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'Partial' Stress Disorder Can Hit Anywhere

One or two symptoms can throw you off stride, say researchers

MONDAY, Oct. 15, 2001 (HealthDayNews) -- People who witnessed the terrorist attacks on New York and the Pentagon -- even through television -- and now worry about the possibility of coming down with anthrax could develop some symptoms of post-traumatic stress disorder, if not the full-blown syndrome, psychologists say.

People who have what researchers are calling "partial" post-traumatic stress disorder are more likely to be depressed and think of suicide, as well as have more difficulty coping with life, including handling a job and maintaining personal relationships, new research shows.

"With each additional symptom, the risk of suicidal thoughts, depression and being functionally impaired increases," said lead study author Dr. Randall Marshall, an associate professor of clinical psychiatry at Columbia University in New York City. "Post-traumatic stress disorder is not an 'on' or 'off' thing. It's a spectrum."

Psychologists have known for decades that people with post-traumatic stress disorder have higher rates of depression, suicide and problems coping with work and life in general.

But this new study has found people who have only one or two of the symptoms of post-traumatic stress disorder also have higher rates of depression, suicidal thoughts and difficulty getting through the day. These people would not be diagnosed with the full-blown disorder as doctors define it today, Marshall said.

"The field is going to need to rethink the way it diagnoses post-traumatic stress disorder," Marshall said.

In psychology lingo, it's called "sub-threshold" post-traumatic stress disorder -- not enough symptoms to get you diagnosed with full-blown post-traumatic stress disorder, but enough to cause serious problems in dealing with life.

The study appears in a recent issue of the American Journal of Psychiatry.

Post-traumatic stress disorder, a term first used in 1980, is an anxiety disorder caused by a traumatic physical or mental event. In the United States, assaults and serious car accidents are common causes of post-traumatic stress.

The American Psychiatric Association estimates one in eight have suffered from post-traumatic stress disorder at some point.

Symptoms include persistent re-experience, or reliving of the event in thoughts or nightmares. Flashbacks are a rare type of reliving during which the person loses touch with reality. Only those with the most severe post-traumatic stress experience flashbacks, Marshall said.

Other symptoms of post-traumatic stress include anxiety, insomnia and irritability; emotional numbing, in which the person feels distant from others and unable to feel positive emotions; "internal" avoidance, in which the person has to try very hard not to think about the event and "external" avoidance, in which the person avoids people or places that remind of the event.

Many millions of people in the United States will feel some of these emotions in the weeks after the attacks, said Marshall, director of trauma studies for the New York State Office of Mental Health in Manhattan. The problem occurs when these feelings do not subside as time passes, he said.

"It's normal to feel anger, fear and sorrow after something like this," Marshall said. "But there are going to be some individuals who suffer from a more chronic disorder. The feelings will not gradually go away, and in some cases they may even get stronger. If it doesn't go away, that's the time people should get help."

Post-traumatic stress disorder is highly treatable with psychotherapy and medications, including antidepressants, said Steven Kingsbury, an associate professor of clinical psychiatry and behavioral sciences at University of Southern California in Los Angeles.

Even people thousands of miles from the sites of the attacks can be deeply affected by them. Across the country, millions of people saw their notions of the country as "safe" shattered, he said.

"Even if you don't have full-blown post-traumatic stress disorder, there are a lot of people walking around who have badly bruised assumptions that their lives are safe and that they are in control of what happens," Kingsbury said. "As a result, they can be having difficult coping. This can really disrupt their ability to get through the day."

What To Do

For more information about coping at this difficult time, visit the Post-Traumatic Stress Disorder Alliance.

Learn more about the disorder in this fact sheet from the Sidran Traumatic Stress Foundation.

SOURCES: Interviews with Randall Marshall, M.D., associate professor of clinical psychiatry, Columbia University, New York City; Steven Kingsbury, M.D., Ph.D.; associate professor of clinical psychiatry and behavioral sciences, University of Southern California in Los Angeles; September 2001 American Journal of Psychiatry
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