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Post Traumatic Stress Disorder
(PTSD)

Post-Traumatic Stress Disorder (PTSD), is a form of anxiety disorder that may develop after a person is exposed to trauma. The patient may, or may not, have experienced physical harm during the event, but the threat of harm is often enough to trigger the symptoms. These events may include violent assault, disasters (either natural or caused by humans), accidents, military combat, and sexual assault, to name a few. When a person is in danger they may be overwhelmed with fear, helplessness and terror. After the trauma, patients may seem normal. Some people feel that they should be able to handle any situation, no matter how horrifying or extreme, and go forward with their daily activities as though nothing had happened. For some, the symptoms of PTSD fade a short time after the event, with or without treatment. Studies show that the more control the patient feels they have during the event, and the more choices they have about how to handle the trauma, the easier it is for them to recover without long term symptoms. But, when the ‘fight of flight’ response is not a choice, when the patient has no options, post-traumatic stress symptoms are typically worse, and last longer. For these people, the memories of the trauma are so stressful and real that many patients are unable to live a normal life if they do not seek treatment. In some patients, the symptoms do not appear immediately after the trauma, but instead the memories are buried, and may be triggered later, perhaps months or years later, by a stressful or similar situation. PTSD patients relive the experience as if it is happening to them again at that moment; they have nightmares and flashbacks, and find it difficult to sleep.

Complex (or Chronic) PTSD is a form of PTSD suffered by those who have endured long-term or persistent trauma or abuse. Doctors treat victims of long-term trauma differently (see Complex PTSD for more details)

What are the symptoms?

There are various primary and secondary symptoms associated with PTSD. Some are physical responses to stress and some are emotional and social responses.

• Headache, gastrointestinal symptoms, immune system depression, dizziness, chest pain, thyroid abnormality
• Hyper-arousal of nervous system, hyperactive startle reflex
• Interpersonal and social problems
• Feelings of detachment and estrangement, feeling numb
• Feeling strange and out of place
• Agitation when exposed to sense memories reminding patient of trauma (touch, smell, taste or sound)
• Blanks or gaps in memory of traumatic event
• Avoiding activities, people, discussions or sensations that remind you of trauma
• Difficulty in experiencing strong feelings of love or attachment
• Heart pounding, difficulty breathing
• Self blame or feelings of guilt about the trauma
• Alcohol and drug abuse
• Reliving traumatic episode, realistic flashbacks (minutes or hours, occasionally for days), nightmares, frightening images and thoughts
• Insomnia or interrupted sleep cycles, trouble falling asleep or staying asleep
• Shaking, trembling, sweating
• Abnormal neuro-hormonal levels (cortisol, epinephrine, norepinephrine, natural opiates)
• Feelings of danger or fear
• Physical numbness or strange physical sensations that can’t be otherwise explained
• Anger, aggression, need to defend self
• Memory and cognitive difficulties, inability to focus or concentrate
• Depression, loss of interest in activities that used to be pleasurable, loss of religious beliefs or hope
• Inability to feel pain or sensation
• Physical health symptoms that do not have any other cause
• Self Esteem and Identity problems

How is it diagnosed and treated?

Treatment(s) can include:

• Psychodynamic Therapy
• Psychotherapy
• Eye Movement Desensitization and Reprocessing (EMDR)
• Cognitive Behavioral Therapy
• Group and Family Therapy
• Medication (Sertraline, psychotropic medications, lorazepam, neuroleptics, haldol, anticholinergic, antiadrenergic agents (clonidine, guanfacine, propranolol) Seratonin Reuptake Inhibitors (SSRIs), Antidepressants
• Coping Skills for Survivor and Family

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