Post-Traumatic Stress Disorder (PTSD) Causes, Symptoms, Treatment

Post-traumatic stress disorder Causes, Symptoms, Treatment


What is post-traumatic stress disorder (PTSD)? 


Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

Post-traumatic stress disorder (PTSD) Causes, Symptoms, Diagnosis, Treatment
Post-traumatic stress disorder (PTSD)


Among those who may experience PTSD 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, D.C.; 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. Family members of victims also can develop the disorder. PTSD can occur in people of any age, including children and adolescents.

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.

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.

Causes of Post-traumatic stress disorder (PTSD)


Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience.

Types of events that can lead to PTSD include:
  • serious road accidents
  • violent personal assaults, such as sexual assault, mugging or robbery
  • prolonged sexual abuse, violence or severe neglect
  • witnessing violent deaths
  • military combat
  • being held hostage
  • terrorist attacks
  • natural disasters, such as severe floods, earthquakes or tsunamis
PTSD is not usually related to situations that are simply upsetting, such as divorce, job loss or failing exams.
PTSD develops in about 1 in 3 people who experience severe trauma. It is not fully understood why some people develop the condition while others don't, but there are factors that appear to make certain people more likely to develop PTSD.

Post-traumatic stress disorder (PTSD) Causes, Symptoms, Diagnosis, Treatment

If you've had depression or anxiety in the past, or you don't receive much support from family or friends, you are more susceptible to developing PTSD after a traumatic event.

There may also be a genetic factor involved in PTSD. For example, having a parent with a mental health problem is thought to increase your chances of developing the condition.

Although the diagnosis of PTSD currently requires that the sufferer has a history of experiencing a traumatic event as defined here, people may develop PTSD in reaction to events that may not qualify as traumatic but can be devastating life events like divorce or unemployment.

What are Post-traumatic stress disorder (PTSD) risk factors and protective factors?


Issues that tend to put people at higher risk for developing PTSD include increased duration of a traumatic event, higher number of traumatic events endured, higher severity of the trauma experienced, having an emotional condition prior to the event, or having little social support in the form of family or friends. In addition to those risk factors, children and adolescents, females, and people with learning disabilities or violence in the home seem to have a greater risk of developing PTSD after a traumatic event.

While disaster-preparedness training is generally seen as a good idea in terms of improving the immediate physical safety and logistical issues involved with a traumatic event, such training may also provide important preventive factors against developing PTSD. That is as evidenced by the fact that those with more professional-level training and experience (for example, police, firefighters, mental-health professionals, paramedics, and other medical professionals) tend to develop PTSD less often when coping with disaster than those without the benefit of such training or experience.

There are medications that have been found to help prevent the development of PTSD. Some medicines that treat depression, decrease the heart rate, or increase the action of other body chemicals are thought to be effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event.

Signs and symptoms of post-traumatic stress disorder (PTSD)


Post-traumatic stress disorder (PTSD) Causes, Symptoms, Diagnosis, Treatment
Post-traumatic stress disorder (PTSD)

  • Recurring thoughts, memories, images, dreams, or flashbacks of the trauma which are distressing.
  • You try to avoid thoughts, conversations, places, people, activities or anything which may trigger memories of the trauma, as these make you distressed or anxious.
  • Feeling emotionally numb and feeling detached from others. You may find it difficult to have loving feelings.
  • Your outlook for the future is often pessimistic. You may lose interest in activities which you used to enjoy and find it difficult to plan for the future.
  • Increased arousal which you did not have before the trauma. This may include:
*  Difficulty in getting off to sleep or staying asleep.
*  Being irritable which may include outbursts of anger.
*  Difficulty concentrating.
*  Increased vigilance.
*  Being more easily startled than you were before.
Note: it is normal to feel upset straight after a traumatic event. But for many people the distress gradually eases. If you have PTSD the distressing feelings and symptoms persist. In some cases the symptoms last just a few months and then ease or go. However, in some cases the symptoms persist long-term.

Up to 4 in 5 people with PTSD also have other mental health problems; for example, depression, persistent anxiety, panic attacks, phobias, drug or alcohol abuse.

Having a mental health disorder before the trauma seems to increase your chance of developing PTSD. But also, having PTSD seems to increase your risk of developing other mental health disorders.

Symptoms of Post-traumatic stress disorder (PTSD) in children and adolescents


In children - especially those who are very young - the symptoms of PTSD can be different than the symptoms in adults. Symptoms in children include:

  • Fear of being separated from parent
  • Losing previously-acquired skills (such as toilet training)
  • Sleep problems and nightmares without recognizable content
  • Somber, compulsive play in which themes or aspects of the trauma are repeated
  • New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters)
  • Acting out the trauma through play, stories, or drawings
  • Aches and pains with no apparent cause
  • Irritability and aggression

When to seek medical advice


It is normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these will improve naturally over a few weeks.

You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.

Your GP will want to discuss your symptoms with you in as much detail as possible. They will ask whether you have experienced a traumatic event, either in the recent or distant past, and whether you have re-experienced the event through flashbacks or nightmares.

Your GP can refer you to mental health specialists if they feel you would benefit from treatment. See treating PTSD for more information.

What is the treatment for post-traumatic stress disorder?


Post-traumatic stress disorder (PTSD) Causes, Symptoms, Diagnosis, Treatment
Treatments for PTSD usually include psychological and medical interventions. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that it is caused by extraordinary stress rather than weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and therefore avoid doing so.

Cognitive behavioural therapy


Cognitive behavioural therapy (CBT) may be advised. Briefly, CBT is based on the idea that certain ways of thinking can trigger or fuel certain mental health problems such as PTSD. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful and false ideas or thoughts. The aim is then to change your ways of thinking in order to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. It may help especially to counter recurring distressing thoughts and avoidance behaviour. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part and are given homework for between sessions.

Eye movement desensitisation and reprocessing


Eye movement desensitisation and reprocessing (EMDR) is a treatment that seems to work quite well for PTSD. Briefly, during this treatment a therapist asks you to think of aspects of the traumatic event. Whilst you are thinking about this you follow the movement of the therapist's moving fingers with your eyes. It is not clear how this works. It seems to desensitise your thought patterns about the traumatic event. After a few sessions of therapy, you may find that the memories of the event do not upset you as much as before.

Families


Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couple's counseling, parenting classes, and conflict-resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the illness are unable or unwilling to share.

Self-help


Joining a group where members have similar symptoms can be useful. This does not appeal to everyone but books and leaflets on understanding PTSD and how to combat it may help.

Directly addressing the sleep problems that can be part of PTSD has been found to not only help alleviate those problems but to thereby help decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for other sleep problems have been found to be particularly helpful in decreasing the sleep problems associated with PTSD.

Medication for Post-traumatic stress disorder (PTSD)


Antidepressant medicines


Antidepressant medicines are often prescribed. These are commonly used to treat depression but have been found to help reduce the main symptoms of PTSD even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing symptoms.

Antidepressants take 2-4 weeks before their effect builds up and can take up to three months. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give an antidepressant time to work. If one does help, it is usual to stay on the medication for 6-12 months, sometimes longer.

There are several types of antidepressants. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for PTSD. There are various types and brands of SSRI. Paroxetine has been found to be particularly useful for general use. Non-SSRI medicines sometimes used by specialists are mirtazapine and phenelzine.

Benzodiazepines such as diazepam are sometimes prescribed for a short time to ease symptoms of anxiety, poor sleep and irritability. The problem is, they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not used long-term. A short course of up to 2-3 weeks may be prescribed now and then if you have a particularly bad spell of anxiety symptoms.

Other medicines


Other medicines such as beta-blockers, mood stabilisers and anticonvulsants are being studied. These are normally used to treat other conditions but there is some evidence that they may help some people with PTSD. Further research is needed to clarify their role.

A combination of treatments such as CBT and an SSRI antidepressant may work better in some cases than either treatment alone.

How can family and friends help people with post-traumatic stress disorder?


If a loved one has post-traumatic stress disorder (PTSD), it’s essential that you take care of yourself and get extra support. PTSD can take a heavy toll on the family if you let it. It can be hard to understand why your loved one won’t open up to you - why he or she is less affectionate and more volatile. The symptoms of PTSD can also result in job loss, substance abuse, and other stressful problems.

Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to take care of your loved one, you first need to take care of yourself. It’s also helpful to learn all you can about post-traumatic stress disorder (PTSD). The more you know about the symptoms and treatment options, the better equipped you'll be to help your loved one and keep things in perspective.

Helping a loved one with PTSD


Be patient and understanding. Getting better takes time, even when a person is committed to treatment for PTSD. Be patient with the pace of recovery and offer a sympathetic ear. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.

Try to anticipate and prepare for PTSD triggers. Common triggers include anniversary dates; people or places associated with the trauma; and certain sights, sounds, or smells. If you are aware of what triggers may cause an upsetting reaction, you’ll be in a better position to offer your support and help your loved one calm down.

Don’t take the symptoms of PTSD personally. Common symptoms of post-traumatic stress disorder (PTSD) include emotional numbness, anger, and withdrawal. If your loved one seems distant, irritable, or closed off, remember that this may not have anything to do with you or your relationship.

Don’t pressure your loved one into talking. It is very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Never try to force your loved one to open up. Let the person know, however, that you’re there when and if he or she wants to talk.

How can people cope with Post-traumatic stress disorder (PTSD)?


Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and PTSD survivors for support. Joining a support group may be helpful. Other tips include reducing stress by using relaxation techniques (for example, breathing exercises, positive imagery), actively participating in treatment as recommended by professionals, increasing positive lifestyle practices (for example, exercise, healthy eating, distracting oneself through keeping a healthy work schedule if employed, volunteering whether employed or not), and minimizing negative lifestyle practices like substance abuse, social isolation, working to excess, and self-destructive or suicidal behaviors.

Research Findings


Research is continuing to reveal factors that may lead to PTSD. People who have been abused as children or who have had other previous traumatic experiences are more likely to develop the disorder. In addition, it used to be believed that people who tend to be emotionally numb after a trauma were showing a healthy response; but now some researchers suspect that people who experience this emotional distancing may be more prone to PTSD.

Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which are important for understanding anxiety disorders such as PTSD. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. It has been found that the fear response is coordinated by a small structure deep inside the brain, called the amygdala. The amygdala, although relatively small, is a very complicated structure, and recent research suggests that different anxiety disorders may be associated with abnormal activation of the amygdala.

People with PTSD tend to have abnormal levels of key hormones involved in response to stress. When people are in danger, they produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with PTSD continue to produce those higher levels even after the danger has passed; this may lead to the blunted emotions associated with the condition.

Some studies have shown that cortisol levels are lower than normal and epinephrine and norepinephrine are higher than normal. Norepinephrine is a neurotransmitter released during stress, and one of its functions is to activate the hippocampus, the brain structure involved with organizing and storing information for long-term memory.

This action of norepinephrine is thought to be one reason why people generally can remember emotionally arousing events better than other situations. Under the extreme stress of trauma, norepinephrine may act longer or more intensely on the hippocampus, leading to the formation of abnormally strong memories that are then experienced as flashbacks or intrusions. Since cortisol normally limits norepinephrine activation, low cortisol levels may represent a significant risk factor for developing PTSD.

Research to understand these neurotransmitter systems involved in memories of emotionally charged events may lead to the discovery of drugs or psychosocial interventions that, if given early, could block the development of PTSD symptoms.