Post-traumatic Stress Disorder Health Article

Definition

Post-traumatic stress disorder (PTSD) is a debilitating psychological condition trigged by a traumatic event, such as rape, war, a terrorist act, sudden or violent death of a loved one, natural disaster, or catastrophic accident. It is marked by recurring memories or thoughts of the event, "blunting" of emotions, increased arousal, and sometimes severe personality changes.

Description

Officially termed post-traumatic stress disorder since 1980, descriptions of post-traumatic stress were documented as early as the Civil War and in nineteenth century train crash victims. In the period between World War I and II, a condition known as "shell shock" or "battle fatigue" was recognized. Initially, it was thought that shrapnel entered the brain during battle explosions and caused small brain hemorrhages. When symptoms occurred in war veterans who had not been exposed to explosions, it was then often viewed as a character flaw.

In the 1970s, during and after the Vietnam War, post-traumatic stress received more serious research and documentation. In 1989, the National Center for Post-traumatic Stress Disorder was established in the U.S. Department of Veterans Affairs. Another benchmark was its addition to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) published by the American Psychiatric Association. In the past 20 years, those who have been diagnosed with PTSD have been rape victims, victims of violent crimes, and survivors of natural disasters, terrorist attacks, and random shootings in schools and the workplace.

Although people of all ages, cultures, and socioeconomic backgrounds can develop PTSD if exposed to a life-threatening event, statistics gathered from past events indicate that the risk of PTSD increases in order of the following factors:

• female gender
• middle-aged (40 to 60 years old)
• little or no experience coping with traumatic events
• ethnic minority
• lower socioeconomic status
• children in the home
• women with spouses exhibiting PTSD symptoms
• pre-existing psychiatric conditions
• primary exposure to the event including injury, life-threatening situation, and loss
• living in a traumatized community

For example, over a third of the survivors of the 1995 Murrah Federal Building bombing in Oklahoma City developed PTSD and over half showed signs of anxiety, depression, and alcohol abuse. More than a year later, Oklahomans in general had an increased use of alcohol and tobacco products, as well as PTSD symptoms.

Children are also susceptible to PTSD and their risk is increased exponentially as their exposure to the event increases. Children experiencing abuse, the death of a parent, or those located in a community suffering a traumatic event can develop PTSD. Two years after the Oklahoma City bombing, 16% of children in a 100-mile radius of Oklahoma City with no direct exposure to the bombing had increased symptoms of PTSD. Weak parental response to the event, having a parent suffering from PTSD, and increased exposure to the event via the media all increase the possibility of the child developing PTSD symptoms.

Causes & symptoms

Specific causes for the onset of post-traumatic stress disorder are not clearly defined, although experts suspect it may be influenced both by the severity of the event, by the person's personality and genetic make-up, and by whether or not the event was expected. First response emergency personnel and those directly involved in the event or families who have lost loved ones in the event are most like to experience PTSD.

People exposed to mass destruction or death, toxic contamination, the sudden or violent death of a loved

one, or the loss of home or community, are also at high risk for PTSD. Victims of human-caused trauma have a higher incidence of PTSD than those of natural disasters. Among rape and Holocaust survivors, the rate of PTSD is 50%.

A sampling of the types of traumatic events and the percentage of those exposed to them who develop PTSD includes:

• natural disaster, 4–5%
• mass shooting, 28%
• plane crash into hotel, 29%
• bombing, 34%

For men, events most likely to trigger PTSD are rape, combat exposure, childhood neglect, and childhood physical abuse. For women, these events are rape, sexual molestation, physical attack, threat with a weapon, and childhood physical abuse.

A related condition, Acute Stress Disorder (ASD), which occurs two days to four weeks after a traumatic event, is thought to be an indicator of the occurrence of PTSD. This is especially true if the following factors are present:

• lack of emotional and social support
• the presence of other stressors such as fatigue, cold, hunger, fear, uncertainty, and loss
• continued difficulties at the scene of the event
• lack of information about the event
• lack of self-determination
• treatment given in an authoritarian or impersonal manner
• lack of follow-up

PTSD symptoms are distinct and prolonged stress reactions that naturally occur during a highly stressful event. Common symptoms are:

• hyperalertness
• fear and anxiety
• nightmares and flashbacks
• sight, sound, and smell recollection
• avoidance of recall situations
• anger and irritability
• guilt
• depression
• increased substance abuse
• negative world view
• decreased sexual activity

Symptoms usually begin within three months of the trauma, although sometimes PTSD does not develop until years after the initial trauma occurred. Once the symptoms begin, they may fade away again within six months. Others suffer with the symptoms for far longer and in some cases, the problem may become chronic.

Among the most troubling symptoms of PTSD are flashbacks, which can be triggered by sounds, smells, feelings, or images. During a flashback, the person relives the traumatic event and may completely lose touch with reality, suffering through the trauma for minutes or hours at a time, believing that the traumatizing event is actually happening all over again.

Research conducted in the late 20th century suggests that PTSD sufferers undergo neurological and physiological changes stemming from altered brain activity. A decrease in size of the hippocampus (one of two seahorse-shaped parts of the brain generally believed by scientists to pay an essential role in formation of new memories) may affect the processing and integration of memory while abnormal activation of the amygdala (almondshaped parts of the brain believed to have strong connections to mental and physical reactions) may be tied to fear response. This altered brain activity can lead to hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.

The hormone levels of PTSD patients may also show abnormalities: for example, high levels of thyroid, epinephrine, and natural opiates coupled with low levels of cortisol. Blunted, or depressed, responses to a trauma may be the result of the body's increased production of opiates (narcotic-like hormones that induce mental lethargy), which masks the emotional pain.

People with post traumatic stress disorder are also like to suffer from other psychiatric disorders. Eighty-eight percent of men and 79% of women with PTSD meet the diagnostic criteria for other disorders. Physical ailments such as headaches, gastrointestinal ailments, immune system weaknesses, dizziness, chest pain, and general body discomfort are also common in PTSD sufferers.