In post-traumatic stress disorder (PTSD), distressing symptoms occur after a frightening incident. For the most part, a person with this disorder must have experienced the event him or herself, or witnessed the event in person. The person may also have learned about violence to a close loved one. The event must have involved serious physical injury or the threat of serious injury or death.
Exposure to violence through media (news reports or electronic images) is usually not considered a traumatic incident for the purposes of this diagnosis, unless it is part of a person's work (for example, police officers or first responders to a violent event).
Some examples of traumas include:
In the United States, physical assault and rape are the most common stressors causing PTSD in women, and military combat is the most common PTSD stressor in men.
Stress of this severity does not automatically cause PTSD. In fact, most people who are exposed to terrible trauma do not develop this particular illness. The severity of the stressor does not necessarily match the severity of symptoms. Responses to trauma vary widely. Many people develop mental disorders other than PTSD.
Acute Stress Disorder is the term used when symptoms develop within the first one to three months after a traumatic event. The term PTSD with delayed onset (or delayed expression) is used when symptoms surface six months or more after the traumatic event.
It is not clear what makes some people more likely to develop PTSD. Certain people may have a higher risk of PTSD because of a genetic (inherited) predisposition toward a more intense reaction to stress. Another way to put this is that some people have greater inborn resilience in response to trauma. A person's personality or temperament may affect the outcome after a trauma. Lifetime experience of other traumas (especially in childhood) and current social support (having loving and concerned friends and relatives) also may influence whether or not a person develops symptoms of PTSD.
People with PTSD are more likely to have a personality disorder. They also are more likely to have depression and to abuse substances.
Up to 3% or so of all people in the United States have full-fledged PTSD in any given year. Up to 10% of women and 5% of men have PTSD at some point in their lifetime. Although PTSD can develop at any time in life, the disorder occurs more frequently in young adults than in any other group. This may be because young adults are more frequently exposed to the types of traumas that can cause PTSD. The risk of developing PTSD is also higher than average in people who are poor, unmarried or socially isolated, perhaps because they have fewer supports and resources helping them to cope.
The way PTSD is defined has evolved over the last 20 years or more. As research evolves, so does the description of the illness. The trend has been to define the illness more narrowly.
In most cases, a diagnosis of PTSD requires that you have been exposed to a severe trauma. The trauma must have happened directly to you, you must have witnessed the event in person, or -- if you were not present for the trauma, it occurred to someone very, very close to you. The trauma must have involved death, or serious physical injury, or the threat of serious injury or death.
At some later time, you may begin to have the following symptoms:
According to the definition, PTSD symptoms must last for at least one month and must seriously affect your ability to function normally at home, at work or in social situations.
In addition to asking about the traumatic events that triggered your symptoms, your doctor will ask about your life history and will ask you to describe both positive experiences and negative or traumatic ones. Your current circumstances are very important. Here are sample questions your doctor may ask:
Your doctor will evaluate you to see if a different disorder might be at the root of your distress. You may have an anxiety disorder other than PTSD (for example, panic disorder). Or perhaps you have a mood disorder, such as depression or bipolar illness. Don't be surprised by detailed questions about drug or alcohol use. If you have a problem with substances, treatment is essential.
By definition, symptoms of PTSD must last for at least one month. However, untreated PTSD can be long-lasting. Symptoms may come and go over many years. For example, according to one study of World War II prisoners of war, 29% of those who developed PTSD still had symptoms more than 40 years after the conflict ended.
Some trauma cannot be prevented, but it can be a great source of relief to receive counseling and supportive therapy immediately afterward. Don't let others push you to describe all the details of the trauma because such conversations may re-expose you to the trauma as you relive it in your mind. (A technique called "critical incident stress debriefing," has not been shown to reduce risk. In fact, controlled studies indicate that this technique may actually increase risk of developing PTSD. The term, debriefing, refers to a process of asking detailed questions about a traumatic experience.)
Not all victims of a trauma want treatment, and that should be respected because most victims recover on their own with the support of family and friends. Treatment, however, should be made available to those who want it. In the aftermath of a traumatic event, health professionals should attend to a victim's basic physical and emotional needs first, providing reassurance and emphasizing coping.
Treatment can take a long time, which may explain the high dropout rate. Some researchers have found that three-quarters of people with PTSD stop treatment. However, treatment (usually a combination of medications and psychotherapy) can be helpful if you stick with it.
People respond to severe stress in many different ways. Your doctor may recommend medications for prominent symptoms. Controlled studies have not yet provided clear guidance about which medications are most helpful. Several classes of medications are commonly prescribed to treat PTSD. Antidepressants have been used most and can provide some relief. Some of the most commonly used drug classes are described below:
The aim of psychotherapy is to help a person cope with painful memories and manage emotional and physical reactions to stress. A variety of techniques can be helpful. Regardless of the technique used, education about human responses to trauma is valuable. Psychotherapy and education can help family members understand the disorder and cope with its effects.
If you have had a frightening experience, it can change your view of the world. Dealing with the stress of a traumatic event can be more difficult if you see yourself as a victim and your self-image centers on your experience of being a victim. If psychotherapy reinforces this belief, it can be counterproductive. In psychotherapy, you can recognize that tragedy, violence and evil are human experiences, that the desire for revenge or compensation is normal, but that many parts of your life remain in your control. The goal is to help you live the best life you can despite the frightening experience.
Two of the techniques that can be helpful and it is quite common in practice to combine elements of both:
If you have been exposed to one of the traumatic stressors that can trigger PTSD or if you already have PTSD symptoms, consult your doctor. He or she can direct you to a qualified therapist who will help you to identify your reactions to the trauma and deal with them.
The long-term outlook for PTSD varies widely and depends on many factors, such as your ability to cope with stress, your personality or temperament, a history of depression, the use of substances, the nature of social support, your level of ongoing stress and your ability to stay in treatment. Overall, about 30% of people eventually recover completely with proper treatment, and another 40% get better, even though less-intense symptoms may remain. Treatment with psychotherapy and/or medications, such as SSRIs, has been very helpful. Even without formal treatment, many people receive the support they need to make a successful adjustment as time puts distance between them and the traumatic event.
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