What is Posttraumatic Stress Disorder?
Posttraumatic Stress Disorder, or PTSD, is a
psychiatric disorder that can occur
following the experience or witnessing of
life-threatening events such as military
combat, natural disasters, terrorist
incidents, serious accidents, or violent
personal assaults like rape. People who
suffer from PTSD often relive the experience
through nightmares and flashbacks, have
difficulty sleeping, and feel detached or
estranged, and these symptoms can be severe
enough and last long enough to significantly
impair the person's daily life.
PTSD is marked by clear biological changes
as well as psychological symptoms. PTSD is
complicated by the fact that it frequently
occurs in conjunction with related disorders
such as depression, substance abuse,
problems of memory and cognition, and other
problems of physical and mental health. The
disorder is also associated with impairment
of the person's ability to function in
social or family life, including
occupational instability, marital problems
and divorces, family discord, and
difficulties in parenting.
Understanding PTSD
PTSD is not a new disorder. There are
written accounts of similar symptoms that go
back to ancient times, and there is clear
documentation in the historical medical
literature starting with the Civil War, when
a PTSD-like disorder was known as "Da
Costa's Syndrome." There are particularly
good descriptions of posttraumatic stress
symptoms in the medical literature on combat
veterans of World War II and on Holocaust
survivors.
Careful research and documentation of PTSD
began in earnest after the Vietnam War. The
National Vietnam Veterans Readjustment Study
estimated in 1988 that the prevalence of
PTSD in that group was 15.2% at that time
and that 30% had experienced the disorder at
some point since returning from Vietnam.
PTSD has subsequently been observed in all
veteran populations that have been studied,
including World War II, Korean conflict, and
Persian Gulf populations, and in United
Nations peacekeeping forces deployed to
other war zones around the world. There are
remarkably similar findings of PTSD in
military veterans in other countries. For
example, Australian Vietnam veterans
experience many of the same symptoms that
American Vietnam veterans experience.
PTSD is not only a problem for veterans,
however. Although there are unique cultural-
and gender-based aspects of the disorder, it
occurs in men and women, adults and
children, Western and non-Western cultural
groups, and all socioeconomic strata. A
national study of American civilians
conducted in 1995 estimated that the
lifetime prevalence of PTSD was 5% in men
and 10% in women.
How does PTSD develop?
Most people who are exposed to a traumatic,
stressful event experience some of the
symptoms of PTSD in the days and weeks
following exposure. Available data suggest
that about 8% of men and 20% of women go on
to develop PTSD, and roughly 30% of these
individuals develop a chronic form that
persists throughout their lifetimes.
The course of chronic PTSD usually involves
periods of symptom increase followed by
remission or decrease, although some
individuals may experience symptoms that are
unremitting and severe. Some older veterans,
who report a lifetime of only mild symptoms,
experience significant increases in symptoms
following retirement, severe medical illness
in themselves or their spouses, or reminders
of their military service (such as reunions
or media broadcasts of the anniversaries of
war events).
How is PTSD assessed?
In recent years, a great deal of research
has been aimed at developing and testing
reliable assessment tools. It is generally
thought that the best way to diagnose PTSD-or
any psychiatric disorder, for that matter-is
to combine findings from structured
interviews and questionnaires with
physiological assessments. A multi-method
approach especially helps address concerns
that some patients might be either denying
or exaggerating their symptoms.
How common is PTSD?
An estimated 7.8 percent of Americans will
experience PTSD at some point in their
lives, with women (10.4%) twice as likely as
men (5%) to develop PTSD. About 3.6 percent
of U.S. adults aged 18 to 54 (5.2 million
people) have PTSD during the course of a
given year. This represents a small portion
of those who have experienced at least one
traumatic event; 60.7% of men and 51.2% of
women reported at least one traumatic event.
The traumatic events most often associated
with PTSD for men are rape, combat exposure,
childhood neglect, and childhood physical
abuse. The most traumatic events for women
are rape, sexual molestation, physical
attack, being threatened with a weapon, and
childhood physical abuse.
About 30 percent of the men and women who
have spent time in war zones experience PTSD.
An additional 20 to 25 percent have had
partial PTSD at some point in their lives.
More than half of all male Vietnam veterans
and almost half of all female Vietnam
veterans have experienced "clinically
serious stress reaction symptoms." PTSD has
also been detected among veterans of the
Gulf War, with some estimates running as
high as 8 percent.
Who is most likely to develop PTSD?
1. Those who experience greater
stressor magnitude and intensity,
unpredictability, uncontrollability,
sexual (as opposed to nonsexual)
victimization, real or perceived
responsibility, and betrayal
2. Those with prior vulnerability
factors such as genetics, early age of
onset and longer-lasting childhood
trauma, lack of functional social
support, and concurrent stressful life
events
3. Those who report greater perceived
threat or danger, suffering, upset,
terror, and horror or fear
4. Those with a social environment that
produces shame, guilt, stigmatization,
or self-hatred
What are the consequences associated with
PTSD?
PTSD is associated with a number of
distinctive neurobiological and
physiological changes. PTSD may be
associated with stable neurobiological
alterations in both the central and
autonomic nervous systems, such as altered
brainwave activity, decreased volume of the
hippocampus, and abnormal activation of the
amygdala. Both the hippocampus and the
amygdala are involved in the processing and
integration of memory. The amygdala has also
been found to be involved in coordinating
the body's fear response.
Psychophysiological alterations associated
with PTSD include hyper-arousal of the
sympathetic nervous system, increased
sensitivity of the startle reflex, and sleep
abnormalities.
People with PTSD tend to have abnormal
levels of key hormones involved in the
body's response to stress. Thyroid function
also seems to be enhanced in people with
PTSD. Some studies have shown that cortisol
levels in those with PTSD are lower than
normal and epinephrine and norepinephrine
levels are higher than normal. People with
PTSD also continue to produce higher than
normal levels of natural opiates after the
trauma has passed. An important finding is
that the neurohormonal changes seen in PTSD
are distinct from, and actually opposite to,
those seen in major depression. The
distinctive profile associated with PTSD is
also seen in individuals who have both PTSD
and depression.
PTSD is associated with the increased
likelihood of co-occurring psychiatric
disorders. In a large-scale study, 88
percent of men and 79 percent of women with
PTSD met criteria for another psychiatric
disorder. The co-occurring disorders most
prevalent for men with PTSD were alcohol
abuse or dependence (51.9 percent), major
depressive episodes (47.9 percent), conduct
disorders (43.3 percent), and drug abuse and
dependence (34.5 percent). The disorders
most frequently comorbid with PTSD among
women were major depressive disorders (48.5
percent), simple phobias (29 percent),
social phobias (28.4 percent), and alcohol
abuse/dependence (27.9 percent).
PTSD also significantly impacts psychosocial
functioning, independent of comorbid
conditions. For instance, Vietnam veterans
with PTSD were found to have profound and
pervasive problems in their daily lives.
These included problems in family and other
interpersonal relationships, problems with
employment, and involvement with the
criminal justice system.
Headaches, gastrointestinal complaints,
immune system problems, dizziness, chest
pain, and discomfort in other parts of the
body are common in people with PTSD. Often,
medical doctors treat the symptoms without
being aware that they stem from PTSD.
How is PTSD treated?
PTSD is treated by a variety of forms of
psychotherapy and drug therapy. There is no
definitive treatment, and no cure, but some
treatments appear to be quite promising,
especially cognitive-behavioral therapy,
group therapy, and exposure therapy.
Exposure therapy involves having the patient
repeatedly relive the frightening experience
under controlled conditions to help him or
her work through the trauma. Studies have
also shown that medications help ease
associated symptoms of depression and
anxiety and help with sleep. The most widely
used drug treatments for PTSD are the
selective serotonin reuptake inhibitors,
such as Prozac and Zoloft. At present,
cognitive-behavioral therapy appears to be
somewhat more effective than drug therapy.
However, it would be premature to conclude
that drug therapy is less effective overall
since drug trials for PTSD are at a very
early stage. Drug therapy appears to be
highly effective for some individuals and is
helpful for many more. In addition, the
recent findings on the biological changes
associated with PTSD have spurred new
research into drugs that target these
biological changes, which may lead to much
increased efficacy.
Source: National Center
for PTSD
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