Post-Traumatic Stress Disorder

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is an anxiety disorder that a person can develop after experiencing or witnessing a traumatic event or life-threatening situation. A traumatic event can be any situation that causes stress, horror, helplessness, serious injury, or the threat of serious injury or death.

What are the symptoms of PTSD?

People who have PTSD may have the following symptoms:

• Flashbacks (vivid feelings that the traumatic event is happening again). Sometimes, a person can dissociate in such a way as to lose track of time.
• Nightmares about the event
• Hallucinations (seeing or hearing things that aren’t there)
• Decreased interest in things that were once important
• Feeling hopeless about the future
• Avoiding things that remind the person of the event, not wanting to think or talk about the event
• Having amnesia for all or some of the event; not remembering all or some of the event
• Difficulty falling or staying asleep
• Very alert and easily startled
• Difficulty concentrating
• Outbursts of anger
• Irritability
• Suicidal thoughts - thinking about hurting or killing himself or herself

If these symptoms last longer than a month and interfere with the person’s social life, work, or relationships, it could be considered PTSD.

Most symptoms of PTSD usually occur within three months of the traumatic event, but can emerge years later. Not everyone who experiences a traumatic event will have PTSD.

What other problems are associated with PTSD?

In addition to the symptoms listed above, people who have PTSD may have other problems, including:

• Alcohol and/or substance abuse
• Trouble finding or keeping a job
• Relationship problems
• Physical symptoms, such as upset stomach, rapid breathing, tightness in the chest, headaches
• An increased risk of depression and substance abuse

What are the causes of PTSD?

Any event that is life-threatening or greatly affects a person’s emotional well-being can result in PTSD. Examples of these traumatic events include:

• rape
• war
• natural disasters (hurricane, tornado, etc.)
• abuse
• serious accidents
• captivity

Traumas caused by other people (such as rape or assault) are more likely to cause PTSD. Strong emotions caused by these events can create changes in the brain that can bring about PTSD. People can also have PTSD for traumas they have perpetrated (i.e., soldiers who have shot enemy combatants can have PTSD).

Who is at risk for PTSD?

Anyone who witnesses or experiences a traumatic event, especially if it is long-term or repeated, is at risk for PTSD. Certain groups, including war veterans and women, may be more likely to develop PTSD. For example, about eight percent of men and 20 percent of women develop PTSD after a traumatic event.

It is not known why some people suffer from PTSD after a traumatic event and some do not. Some factors make you more likely to develop PTSD, including:

• Exposure to multiple traumatic events
• Exposure to long-term or repeated traumas
• Personal history of mental health problems, especially anxiety disorders
• Lack of support from family and friends after a trauma

How many people suffer from PTSD?

Approximately 5 million Americans suffer from PTSD. Some 15-30 percent of the 3.5 million men and women who served in Vietnam have suffered from PTSD.

What types of treatment are available for PTSD?

There are several different types of treatment for PTSD. There is no one treatment that works for everyone. If you feel that you may have PTSD, talk with your doctor or mental health provider to determine what treatment options are best for you.

Types of therapy that are often successful with PTSD are:

• Group therapy: In this type of therapy, you talk with others who have had similar traumatic experiences and have PTSD. Sharing your feelings with others can help you to feel more comfortable talking about the event and can help you cope with bad memories and feelings such as guilt, anger, shame, embarrassment, and fear. It can also help you build self-confidence and trust.
• Cognitive-behavioral therapy: This is a type of counseling in which you will learn to identify the things that make you feel upset or afraid. With the help of your doctor, you will learn to replace those thoughts with more accurate and less upsetting thoughts. Your doctor will also teach you ways to cope with feelings such as anger, guilt, and fear. The goal of this therapy is to help you understand how certain thoughts about your trauma make your symptoms worse and cause you stress.
• Exposure therapy: People who have experienced trauma fear the thoughts, feelings, and situations that remind them of it. The goal of exposure therapy is to eventually have less fear about your memories, and to learn to control your thoughts and feelings about the traumatic event. You will talk with your doctor about other memories that are less upsetting to you; this is called "desensitization." You may be asked to remember bad memories at the same time; this is called "flooding." It helps you to eventually feel less overwhelmed.

Medications

A type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI) is often used in PTSD cases. This type of medication can help you feel less sad and worried. Some commonly prescribed SSRIs are citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Zoloft has been approved by the Food and Drug Administration (FDA) for the long-term treatment of PTSD. A combination of therapy and medication is often successful in treating PTSD.

Other medications are used but have less evidence to support their use. Any time a medication is used, the expected outcome should be clearly defined; that is, the target symptoms should be clearly identified and then the medication should be evaluated as to whether it is effective in addressing that symptom. This should be compared to the side effects of the medication, and the patient and clinician should carefully assess if the medication should be continued.

Clonidine (Catapres) and propranolol (Inderal) have been used to treat flashbacks. Antipsychotic medications have been used to treat hypervigilance, but have little evidence to support their use. Medications to help with sleep are also commonly used. Patients should note that the medical consensus is that therapy is the treatment of choice for PTSD, and medications are used adjunctively.

Although some people improve within six months of treatment, it may take longer for many others.

Where can I get more information?

National Center for PTSD
802.296.6300
e-mail: ncptsd@va.gov

PTSD Alliance
877.507.7873
e-mail: info@ptsdalliance.org

If you or someone you know is in a crisis and threatening to hurt or kill himself or herself, immediately call 9-1-1 or the National Suicide Prevention Lifeline: 800.273.TALK (8255)