Post-Traumatic Stress Disorder

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When Hurricane Katrina unleashed its fury over southern Louisiana, it wiped out more than just buildings and homes. Survivors escaped harm only to find themselves reliving the nightmare again and again.

More than a month after the hurricane passed, nearly half the survivors still showed signs of emotional distress, including intense fear and anxiety, according to a survey by the Centers for Disease Control and Prevention.

Nightmares and flashbacks have kept those feelings alive and put many on constant alert. Experts identify the suffering of Katrina victims (as well as countless others who relive the feelings from wartime and other terrifying experiences) as post-traumatic stress disorder. More than 5 million Americans suffer from PTSD in any given year, according to a report from the Mayo Clinic.

Some will be haunted for years or longer, but many others will move past their fears and get on with their lives. Whether they're survivors of childhood abuse or Hurricane Katrina, there's one thing that people who successfully overcome PTSD tend to have in common: They aren't handling the disorder on their own.

Who gets PTSD?

Many people associate PTSD with large-scale calamities such as war or natural disasters. But more personal traumas can leave a lasting mark, too. For example, the impact of trauma from childhood neglect or abuse can linger for a lifetime. As reported in the Harvard Mental Health Letter, abuse or neglect primes a child to become extra-sensitive to stress. Future trauma -- whether it happens weeks or decades later -- may trigger PTSD.

Other things besides childhood trauma can prime people for a case of PTSD. People who have abused alcohol or drugs, or who have suffered from anxiety or depression before a trauma occurs are especially vulnerable. Certain genes also appear to be a factor in who gets PTSD and who does not.

What are the symptoms of PTSD?

PTSD is a well-defined syndrome that produces a clear set of symptoms. People with the condition have trouble shaking memories of the traumatic event. They're haunted by memories so terrible that they can recur without warning. Nightmares and troubling dreams associated with the ordeal make it difficult to get a restful nights sleep. Some victims also have flashbacks -- minutes, hours, or even days during which normal thought is interrupted, the horrifying event is relived, and the person feels and behaves as though he were experiencing the actual horror all over again. Many people have heard of flashbacks in connection with war veterans who panic and leap for cover when a car backfires -- a sound much like the gunfire they once endured.

As the fear lingers, people with PTSD naturally turn to the next major component of the condition: avoidance. They will stay away from any situation that could possibly stir up old memories. They may also try to shield themselves by cutting off ties with friends and family. When they aren't suffering from wrenching memories and flashbacks, they may find themselves emotionally numb -- often with the help of alcohol or drugs. They may also feel overwhelmed by shame and guilt, especially if they survived when people close to them didn't.

Finally, people with PTSD stay "on edge," as if they expect the danger to return. They startle easily and often overreact to the slightest threats, real or perceived. When they do think about the past, their pulse and breathing quickens and their muscles tense. People in a constant state of alert may have trouble relaxing or getting enough sleep. They may also seem distracted and have trouble concentrating at work. This constant state of stress is hard on the body and can lead to a host of other health problems such as early heart disease or metabolic syndrome (a cluster of conditions that increase the risk for heart disease, diabetes, and stroke).

How is PTSD diagnosed?

According to guidelines used to diagnose the disorder, psychologists and doctors may find you have PTSD if:

  • You experienced a horrific event and your response included intense fear, helplessness, or horror. (In children, that may show up as disorganized or agitated behavior, and include physical symptoms such as headaches or stomachaches.)

AND

  • You relive the traumatic event over and over in one or more of the following ways:
  • Nightmares or distressing dreams about the trauma (or in young children, frightening dreams and play reenacting the trauma)
  • Recurrent and intrusive thoughts about the trauma
  • Flashbacks, hallucinations, or illusions in which the horror is relived
  • Intense distress over anything that reminds you of the trauma
  • Physiological reactions to situations that remind you of the traumatic event.
  • These reactions may include a rapid heart rate, rapid breathing, muscle tension, nausea and diarrhea, and an increase in blood pressure;

AND

You feel emotionally numb and avoid situations that could stir up memories of the trauma, as seen by three or more of the following:

  • Avoiding thoughts, feelings, or conversations about the trauma
  • Avoiding places, activities, and people connected with the trauma
  • An inability to recall parts of the trauma
  • Significantly diminished interest or participation in activities that you once found deeply fulfilling
  • Feelings of detachment or alienation from others
  • An inability to experience loving feelings
  • Hopelessness about the future (For example, you don't expect to have a career, marriage, children, or to live very long.)
  • Young children may regress developmentally, and exhibit poor language or motor skills;

AND

  • You experience a mental and physical hypersensitivity that wasn't present before the trauma and includes two or more of the following reactions:
  • Trouble sleeping
  • Irritability or outbursts of anger
  • Difficulty concentrating
  • An excessive startle reaction and hypervigilance

AND

All these symptoms last for more than one month and cause turmoil in your family, work, or social life.

What is the treatment for PTSD?

Some people wracked with memories of a traumatic event can recover with support only from friends and family. But when disturbing feelings last for more than a month, or start to overwhelm a person in all areas of his life, it's time to seek professional help.

Psychiatrists and other mental health professionals can take several different approaches to treating PTSD. Cognitive behavior therapy can help keep the person from dwelling on intolerable memories by using relaxation techniques and challenging the mental processes that are triggering the problem. Training in stress management can teach a person how to handle future problems more easily, big and small. Discussion groups or peer counseling can help people with PTSD know that they aren't the only ones dealing with a horrific past.

At least one therapist is using groups of veterans with PTSD to role play different characters involved in a trauma, expressing forgiveness, love, and validation, according to a 2014 article in the New York Times Magazine. One tormented veteran, sobbing over the memory of a young man he had killed in Iraq who was then discovered by his mother, was "forgiven" by a participant playing the mother. Although he still experiences symptoms of the disorder, he said he is planning to get get further treatment and felt more hopeful about the future.

Antidepressant medications, such as paroxetine (Paxil) or fluoxetine (Prozac), can help relieve anxiety and make it possible for a person to relax. People who need extra help calming down may also need tranquilizers such as lorazepam (Ativan).

Along with whatever medical treatment is recommended, it's just as important for people with PTSD to follow a healthy lifestyle. That means working closely with a doctor, staying away from alcohol or recreational drugs, and finding healthy ways to face fears. Regular exercise or a hobby can also help keep anxiety in check. Above all, it helps to talk about fears and feelings. Fear can't escape if it's bottled up inside.

References

Hoge CW et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351(1): 13-22.

Interland, Jeneen. A Revolutionary Approach to treating PTSD. The New York Times Magazine. May 22, 2014.

American Psychiatric Association. Let's talk facts about posttraumatic stress disorder. http://www.healthyminds.org/letstalkfacts.cfm#pos

American Academy of Family Physicians. Post-traumatic stress disorder. http://familydoctor.org/624.xml

Mayo Clinic. Post-traumatic stress disorder (PTSD). http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246

Mortality and Morbidity Weekly Report. Assessment of Health-Related Needs After Hurricanes Katrina and Rita -- Orleans and Jefferson Parishes, New Orleans Area, Louisiana, Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5502a5.htm?s_cid=mm5502a5_x

Merck Manual of Diagnosis and Therapy. Posttraumatic Stress Disorder. http://www.merck.com/mrkshared/mmanual/section15/chapter187/187e.jsp

Harvard Medical International. Re-print of Disaster and Trauma from Harvard Health Publications. http://hmiworld.org/hmi/issues/March_April_2002/disaster_trauma_pf.html

Mayo Clinic. Post-traumatic stress disorder: Can it be associated with psychosis? http://www.mayoclinic.com/health/post-traumatic-stress-disorder/AN00851

A Prospective Study of PTSD and Early-Age Heart Disease Mortality Among Vietnam Veterans: Implications for Surveillance and Prevention. Joseph A. Boscarino, PhD, MPH. Psychosomatic Medicine. 70: 668-676. http://www.psychosomaticmedicine.org/cgi/content/abstract/70/6/668

Mayo Clinic. Metabolic Syndrome. November 2007. http://www.mayoclinic.com/health/metabolic%20syndrome/DS00522

National Institutes of Health. Past Child Abuse Plus Variations in Gene Result in Potent PTSD Risk for Adults. March 2008. http://www.nih.gov/news/health/mar2008/nimh-18.htm

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