Psychiatrist Blog

What Is Post-Traumatic Stress Disorder? (PTSD)

Post-Traumatic stress disorder, also known as 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, 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, PTSD is not exclusive to combat veterans. PTSD can occur in all people, of any ethnicity, nationality, or culture, and of any age. PTSD affects approximately 3.5 percent of U.S. adults every year, and approximately one in 11 people will be diagnosed with PTSD 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 is characterized by disturbing thoughts and feelings related to the experience that lasts long after the traumatic event has ended. There are flashbacks or nightmares; 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 event, 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 first hand. 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.

Symptoms of PTSD 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 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 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 with PTSD, symptoms must last for more than a month and must cause significant distress or problems in the individual’s daily functions. Many develop symptoms within three months of the trauma, but symptoms may appear after and often persist for months and sometimes years. 

PTSD often occurs with other psychiatric conditions including depression, substance abuse, anxiety, memory problems and other physical health issues.

When you have PTSD, it might feel like you’ll never get your life back. But it can be treated. Short- and long-term psychotherapy and medications can work very well. Often, the two kinds of treatment 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). Group or family therapy might be a good choice for you instead of individual sessions depending on your situation.

These are some therapy modalities:

Cognitive Processing Therapy

CPT is a 12-week course of treatment, with weekly sessions of 60-90 minutes.

You talk about the traumatic event with your therapist 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, PE 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 what happened. 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 ease your symptoms.

Eye Movement Desensitization and Reprocessing

With EMDR, 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 a 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 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 deal with the 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 brains of people with PTSD process danger signals differently because of the imbalance of neuro-chemicals. 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 doctor will usually start with medications that affect the neurotransmitters, serotonin or norepinephrine (SSRIs and SNRIs), including:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Venlafaxine (Effexor)

It should be noted that the FDA has approved only paroxetine and sertraline for treating PTSD. Your doctor may prescribe other “off label” medications due to people responding differently to certain medications. (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:

  • Antidepressants
  • Monoamine oxidase inhibitors (MAOIs)
  • Antipsychotics or second-generation antipsychotics (SGAs)
  • Beta-blockers
  • Benzodiazepines

It’s OK for you to use an off-label medication if your doctor believes there is a reason to do so. 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 you need to check in with your doctor because of possible side effects and to monitor response.

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, and satisfying life.

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