Definition

Posttraumatic Stress Disorder is classed as an Anxiety Disorder in the DSM-IV. Its modern history can be traced, most notably, to World War I when it came to be known as "shell shock", and World War II and the Korean War when it was known as "combat exhaustion" or "combat fatigue." Today, research has shown that the disorder can be precipitated not only by the stresses of combat, but by any number of exceptionally stressful, threatening or catastrophic events or situations that can evoke intense fear, terror or helplessness (e.g., natural or human-made disasters, serious accidents, witnessing the violent death of others, being a victim of torture, terrorism, rape, or other crime). PTSD is essentially a delayed or prolonged response to such stressors and is characterized by repeated episodes of reexperiencing the original traumatic event in intrusive memories (flashbacks) or dreams, avoidance of anything remotely reminiscent of the trauma, emotional "numbing," and increased arousal and/or anxiety. In addition, in order for a diagnosis to be warranted, the disturbance must persist for at least one month.

PTSD is evident throughout the world and both males and females appear equally susceptible to it, as are children. The personal costs associated with this disorder are considerable. Individuals can experience tremendous, prolonged distress that can have a devastating impact on family and interpersonal relationships, and work performance. Research is also indicating that PTSD sufferers access medical services more often than those without the disorder. Furthermore, it is not uncommon for PTSD to be associated with other psychiatric conditions, including Depression, Anxiety, Alcohol and/or Substance Abuse.

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Symptoms

PTSD is associated with a constellation of symptoms that can be grouped generally into the following categories: Intrusions, Avoidance and Emotional Numbing, and Hyperalertness/arousal.

Intrusions

• reexperience of the traumatic event in the form of thoughts, flashbacks, and distressing dreams that occur suddenly and are beyond the person's control
• experience of physiological state that was associated with the original trauma (e.g., sweating, pounding heartbeat, shaking or tremors)

• person tends to avoid anything that may potentially trigger a memory of or feeling from the original traumatic event, as well as some of the following:
• diminished interest in activities
• feelings of detachment or estrangement from others
• limited or blunted emotions
• inability to recall important details of the trauma
• pervasive pessimism, despair or hopelessness

• hypervigilance, i.e., being particularly sensitive to such things as sudden or unexpected noises, or the sudden appearance of an individual
• exaggerated startle response
• difficulty falling or staying asleep
• irritability or outbursts of anger
• difficulty concentrating

Cause(s)

The precise cause(s) of PTSD is presently unknown. Certainly, exposure to a traumatic event is a necessary precondition for the development of the disorder; however, this alone is insufficient for explaining such things as why only some individuals are affected and others are not and why one person may suffer severe symptoms while another may not.

A variety of physical, psychological and social factors likely play a role in the onset of the disorder. Research is indicating, for example, that the presence of preexisting clinical problems and a family history of psychiatric problems increase the likelihood that an individual will suffer from the disorder.

A number of potential explanations are being considered by researchers. Behavioral explanations suggest that PTSD symptoms arise as a result of learning or conditioning. This view suggests that events or situations that are remotely similar to or reminiscent of the original traumatic event can elicit the kinds of reactions that were experienced on that occasion. Biological explanations are considering such things as whether PTSD symptoms are brought on by damage or alterations to neuronal pathways or neurochemical systems as a result of experiencing the traumatic event, and whether PTSD sufferers inherit a predisposition to respond to stress with chronic overarousal.

Course

PTSD can afflict both adults and children. Intrusion symptoms (i.e., the reexperience of aspects of the trauma) will likely begin months or years after the trauma. Avoidance symptoms and hyperalertness may be present immediately following the trauma or soon after. If left unchecked, the disorder can become increasingly incapacitating over time.

Treatment

In most cases of PTSD, a combination of medication and cognitive-behavioral treatment has proved effective.

Common drug therapy involves the prescription of a class of drugs, SSRI's (Selective Serotonin Reuptake Inhibitor's), that have a particular effect on the neurotransmitter Serotonin. These drugs have proved successful in managing symptoms of intrusion, numbing and social withdrawal. Mood stabilizers and Anti-Anxiety medication may also be prescribed to assist with issues of impulsivity and anger, and significant anxiety.

Psychological treatments of PTSD can include components of Anxiety Management, Cognitive Therapy and Exposure Therapy. Anxiety Management can involve such things as relaxation training, breathing retraining, encouragement of positive thinking and self-talk, assertiveness training and thought stopping. Cognitive Therapy focuses on correcting irrational beliefs, most notably unrealistic guilt about the trauma. Exposure Therapy requires an individual to confront the source(s) of his/her anxiety and distress through either imaginative exercises or direct encounters, or a combination of both. The basic rationale behind this technique is that multiple exposures to the source(s) of discomfort will reduce the individual's feelings of anxiety. It is worth noting that Exposure Therapy may not be appropriate for everyone. In some cases, employing such a technique may prove to be counter-productive.

Dealing with Relapse

During a period of stability and wellness, individuals should devise a relapse management plan with their mental health professional and family members or friends that will outline what steps may need to be taken should a relapse occur. The plan will need to identify symptoms that may constitute warning signs and, if they are evident, an agreement should be made by the individual and members of his or her immediate support network to contact the family physician, counselor, or other mental health professional. In addition, methods to reduce stress and stimulation should be established with a counselor so that they can be put into effect pending any relapse.

Emergencies

In the case of an emergency, individuals should call their physician, therapist, or the emergency ward of their local hospital. Additional assistance may also be obtained by clicking on the Further Information and Support link below.

Further Information and Support (Coming Soon)