Posttraumatic stress disorder (PTSD) is a condition characterized by a pattern of symptoms that often follows a terrifying physical or emotional event, causing the person who survived the event to have persistent, intrusive thoughts, memories, or flashbacks of the ordeal. Persons with PTSD often feel chronically emotionally numb.
PTSD was first brought to public attention by war veterans and was once referred to as "shell shock" or "battle fatigue." The likelihood of developing PTSD depends on the severity and duration of the traumatic event as well as the person's nearness to it.
The event that triggers PTSD may be:
- Something that occurred in the person's life
- Something that occurred in the life of someone close to him or her
- Something the person witnessed
- Serious accidents (such as a burn injury, car accident, train wreck, or plane crash)
- Natural disasters (such as a flood or earthquake)
- Man-made tragedies (such as terror attacks or industrial accidents)
- Violent personal attacks (such as a car jacking, mugging, rape, torture, or kidnapping)
- Military combat
- Abuse in childhood
Persons with PTSD experience extreme emotional and physical distress when exposed to situations that remind them of the traumatic event. They may repeatedly relive the trauma in the form of nightmares and disturbing recollections, and may also experience the following:
- Sleep problems
- Avoiding places or situations that remind one of the trauma
- Avoiding thoughts or feelings about the trauma
- Difficulty remembering important aspects of the traumatic event
- Being easily startled
- Feeling less interested in things they used to enjoy
- Feeling detached or emotionally numb
- Feeling irritable or angry
- Trouble working or socializing
- Flashbacks or intrusive images (A person having a flashback may momentarily re-experience an aspect of the traumatic event, such as an image, sound, or smell.)
The symptoms of PTSD may resemble other psychiatric conditions. Always consult a trauma expert for a diagnosis.
Not every person who experiences a trauma develops PTSD. Exposure to early life traumas or multiple traumas may make the development of PTSD more likely. PTSD is diagnosed only if symptoms last more than one month. In those who do develop PTSD, symptoms usually begin within three months of the trauma, but can also start later.
PTSD can occur at any age, including childhood, and may be accompanied by the following co-morbid conditions:
- Substance misuse
- Panic symptoms
- Suicidal thoughts or feelings
The length of the illness varies. Some people recover within a few months; others have symptoms that last much longer. Specific treatment for PTSD will be determined by your clinician based on:
- Severity of symptoms
- Your tolerance for specific therapies or medications
- Your opinion or preference
Research shows that the most effective treatment for PTSD is cognitive behavioral treatment with exposure therapy. This is a brief form of therapy that can bring significant symptom relief within 12-15 treatment sessions. Multiple expert clinical guidelines have recommended that exposure therapy should be the first line treatment for PTSD, and in 2008 the Institute of Medicine found that it was the only treatment for PTSD, including both other types of therapies and medications, with evidence showing that it is effective.
Some examples of specific types of therapy that are considered exposure therapy are:
- Prolonged Exposure: In this treatment, the therapist helps the individual with PTSD gradually address feared memories and situations that are not realistically dangerous but are avoided because they are associated with the trauma and thus trigger anxiety. The therapist also helps the individual evaluate thoughts or beliefs related to the trauma. Through this process, the individual is able to process and make sense of the trauma so that it does not continually interfere with daily life.
- Virtual Reality Exposure Therapy: This therapy is similar to Prolonged Exposure, except that it uses a virtual reality environment to further help the individual engage in treatment.
- Cognitive Processing Therapy: This therapy helps the individual with PTSD identify unhelpful thoughts about themselves, others, and the world that may have developed in the aftermath of the trauma. The therapist also helps the patient address memories of the trauma. The individual is taught specific techniques to evaluate and challenge unhelpful thoughts.
Medications may also be prescribed to help with specific symptoms (e.g., antidepressants to help with insomnia or depressed mood). Medications with the most evidence supporting their effectiveness for PTSD are selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs).