It was first characterized as a condition experienced by veterans who had been in military combat, but mental health experts are discovering that it can affect anyone who has witnessed a traumatic event.
What is PTSD?
PTSD is short for a post-traumatic stress disorder. It is a debilitating mental health disorder which is caused by exposure to traumatic events. PTSD causes a number of emotional, psychological and physical reactions which can occur right after an event but may be delayed for many months or even years.
PTSD was thought to be a disorder which affected mainly combat veterans but has been found to occur in others. It often occurs when someone has been directly involved in a dangerous or threatening event but may occur when a person has simply witnessed such an event or when someone is subjected to chronic stress.
About 8% of the population or 24 million Americans will experience symptoms of PTSD during their lifetime. Women are more likely to develop PTSD than men.
Aside from the well-known combat-related PTSD occurrences, traumatic events may also include:
- Car accidents
- Natural disasters
- Living in a war zone
- Life-altering experiences – a death of a loved one, traumatic childbirth
- Other situations which cause extreme feelings of shock, sadness or fear
Many PTSD victims recover on their own, others experience distress and symptoms of PTSD for months or even years.
Symptoms of PTSD
In most cases, PTSD symptoms will begin to appear within three months of a traumatic event. In other cases, however, symptoms may not appear until years later. The severity of symptoms can range from mild to extreme and may be irregular in length or severity.
In order to be diagnosed with PTSD, symptoms must occur for at least 4 weeks, cause severe distress, interfere with home or work activities and must include at least:
One re-experience symptom
- Bad dreams
- Frightening thoughts
One avoidance symptom
- Avoiding thoughts or feelings related to an event
- Staying away from places, events or objects that are reminders
Two arousal symptoms
- Easily startled
- Feeling tense
- Angry outbursts
- Difficulty sleeping
Two mood or cognitive symptoms
- Trouble remembering key portions of an event
- Negative thoughts about self or others
- Distorted feelings of guilt or blame
- Loss of interest in normally enjoyable activities
PTSD symptoms may be similar to depression or anxiety and individuals may also have problems related to alcohol or drug abuse, employment difficulties, relationship issues and physical symptoms of chronic pain or illness.
PTSD is usually treated with a combination approach which includes medication and one or more types of therapy.
There are several different types of therapy which may be used for PTSD. All of them, however, have three main goals which include:
- Symptom reduction
- Increased self-esteem
- Improved coping skills
Many PTSD patients will benefit from simple “talk therapy” which can help individuals understand the disorder and how their life may be impacted. Patients will work individually with a trained therapist or may participate in group therapy with others who also suffer from PTSD.
As a large percentage of people diagnosed with PTSD are combat veterans, the Veterans Administration has developed recommendations for treatment of the disorder. Part of the recommendations includes trauma-focused therapy which concentrates on memory or memories of the traumatic event.
- Cognitive Processing Therapy – a 12-week course of treatment with 60-90 minute sessions which involve discussions and written assignments to identify memories, problems, and solutions learned by understanding how the trauma has affected thoughts and feelings.
- Prolonged Exposure – A series of 8 to 15-minute sessions in which patients are taught self-calming techniques and then asked to discuss specific features of the traumatic event in detail. Sessions are taped and the participant is asked to listen to the conversations at home. Over time, the repeated exposure can help to reduce symptoms.
- Eye Movement Desensitization and Reprocessing (EMDR) – Usually conducted over 3 months. Participants are asked to remember traumatic events while listening or watching something more calming or distracting. The goal is to develop an ability to think of something positive when PTSD symptoms emerge.
- Stress Inoculation Therapy – A form of Cognitive Behavioral Therapy (CBT) which is used for other mental disorders. SIT focuses on solutions through behaviors, self-calming techniques or positive self-talk messaging to change negative thought and behavior patterns.
Medications for PTSD
Antidepressants are considered the mainstay for PTSD and are the only medications approved to treat the disorder, though other medications may be used as well. Antidepressants work by increasing neurotransmitters in the mood centers of the brain.
SSRIs – Selective serotonin reuptake inhibitors (SSRIs) work mainly on the neurotransmitter Serotonin. Examples include:
- Prozac (fluoxetine)
- Zoloft (sertraline)
- Paxil (paroxetine)
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox (fluvoxamine
Only Zoloft and Paxil are officially approved to treat PTSD but other SSRIs are frequently used.
SNRIs – Serotonin and norepinephrine reuptake inhibitors (SNRIs) work on both serotonin and norepinephrine and may have different side effects. SNRIs include:
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
- Cymbalta (duloxetine)
- Savella (milnacipran)
Only SSRI antidepressants Zoloft and Paxil have been tested and approved by the FDA to treat PTSD but other medications may be used “off-label” when considered appropriate by a physician. Other medications which have been found to be effective in specific cases include:
- Antianxiety agents – Benzodiazepines (Xanax, Ativan) and medications for insomnia (Lunesta, Belsomra) may be used for short-term treatment of severe anxiety or insomnia but may be limited due to a potential for abuse
- Blood pressure medications – Propranolol can help to reduce physical symptoms of panic attacks while another drug, prazosin can help to control nightmares
- Atypical antipsychotics – Atypical or second-generation antipsychotics have been helpful for some PTSD patients whose symptoms are severe including medications like Abilify, Latuda and Zyprexa.
Managing PTSD at Home
In addition to professional help, individuals with PTSD can help to manage their disorder through lifestyle changes and behavioral modification. Routines and techniques may include:
- Meditation and breathing exercises
- Physical exercise
- Social interaction
- Healthy eating
- Pet therapy
Family Members and Friends
Loved ones of people with PTSD can be of great benefit in encouraging adherence to professional care recommendations and self-care practices and in providing support.
Things a family member or friend can do to help may include:
- Help with appointments. Provide transportation, moral support, or assistance with recording instructions or keeping track of medications.
- Listening when the individual with PTSD is needing to talk.
- Invitation to social activity outside of the home such as a movie or restaurant.
- Participation in an exercise class or other physical activity like bike riding or walking.
- Encouraging other friends and family members to do the same.
Those closest to an individual with PTSD may find it challenging or stressful as the illness may have caused difficulties with communication, trust, and intimate situations. Caregivers or loved ones who find they are having difficulties of their own should seek guidance or assistance from a mental health professional or counselor. When necessary, they should ask for help from extended family or friends.
Understanding of PTSD is expanding, and new treatments are being developed by both individual health professionals and as part of clinical research programs at academic and health facilities around the U.S.
As understanding of the disorder increases, the diagnosis has also been extended to include more non-combat sufferers. Recent focus has included chronic and complex forms of PTSD with victims of long-term abuse, medical illness, and even traumatic birth. The more attention the disorder gets, the more likely that treatments may be successful.