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“The human nervous system learns well, sometimes too well. A life-threatening experience, just once, can teach your brain to be cautious about anything even remotely resembling that experience, for years.” This, says psychiatrist Jim Phelps, appears to be central in the development of post-traumatic stress disorder.

What is PTSD?
Post-traumatic stress disorder (PTSD) can develop after a person experiences a traumatic event that harmed or threatened to harm them or a loved one, or they witness such an event. Examples of traumatic events that can cause PTSD include: violent assault (i.e., sexual assault, robbery), the death of a child, natural or manmade disasters, military combat, and automobile accidents.

Anyone who lives through a terrifying ordeal may experience blunted emotions, distorted memories or nightmares which fade after a few weeks. But for those who develop PTSD, these symptoms don't go away.

Fear, an emotion that evolved to protect us from danger, causes an automatic protective response of hormones and neurotransmitters. But for people with PTSD, that response continues to occur long after the danger has passed. And, as time passes, our brain doesn't call up the original memory. Instead, the last version we thought about, colored by our emotions, replaces the original, reinforcing fear and stress.

Studies indicate that about 7% of Americans have had or will have PTSD at some point in their lives. It can occur at any age, including childhood. Women are twice as likely as men to develop PTSD and there is some evidence that susceptibility to the disorder may run in families.

For most people, post-traumatic stress disorder starts within about three months of the event. For some, signs of PTSD don't show up until years later. Some people get better within six months, while others may have the illness for much longer. PTSD is often accompanied by depression, substance abuse, sleep disorders, or one or more of other anxiety disorders.

What are the symptoms of PTSD?
If you have PTSD, you often have nightmares or scary thoughts or memories about the experience you went through. You may try to avoid anything that reminds you of your experience.

You may have PTSD if you experience symptoms like these for a month or longer:

• feeling emotionally numb,
• feeling unable to trust or care about other people.
• having sleeping difficulties
• startling easily
• losing interest in things you used to enjoy
• feeling guilty
• become angry or more aggressive
• having trouble doing everyday things
• having difficulty remembering important aspects of the event
• feeling restless
• having difficulty concentrating

Physical symptoms such as headaches, gastrointestinal distress, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are common in people with PTSD. Often, doctors treat these symptoms without being aware that they stem from an anxiety disorder.

How is it treated?
Certain kinds of medication and certain kinds of psychotherapy have proven successful in treating the symptoms of PTSD.

Choose a doctor who has special training and experience in treating people with PTSD. Once you find one with whom you are comfortable, you can work together to develop a plan to treat your disorder.

Therapy
Three kinds of psychotherapy have been shown to be effective in the treatment of PTSD: exposure therapy, anxiety management and cognitive therapy.

In exposure therapy, patients relive their traumatic experience, in a safe way, and gradually confront situations that trigger their unrealistic anxiety.

Anxiety management teaches coping skills, including

• Relaxation techniques
• Assertiveness training
• Positive self-talk

Cognitive therapy helps patients learn to recognize the distorted thoughts and beliefs that cause pain and replace them with those that help them feel and function better.

Medications
For patients with severe symptoms, medications may be used. These include antidepressants, usually SSRIs; antianxiety medications; and when necessary, antipsychotic medications, anticonvulsants and possibly benzodiazepines. It may take a few weeks for the medicine to work.

Self help

• These steps can help speed up the healing process:
• learn about the disorder
• talk to others about what you're experiencing
• use aerobic exercise for its calming effect
• meditate to relax join a support group.
• Avoid caffeine which can make symptoms worse
• Don't use alcohol or drugs to mask your pain
• Ask family members for their support
• Remember that it's not your fault

For more information about PTSD

• Find a qualified PTSD professional at Facts for Health, Madison Institute of Medicine
• PTSD Alliance: Educational materials for professionals, individuals diagnosed with PTSD and their loved ones, and the general public.
• The Anxiety Disorders Association of America Information, resources and referrals

Related articles
Understanding anxiety disorders
Anxiety or anxiety disorder?
Managing anxiety

Sources
Medline Plus, a service of The National Library of Medicine and the National Institute of Health
The National Institute of Mental Health (NIMH)
Facts For Health, Madison Institute of Medicine

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