Post-Traumatic Stress Disorder
The essential feature of post-traumatic stress disorder is the development of disabling psychological symptoms following a traumatic event. It was first identified during World War I, when soldiers were observed to suffer chronic anxiety, nightmares, and flashbacks for weeks, months, or even years following combat. This condition came to be known as shell shock.
Post-traumatic stress disorder can occur in anyone in the wake of a severe trauma outside the normal range of human experience. These are traumas that would produce intense fear, terror, and feelings of helplessness in anyone and include natural disasters such as earthquakes or tornadoes, car or plane crashes, rape, assault, or other violent crimes against yourself or your immediate family. It appears that the symptoms are more intense and longer lasting when the trauma is personal, as in rape or other violent crimes.
Among the variety of symptoms that can occur with post-traumatic stress disorder, the following nine are particularly common:
- Repetitive, distressing thoughts about the event
- Nightmares related to the event
- Flashbacks so intense that you feel or act as though the trauma were occurring all over again
- An attempt to avoid thoughts or feelings associated with the trauma
- An attempt to avoid activities or external situations associated with the trauma—such as a phobia about driving developing after you have been in an auto accident
- Emotional numbness—being out of touch with your feelings (dissociation)
- Feelings of detachment or estrangement from others
- Losing interest in activities that used to give you pleasure
- Persistent symptoms of increased anxiety, such as difficulty falling or staying asleep, difficulty concentrating, startling easily, or irritability and outbursts of anger
If you suffer from post-traumatic stress disorder, you tend to be anxious and depressed. Sometimes you will find yourself acting impulsively, suddenly changing residence or going on a trip with hardly any plans. If you have been through a trauma where others around you died, you may suffer from guilt about having survived.
Post-traumatic stress disorder can occur at any age and affects 6 to 7 percent of the population. Children with the disorder tend not to relive the trauma consciously but continually reenact it in their play or in distressing dreams. About 50% of persons with post-traumatic stress disorder will recover within six months. The remainder take longer, sometimes several years, and may benefit from intensive therapy as well as medication.
Treatment for post-traumatic stress disorder (PTSD) is complex and multifaceted. Many of the strategies described above for other anxiety disorders are helpful, but additional techniques may be used as well.
Relaxation Training
Abdominal breathing and progressive muscle relaxation techniques are practiced to better control anxiety symptoms.
Daily physical exercise is also part of the treatment.
Cognitive Therapy
Fearful or depressed thinking is identified, challenged, and replaced with more productive thinking. For example, guilt about having been responsible for the trauma—or having survived when someone you loved did not—would be challenged. You would reinforce more supportive, constructive thoughts such as, "What happened was horrible, and I accept that there is nothing I could have done to prevent it. I'm learning now that I can go on."
Exposure Therapy
A therapist or support person helps you confront fearful situations that you want to avoid because they trigger strong anxiety. In imagery exposure, you would repeatedly go back over fearful memories of specific events, objects, and persons associated with the original trauma. In real-life exposure, you would return to the actual situation where the trauma occurred. For example, if you were assaulted on an elevator, you would return to the elevator several times. Repeated exposure helps you to desensitize and understand that the fearful situation is no longer dangerous.
Medication
SSRI medications such as Lexapro, Zoloft, Luvox, Prozac, or Celexa are often helpful in alleviating PTSD symptoms. Especially when these symptoms are severe, a longer course of medication lasting one or two years might be utilized. Tranquilizers such as Xanax or Klonopin might be used on a short-term basis to deal with severe symptoms.
Support Groups
Support groups are particularly helpful in enabling PTSD victims to realize that they are not alone. Support groups for rape or crime survivors are often available in larger metropolitan areas.
EMDR or Hypnotherapy
Eye-movement desensitization and reprocessing (EMDR) or hypnotherapy are often helpful in enabling PTSD victims to retrieve and work through memories of the original traumatic incident. These techniques may be used to accelerate the course of therapy and/or overcome resistance to exposure.
Further Resources
Several good books on PTSD are available, including The PTSD Workbook by Mary Beth Williams and The Post-Traumatic Stress Disorder Sourcebook by Glenn R. Schiraldi. Information on therapists who specialize in treating PTSD can be found online under The National Center For PTSD.
It's important to add that the treatment for any anxiety disorder may include marital or family therapy. Interpersonal problems with spouses and/or family may serve to perpetuate anxiety and undermine the success of treatment until these issues are addressed. Family therapy is also useful in educating family members about how to understand, support and, in some cases, set limits with the family member suffering with the anxiety disorder.
