Post-Traumatic Stress Disorder (PTSD)

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) can begin after you witness or are involved in a very stressful event. The event usually involves a real or potential severe injury or the threat of death. It causes feelings of extreme fear, helplessness, or horror. After being involved in such an event, many people have trouble sleeping, have nightmares or daytime memories of the event, and feel emotionally numb and cut off from others. For most people, these symptoms stop within a month after the stressful event. When these symptoms continue for months or years, it is called post-traumatic stress disorder.

How does it occur?

Not everyone who is exposed to a stressful event gets PTSD. It is not fully clear why one person involved in something like a robbery, rape, or severe car accident develops PTSD while another does not. Some factors that may lead to PTSD include:

• a personal history of a mental health problem
• the severity of the stressful event
• a family history of mental illness
• lack of family and social support available after the event.

Studies show that from 1 to 14% of people will have PTSD for some period in their lives, at least in a very mild form.

PTSD can occur at any age. Symptoms can start right after the stressful event, but sometimes symptoms begin 3 months or more after the event. Having PTSD symptoms for up to a month after a stressful event is a normal human reaction and is not considered PTSD. It is called acute stress disorder. If symptoms last more than a month it is called PTSD.

What are the symptoms?

PTSD symptoms fall into 3 areas. You may not have all the symptoms, but most people with PTSD have some symptoms in each area.

1. Reexperiencing the stressful event
   • bothersome and repeated thoughts, emotions, and images of the event
   • repeated dreams about the event
   • moments when you feel the event is happening again
   • panic attacks when things happen that remind you of the stressful event.
2. Avoiding things related to the stressful event or feeling numb
   • avoiding conversations, thoughts, or places that remind you of the event
   • not being able to remember important parts of the event
   • feeling and acting very distant and detached from others close to you
   • having fewer emotions than you had before the event, or seeming emotionally flat to others
   • feeling hopeless about the future.
3. Being physically alert all or most of the time
   • having a lot of trouble falling or staying asleep
   • being very irritable or having angry outbursts
   • having trouble concentrating or staying focused
   • being startled or jumping at sudden or loud noises
   • feeling very suspicious and being on guard all the time.

How is it diagnosed?

Your health care provider or a mental health professional can tell you if your symptoms are PTSD. He or she will ask about your symptoms and any drug or alcohol use. There are no lab tests to diagnose PTSD, but you may have lab tests to rule out medical problems, such as hormone imbalances.

Your health care provider may ask you to change medicines or dosages you are currently taking to make sure medicines are not causing or increasing your symptoms.

How is it treated?

Do not try to overcome PTSD by yourself. PTSD can be successfully treated with psychotherapy, medicine, or both. Discuss this with your health care provider or therapist.

Medicine

Several prescription medicines can help treat PTSD. Your health care provider will carefully select the best one for you. Some medicines are:

• selective serotonin reuptake inhibitor (SSRI) antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), and paroxetine (Paxil)
• other antidepressant medicines.

No nonprescription medicines are available to treat PTSD.

Therapy

Seeing a psychiatrist or other psychotherapist can help when you are having symptoms of PTSD. Therapy may last just a short time or may need to last for months or years. Two types of psychotherapy sometimes used to treat PTSD are cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR).

CBT is a way to help you identify and change thoughts that lead to PTSD symptoms. Replacing negative thoughts with more positive ones can help you to control your symptoms.

EMDR is a fairly new psychotherapy technique that uses eye movement to activate the brain while you remember the stressful event and your feelings about the experience. The therapy is designed to release "trapped" emotional experiences from the stressful event. Dealing with these experiences may help you to have more peaceful, calm feelings.

Natural and Alternative Treatments

• Herbs and Supplements. Claims have been made that certain herbal and dietary products (kava root, lemon balm, lavender, passion flower, valerian) help PTSD. No herb or dietary supplement has been proven to help PTSD.
• Biofeedback. With biofeedback you learn to control body functions such as heart rate, blood pressure, muscle tension, or brain wave patterns. Biofeedback can help with tension, anxiety, and concentration. It is an effective treatment for several types of anxiety disorders. However, there is limited research supporting its effectiveness for treatment of PTSD.
• Massage Therapy. Massage therapy may help lower stress and muscle tension. These changes may be very helpful as a secondary treatment for the broader tension and anxiety symptoms that may go along with PTSD.
• Relaxation Therapies. Special relaxation methods, along with medicines and psychotherapy, can help you control some of the tension, irritability, and sleep problems that are symptoms of PTSD. Yoga and meditation may also be helpful.
• Hypnotherapy. Hypnosis has not been tested as a treatment for PTSD. If your therapist is trained in this technique, ask how he or she thinks this therapy might help your symptoms.
• Art and Music Therapies. Some people find art and music therapy, along with medicines and psychotherapy, to be helpful. These therapies may help you express and better manage the difficult feelings and memories of the stressful event.

How long will the effects last?

For at least half of the people who get PTSD, it goes away within 3 months. For some people, the symptoms last for more than a year. How long it lasts depends on your being able to talk about the trauma with others, the severity of the trauma, and how often you are reminded of the stressful event.

What can I do to help myself or my loved one?

Maintaining a healthy lifestyle is important. To help control PTSD:

• Exercise for at least 20 minutes every day. For example, take brisk walks.
• Learn which activities make you feel better and do them often.
• Talk to your family and friends.
• Eat a healthy diet.
• Get 6 to 8 hours of sleep each night.
• Keep a regular schedule for going to sleep and getting up.
• Avoid alcohol or drugs that have not been prescribed by your health care provider. Limit the caffeine in your diet.
• Learn breathing exercises, relaxation techniques, or yoga.

Many towns and cities have support groups that meet to help survivors of trauma to cope. Look in the telephone book under Support Groups or ask your local community mental health center.

When should I seek help?

Do not try to get over a severely stressful event all by yourself. Seek professional help if you have experienced a stressful event or have the symptoms of PTSD.

When should I seek immediate help?

Get emergency care if you or a loved one has serious thoughts of suicide, violence, or harming others. Also seek immediate help if you have severe chest pain or trouble breathing.