Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a debilitating condition that can develop following a terrifying event.
War veterans first brought PTSD to public attention, but it can result from any traumatic incident, including violent attacks such as mugging, rape, or torture; being kidnapped or held captive; child abuse; serious accidents such as car or train wrecks; and natural disasters such as floods or earthquakes. The event that triggers PTSD may be something that threatened the person's life or the life of someone close to him or her. The trigger could also be something witnessed, such as massive death and destruction after a bombing or a crashed plane.
Whatever the source of the problem, people with PTSD may:
- repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day
- experience other sleep problems, feel detached or numb or be easily startled
- lose interest in things they used to enjoy and have trouble feeling affectionate
- feel irritable, more aggressive than before or even violent
- experience triggers of the trauma as distressing, leading them to avoid certain places or situations that bring back those memories. Traumatic event anniversaries are often very difficult.
PTSD affects about 7.7 million or 3.5 percent of adult Americans, with women more likely than men to develop the condition. It can occur at any age, including childhood; susceptibility may run in families. Depression, substance abuse, or one or more other anxiety disorders often accompanies PTSD. In severe cases, the person may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was deliberately initiated by a person—such as a rape or kidnapping. Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, may lose touch with reality and believe that the traumatic event is happening again.
Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do develop PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn't show up until years after the traumatic event.
People with PTSD can be helped by medications and carefully targeted psychotherapy.
Updated in October 2009
Fact sheet content reviewed by a member of NARSAD's Scientific Council
Overview
After traumatic events, such as death, an earthquake, war, car accidents, floods or fires, it is not uncommon for people to experience feelings of heightened fear, worry, sadness or anger. But if the emotions persist or become severe, and affect the person's ability to function, it may be a sign someone is suffering from Post-Traumatic Stress Disorder (PTSD).
About 8 percent of Americans will have PTSD symptoms at some point in their lives. Approximately 5.2 million adults have PTSD in any given year. Although experiencing or witnessing life-threatening events is common in the United States -- about 60 percent of men and 50 percent of women experience a traumatic event in their lives - only 8 percent of men and 20 percent of women develop PTSD.
Some people are more likely to develop PTSD after a traumatic event than others, research shows. A history of mental illness, getting hurt during the traumatic incident, seeing someone get killed, having poor coping skills and not having a good support system of friends and family are risk factors for PTSD. Current research about PTSD examines risk and resilience factors to predict those more likely to get PTSD after a trauma.
PTSD was first identified among combat veterans, referred to as shellshock or battle fatigue. Now, PTSD is recognized as an anxiety disorder that can occur after a life-threatening event, such as combat, rape, sexual or physical abuse, terrorist attacks, natural disasters, or a severe motor vehicle accident.
What are the symptoms of PTSD?
Clinicians divide PTSD symptoms into four types:
• Re-experiencing: People who relive traumatic events have nightmares or feel they are experiencing the event repeatedly, in what is referred to as a flashback. Flashbacks often are triggered by a news report of a similar event or a sound or sight that reminds the person of an event. For example, if someone was affected by the World Trade Center attacks, a new terrorist warning may cause great distress. Seeing someone that reminds the person of the traumatic event also can act as a trigger.
• Avoidance: Many people who suffer from PTSD avoid situations that remind them of the event. For example, victims of sexual assault will not go to films about the topic and will avoid reading news stories about it. A car crash survivor may resist ever getting in a car again.
• Numbing: People with PTSD often report feeling numb and have great difficulty expressing feelings. They find it hard to enjoy activities they liked in the past, find it difficult to enter into in a romantic relationship and are unable or unwilling to talk about the event. Often, they have trouble remembering the details of the trauma. These are all coping mechanisms to avoid the unpleasant emotions the traumatic event caused.
• Worked up: On the opposite spectrum, many people with PTSD always are on alert and sense danger in everyday events. Being in a state of constant arousal, known as hyperarousal, makes sleep and concentration difficult, and causes irritability and anger.
Some people will experience more than one symptom at the same time, while others experience different symptoms at different times based on the trauma and what is occurring around them.
How is PTSD diagnosed?
In order for a person to be diagnosed with PTSD, he or she must have experienced a traumatic event and report feeling all of the following for at least 1 month:
• At least one re-experiencing symptom
• At least three avoidance or numbing symptoms
• At least two "worked up" or hyperarousal symptoms
• Symptoms that make it hard to go about daily life, go to school or work, be with friends, and take care of important tasks.
A diagnosis of PTSD is usually made by psychiatrist or psychologist after the individual describes his or her feelings.
New NARSAD-supported research to improve the diagnosis of PTSD includes:
• Understanding that patients with major depression may be suffering from PTSD
• Educating clinicians about how children may have different responses to traumatic events compared to adults
• Monitoring rape victims and accident victims for PTSD since many individuals in both groups will develop PTSD
• Monitoring accident victims for PTSD since there is a high association between survivors of life-threatening accidents and PTSD
How is PTSD treated?
A combination of psychotherapy and medication is effective for most people with PTSD. The objective of treatment is to help people with PTSD understand and cope with their reactions to the major life event that caused the problem. The earlier the treatment begins, the better the outcome in most cases.
After diagnosis, people usually are prescribed medications to allay their symptoms and psychotherapy to help restore their sense of control and reduce the impact of painful memories. People may not benefit from psychotherapy unless they take medications initially to deal with the intensity of their feelings.
The U.S. Food and Drug Administration has approved two antidepressant medications to treat PTSD: paroxetine (Paxil) and sertraline (Zoloft). Because many people with long-lasting PTSD do not respond to these medications, other antidepressants are also used. In a typical case, a treating physician will prescribe a combination of drugs including an antidepressant and a medication to facilitate sleep or reduce insomnia, such as trazodone (a tetracyclic antidepressant); the antipsychotic quetiapine (Seroquel) for some of the PTSD symptoms; or the antihypertensive prazosin, which blocks adrenaline, a hormone produced in response to emergencies.
Cognitive-behavioral therapy (CBT), a psychotherapeutic approach aimed at identifying and modifying faulty or distorted negative thinking styles, works well in treating PTSD.
There are two major types of CBT used for PTSD:
• Exposure-based therapy enables people to tolerate and then master emotional reactions to the stressful event. For a person who has been in a terrifying car accident, the therapist will help the person by gradually "exposing" him to driving. The first step might just be sitting in a car. Exposure therapy is deemed the most effective intervention for PTSD (and other anxiety-related disorders) for youths and adults.
• During cognitive processing therapy, a therapist and patient talk about the event to help the patient understand the event and his or her reactions to it in a more constructive way.
Eye movement desensitization and reprocessing therapy, EMDR, also is used as a treatment for PTSD. During EMDR, patients focus on negative thoughts and images while moving their eyes back and forth following the therapist's fingers across their field of vision. The goal of treatment is to replace disturbing images and feelings in the brain and help the patient reach a more peaceful state. Researchers are investigating how EMDR may change the circuitry of the brain in individuals with PTSD.
PTSD is not easy to treat. Some people are so horrified by their experience, the thought of talking about it fills them with anxiety and dread. Also, people with PTSD often have sustained terrible injuries during their traumatic experience, making them physically unable to go to facilities to obtain treatment.
New NARSAD-supported research to improve the treatment of PTSD includes:
• Looking into ways to prevent the development of PTSD by blocking hyperactivity in the part of the brain thought to be responsible for its development
• Finding new pharmacological treatments for PTSD
• Exploring ways to extinguish fearful memories associated with PTSD
• Studying ways to improve the efficacy of exposure treatments in children with PTSD
Living with PTSD - from diagnosis to daily life
The symptoms of Post-Traumatic Stress Disorder can be so terrifying some people fear leaving home or putting themselves in a situation, such as a public gathering, where they feel unsafe.
Many people with PTSD end up having alcohol or drug problems, employment difficulties, violent behavior, physical symptoms, and relationship problems, including divorce. They use substances to reduce their emotional reactions, such as fear or anger, but find that being drunk or high may lead to divorce or job loss. They avoid activities that could add meaning and pleasure to their lives and isolate themselves from people who they think don't understand them, but might be able provide support. All these negative behaviors are ways of avoiding anxiety, but they actually tend to increase preoccupation with the traumatic event. When people recognize they are having persistent problems after a stressful event, it is important to get help.
When a person develops PTSD as the result of a physical assault or an accident, treatment may be complicated. If a person had a traumatic brain injury or lost a limb, adapting to a life with a disability creates physical as well as psychological challenges.
It is important that family members of patients with PTSD be supportive and try to understand the illness. People with PTSD often withdraw from or become hostile to their families. Such behavior can be hard on a spouse and on young children who do not understand why a parent is acting differently, or in the case of accidents looks different. For these families, family therapy is often very helpful.
For most people, treatment for PTSD usually lasts 3 months to 6 months. For people with PTSD who have other mental health problems, the treatment may last 1 year to 2 years or longer. Most clinicians feel people with PTSD need continued support and professional help for life.
What causes PTSD?
PTSD seems to lead to detrimental changes in the brain due to stress. Scientists have found that several brain regions appear smaller in people with chronic PTSD and adults with early childhood trauma. The size reductions may arise from a combination of genetics and the environment. The brain of someone with a genetic predisposition to PTSD may have developed differently than other people's brains, in a way that makes the person especially vulnerable to the stress of trauma. Research studies suggest structural changes in the brain may contribute to cognitive impairments and the depression associated with PTSD.
People with PTSD also have been found to have abnormalities in the hormone system that coordinates the body's response to both acute and chronic stress. Laboratory animal experiments show that stress early in life during critical periods of brain development can permanently change the way the stress system regulates itself. Researchers are trying to determine if these changes predispose an individual to anxiety disorders, including PTSD, later in life.
New NARSAD-supported research to understand the causes of PTSD includes:
• Understanding the impact of stress on the brain and how it leads to a decrease in certain chemicals in the brain
• Looking at how fearful memories that haunt PTSD patients are formed and how they might be extinguished
• Characterizing how the hippocampus, the portion of the brain involved in the formation and storage of memories, as well as complex cognitive processing, affects PTSD and other anxiety disorders
• Studying people who have survived terrorist attacks here and abroad and analyzing who among them develop PTSD and why
• Determining whether alterations in a child's hormonal system predispose the individual to anxiety disorders, including PTSD, later in life .
For the past 23 years, NARSAD has been at the forefront of research on mental illness. From 1987 through 2009, NARSAD has given more than $252 million in grants to support innovative research by more than 2,800 scientists at leading universities, medical centers and research institutions around the world. Besides Post-Traumatic Stress Disorder, NARSAD funds research on schizophrenia, depression, bipolar disorder, anxiety disorders, and childhood mental illness.
NARSAD supports research on all aspects of PTSD and other mental illnesses-the causes and nature of the disease, structural and functional changes in the brain, chemical abnormalities, genetics, pharmacological and non-pharmacological treatments, and social and behavioral aspects of the illness. NARSAD's grantmaking program is guided by its Scientific Council, a volunteer group of 116 leading neuroscientists, which reviews and recommends research proposals for funding.
NARSAD relies on the generosity of thousands of donors and volunteers to support this research, which has yielded great progress in the understanding, diagnosis and treatment of mental illnesses. Formerly known as the National Alliance for Research on Schizophrenia and Depression, NARSAD is a 501 (c)(3) organization that receives no government support. All donations are tax-deductible. To donate to NARSAD and to learn more about our work, click here.
