What is post traumatic stress disorder (PTSD)?
Post Traumatic Stress Disorder (PTSD) is a condition that develops in some people after they have witnessed or experienced a shocking, tragic, scary, abusive or dangerous event. For some people, PTSD may develop after repeated exposure to details of disturbing events in the course of their professional duties, or after being told a loved one has suffered a violent or accidental death.
PTSD can happen to anyone. The more disturbing the experience, the more likely someone is to develop PTSD. It may occur immediately following the event, months or even years afterward. While it is natural to feel stressed or afraid during or soon after a traumatic event, these feelings persist in people with PTSD, sometimes for the rest of their life.
What causes post traumatic stress disorder (PTSD)?
When we witness or experience a traumatic or dangerous event, our body instinctively reacts. This acute stress response (also known as “fight or flight”) is our body's way of increasing our chance of survival.
Our sympathetic nervous system instructs our adrenal glands (located on the top of each kidney) to release epinephrine and norepinephrine into the bloodstream. At the same time, our hypothalamus triggers the release of adrenocorticotropic hormone (ACTH) from our pituitary gland which in turn triggers the release of more than 30 other hormones.
All these "stress hormones" prepare our body to fight or flee. Our heart rate and blood pressure increase, our pupils dilate, and the veins in our skin constrict in order to direct blood to our muscles and heart. In addition, smooth muscle inside our lungs relaxes allowing better oxygen flow; glucose is released from stored glycogen in our liver; and non-essential functions, such as our digestive and immune system, shut down.
If we successfully fight or flight, then our stress hormones naturally dissipate allowing our bodies to return to a normal level of functioning. If the threat is so extreme that it causes us to freeze, or so persistent that our stress hormones remain elevated for extended periods of time, we become at risk of PTSD.
Who is more likely to develop post traumatic stress disorder (PTSD)?
PTSD is common, affecting about 1 in 10 men and 2 in 10 women. Prevalence increases depending on occupation, or in the case of the military, service era with PTSD reported in 11-20% of veterans involved in Operations Iraqi and Enduring Freedom; 12% of veterans who experienced the Gulf War, and over 30% of those who served in Vietnam.
PTSD can happen to anybody who experiences, witnesses, or hears about a life-threatening or disturbing event. Examples of events that may cause PTSD include:
- Military combat or a stressful or terrifying experience in a war zone
- Sexual or physical assault as an adult or a child
- Serious motor vehicle or workplace accidents
- Earthquakes, fires, floods, hurricanes, tornados, tsunamis or other natural disasters
- Terrorist attacks.
PTSD is also more likely to affect people who have little or no support following a traumatic event; with a history of childhood trauma, mental illness or substance abuse; without adequate coping strategies; who have witnessed a death or seen a dead body; or who feel troubled by their own actions during the event.
What are the symptoms of post traumatic stress disorder (PTSD)?
Actual symptoms and the length of time somebody has PTSD varies, but to be diagnosed with PTSD, all the following must be present:
- One or more re-experiencing symptoms - for example, flashbacks (reliving the trauma repeatedly), nightmares, frightening thoughts
- One or more avoidance symptoms - avoiding thoughts or feelings, places, activities, or objects that remind you of the event
- Two or more arousal and reactivity symptoms - feeling on edge, sleeping difficulties, angry outbursts
- Two or more cognition and mood symptoms - trouble remembering key details of the event, feeling guilt or blame, pessimistic thoughts, loss of interest in previously enjoyable things.
Symptoms of PTSD in children may be different from those in adults. Children less than six may become clingier, wet the bed at night despite previously having learned how to use the toilet, constantly act out the scary event, or refuse or be unable to talk.
Older children may develop destructive or disruptive behaviors and be disrespectful. Revenge may be high on their agenda. Guilt or self-blame is also common.
How is post traumatic stress disorder (PTSD) diagnosed?
If you have experienced or witnessed some kind of traumatic event and are still struggling to come to terms with it, read the following questions and see how many times you answer "Yes".
In the past month, have you:
- Had nightmares or thought about the event when you didn't want to?
- Tried not to think about the event or have gone out of your way to avoid situations that remind you of the event?
- Been easily startled or felt constantly on guard or watchful?
- Blamed yourself or others or felt guilty about the event or the problems it may have caused?
If you returned at least three "yes" answers, then you should talk to a mental health care provider about PTSD. Even if you scored less than three, but your symptoms are affecting your quality of life, talk to your doctor because certain treatments may help even if you don't have PTSD.
A diagnosis of PTSD can only be given if the symptoms last more than a month following the event, and are not due to any substance misuse, medical illness, or injury. People who experience similar symptoms that go away after a few weeks are usually diagnosed with acute stress disorder (ASD). ASD can develop into PTSD.
PTSD may coexist with depression, substance and alcohol misuse, and anxiety disorders. Treatment for PTSD often helps these other problems too.
How is post traumatic stress disorder (PTSD) treated?
PTSD can be treated in several different ways. One type of therapy may suit one person but not another and several may need to be tried or used in combination before you feel better.
Treatments for PTSD include:
- Psychotherapy (also called Talk Therapy), includes Cognitive Behavioral Therapy (CBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Stress Inoculation Training (SIT)
- Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) and others
- Sometimes antipsychotics if psychotic symptoms are present
- Participation in support groups.