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Hollywood has made millions of dollars portraying the popular notion of post-traumatic stress disorder (PTSD). A combat veteran seemingly loses his mind while having flashbacks of blood and mayhem on the battlefield years after the war ended. In truth, PTSD does not just affect veterans. Anyone who has experienced or witnessed any life-threatening or highly traumatic event may be vulnerable to PTSD. Witnesses or victims of violent crime, such as rape, domestic violence, kidnapping, armed robbery or assault, and people who lived through fires, earthquakes, hurricanes, plane crashes, major traffic accidents and other disasters all are susceptible to PTSD. This is especially true when a loved one died in the disaster. Why some people who suffer traumatic events develop PTSD and others do not is a mystery. One theory is that people with PTSD tend to have abnormal levels of key hormones involved in response to stress.
Symptoms
According to DSM-IV, the American Psychiatric Association's diagnostic manual, PTSD has two precipitating components:
- The person experienced or witnessed an event that involved real or threatened death or serious injury to themselves or others.
- The experience evoked feelings of intense fear, helplessness or horror.
Symptoms vary but often involve reliving the ordeal in the form of flashbacks, distressing memories, nightmares or frightening thoughts, especially when exposed to something reminiscent of the trauma or on the anniversary of their trauma, according to the National Institute of Mental Health (NIMH). Emotional numbness, feeling detached from other people, sleep disturbances, depression, anxiety, guilt, irritability or angry outbursts are not unusual among PTSD sufferers. Not surprisingly, PTSD often interferes with a person's ability to shoulder responsibilities at work or school. The disorder also can spark conflicts with friends and family members.
Symptoms typically begin within a few hours or days of the traumatic event, and PTSD is diagnosed when symptoms last more than one month. More than 4 percent of the U.S. population, or at least 5.7 million people, experience PTSD each year, according to the NIMH and the U.S. Department of Veterans Affairs. A similar but abbreviated form of PTSD, acute stress disorder, is a relatively new diagnosis that is made when symptoms last from two days to four weeks and occur within four weeks of the trauma.
Treatments
No particular drug has emerged as a definitive treatment for PTSD, although medication is clearly useful for the symptom relief that makes it possible for survivors to participate in psychotherapy. According to the National Center for Post-Traumatic Stress Disorder, medication can reduce the anxiety, depression and insomnia often experienced with PTSD and, in some cases, may help relieve the distress and emotional numbness caused by trauma memories. Most clinical trials show several kinds of antidepressants help, and some other classes of drugs have shown promise.
 Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns with a doctor.
Many PTSD patients have improved markedly with cognitive-behavioral therapy, group therapy or exposure therapy, according to research. Support from family and friends can also aid recovery. One large study of Vietnam veterans found that soldiers who had good social support after they returned home were less likely to develop PTSD.
According to the American Psychiatric Association, early intervention may include taking sleep medication, obtaining professional counseling and freely venting feelings as soon as possible after the traumatic event.
This article was reviewed and updated June 2007.
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