What Is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in someone who has experienced or witnessed a traumatic event, such as a natural disaster, a serious accident, a terrorist act, war, or rape, or who has been threatened with death, sexual violence or serious bodily injury.
PTSD has been known in the past as “shell shock” during World War I and “combat fatigue” after World War II. However, this mental health condition is not exclusive to combat veterans. PTSD can occur in all people, of any ethnicity, nationality, or culture, and of any age.
How Common is PTSD?
In the U.S., PTSD affects approximately 3.5 percent of adults every year, and approximately one in 11 people will be diagnosed with this disorder in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups; Latinos, Blacks, and American Indians have higher rates of PTSD than whites.
PTSD Diagnosis
PTSD is characterized by disturbing thoughts and feelings related to the experience that last long after the traumatic event has ended.
There are flashbacks or nightmares from traumatic events; they may feel depressed, fearful, or angry; and they may feel detached from other people.
People with PTSD avoid situations or people that remind them of the traumatic memories and have strong negative reactions to something as ordinary as a loud noise.
A diagnosis of PTSD requires exposure to a traumatic event. The exposure could be indirect or firsthand. For example, an individual witnessing a robbery or a shooting. It can also occur as a result of experiencing or witnessing trauma such as first responders.
Post-Traumatic Stress Disorder (PTSD) Symptoms
PTSD symptoms are found in the following categories:
- Intrusive thoughts, which include repeated, involuntary memories, bad dreams; or flashbacks of the traumatic event.
- Avoiding reminders of the trauma, which include people, places, activities, and situations that may trigger distressful trauma-related memories.
- Alterations in cognition and mood: Inability to remember important aspects of the event, negative thoughts, and feelings leading to ongoing, distorted beliefs about oneself, or distorted thoughts about the cause and consequences of the event leading to self-blame, constant fear, anger, or shame. Decreased interest in activities previously enjoyed; feeling detached or estranged from others and unable to experience happiness.
- Arousal and reactive symptoms, which include irritability, anger, behaving in a self-destructive way; being suspicious, easily startled, and having problems with concentration and sleep.
For a person to be diagnosed by a mental health professional, PTSD symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functioning. Many develop symptoms within three months of the trauma, but they may also appear after and often persist for months and sometimes years.
PTSD often occurs with other psychiatric conditions, including depression, substance abuse, anxiety disorders, memory problems, and other physical health issues.
How to Treat PTSD
When you have PTSD, it might feel like you’ll never get your life back. But remember: treating PTSD symptoms and other mental health conditions associated with it is possible.
Short- and long-term psychotherapy and medications can work very well when treating PTSD. Often, the two kinds of treatment options are more effective together.
PTSD therapy has three main goals:
- Improve your symptoms
- Teach you skills to deal with it
- Restore your self-esteem
Most PTSD therapies fall under the umbrella of cognitive-behavioral therapy (CBT). Depending on your situation, family or group therapy might be a good choice for you instead of individual sessions.
These are some therapy modalities:
Cognitive Processing Therapy
CPT or Cognitive Processing Therapy is a 12-week course of treatment, with weekly sessions of 60-90 minutes.
You talk about the traumatic event with your therapist (a mental health professional) and how your thoughts related to it have affected your life. Then you’ll write in detail about what happened. This process helps you examine how you think about your trauma and figure out new ways to live with it.
Prolonged Exposure Therapy
If you’ve been avoiding things that remind you of the traumatic event, Prolonged Exposure (PE) Therapy will help you confront them. It involves eight to 15 sessions, usually 90 minutes each.
Your therapist will teach you breathing techniques to ease your anxiety when you think about trauma-related memories. Later, you’ll make a list of the things you’ve been avoiding and learn how to face them, one by one.
In another session, you’ll recount the traumatic experience to your therapist, then go home and listen to a recording of yourself. Doing this as “homework” over time may help reduce PTSD symptoms.
Eye Movement Desensitization and Reprocessing
With Eye Movement Desensitization and Reprocessing (EMDR) as a PTSD treatment, you might not have to tell your therapist about your experience. Instead, you concentrate on it while you watch or listen to something they’re moving like a hand, flashing light, or a sound.
The goal is to be able to think about something positive while you remember your trauma. It takes about 3 months of weekly sessions.
Stress Inoculation Training (SIT)
SIT is a type of CBT. You can do it yourself or in a group. You won’t have to go into detail about what happened. The focus is more on changing how you manage stress from the event. You might learn relaxation and breathing techniques and other ways to stop negative thoughts by relaxing your mind and body. After about 3 months, you should have the skills to release the added stress from your life.
Medications
The brain of people with post-traumatic stress disorder process danger signals differently, in part because the balance of neuro-chemicals is out of balance. They have an easily triggered “fight or flight” response, which is what makes you jumpy and on-edge. Constantly trying to shut that down could lead to feeling emotionally cold and removed.
Several types of drugs affect the chemistry in your brain related to fear and anxiety. Your mental health professional will usually start with medications that affect the neurotransmitters serotonin or norepinephrine (SSRIs and SNRIs), including:
1. Fluoxetine (Prozac)
2. Paroxetine (Paxil)
3. Sertraline (Zoloft)
4. Venlafaxine (Effexor)
It should be noted that the FDA has approved only paroxetine and sertraline for PTSD treatment. Since people respond differently to medications, and not everyone’s PTSD is the same, your doctor may prescribe other medicines “off label”. (That means the manufacturer didn’t ask the FDA to review studies of the drug showing that it’s effective specifically for PTSD.) These may include:
1. Antidepressants
2. Monoamine oxidase inhibitors (MAOIs)
3. Antipsychotics or second-generation antipsychotics (SGAs)
4. Beta-blockers
5. Benzodiazepines
It’s OK for you to use a medicine off-label if your doctor thinks there’s a reason to. Medications might help you with specific symptoms or related issues, such as prazosin (Minipress) for insomnia and nightmares.
Which one or combination of meds is likely to work best for you depends in part on the stressors you’re experiencing in your life, what the side effects are like, and whether you also have anxiety, depression, bipolar disorder, or substance abuse problems.
It takes time to get the dosage of some medications right. With certain medications, you might need to have regular tests, for example, to see how your liver is working or check in with your doctor because of possible side effects and to monitor response.
There is hope
Medications probably won’t get rid of all your symptoms, but they can make them less intense and more manageable.
In conclusion, PTSD can be life-altering, however with the right combination of medication management and therapy, you will come back to enjoy a safe, fulfilling, satisfying life.
If you or someone you know is suffering from post-traumatic stress disorder, we are here to help you explore your treatment options with our mental health services in Orange County.