Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is a biological, progressive disorder that affects people who lived through a terrible and traumatic event. People with PTSD often have upsetting memories or thoughts of that experience, they can't feel or are "numb" of emotions, they feel detached or estranged, their feelings are easily hurt or they are very moody, and sometimes there are big changes in the person's personality.

PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the persons ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

PTSD is a response to a very stressful and terrible trauma that involves actual or threatened death or serious injury. It is not known why some people get PTSD and others do not. Some experts think it may be connected to how bad the person perceives the event was, the person's personality and genetic makeup, or if it was an unexpected event. As the person tries to deal with life after the event, normal things can remind them of the event and cause frightening and vivid memories or "flashbacks".

For most people, symptoms usually begin within a few months of the trauma. For others, the signs do not show up until years later. Once the symptoms begin, they may get better within six months, while others may have the illness much longer. In some cases, the person may always have PTSD. For example, some Vietnam veterans who were not treated for PTSD have spent many years struggling with the horrors of war.

The seriousness of the PTSD depends in part on whether the trauma was expected or not, now bad it was and how long it lasted, and the person's personality and hereditary makeup

PTSD is not a new disorder. There are written accounts of similar symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome." There are particularly good descriptions of posttraumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.

Once called "shell shock" or "Battle fatigue" PTSD is best known for how it changes war veterans returning home from the battlefield. Although PTSD is often associated with Vietnam veterans, it appears in veterans of all wars and eras all the way back to Babylon (circa 1780 B.C.) where Hammurabi described the lost warriors, warriors who returned home from battle but left their souls on the battlefield. It is interesting that Hammurabi's description of the symptoms form the basis of today's clinical diagnostic protocols for PTSD.

Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.

PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, Korean conflict, and Persian Gulf populations, and in United Nations peacekeeping forces deployed to other war zones around the world. There are remarkably similar findings of PTSD in military veterans in other countries. For example, Australian Vietnam veterans experience many of the same symptoms that American Vietnam veterans experience.

PTSD is associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with stable neurobiological alterations in both the central and autonomic nervous systems, such as altered brainwave activity, decreased volume of the hippocampus, and abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response.

Psychophysiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.

People with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress. Thyroid function also seems to be enhanced in people with PTSD. Some studies have shown that cortisol levels in those with PTSD are lower than normal and epinephrine and norepinephrine levels are higher than normal. People with PTSD also continue to produce higher than normal levels of natural opiates after the trauma has passed. An important finding is that the neurohormonal changes seen in PTSD are distinct from, and actually opposite to, those seen in major depression. The distinctive profile associated with PTSD is also seen in individuals who have both PTSD and depression.

PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. In a large-scale study, 88 percent of men and 79 percent of women with PTSD met criteria for another psychiatric disorder. The co-occurring disorders most prevalent for men with PTSD were alcohol abuse or dependence (51.9 percent), major depressive episodes (47.9 percent), conduct disorders (43.3 percent), and drug abuse and dependence (34.5 percent). The disorders most frequently comorbid with PTSD among women were major depressive disorders (48.5 percent), simple phobias (29 percent), social phobias (28.4 percent), and alcohol abuse/dependence (27.9 percent).

PTSD also significantly impacts psychosocial functioning, independent of comorbid conditions. For instance, Vietnam veterans with PTSD were found to have profound and pervasive problems in their daily lives. These included problems in family and other interpersonal relationships, problems with employment, and involvement with the criminal justice system.

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common in people with PTSD. Often, medical doctors treat the symptoms without being aware that they stem from PTSD.

PTSD is treated by a variety of forms of psychotherapy and drug therapy. There is no definitive treatment, but some treatments appear to be quite promising, especially cognitive-behavioral therapy and group therapy. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help with sleep. The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft. At present, cognitive-behavioral therapy appears to be somewhat more effective than drug therapy. However, it would be premature to conclude that drug therapy is less effective overall since drug trials for PTSD are at a very early stage. Drug therapy appears to be highly effective for some individuals and is helpful for many more. In addition, the recent findings on the biological changes associated with PTSD have spurred new research into drugs that target these biological changes, which may lead to much increased efficacy.

With medication, emotional support, and counseling, most people show improvement. However, long drawn out exposure to severe trauma may cause permanent emotional scars.

PTSD News and Resources If you are suffering from PTSD, or know someone who is, use these resources and information for find help in dealing.