Facts about Post-traumatic Stress Disorder

What is Post Traumatic Stress Disorder?
Post-traumatic Stress Disorder (PTSD) is a major psychiatric disorder that develops in some individuals after
experiencing a traumatic, often life-threatening event.  Common events that can lead to PTSD include combat, assault,
or rape, accidents, and natural disasters.  People with PTSD experience high levels of anxiety, arousal, and avoidance
due to recurrent memories of the traumatic event.  This severe anxiety often interferes with the client's interpersonal
relationships, enjoyment of life, and ability to maintain a job or meet other role responsibilities (such as homemaker).
    The experience of having PTSD (or living with someone who does) can feel like living in constant danger; the client
constantly attempts to avoid situations that might remind him or her of the trauma, but no matter how hard he or she
tries, the memories resurface when least expected.

How Common Is PTSD?
PTSD is quite common.  About ten in every one hundred persons (10 percent) develop PTSD at some time during his
or her life.

How Is the Disorder Diagnosed?
PTSD can only be diagnosed by a clinical interview.  The purpose of the interview is to determine whether the client has
experienced specific "symptoms" of the disorder and whether these symptoms have been present long enough to merit
the diagnosis.  PTSD cannot be diagnosed with a blood test, an X ray, a CAT scan, or any other laboratory test.

The Characteristic Symptoms of PTSD
    The symptoms of PTSD can be broadly divided into four different categories: reexperiencing of the trauma,
avoidance of stimuli associated with the trauma, increased arousal, and other symptoms.  
These symptoms are
described below.  Although every client with PTSD has at least some of the symptoms in each of these first three
categories, clients do not need to have all of these symptoms in order to be diagnosed with PTSD.  Each client's
specific symptoms are unique to that individual.

    Reexperiencing the Trauma
    This can occur in various ways, such as:

Recurrent and Intrusive Memories of the Event.  Memories of the trauma are often intrusive images that can
happen at any time, any place.  The memories may be triggered by something that reminds the client of the trauma, or
by nothing in particular.

Recurrent Nightmares of the Event.  Nightmares about the traumatic event often interfere with the client's ability to
get a good night of sleep.  Sometimes during sleep the person will experience the onset of sudden, violent,
anxiety-provoking dreams that are not exactly a nightmare of the event but are very disturbing.

Sudden Acting or Feeling as if the Event Were Recurring.  The client may have a flashback as though the event
were happening again, or have illusions or hallucinations of the event.

Distress at Events that Remind the Client of the Trauma.  Ordinary, everyday things may remind the client of the
trauma, causing intense distress.  Memories may recur and symptoms worsen at anniversaries of the trauma.

    Avoidance of Stimuli Associated with the Trauma or Numbing of Responsiveness
    Several different types of avoidance or numbing are common, including:

Efforts to Avoid Thoughts, Feelings, Situations, or Activities That Trigger Memories of the Trauma.  The
client may try to distract himself or herself from these unpleasant memories by using alcohol or drugs, or by maintaining
a high level of activity.  Some clients avoid so many different situations that their range of activity is quite restricted and
they are socially withdrawn.

Inability to Recall an Important Aspect of the Trauma.  The client is able to remember some but not other parts of
the traumatic event.

Diminished Interest in Significant Activities.  Activities that were formerly enjoyable are no longer pleasurable.  
The client may feel apathetic and not pursue leisure activities.

Feeling Detached or Estranged from Others.  The client does not feel close to others or is not able to experience
love, feeling numb instead.

A Sense of Foreshortened Future.  It is difficult for the client to look into the future.  He or she may sense that he or
she may not have a long life, or he or she may not expect to marry, have children, or have a career.

  
  Increased Arousal
    Several different symptoms can be due to heightened arousal, including:

Increased Arousal in Situations that Remind Client of the Trauma.  For example, a person who was assaulted in
an elevator experiences increased heart rate and perspiration when entering any elevator.

Hypervigilance.  The client feels "super-alert", constantly scanning his or her environment for possible threats or
challenges.  It may be difficult or impossible to relax, even when tired, because of the need to remain alert.

Exaggerated Startle Response.  A sudden, unexpected loud noise or flash can jolt or startle the person in an
exaggerated manner.

Difficulty Sleeping.  Problems falling asleep or staying asleep are most common.

Irritability or Anger Outbursts.  The client is often irritable and easily annoyed.  Anger outbursts may occur over
seemingly trivial matters.

Difficulty Concentrating.  Problems with concentration may interfere with the ability to work, enjoy leisure activities, or
pursue short- and long-term goals.

    Other Symptoms
    A variety of other symptoms are often present in clients with PTSD.  Depression is a common problem for many
persons with this disorder, and the recurrent, intrusive memories of the trauma lead some clients to contemplate or
attempt suicide.  Alcohol and drug abuse problems are quite common in PTSD, because clients use these substances
to help them escape their unpleasant memories, to relax, or to sleep.  Some clients with PTSD experience mild levels of
hallucinations (such as hearing voices) or delusions (such as feeling paranoid).

What Is the Course of the Disorder?
The course of PTSD is highly variable, depending upon the individual, when the trauma occurred, how severe it was,
and how long after the trauma the person received treatment.  Most people who have been traumatized experience the
symptoms of PTSD for several days or weeks after the trauma but do not actually have PTSD.  While for some
individuals these symptoms gradually disappear over weeks or months, for others the symptoms remain or worsen.  
Individuals who continue to experience symptoms for more than one month after the traumatic event have PTSD.
    Many people who receive treatment soon after the traumatic event (within several weeks or months) recover
completely.  Some clients with PTSD who were traumatized but did not receive treatment until a long time later (such as
after several years) are nevertheless able to recover fully from the disorder.  However, for other clients with PTSD their
disorder can be a more long-lasting one that continues, even after treatment, to affect their day-to-day lives.

What Causes PTSD?
It is not known why some persons develop PTSD after a trauma and others do not.  However, theories about the causes
of PTSD suggest that both
learning and biological factors may play a role in the development of PTSD.
    Some of the most common anxiety symptoms in PTSD (such as avoidance of stimuli that remind the person of the
trauma) may be learned as the person tries to decrease his or her anxiety and cope with unpredictable reminders of the
trauma.  There is also evidence that exposure to traumatic events can lead to physiological changes in the nervous
system, resulting in chronically high levels of arousal.  This may be more likely to happen if the trauma occurred when
the person was young and if they did not receive treatment for a long time.  For most persons with PTSD, symptoms are
probably caused by a combination of both learning and biological factors.
    A final factor to be considered is multiple traumatization.  Some individuals may have experienced a series of
traumas in their life (e.g., intense childhood abuse, a sexual assault during adolescence, and a severe car accident
during adulthood).  In comparison with the person who did not have a history of prior traumas, the previously
traumatized individual may appear to have an especially intense PTSD reaction to the later trauma (in this example, the
car accident).  In short, the effects of repeated traumas may accumulate over time and contribute to the increased
severity of symptoms with subsequent traumatic events.

Are There Factors That Might Increase the Likelihood of Relapse?
PTSD symptoms tend to worsen when individuals have too much unstructured time, suffer a loss, or are retraumatized.

How is PTSD Treated?
A number of different treatments can be helpful to persons with PTSD.  Behavior therapy that focuses on reviewing the
traumatic events with the encouragement of a caring therapist and teaching stress management techniques can
substantially improve symptoms.  Many people with PTSD find that supportive therapy (either individual or group) is also
helpful.  Family therapy can help reduce stress on all family members and help develop strategies for managing chronic
symptoms.
    Pharmacological treatments can also be useful in the treatment of PTSD.  Antidepressant medications are often
used to relieve depression.  Antianxiety and sedative drugs are sometimes prescribed to reduce anxiety and agitation,
and to facilitate sleep.  Antipsychotic medications are occasionally used to treat less common symptoms, such as
hallucinations or delusions.




Recommended Readings

Matsakis, A. (1996), I can't Get Over It: A Handbook for Trauma Survivors, (Second Edition).  Oakland, CA: New
Harbinger.

Sterns, A.K. (1988),
Coming Back: Rebuilding Lives after Crisis and Loss.  New York: Ballantine.

Veninga, R.L. (1985),
A Gift of Hope: How We Survive Our Tragedies.  New York: Ballantine.


*Note:  This handout is taken from the book
Behavioral Family Therapy for Psychiatric Disorders (1999) by Kim T.
Meuser and Shirley M. Glynn, published by New Harbinger Publications.  Used with permission.
Consult a mental health professional (such as a psychiatrist, social worker, or
psychiaric nurse) about any questions you have concerning this handout.