Posttraumatic stress disorder, or PTSD, is a condition resulting from a severely traumatic event outside the range of a person's normal experience.
PTSD is a psychological and physiological reaction to a catastrophic event outside of the individual. Researchers have identified changes in the central and autonomic nervous systems in people with PTSD. Changes in hormone systems have also been identified.
PTSD reactions are classified into three types: acute, in which symptoms last less than 3 monthschronic, in which symptoms last longer than 3 monthsdelayed, in which symptoms start at least 6 months after the actual trauma occurs
Symptoms of PTSD fall into three main categories. The first is reliving the event in one or more of the following ways: flashbacks, or reliving events as if they are occurring right nowpersistent memories of the eventphysical sensations when the event is recalledrecurrent dreams of the eventsevere emotional responses to new events similar to the traumatic event
The second category involves a tendency to avoid reminders of the event. This tendency includes the following symptoms: avoidance of activities, places, or people that might bring the event to mindavoidance of thoughts, feelings, or talking about the eventdifficulty maintaining healthy family, social, or job relationshipsfeelings of detachment or emotional distance from othersloss of interest in daily activitiesa sense of a shortened futuresurvivor guilt, that is, feeling guilty about surviving when others did nottrouble recalling key parts of the event
The third category involves a higher level of arousal and anxiety than before the trauma. At this level, the following symptoms can occur: agitation, or feelings of restlessnesschest paindifficulty concentratingdizzinessan exaggerated startle responseexcessive sweatingheadacheirritabilitymemory lossnauseapersistent anxiety
PTSD is caused by exposure to excessive stress or trauma. Events that spark the condition are not normally part of most people's life experience. Events that can trigger PTSD include the following: child abusehigh school violence, including shooting incidentsimprisonmentman-made disasters, such as bombingsnatural disasters, such as earthquakesplane crashessevere assaultsexual abuse, including rapetorturewar
Not everyone exposed to such events will develop PTSD. It is not known why some individuals develop PTSD, though research done on wartime experiences shows that a strong sense of hope is protective. Having strong support systems reduces a person's risk of the disorder.
Critical incident stress debriefing involves immediate counseling after the traumatic event. It may cut down on the chances of developing PTSD. The earlier counseling is started, the better the chances for success.
Diagnosis of PTSD begins with a medical history and physical exam. PTSD is diagnosed based on a person's symptoms. In addition, a major, extreme event must have taken place.
People with PTSD often have problems in their relationships with others. Marriage problems and high divorce rates are common. Job and legal problems also occur frequently in persons with the syndrome.
Alcoholism and drug abuse are significant among people with PTSD. Sleep disorders, trouble with anger, and suicide attempts are not uncommon.
PTSD is not contagious and poses no risk to others.
Treatment of PTSD can help reduce symptoms in some individuals. Cognitive-behavioral therapy helps the individual change perceptions and attitudes about the trauma. Group therapy can be helpful, especially if others in the group suffered the same trauma.
Exposure therapy allows the person to repeatedly relive the frightening experience under controlled conditions. This can help him or her work through the trauma. People with PTSD often need treatment for depression or substance abuse. This needs to occur before measures directed at decreasing symptoms of PTSD can be effective.
Medicines used to treat PTSD include the following: azaspirones, such as buspirone (i.e., BuSpar)benzodiazepines, such as alprazolam (i.e., Niravam, Xanax) or lorazepam (i.e., Ativan), should be used selectively and with cautionMAO inhibitors, such as phenelazine (i.e., Nardil)serotonin reuptake inhibitors (SSRIs), such as paroxetine (i.e., Paxil, Pexeva), fluoxetine (i.e., Prozac, Serafem), citalopram (i.e., Celexa), excitalopram (i.e., Lexapro) or sertraline(i.e., Zoloft)combination norepinephrine reuptake/serotonin reuptake inhibitors (NRI/SSRI) such as venlafaxine (i.e., Effexor) or duloxetine (i.e., Cymbalta)tricyclic antidepressants, such as amitriptyline (i.e., Elavil), doxepin (i.e., Sinequan), nortriptyline (i.e., Aventyl, Pamelor), imipramine (i.e., Tofranil), desipramine (i.e., Norpramin) or protriptyline (i.e., Vivactil)trazodone (i.e., Desyrel)bupropion (i.e., Wellbutrin, Zyban)
Medicines used to treat PTSD can cause drowsiness, stomach upset, and allergic reactions.
Chronic PTSD often persists for years. It usually becomes less intense and bothersome as time passes.
PTSD is monitored with regular visits to the healthcare professional, usually a psychiatrist. Blood tests may be done periodically to measure levels of medicines. Any new or worsening symptoms should be reported to the healthcare professional.
