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Post-traumatic stress disorder

Definition

Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.

Alternative Names

PTSD

Causes, incidence, and risk factors

PTSD can occur at any age. It can follow a natural disaster such as a flood or fire, or events such as:

  • Assault
  • Domestic abuse
  • Prison stay
  • Rape
  • Terrorism
  • War

For example, the terrorist attacks of September 11, 2001 may have caused PTSD in some people who were involved, in people who saw the disaster, and in people who lost relatives and friends.

Veterans returning home from a war often have PTSD.

The cause of PTSD is unknown. Psychological, genetic, physical, and social factors are involved. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters).

It is not known why traumatic events cause PTSD in some people but not others. Having a history of trauma may increase your risk for getting PTSD after a recent traumatic event.

Symptoms

Symptoms of PTSD fall into three main categories:

1. "Reliving" the event, which disturbs day-to-day activity

  • Flashback episodes, where the event seems to be happening again and again
  • Repeated upsetting memories of the event
  • Repeated nightmares of the event
  • Strong, uncomfortable reactions to situations that remind you of the event

2. Avoidance

  • Emotional "numbing," or feeling as though you don't care about anything
  • Feeling detached
  • Being unable to remember important aspects of the trauma
  • Having a lack of interest in normal activities
  • Showing less of your moods
  • Avoiding places, people, or thoughts that remind you of the event
  • Feeling like you have no future

3. Arousal

  • Difficulty concentrating
  • Startling easily
  • Having an exaggerated response to things that startle you
  • Feeling more aware (hypervigilance)
  • Feeling irritable or having outbursts of anger
  • Having trouble falling or staying asleep

You might feel guilt about the event (including "survivor guilt"). You might also have some of the following symptoms, which are typical of anxiety, stress, and tension:

  • Agitation or excitability
  • Dizziness
  • Fainting
  • Feeling your heart beat in your chest
  • Headache

Signs and tests

There are no tests that can be done to diagnose PTSD. The diagnosis is made based on certain symptoms.

Your health care provider may ask for how long you have had symptoms. This will help your health care provider know if you have PTSD or a similar condition called Acute Stress Disorder (ASD).

  • In PTSD, symptoms are present for at least 30 days.
  • In ASD, symptoms will be present for a shorter period of time.

Your health care provider may also do mental health exams, physical exams, and blood tests to look for other illnesses that are similar to PTSD.

Treatment

Treatment can help prevent PTSD from developing after a trauma. A good social support system may also help protect against PTSD.

If PTSD does occur, a form of treatment called "desensitization" may be used.

  • This treatment helps reduce symptoms by encouraging you to remember the traumatic event and express your feelings about it.
  • Over time, memories of the event should become less frightening.

Support groups, where people who have had similar experiences share their feelings, may also be helpful.

People with PTSD may also have problems with:

  • Alcohol or other substance abuse
  • Depression
  • Related medical conditions

In most cases, these problems should be treated before trying desensitization therapy.

Medicines that act on the nervous system can help reduce anxiety and other symptoms of PTSD. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), can be effective in treating PTSD. Other anti-anxiety and sleep medicines may also be helpful.

Support Groups

You can get more information about post-traumatic stress disorder from the American Psychiatric Association -- www.psych.org.

Expectations (prognosis)

You can increase the chance of a good outcome with:

  • Early diagnosis
  • Prompt treatment
  • Strong social support

Complications

Calling your health care provider

Although traumatic events can cause distress, not all feelings of distress are symptoms of PTSD. Talk about your feelings with friends and relatives. If your symptoms do not improve soon or are making you very upset, contact your health care provider.

Seek help right away if:

  • You feel overwhelmed
  • You are thinking of hurting yourself or anybody else
  • You are unable to control your behavior
  • You have other very upsetting symptoms of PTSD

You can also contact your health care provider for help with problems such as repeated upsetting thoughts, irritability, and problems with sleep.

Prevention

Research into ways to prevent PTSD is ongoing.

References

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;(3):CD003388.

Hetrick SE, Purcell R, Garner B, Parslow B. Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2010;(7):CD007316.

Roberts NP, Kitchiner NJ, Kenardy J, Bisson JI. Early psychological interventions to treat acute traumatic stress symptoms. Cochrane Database Syst Rev. 2010;(3):CD007944.

Gilbertson MW, Orr SP, Rauch SL, Pitman RK. Trauma and posttraumatic stress disorder. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 34.


Review Date: 2/13/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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