Columbia Center for Occupational and Forensic Psychiatry - Washington, D.C. - Dr. David J. Fischer, M.D. Medical Director

COLUMBIA CENTER FOR
OCCUPATIONAL & FORENSIC PSYCHIATRY

DAVID J. FISCHER, MD MEDICAL DIRECTOR

PHONE: 202-363-4333
PHONE: 202-686-0114
 

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POSTTRAUMATIC STRESS DISORDER - PTSD

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Posttraumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event that is perceived as threatening and results in psychological trauma. Generally PTSD develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat. PTSD can be extremely disabling.

The traumatic event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity. The traumatic event can involve a single experience or an enduring or repeated event or events that completely overwhelm the individual's ability to cope. Stress is caused by the sufferer's inability to integrate the ideas and emotions caused by the traumatic experience. The sense of being overwhelmed can be delayed by weeks, years, even decades. As a result of psychological trauma, PTSD is less frequent but more enduring, damaging and incapacitating than acute stress.

Trauma can be caused by a wide variety of events. Examples of psychological trauma are military troops who served in the Vietnam and Gulf Wars; rescue workers involved in the aftermath of disasters like the terrorist attacks on New York City and Washington, DC; survivors of the Oklahoma City bombing; survivors of accidents, rape, physical and sexual abuse, and other crimes; immigrants fleeing violence in their countries; survivors of the 1994 California earthquake, the 1997 North and South Dakota floods, and hurricanes Hugo and Andrew; and people who witness traumatic events are among those at risk for developing PTSD. Families of victims can also develop the disorder.

There are a few common aspects to the cause of PTSD. Primarily threats to one's physical or psychological existence are precipitating factors. There is frequently a violation of the person's ideas about the world and of their human rights, putting the person in a state of extreme confusion and insecurity. This is also seen when trusted people or institutions violate, betray or disillusion the person in some unforeseen way. Psychological trauma may accompany physical trauma or exist independently of it. Trauma can be the result of experiencing, witnessing or being threatened with sexual abuse, bullying or domestic violence. posttraumatic stress disorder tends to be more frequent when these traumatic events are experienced in childhood. War or other mass violence and natural disasters like earthquakes or floods sometimes lead to psychological trauma. Long-term exposure to conditions of extreme poverty or to verbal abuse can be traumatic.

Different people react differently to similar events. One person may experience an event as being very traumatic while another person experiencing the same event does not experience it as traumatic at all. Not all people who experience a potentially traumatic event will actually become psychologically traumatized.

posttraumatic stress disorder is characterized by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma. A serious accident, a natural disaster, or criminal assault can result in PTSD. When the aftermath of a traumatic experience interferes with normal functioning, the person may be suffering from posttraumatic stress disorder. The recent recognition and definition of posttraumatic stress disorder as a syndrome has elevated the diagnosis and treatment of people who suffer from PTSD.

posttraumatic stress disorder can occur at any age, and traumatic stress can be accumulated over a lifetime. Responses to trauma include feelings of intense fear, helplessness or horror.

 

THERE ARE THREE TYPES OF GENERALLY RECOGNIZED STRESSORS:
  1. Threatened death or serious injury to one's person, such as: being the victim of a rape or violent crime
  2. Learning about the death, near death or serious injury of a family member or close friend
  3. Witnessing the death, near death or serious injury of another person

Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or outbursts of anger. Feelings of intense guilt are also common. Most people with PTSD try to avoid any reminders or thoughts of the ordeal. PTSD is diagnosed when symptoms last more than 1 month.

SYMPTOMS OF POSTTRAUMATIC STRESS DISORDER ARE:
  • RE-EXPERIENCING THE EVENT
    These symptoms are in the form of intrusive thoughts and recollections or recurrent dreams of the event.
  • AVOIDANCE BEHAVIOR
    The sufferer avoids activities, situations, people, or conversations they associate with the traumatic event.
  • AFFECTIVE OR EMOTIONAL NUMBING
    Detachment or general numbing of the general responsiveness to the external world. This numbing is demonstrated by the development of a restricted range in affect, resulting in a diminished responsiveness to the external world (and an overall constriction of the personality).
  • HYPERAROUSAL OR EXCESSIVE AUTONOMIC AROUSAL
    The inability to sleep, anxious feelings, overactive startle response, hypervigilance, poor concentration, irritability and outbursts of anger. Symptoms usually begin within three months of a trauma, but sometimes years pass before they arise. These late symptoms are often triggered by the anniversary of the trauma or with the experience of another traumatic event.

HOW COMMON IS PTSD?

About 3.6 percent of U.S. adults ages 18 to 54 (5.2 million people) have PTSD during the course of a given year.

PROGNOSIS

The illness prognosis of PTSD varies. Some people recover within 6 months, while others suffer much longer.

TREATMENTS AVAILABLE FOR PTSD

  • Medication and psychotherapy
  • Some studies show that giving people an opportunity to talk about their experiences very soon after a catastrophic event may reduce some of the symptoms of PTSD.

OTHER ILLNESSES TEND TO ACCOMPANY PTSD

Co-occurring Illnesses are not uncommon

  • Depression
  • Alcohol
  • Substance abuse
  • Anxiety disorder

The likelihood of treatment success is increased when these other conditions are appropriately identified and treated as well.

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are common.

FACTORS IN THE DEVELOPMENT OF PTSD

People who have suffered abuse as children or who have had other previous traumatic experiences are more likely to develop the disorder.



 
 
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