Post-traumatic stress disorder (PTSD)

Introduction

Post-traumatic stress disorder is a type of anxiety disorder that's triggered by an extremely traumatic event. You can develop post-traumatic stress disorder (PTSD) when a traumatic event happens to you or when you see a traumatic event happen to someone else.

Many people who are involved in traumatic events or witness them have a brief period of difficulty adjusting and coping. But with time and some healthy coping methods, such traumatic reactions usually get better on their own. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes, they may even completely disrupt your life. In these cases, you may have post-traumatic stress disorder.

Post-traumatic stress disorder may affect survivors of such traumatic events as sexual or physical assault, war, torture, a natural disaster or an airplane crash. Post-traumatic stress disorder also can affect rescue workers at the site of mass casualties or other tragedies. These kinds of events may cause intense fear, helplessness or horror.

It's important to get treatment as soon as possible to help prevent PTSD from getting worse.

Signs and symptoms

Signs and symptoms of post-traumatic stress disorder typically begin within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not occur until years after the event.

Post-traumatic stress disorder symptoms may include:

Flashbacks, or reliving the traumatic event for minutes or even days at a time
Shame or guilt
Upsetting dreams about the traumatic event
Trying to avoid thinking or talking about the traumatic event
Feeling emotionally numb
Irritability or anger
Poor relationships
Self-destructive behavior, such as drinking too much
Hopelessness about the future
Trouble sleeping
Memory problems
Trouble concentrating
Being easily startled or frightened
Not enjoying activities you once enjoyed
Hearing or seeing things that aren't there
Post-traumatic stress disorder symptoms can come and go. You may have more symptoms during times of higher stress or when you experience symbolic reminders of what you went through. For example, some people whose PTSD symptoms had been gone for years saw their symptoms come back again with the terrorist attacks in the U.S. on Sept. 11, 2001.

When you have PTSD, you may relive the traumatic event numerous times. You may have upsetting memories. Or you may see reminders wherever you go. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape, and feel again the horror and fear of your own assault.

Causes

Researchers are still trying to better understand what causes someone to get post-traumatic stress disorder. As with most mental illnesses, post-traumatic stress disorder is probably caused by a complex mix of:

Biology and genetics
Your life experiences
Your temperament
Changes in the natural chemicals in your brain
Risk factors

Although researchers don't know exactly what causes post-traumatic stress disorder, they do know some of the risk factors involved, or the things that make you more likely to get PTSD.

People of all ages can have post-traumatic stress disorder. It's relatively common among adults, with about 7 percent to 8 percent of the population having PTSD at some point in their lives. In any given year, about 5 million U.S. adults have PTSD. Post traumatic stress disorder is especially common among those who have served in combat, and it's sometimes called "shell shock," "battle fatigue" and "combat stress."

Kinds of traumatic events
People with PTSD most often experience one or more of these four types of traumatic events:

Seeing someone being killed or badly injured
Living through a fire, flood or natural disaster
Living through a life-threatening accident
Having been in combat
But many other traumatic events also can lead to post-traumatic stress disorder, including rape, mugging, robbery, assault, civil conflict, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, childhood physical abuse or neglect, sexual molestation, being threatened with a weapon, terrorist attacks, and other extreme or life-threatening events.

Increasing your risk
Not everyone who experiences these kinds of traumatic events goes on to develop post-traumatic stress disorders. Some factors that may make you more likely to get PTSD after a traumatic event include:

The traumatic event is especially severe or intense.
The traumatic event was long-lasting.
Having an existing mental health condition.
Lacking a good support system of family and friends.
Having family members with PTSD.
Having family members with depression.
When to seek medical advice

It's normal to have a wide range of feelings and emotions after a traumatic event. The feelings you experience may include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating patterns, or bouts of crying that come easily. You may have recurrent nightmares or thoughts about the event. This doesn't mean you have post-traumatic stress disorder.

But if you have these disturbing feelings for more than a month, if they're severe or if you feel you're having trouble getting your life back under control, consider talking to your health care professional.

It's important to get treatment as soon as possible when symptoms begin because that can help prevent PTSD symptoms from getting worse. If you don't get treatment, PTSD symptoms may become disabling. You may be wracked by guilt about surviving when others didn't. Or you may feel guilty because you think you could have done something more to help. Your relationships may suffer, and you may have conflicts that result in a breakup. You may not be able to do your job as well as you normally can.

In some cases, symptoms may be so severe that you need emergency help, especially if you're thinking about harming yourself or someone else. If possible, call 911 or other emergency services, or ask a supportive family member or friend for help.

Screening and diagnosis

Post-traumatic stress disorder is diagnosed based on signs and symptoms and a thorough psychological evaluation. Your doctor or mental health professional will ask you to describe the signs and symptoms you're experiencing — what they are, when they occur, how intense they are and how long they last. Your doctor also might ask you to describe the event that led up to your symptoms. You may also have a physical exam to check for any other medical problems.

To be diagnosed with PTSD, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

For post-traumatic stress disorder to be diagnosed, several criteria must be met, including:

You experienced or witnessed an event that involved death or serious injury, or the threat of death or serious injury
Your response to the event involved intense fear, horror or a sense of helplessness
You relive experiences of the event, such as having distressing images and memories, upsetting dreams, flashbacks or even physical reactions
You try to avoid situations or things that remind you of the traumatic event or feel a sense of emotional numbness
You feel as if you're constantly on guard or alert for signs of danger, which may make you have trouble sleeping or concentrating
Your symptoms last longer than one month
The symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks
Complications

Post-traumatic stress disorder can disrupt your whole life, from your job to your relationships to your enjoyment of everyday activities.

Having PTSD also may place you at a higher risk of other mental health problems, including:

Depression
Drug abuse
Alcohol abuse
Eating disorders
Suicidal thoughts and actions
Treatment

Treatment of post-traumatic stress disorder can be very effective and help you regain a sense of control over your life. With successful treatment, you can also feel better about yourself and learn ways to cope if any symptoms arise again.

Post-traumatic stress disorder treatment often includes both medications and psychotherapy. This combined approach can help improve your symptoms and teach you skills to cope better with the traumatic event and its aftermath.

Medications
Several types of medications can help symptoms of post-traumatic stress disorder get better. Antidepressants can help symptoms of both depression and anxiety. They can also help improve sleep problems and improve your concentration. Anti-anxiety medications also can improve feelings of anxiety and stress.

Which medications are best for you depends on your specific symptoms and situation. You and your doctor will work together to find medications that work well and have the fewest side effects. It may take a few tries. But you may see an improvement in your mood and other symptoms within a few weeks. Be sure to tell your health care professional about any side effects or problems you have with the medications, as you may be able to try something different.

Psychotherapy
Several forms of therapy may be used to treat both children and adults with post-traumatic stress disorder. Which form is best for you depends on your symptoms and situation. You may try one type and then a different type of therapy, or combine elements of several. You may also try individual therapy, group therapy or both. Group therapy can offer a way to connect to others going through similar experiences.

Some types of therapy used in PTSD treatment include:

Cognitive therapy
Cognitive behavior therapy
Exposure therapy
All these approaches can help you gain control of the fear and distress that happen after a traumatic event. They can help you learn more about why you have certain feelings and thoughts, and how to replace them with more positive and realistic thinking. You may also gain skills in stress management and healthy coping. Through psychotherapy, you learn ways to cope so that you don't feel overwhelmed by thoughts and feelings related to your traumatic experience. The type of therapy that may be best for you depends on a number of factors that you and your health care professional can discuss.

Medications and psychotherapy also can help you if you've developed other problems related to your traumatic experience, such as depression, anxiety, alcohol or substance abuse. You don't have to try to handle the burden of PTSD on your own.

Prevention

After surviving a traumatic event, most people are unable to stop thinking about what's happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. Although you may not want to talk about it to anyone or you don't want to even think about what's happened, getting support can help you recover. This may mean turning to supportive family and friends who will listen and offer comfort. It may mean that you seek out a mental health professional for a brief course of therapy. Some people also may find it helpful to turn to their faith community or a pastoral crisis counselor.

However you choose to get support and help, research shows that doing so can help prevent normal stress reactions from getting worse and developing into post-traumatic stress disorder. Getting support may also help prevent you from turning to unhealthy coping methods, such as alcohol use. Researchers are still learning more about how best to combine medical and psychiatric help for survivors of trauma. Some research shows that tending to both medical and mental health needs immediately after extreme trauma can head off severe symptoms later.

Coping skills

If distress caused by a traumatic event affects your life, seeing your health care professional is an important first step. But you can take actions to help yourself cope as you continue with treatment for post-traumatic stress disorder. Things you can do include:

Follow your health professional's instructions. Although it may take a while to feel benefits from therapy or medications, most people do begin to feel better within a few weeks. Remind yourself that it takes time. Healing won't come overnight. Following your treatment plan will help move you forward.
Take care of yourself. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus.
Talk to someone. Stay connected with supportive and caring family, friends, faith leaders or others. You don't have to talk about what happened, if you don't want to. Just sharing time together with loved ones can offer healing and comfort.
Consider a support group. Many communities have support groups geared for specific situations. Ask your health care professional for help finding one, look in your local phone book, or contact your community's social services system.
Make a resolution. For many people, living through a traumatic event becomes a turning point to make positive changes in their lives and grow emotionally and psychologically. For instance, some people who live through a serious car accident caused by someone under the influence of alcohol may resolve to combat drinking and driving.

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