reaction to the event and learns to come to terms with the occurrence of the trauma, adapting one's beliefs about the self and the world.
- Medication may be considered as well.
Drug TherapiesHealthcare providers may prescribe antidepressants such as selective serotonin re-uptake inhibitors (SSRIs, such as sertraline, fluoxetine, fluvoxamine, or paroxetine) or monoamine oxidase inhibitors (MAOIs, such as phenelzine) for symptoms of PTSD. Medications for anxiety may be helpful as well.
Complementary and Alternative TherapiesConventional psychotherapy with behavioral, cognitive, and psychodynamic components is the main treatment for PTSD. However, a number of mind/body techniques as well as other approaches have shown some promise as possible adjunctive treatments for this disorder.
- Eye Movement Desensitization and Reprocessing (EMDR), which requires one to make several sets of side-to-side eye movements while recalling a traumatic incident, seems to help reduce distress for many with PTSD. It is uncertain, however, whether this technique offers anything equivalent to or better than standard treatment alone. Nor is it entirely clear how long the reduction of PTSD symptoms lasts using EMDR.
- Biofeedback involves learning to sense bodily functions that are normally unconscious and occur involuntarily (for example, heart rate and temperature) in order to try to control these responses in times of stress. Some studies suggest that biofeedback, among other forms of relaxation training, may be an effective treatment for certain individuals with PTSD.
- Hypnosis has long been used to treat war-related post-traumatic conditions. More recently it has been used in cases of sexual assault (including rape), anesthesia failure, Holocaust survival, and car accidents. Hypnosis induces a deep state of relaxation, which may help patients with PTSD feel more safe and less anxious, decrease intrusive thoughts, and become reinvolved in daily activities.
- Inositol, considered to be part of the vitamin B complex and found in citrus fruits, vegetables, cereal grains, meats, and supplement form, may help reduce anxiety associated with PTSD.
- Avoid depressants, such as alcohol.
- Maintain balanced blood sugar to help stabilize mood. For example, eat small, frequent meals that each includes a small amount of protein. Avoid processed, refined, and simple sugars.
- Eat whole grains, fresh fruits and vegetables, and protein from vegetables (legumes and nuts, for example) and fish.
- Kava kava (Piper methysticum)—studies suggest that this herb reduces stress-related anxiety and is an effective and safe alternative to anti-anxiety medications without undesirable side effects; although not studied specifically for PTSD, the general effects of kava kava may be of value in this setting.
- Passionflower herb (Passiflora incarnata)
- Valerian root (Valeriana officinalis)
There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for PTSD based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Aconitum — for recurring panic following a traumatic experience; this remedy is most appropriate for individuals who have heart palpitations and shortness of breath which produce a tremendous fear of death
- Arnica — for chronic conditions (such as depression) that occur after a traumatic experience; this remedy is most appropriate for individuals who generally deny that anything is wrong
- Staphysagria — for individuals who feel fearful, powerless, or unable to speak up or defend themselves
- Stramonium — for anxiety disorders that occur after a shock or traumatic experience involving violence; the individual for whom this remedy is most appropriate tends to be generally fearful and have night terrors
Acupuncture is typically used to help release endorphins and may help with insomnia, anxiety, and depression, each of which can accompany PTSD. Guided imagery has been shown to regulate the release of nervous system chemicals, including endorphins, which are thought to be healing. In one case involving a Vietnam war veteran, acupuncture and relaxation with guided imagery reportedly reduced insomnia, nightmares, and panic attacks over a treatment period of 12 weeks.
Prognosis/Possible ComplicationsIf PTSD symptoms continue for longer than three months, the condition is considered to be chronic. Chronic PTSD may become less severe even if it is not treated. However, it may become severely disabling, interfering with many areas of life and causing physical complaints.
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