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PTSD: Post-traumatic stress disorder
What Is PTSD?
Posttraumatic stress disorder (PTSD), once called shell shock or battle fatigue syndrome, is a serious condition that can develop after a person has experienced or witnessed a traumatic or terrifying event in which there was serious physical harm or threat. PTSD is a lasting consequence of traumatic ordeals that cause intense fear, helplessness, or horror. Examples of things that can bring on PTSD include sexual or physical assault, the unexpected death of a loved one, an accident, war, or natural disaster. Families of victims can develop PTSD, as can emergency personnel and rescue workers.
Most people who have a traumatic event will have reactions that may include shock, anger, nervousness, fear, and even guilt. These reactions are common, and for most people, they go away over time. For a person with PTSD, however, these feelings continue and even increase, becoming so strong that they keep the person from going about their life as expected. People with PTSD have symptoms for longer than one month and can’t function as well as before the event that triggered it happened.
Post-traumatic stress disorder symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.
PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.
Symptoms of intrusive memories may include:
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams or nightmares about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the traumatic event
Symptoms of avoidance may include:
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or people that remind you of the traumatic event
Negative changes in thinking and mood
Symptoms of negative changes in thinking and mood may include:
- Negative thoughts about yourself, other people or the world
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
- Feeling detached from family and friends
- Lack of interest in activities you once enjoyed
- Difficulty experiencing positive emotions
- Feeling emotionally numb
Changes in physical and emotional reactions
Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:
- Being easily startled or frightened
- Always being on guard for danger
- Self-destructive behavior, such as drinking too much or driving too fast
- Trouble sleeping
- Trouble concentrating
- Irritability, angry outbursts or aggressive behavior
- Overwhelming guilt or shame
For children 6 years old and younger, signs and symptoms may also include:
- Re-enacting the traumatic event or aspects of the traumatic event through play
- Frightening dreams that may or may not include aspects of the traumatic event
Intensity of symptoms
PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you’re stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.
When to see a doctor
If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your doctor or a mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.
If you have suicidal thoughts
If you or someone you know has suicidal thoughts, get help right away through one or more of these resources:
- Reach out to a close friend or loved one.
- Contact a minister, a spiritual leader or someone in your faith community.
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
- Make an appointment with your doctor or a mental health professional.
Doctors use certain antidepressant medications to treat PTSD — and to control the feelings of anxiety and its associated symptoms — including:
- Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
- Tricyclic antidepressants such as amitriptyline (Elavil) and isocarboxazid (Doxepin)
- Mood stabilizers such as divalproex (Depakote) and lamotrigine (Lamictal)
- Atypical antipsychotics such as aripiprazole (Abilify) and quetiapine (Seroquel )
Certain blood pressure medicines are also sometimes used to control particular symptoms:
- Prazosin for nightmares
- Clonidine (Catapres) for sleep
- Propranolol (Inderal) to help minimize the formation of traumatic memories
Experts discourage the use of tranquilizers such as lorazepam (Ativan) or clonazepam (Klonopin) for PTSD because studies have not shown them to be helpful, plus they carry a risk for physical dependence or addiction.
Psychotherapy for PTSD involves helping the person learn skills to manage symptoms and develop ways of coping. Therapy also aims to teach the person and their family about the disorder, and help the person work through the fears associated with the traumatic event. A variety of psychotherapy approaches are used to treat people with PTSD, including:
- Cognitive behavioral therapy, which involves learning to recognize and change thought patterns that lead to troublesome emotions, feelings, and behavior.
- Prolonged exposure therapy, a type of behavioral therapy that involves having the person relive the traumatic event, or exposing the person to objects or situations that cause anxiety. This is done in a well-controlled and safe environment. Prolonged exposure therapy helps the person confront the fear and gradually become more comfortable with situations that are frightening and cause anxiety. This has been very successful at treating PTSD.
- Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event.
- Family therapy may be useful because the behavior of the person with PTSD can have an affect on other family members.
- Group therapy may be helpful by allowing the person to share thoughts, fears, and feelings with other people who have experienced traumatic events.
- Eye Desensitization and Reprocessing (EMDR) is a complex form of psychotherapy that was initially designed to alleviate distress associated with traumatic memories and is now also used to treat phobias.
After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what’s happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.
Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.
Support from others also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.