The Facts

Posttraumatic stress disorder (PTSD) has been called shell shock or battle fatigue syndrome. It has often been misunderstood or misdiagnosed, even though the disorder has very specific symptoms.

Ten percent of the population has been affected at some point by clinically diagnosable PTSD. Still more show some symptoms of the disorder. Although it was once thought to be mostly a disorder of war veterans who had been involved in heavy combat, researchers now know that PTSD also affects both female and male civilians, and that it strikes more females than males.

In some cases the symptoms of PTSD disappear with time, whereas in others they persist for many years. PTSD often occurs with-or leads to-other psychiatric illnesses, such as depression.

Everyone who experiences trauma does not require treatment; some recover with the help of family, friends, or clergy. But many do need professional treatment to recover from the psychological damage that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic event.

Symptoms

PTSD usually appears within 3 months of the trauma, but sometimes the disorder appears later. PTSD's symptoms fall into three categories:

• Intrusion
• Avoidance
• Hyperarousal

Avoidance
Avoidance symptoms affect relationships with others: The person often avoids close emotional ties with family, colleagues, and friends. At first, the person feels numb, has diminished emotions, and can complete only routine, mechanical activities. Later, when reexperiencing the event, the individual may alternate between the flood of emotions caused by reexperiencing and the inability to feel or express emotions at all. The person with PTSD avoids situations or activities that are reminders of the original traumatic event because such exposure may cause symptoms to worsen.

The inability of people with PTSD to work out grief and anger over injury or loss during the traumatic event means the trauma can continue to affect their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings. Some people also feel guilty because they survived a disaster while others-particularly friends or family-did not.

Hyperarousal
PTSD can cause those who have it to act as if they are constantly threatened by the trauma that caused their illness. They can become suddenly irritable or explosive, even when they are not provoked. They may have trouble concentrating or remembering current information, and, because of their terrifying nightmares, they may develop insomnia. This constant feeling that danger is near causes exaggerated startle reactions.

Finally, many people with PTSD also attempt to rid themselves of their painful re-experiences, loneliness, and panic attacks by abusing alcohol or other drugs as a "selfmedication" that helps them to blunt their pain and forget the trauma temporarily. A person with PTSD may show poor control over his or her impulses and may be at risk for suicide.

Treatment

Today, psychiatrists and other mental health professionals have good success in treating the very real and painful effects of PTSD. These professionals use a variety of treatment methods to help people with PTSD to work through their trauma and pain.

Behavior therapy focuses on correcting the painful and intrusive patterns of behavior and thought by teaching people with PTSD relaxation techniques and examining (and challenging) the mental processes that are causing the problem.

Psychodynamic psychotherapy focuses on helping the individual examine personal values and how behavior and experience during the traumatic event affected them.

Family therapy may also be recommended because the behavior of spouse and children may result from and affect the individual with PTSD.

Discussion groups or peer-counseling groups encourage survivors of similar traumatic events to share their experiences and reactions to them. Group members help one another realize that many people would have done the same thing and felt the same emotions.

Medication can help to control the symptoms of PTSD. The symptom relief that medication provides allows most patients to participate more effectively in psychotherapy when their condition may otherwise prohibit it. Antidepressant medications may be particularly helpful in treating the core symptoms of PTSD-especially intrusive symptoms.

Other Sources of Information