Post-traumatic stress disorder

• Alternative Names

  PTSD

• Causes, incidence, and risk factors

  Post-traumatic stress disorder (PTSD) may occur soon after a major trauma, or it can be delayed for more than 6 months after the event. When it occurs soon after the trauma, it usually gets better after 3 months. However, some people have a longer-term form of PTSD, which can last for many years.

  PTSD can occur at any age and can follow a natural disaster such as a flood or fire, or events such as war, a prison stay, assault, domestic abuse, or rape. The terrorist attacks of September 11, 2001, in the United States may have caused PTSD in some people who were involved, in people who saw the disaster, and in people who lost relatives and friends. These kinds of events can produce stress in anyone, but not everyone develops PTSD.

  The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD.

  Having good social support helps to protect against PTSD. In studies of Vietnam veterans, those with strong support systems were less likely to get PTSD than those without social support.

  People with PTSD re-experience the event again and again in at least one of several ways. They may have frightening dreams and memories of the event, feel as though they are going through the experience again (flashbacks), or become upset during anniversaries of the event.

• Symptoms

  Symptoms of PTSD fall into three main categories:

  1. Repeated "reliving" of the event, which disturbs day-to-day activity

  • Flashback episodes, where the event seems to be happening again and again
  • Recurrent distressing memories of the event
  • Repeated dreams of the event
  • Physical reactions to situations that remind you of the traumatic event

  2. Avoidance

  • Emotional "numbing," or feeling as though you don’t care about anything
  • Feelings of detachment
  • Inability to remember important aspects of the trauma
  • Lack of interest in normal activities
  • Less expression of moods
  • Staying away from places, people, or objects that remind you of the event
  • Sense of having no future

  3. Arousal

  • Difficulty concentrating
  • Exaggerated response to things that startle you
  • Excess awareness (hypervigilance)
  • Irritability or outbursts of anger
  • Sleeping difficulties

  You also might feel a sense of guilt about the event (including "survivor guilt"), and the following symptoms, which are typical of anxiety, stress, and tension:

  • Agitation, or excitability
  • Dizziness
  • Fainting
  • Feeling your heart beat in your chest (palpitations)
  • Fever
  • Headache
  • Paleness
• Signs and tests

  There are no tests that can be done to diagnose PTSD. The diagnosis is made based on a certain set of symptoms that continue after you've had extreme trauma. Your doctor will do psychiatric and physical exams to rule out other illnesses.

• Treatment

  Treatment aims to reduce symptoms by encouraging you to recall the event, express your feelings, and gain some sense of control over the experience. In some cases, expressing grief helps to complete the necessary mourning process. Support groups, where people who have had similar experiences can share their feelings, are helpful.

  People with PTSD may need to treat depression, alcohol or substance abuse, or related medical conditions before addressing symptoms of PTSD. Behavioral therapy is used to treat avoidance symptoms. This can include being exposed to the object that triggers your symptoms until you become used to it and no longer avoid it (called graded exposure and flooding).

  Medicines that act on the nervous system can help reduce anxiety and other symptoms of PTSD. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), can be effective in treating PTSD. A doctor should monitor you if you take these drugs, because they can have side effects. Sedatives can help with sleep disturbance. Anti-anxiety medicines may be useful, but some types, such as benzodiazepines, can be addictive.

• Support Groups

  You can find more information about post-traumatic stress disorder and coping with a national tragedy from the American Psychiatric Association -- www.psych.org.

• Expectations (prognosis)

  The best outcome, or prognosis, depends on how soon the symptoms develop after the trauma, and on how quickly you get diagnosed and treated.

• Complications
  • Alcohol abuse
  • Depression, anxiety, and fear of things that are not usually frightening to other people (phobia), may be part of this disorder
  • Drug abuse
• Calling your health care provider

  Although traumatic events like the September 11 tragedy can cause distress, not all feelings of distress are symptoms of PTSD. Talk about your feelings with friends and relatives. If your symptoms last longer, or are worse, than those of your friends, contact your doctor.

  Seek help immediately by going to the emergency room or calling the local emergency number (such as 911) if:

  • You feel overwhelmed by guilt
  • You are impulsive
  • You are thinking of hurting yourself
  • You are unable to contain your behavior
  • You have other very distressing symptoms of PTSD

  You can also contact your doctor for help with ongoing problems such as recurrent thoughts, irritability, and problems with sleep.

• Prevention

  Research into ways to prevent PTSD is ongoing.

• References

  Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;3:CD003388.

  Ipser JC, Carey P, Dhansay Y, Fakier N, Seedat S, Stein DJ. Pharmacotherapy augmentation strategies in treatment-resistant anxiety disorders. Cochrane Syst Rev. 2006;4:CD005473.

Review Date: 1/20/2009

Reviewed By: Paul Ballas, DO, Department of Psychiatry, Thomas Jefferson University Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.