Post-Traumatic Stress Disorder

Post-traumatic (post-traw-MA-tik) stress disorder is a condition in which a person has long-lasting psychological symptoms after experiencing an extremely stressful event.

Jeff had never belonged to a gang, but a year ago, he was caught in the crossfire of gang violence. As he walked down the street, Jeff was shot in the chest by a boy who mistook him for a member of a rival gang. Luckily, the bullet missed his vital organs, and Jeff recovered without serious damage to his body. His mind did not recover as quickly, however. Several months after the shooting, Jeff began to have terrible nightmares reliving the experience. He felt nervous walking down the street, and would jump at the sound of any loud noise. He also started to have mood swings, shifting from feeling emotionally empty to being filled with rage. Around the first anniversary of the shooting, Jeff sank into a deep despair. At last, his parents took him to a mental health professional, who was able to help him finally deal with the trauma of the shooting and get on with his life.

What Is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a condition that occurs in people who have lived through or seen a traumatic, or very stressful, event, such as war, natural disasters, serious accidents, child abuse, or rape. The traumatic event may be any event which involves the threat of death or serious injury, and to which the person responds with fear, helplessness, or horror. People with this disorder often relive the terrifying event again and again through nightmares and strong, disturbing memories. They may have trouble sleeping, and they may feel emotionally numb or cut off from other people. The symptoms can be severe enough and last long enough to cause serious problems in people's lives.

Who Is Affected by PTSD?

It is estimated that about 10 percent of women and 5 percent of men in the United States will have PTSD at some point in their lives, but this is just a small fraction of all those who have experienced a very stressful event. In women, the events most often linked to PTSD are rape, sexual abuse, physical attack, being threatened with a weapon, and childhood abuse. In men, the most common events are rape, war, and childhood neglect and abuse.

Children and teenagers can show signs of PTSD too. Researchers have found that the disorder is extremely common in young people who experience such violence as seeing a parent murdered or raped, witnessing a school shooting, or being the victim of sexual abuse. It is also very common in young people who are exposed to a lot of violence in their community. While it is unclear why PTSD develops in some people but not

in others, at least one factor, a high degree of family support, lowers the risk of PTSD in young people.

What Causes PTSD?

Researchers are investigating factors that may set apart people who experience PTSD after a very stressful event from those who do not. They have found that people with PTSD tend to have abnormal levels of key hormones ^* involved in the body's response to stress. In particular, levels of cortisol ^* are lower than normal, while levels of epinephrine ^* and norepinephrine ^* are higher. In addition, when people are in danger, they produce high levels of natural opiates ^* , body chemicals that temporarily block pain. Scientists have found that people with PTSD keep making higher levels of these substances even after the danger has passed, which may account in part for the emotional numbness often seen in the disorder.

What Are the Symptoms of PTSD?

The symptoms of PTSD may be mild or severe. One person may become slightly cranky, for instance, while another may have violent outbursts. In general, the symptoms seem to be worse if another person caused the event that triggered PTSD. People may have more trouble with their feelings after a rape, for example, than after a flood. Common symptoms of PTSD include:

• reliving the event in nightmares or disturbing memories
• being very distressed by reminders of the event
• avoiding places or situations that bring back the unwanted memories
• trying to avoid thinking or talking about the event
• being unable to recall an important part of the event
• losing interest in things that were once enjoyed
• feeling distant from other people or emotionally numb
• sleep problems
• crankiness or anger
• trouble concentrating
• being easily startled.

Most people who have been through a very frightening event will have a noticeable reaction in the days and weeks just afterward. The diagnosis of PTSD is considered only if the symptoms last more than a month. The course of the disorder varies. Some people with PTSD recover within months, while others have symptoms that last much longer. Occasionally, the onset of symptoms can be delayed and may not show up until years after the stressful event.

What Are Flashbacks?

Among the most disturbing symptoms of PTSD are flashbacks, vivid waking memories in which people relive a terrifying event. Ordinary things that serve as reminders of the event may be the triggers. During flashbacks, people may lose touch with reality and reenact the event for minutes or hours. While having a flashback, people may think they see, hear, or smell things that were part of the original experience. For a while, they can believe that the awful event is happening all over again.

How Are Children Affected?

Young children with PTSD may experience less specific fears, such as being afraid of strangers. They also may start to avoid situations and become preoccupied with words or things that may or may not be linked to the stressful event. They may have sleep problems, and they may lose previously learned skills, such as toilet training. In addition, they may act out parts of the distressing event in their play.

Older children also may reenact part of the event in play or drawings. They may remember things that happened during the event in the wrong order. In addition, they may believe that there were warning signs that predicted the event. As a result, they may think that they can avoid future problems by always staying alert for such signs. Teenagers show symptoms similar to those of adults, but they are more likely to become aggressive or to make poorly thought-out decisions they later regret.

How Is PTSD Treated?

Cognitive behavioral therapy

Cognitive behavioral (COG-ni-tiv bee-HAV-yor-al) therapy helps people change specific, unwanted types of behavior and faulty thinking patterns. In one form of the therapy, people describe and mentally relive a stressful event under safe, controlled conditions. This lets them face and gain control of the fear that was overwhelming during the actual event. In most approaches, gradual exposure to the traumatic event is paired with relaxation in a supportive environment. With systematic desensitization, people start out with less upsetting events and work up to the most severe event, or they confront the stressful event one piece at a time.

Group therapy

In group therapy, several people with similar problems meet as a group with a therapist. This is often an ideal setting for people with PTSD, because it lets them get support and help from others who understand what they are going through. Group therapy may help people feel more confident and able to trust again. In addition, as people share their stories and tips for coping with the fear, rage, grief, and shame caused by their experiences, they may start to focus on the present rather than the past.

Play therapy

Play therapy may help young children who are not able to talk about their feelings directly. The therapist uses play, games, and art to help children remember and describe the stressful event safely and express their feelings about it.

Medications

Medications may help reduce certain symptoms, such as having trouble sleeping and being easily startled. They also may improve conditions that often occur with PTSD, such as depression and panic disorder, in which repeated attacks of overwhelming fear strike often and without warning. Among the medications that may help are antidepressants (an-tee-de-PRES-antz), drugs used for treating depression and anxiety.

How Can PTSD Be Prevented?

Some studies show that counseling people very soon after a disaster may prevent or relieve the symptoms of PTSD. For example, a study of 12,000 children who lived through a hurricane in Hawaii found that those who got counseling early were doing much better 2 years later than those who did not get counseling.