Post-Traumatic Stress Disorder (PTSD): Therapies & Meds

Such events include military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. Not all the eyewitnesses develop this disorder. Most survivors of trauma return to normal in a short time, but some people will have stress reactions that do not go away on their own, or even get worse over time.

History of PTSD

Although careful research and documentation of PTSD began in earnest after the Vietnam War, PTSD is not a new disorder and there are written accounts of similar

symptoms that go back to ancient times. There are also good descriptions of posttraumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.

Incidence 

A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5% in men and 10% in women. A revision of this study done in 2005, reports that PTSD occurs in about 8% of all Americans. At least 3.6% of U.S. adults have PTSD during the course of a year. About 30 % of men and women who have spent time in war zones experience PTSD. One million war veterans developed PTSD after serving in Vietnam. PTSD has also been detected among veterans of the Persian Gulf War. PTSD can develop at any age. Symptoms typically begin within 3 months of a traumatic event, although occasionally they do not begin until years later.

Signs and symptoms of PTSD

There are some symptoms of PTSD which are considered cardinal and they are:

• general restlessness,
• insomnia,
• aggressiveness,
• depression,
• dissociation,
• emotional detachment,
• nightmares

Some of the other common symptoms are:

• Avoiding thoughts, feelings and activities associated with the trauma.
• Feelings of detachment from others and an inability to love somebody
• Diminished interest or participation in social activities  
• Delayed or developmental retrogression in such areas as toilet training, motor skills and language.
• Flashbacks and distressing dreams associated with the traumatic event.
• Distress at anniversaries of the trauma.
• Hopelessness about the future
• Physical and psychological hypersensitivity accompanied with trouble sleeping, anger, difficulty concentrating, exaggerated startle response to noise, and physiological reaction to situations that remind of the traumatic event. 

Children with PTSD may also show the following symptoms:

• worry about dying at an early age
• losing interest in activities
• having physical symptoms such as headaches and stomachaches
• showing more sudden and extreme emotional reactions
• having problems falling or staying asleep
• showing irritability or angry outbursts
• having problems concentrating
• acting younger than their age  
• showing increased alertness to the environment
• repeating behavior that reminds them of the trauma

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common in people with PTSD.

Most affected population

It is proven that some people are at a higher risk for developing this disorder and they include:

1. Those who experienced greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual victimization, real or perceived responsibility, and betrayal
2. Those with prior vulnerability factors such as genetics, early age of onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events
3. Those who reported greater perceived threat or danger, suffering, upset, terror, and horror or fear
4. Those from a social environment that produces shame, guilt, stigmatization, or self-hatred
5. Those who have a history of alcohol and drug abuse

Pathophysiology of the PTSD

Several researches have came to the conclusion that PTSD may be associated with a number of distinctive neurobiological and physiological changes. Some of those are:

• altered brainwave activity,
• decreased volume of the hippocampus,
• abnormal activation of the amygdale

These brain structures are involved in the processing and integration of memory. 

Physiological alterations associated with PTSD include:

• hyper-arousal of the sympathetic nervous system,
• increased sensitivity of the startle reflex,
• sleep abnormalities

There were also several researches on the subject of hormone imbalances. It was found that people with PTSD have abnormal levels of key hormones involved in the body's response to stress. The response to stress in PTSD is abnormal with long-term high levels of norepinephrine, at the same time as cortisol levels are low, a pattern associated with facilitated learning in animals.

What happens during stress? Body releases adrenaline, which is responsible for increasing blood pressure and heart rate and releasing glucose to muscles. What happens if the cortisol is low? If body does not generate enough cortisol to shut down the flight or stress reaction, patient may continue to feel the stress effects of the adrenaline for a long time.

Another possible factor in PTSD is that persistent depressive symptoms may be caused by an underlying biochemical disorder, associated with insulin resistance.

Co-occurring psychiatric disorders

PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. Some of the most common co-occurring disorders are:

• alcohol abuse or dependence (51.9 percent),
• major depressive episodes (47.9 percent),
• conduct disorders (43.3 percent),
• drug abuse and dependence (34.5 percent)

Cancer as PTSD-trauma

Beside the fact that PTSD is normally associated with trauma, some experts came to the conclusion that there has been a growing number of reports of PTSD among cancer survivors and their relatives. Most studies deal with survivors of breast cancer and most of them showed prevalence figuring between 5 and 20%. Of course, there is a disagreement on whether the traumas associated with cancer treatment actually qualify as PTSD stressors, but it is considered an important risk factor.

Diagnosis of PSTD

A mental health professional should ask a patient to describe the signs and symptoms that he or she is experiencing. Sometimes they ask the petient to describe the event that triggered the symptoms. Diagnosing the condition requires that the symptoms be present longer than one month.

There are several other diagnostic criteria. The stressor criterion, according to the DSM-IV-TR Diagnostic Criteria (Breslau & Kessler 2001): is divided into two parts:

1. The first requires that "the person has experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others."
2. The second requires that "the person’s response involved intense fear, helplessness, or horror." 

Treatment of PSTD

Research has demonstrated the effectiveness of cognitive-behavioral therapy, group therapy, and exposure therapy.
PTSD is treated by a variety of forms of psychotherapy and drug therapy. There is no definitive treatment, but the above mentioned therapies have shown to be quite promising.

Psychotherapy
Exposure therapy involves having the patient repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help with sleep. At present, cognitive-behavioral therapy appears to be somewhat more effective than drug therapy. The repeated exposure to sources of anxiety should diminish the patient’s fear so that he or she no longer needs to avoid certain situations and thoughts.

Medications
The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft. These antidepressants act on the substance called serotonin, the neurotransmitter in the brain that helps brain cells send and receive various messages. Drug therapy appears to be highly effective for some individuals and is helpful for many more. Tranquilizers such as clonazepam (Klonopin) and lorazepam (Ativan) may decrease the feeling of anxiety.

Stress management training
This approach also involves learning how to manage your anxiety through relaxation. You work with the help of a therapist to develop skills to decrease your preoccupation with negative thoughts and the sense of being overwhelmed by the traumatic event.

Possible complications if left untreated

Several researches have been conducted on this subject and they all came to the same conclusion. Having post-traumatic stress disorder may place a person at a higher risk of:

• Depression
• Drug abuse
• Alcohol abuse
• Eating disorders
• Divorce