Post-Traumatic Stress Disorder (PTSD)

A psychological disorder that develops in response to an extremely traumatic event that threatens a person's safety or life.

Although the term post-traumatic stress disorder is relatively new, the symptoms of PTSD can be recognized in many guises throughout history, from the reactions to the great fire of London that Samuel Pepys (1633-1703) described in the 1600s to the "shell shock" of soldiers in World War I. Some psychologists suspect that the "hysterical" women treated by Josef Breuer (1842-1925) and Sigmund Freud at the turn of the twentieth century may have been suffering from symptoms of PTSD as a result of childhood sexual abuse or battering by their husbands.

Post-traumatic stress disorder has been classified as an anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders since 1980. People suffering from PTSD repeatedly re-experience the traumatic event vividly in their thoughts, perceptions, images, or dreams. They may be aware that they are recollecting a previous experience, or they may have hallucinations, delusions, or dissociative flashbacks that make them feel as though the trauma is actually recurring in the present. Children may engage in repetitive play that expresses some aspect of the trauma. A related symptom is the consistent avoidance of people, objects, situations, and other stimuli connected with the event. PTSD sufferers usually experience heightened arousal in the form of agitation, irritability, insomnia, difficulty concentrating, or being easily startled. In contrast, they often "shut down" emotionally and become incapable of expressing certain feelings, especially those associated with affection and intimacy. Children who have been traumatized may stop talking altogether or refuse to discuss the traumatic event that affected them. They may also experience physical symptoms such as headaches or stomach aches.

Events that may lead to post-traumatic stress disorder include natural disasters (earthquakes, floods, hurricanes)

A Bosnian man with post-traumatic stress disorder talks to a therapist. (AP/Wide World Photos. Reproduced with permission.)

or serious accidents such as automobile or plane crashes. However, PTSD is most likely to be caused by traumas in which death and injury are inflicted by other human beings: war, torture, rape, terrorism, and other types of personal assault that violate one's sense of self-esteem and personal integrity. (PTSD also tends to be more severe and long-lasting when it results from traumas of this nature.) In addition to the direct experience of traumatic events, PTSD can also be caused by witnessing such events or by learning of serious harm to a family member or a close friend. Specific populations in which PTSD has been studied include Vietnam veterans and Holocaust survivors.

Among the disorders listed in the Diagnostic and Statistical Manual, the diagnosis for PTSD is unique in its focus on external events rather than internal predispositions or personality features. Studies have found that such factors as race, sex, socioeconomic status, and even previous psychiatric history have little to do with the incidence of PTSD. Whether a person develops PTSD is much more closely related to the severity and duration of the traumatic event experienced than to any preexisting characteristics or situations. Physiologically, post-traumatic stress disorder is thought to be related to changes in brain chemistry and levels of stress-related hormones. When a person is subjected to excessive stress levels on a prolonged basis, the adrenal glands—which fuel the "fight-or-flight" reaction by producing adrenaline—may be permanently damaged. One possible result is overfunctioning during subsequent stress, causing hyperarousal symptoms such as insomnia, jumpiness, and irritability. The brain's neurotransmitters, which play a role in transmitting nerve impulses from one cell to another, may be depleted by severe stress, leading to mood swings, outbursts of temper, and depression.

Post-traumatic stress disorder can affect persons of any age and is thought to occur in as many as 30 percent of disaster victims. In men, it is most commonly caused by war; in women, by rape. Symptoms usually begin within one to three months of the trauma, although in some cases they are delayed by months or even years. If left undiagnosed and untreated, PTSD can last for decades. However, over half of all affected persons who receive treatment recover completely within three months. Short-term psychotherapy (12 to 20 sessions) has been the single most effective treatment for PTSD. It may be accompanied by medication for specific purposes, but medication alone or for extended periods is not recommended as a course of treatment. Sleeping pills may help survivors cope in the immediate aftermath of a trauma, anti-anxiety medications may temporarily ease emotional distress, and antidepressants may reduce nightmares, flashbacks, and panic attacks.

The primary goal of psychotherapy is to have the person confront and work through the traumatic experience. Hypnosis may be especially valuable in retrieving thoughts and memories that have been blocked. One technique used by therapists is to focus on measures that PTSD sufferers took to save or otherwise assert themselves in the face of traumatic events, thus helping to allay the feelings of powerlessness and loss of control that play a large part in the disorder. Behavioral techniques such as relaxation training and systematic desensitization to "triggering" stimuli have also proven helpful. Support groups consisting of other persons who have experienced the same or similar traumas have facilitated the healing process for many persons with PTSD.