Psychiatric Associates

Posttraumatic Stress Disorder (PTSD)

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What is Posttraumatic Stress Disorder (PTSD)?

      When you're in danger, it's natural to feel afraid. This fear triggers many instantaneous changes in your body that prepare you to either defend yourself against the danger or escape it -- the "Fight or Flight" response. This response is a healthy reaction meant to protect you from harm. In PTSD, this reaction is altered or damaged. People who suffer PTSD may feel stressed or scared even when they're no longer in danger.

      PTSD is characterized by intense fear, helplessness, or horror in reaction to seeing or living through a dangerous event involving either someone’s death or the threat or risk of death or serious injury to you or to someone else. Symptoms usually begin within three months of the event but can begin years later. The disorder was first recognized in veterans of the Vietnam War but is now recognized as also happening to people involved in other traumatic experiences, such as:

  • being mugged, raped, tortured, kidnapped, held captive, sexually assaulted, or physically assaulted;
  • being in a motor vehicle accident (MVA), train wreck, ship sinking, or plane crash;
  • being in an explosion or a fire; or
  • being in a natural disaster such as a hurricane, tornado, flood, or earthquake.

One Person's Story:

      "I was in a car crash last year. The crash was frightening and a man in the other car died, so I felt lucky that I lived through it and wasn’t badly hurt. After a while, though, things changed. I started to have nightmares every night and when I was awake I saw the crash happening over and over in my mind. I felt tense every time I rode in a car and therefore avoided that as much as I could. I started yelling at my husband over little things and sometimes felt numb inside.

      "My husband asked me to see my doctor, who told me that I might have PTSD and put me in touch with a mental health provider trained to help people with PTSD. It helped to share my feelings with my therapist. I learned about PTSD and what I could do to stop feeling so scared all the time. I worked on learning how to relax. I soon felt less tense and scared and began to sleep again. It wasn’t easy, but after a couple of months I began to feel better. Now, I'm pretty much back to my old self again."

What are the symptoms of PTSD?

      PTSD is characterized by three categories of symptoms: Re-experiencing, Avoidance, and Hyperarousal. Re-experiencing symptoms include:
  • frightening memories of what happened;
  • unpleasant dreams or nightmares about what happened that may awaken you or cause you to speak, cry out, or strike out while asleep;
  • “flashbacks” -- reliving what happened over and over, including physical symptoms like a racing heart or sweating;
  • crying or becoming angry or enraged by thinking about, remembering, or being reminded of what happened; and
  • increased pulse and respiration rates, sweating, trembling or shaking, nausea or abdominal distress and similar anxiety symptoms in reaction to thinking about, remembering, or being reminded of what happened.
      Re-experiencing symptoms may cause problems in a person's everyday routine. They can start from the person's own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger Re-experiencing symptoms.
      Avoidance symptoms include:
  • efforts to avoid thoughts, feelings, or conversations associated with what happened;
  • efforts to avoid activities, places, or people that bring up memories of what happened;
  • an inability to recall an important aspect of what happened;
  • markedly diminished interest or participation in significant activities;
  • a feeling of detachment or estrangement from others;
  • being unable to experience normal emotions; and
  • not expecting to have a career, marriage, children, or a normal life span.
      Things that remind a person of the traumatic event can trigger Avoidance symptoms. These symptoms may cause a person to change his personal routine. For example, after a bad car accident someone who usually drives himself may avoid driving or even riding in a car.  
      Finally, Hyperarousal symptoms include:
  • difficulty falling or staying asleep, which may be due to recurrent nightmares about what happened;
  • irritability or outbursts of anger;
  • difficulty concentrating;
  • being constantly on edge; and
  • an exaggerated startle response.
      Hyperarousal symptoms are usually constant, instead of being triggered by things that remind the person of the traumatic event. They can make the person feel stressed and angry, and can make it harder to perform daily tasks such as sleeping, eating, or concentrating.
      Children and teens can also have extreme reactions to trauma, but may not display the same symptoms as adults. In very young children symptoms of PTSD include:
  • bedwetting despite earlier successful toilet training;
  • forgetting how to talk or being unable to talk;
  • acting out the scary event during playtime; and
  • being unusually clingy with a parent or other adult.
      Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.
      It's natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called Acute Stress Disorder, or ASD. Some people with PTSD don't show any symptoms for week, months, and in some cases years after the original dangerous event. When the symptoms last more than a few weeks and become an ongoing problem, they could indicate PTSD. 
What disorders often accompany PTSD?
      PTSD may be associated with increased rates of physical symptoms and, possibly, general medical conditions. It’s associated with increased rates of Major Depressive Disorder, Substance-Related Disorders, other Anxiety Disorders, and Bipolar Disorder.
What causes PTSD?
      Not everyone who lives through a dangerous event develops PTSD. In fact, most don't. Many factors play a part in whether a person develops PTSD. These include risk factors that make PTSD more likely and resilience factors that make it less likely. Some of these factors are present before the trauma and others become important during and after it. Risk factors for PTSD include:
  • living through dangerous events and traumas;
  • having a history of mental illness;
  • being hurt;
  • seeing people be hurt or killed;
  • feeling horror, helplessness, or extreme fear;
  • having little or no social support after the event; and
  • dealing with extra stress after the event, such as the loss of a loved one, pain and injury, or the loss of a job or home.
      Resilience factors include:
  • seeking out support from other people, such as friends and family;
  • finding a support group after a traumatic event;
  • feeling good about one’s own actions in the face of danger;
  • having a coping strategy, or a way of getting through the bad event and learning
    from it; and
  • being able to act and respond effectively despite feeling fear.
      Researchers are studying the importance of various risk and resilience factors. With more study, it may be possible someday to predict who is likely to get PTSD and thus to prevent it.
How is PTSD diagnosed?

      Even the most severe PTDS is treatable. As is true of most medical and psychological disorders, the earlier that treatment begins the more effective it is and the higher the likelihood that recurrences can be prevented.

      The first step toward getting help is to see your Primary Care Provider (PCP), the medical provider whom you see for other disorders. Your PCP may prescribe an appropriate medication and/or refer you to a mental health professional for further evaluation.

      A mental health professional will conduct a complete diagnostic evaluation, including a discussion of any family history of Anxiety Disorders and other psychological disorders and a complete history of symptoms. This history will include when your PTSD started; how long you've been fearful; how severely fearful you are; whether or not you've had an Anxiety Disorder before; if so whether or not you received treatment and how successful that treatment was; whether or not alcohol and/or substance abuse are involved; whether or not there are other psychological disorders present; and whether or not you feel suicidal and/or are planning to harm or kill yourself.

      To be diagnosed with PTSD a person must exhibit all of the following for at least 1 month:

  • at least one Re-experiencing symptom;
  • at least three Avoidance symptoms;
  • at least two Hyperarousal symptoms; and
  • symptoms that make it hard to go about daily life, to go to school or work, to be with friends, and to perform important tasks.

How is PTSD treated?

      The main treatments for PTSD are psychotherapy ("talk" therapy), medication, or a combination of the two. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for them. If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both the PTSD and the relationship have to be dealt with.

      Psychotherapy: Psychotherapy involves talking with a mental health provider to treat an emotional problem. Psychotherapy can occur one-on-one or in a group. Psychotherapy for PTSD usually lasts six to 12 weeks, but can take longer.  Psychotherapy teaches people helpful ways to react to frightening events that trigger their PTSD symptoms. Different types of psychotherapy emphasize different things, such as:

  • teaching about trauma and its effects;
  • using relaxation and anger management techniques;
  • providing suggestions for better sleep, diet, and exercise habits;
  • helping people identify and deal with guilt, shame, and other feelings about the dangerous event; and
  • focusing on changing how people react to their PTSD symptoms. For example, psychotherapy helps people to visit places and people that are reminders of the event.

      One helpful type of psychotherapy is Cognitive Behavioral Therapy (CBT). There are several parts to CBT, including Exposure Therapy, Cognitive Restructuring, and Stress Inoculation Training.

  • Exposure Therapy helps people with PTSD face and control their fears by exposing them to the situation or experience they fear, but in a safe way. It uses mental imagery, writing, or visits to the place where the dangerous event occurred. This helps people with PTSD cope with their feelings, particularly their fears.
  • Cognitive Restructuring helps people with PTSD make sense of the bad memories. Sometimes people with PTSD remember the event differently than how it actually happened and, as a result, may feel guilt or shame about what is not their fault. Cognitive Restructuring helps them look at what happened in a realistic way.
  • Stress Inoculation Training reduces symptoms by teaching people with PTSD how to reduce anxiety through looking at memories in a more adaptive and functional way.

      CBT often lasts about 12 weeks. It can be conducted individually or in a group of people with similar problems. CBT often entails “homework,” or exercises for the client to do in between sessions. Research indicates that the effects of CBT last longer than those of treatment with medication for people with Panic Disorder, and possibly for those with OCD, PTSD, and Social Phobia. If CBT is effective, a recurrence of the disorder can often be effectively treated quickly and easily with a brief refresher.

      For those who are mildly or moderately anxious, psychotherapy alone is often the best treatment option. However, for certain people, especially those who are severely fearful, a combination of psychotherapy and medication may be necessary.

      Medications: The U.S. Food and Drug Administration has approved two medications for treating adults with PTSD:

  • Sertraline (Zoloft)
  • Paroxetine (Paxil)

      Both are antidepressants which are also used to treat Anxiety Disorders such as PTSD. They may help control symptoms of PTSD such as sadness, worry, anger, and feeling numb inside and make it easier to go through psychotherapy. Sometimes people who take these medications experience side effects. These side effects can be annoying but usually go away after the person has taken the medication for awhile. However, medications affect everyone differently, so any side effects or unusual reactions should be reported to the doctor who prescribed the medication. Sometimes the medication dose needs to be reduced or the time of day at which the medication is taken needs to be changed to help lessen these side effects. The most common side effects of antidepressants like Zoloft and Paxil are:

  • headache, which usually goes away within a few days;
  • nausea (feeling sick to your stomach), which usually goes away within a few days;
  • sleepiness or drowsiness, which may occur during the first weeks but then goes away;
  • agitation (feeling jittery); and
  • sexual problems, which can affect both men and women, including reduced sex drive and problems having and/or enjoying sex. 
      Doctors may also prescribe other types of medications, such as the ones listed below. There is little information on how effective these medications are for people with PTSD:
  • Benzodiazapines. These medications may be given to help people relax and sleep. People who take benzodiazepines may have memory problems or become dependent on the medication. 
  • Antipsychotics. These medications are usually given to people with other mental disorders, such as schizophrenia. People who take antipsychotics may gain weight and have a higher chance of developing heart disease and/or diabetes.
  • Other antidepressants. Like Zoloft and Paxil, the antidepressants Prozac (fluoxetine) and Celexa (citalopram) may help people with PTSD feel less tense or sad. For people with PTSD who also have other Anxiety Disorders or Depression, antidepressants may be useful in reducing symptoms of these co-occurring disorders.
How can you help someone who has PTSD?
      If you know someone who has PTSD, it affects you, too. The first and most important thing that you can do is to help him get the right diagnosis and treatment. You may need to make an appointment for the person and go with him the first time. Encourage him to stay in treatment, or to seek different treatment if he's not feeling better after six to eight weeks. To help him further, you can:
  • offer emotional support, understanding, patience, and encouragement;
  • learn about PTSD so that you can understand what he's experiencing;
  • talk to him and listen carefully;
  • listen to feelings he expresses and be understanding of situations that may trigger PTSD symptoms;
  • invite him out for positive distractions such as walks, outings, and other activities; and
  • remind him that, with time and treatment, he can get better.

What can you do if you have PTSD?

      It may be very hard to take that first step to help yourself. It's important to realize that, although it may take some time, with treatment you can get better. To help yourself:

  • talk to your doctor about treatment options;
  • engage in mild activity or exercise to help reduce stress;
  • set realistic goals for yourself;
  • break up large tasks into small ones, set some priorities, and do what you can as you can do it;
  • try to spend time with other people and confide in a trusted friend or relative about things that may trigger symptoms;
  • expect your symptoms to improve gradually, not immediately; and
  • identify and seek out comforting situations, places, and people.
© 2010

    Dr. Thomas E. Hranilovich
    Licensed Psychologist

Psychiatric Associates / 4084 Okemos Rd. / Suite A / Okemos, MI 48864
Phone: (517) 347-4848 / Fax: (517) 347-4844