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 Research & Giving News Article  In research conducted prior to September 11 and recently published in the American Journal of Psychiatry, Dr. Blanco and his colleagues studied "subthreshold," or partial, post-traumatic stress disorder (PTSD), in which patients fail to meet the diagnostic criteria for full-blown PTSD, but still have serious symptoms that can significantly affect their ability to function in daily life. The study, funded in part by the National Alliance for Research on Schizophrenia and Depression and appearing in the September issue of the journal, found that significant numbers of people who do not meet all the criteria for a diagnosis of post-traumatic stress disorder can still suffer impairment and are even at risk of suicide. Dr. Blanco says patients with partial PTSD often exhibit some, but not all of the symptoms, which may include a loss of interest in activities, the inability to experience or express emotions, or hyperarousal, which means they are easily startled, are irritable or have difficulty sleeping. These findings are especially meaningful following the events of September 11. Just as the study found that significant numbers of people with subthreshold PTSD are falling through the cracks, Dr. Blanco believes many people who experienced trauma as a result of the terrorist attacks may not be getting needed treatment. "The entire country was traumatized, and although we do not have official statistics on how many people are coming in for treatment, our impression is that the numbers are lower than one would expect based on other disasters," he says. "One reason could be that New Yorkers are very resilient, and they got a lot of support from the whole nation. But it could also be that many of them are having symptoms, but are too embarrassed to seek help." Of those who do seek treatment, many people with partial PTSD may not get the psychotherapy or medication that could help them, he adds. The events of September 11, horrible beyond anything one could have imagined, have focused more attention on PTSD and partial PTSD. Post-Traumatic Stress Disorder was first identified as a diagnosable syndrome in 1980. Since then, numerous studies have demonstrated a high degree of associated disability, including work-related impairment, diminished quality of life, physical complaints, suicidal tendencies, medical illnesses, negative body image, impaired intimacy and social dysfunction. For their study, Dr. Blanco, and fellow investigators, including lead researcher Randall Marshall, MD, looked at questionnaires of people who participated in National Anxiety Disorders Screening Day in 1997, organized by Freedom from Fear, a non-profit group. Of 9,358 people screened nationwide, 2,608 individuals reported at least one PTSD symptom of at least one month's duration. Impairment, co-existing anxiety disorders, major depression, and risk of suicide were determined and compared for those who had one, two, three or four symptoms on the screening questionnaire. The researchers found that substantially greater numbers of individuals experience disability after trauma than is suggested by simply considering rates of full PTSD. Trauma is defined as an extremely frightening, traumatic or horrible experience, such as being the victim of a violent crime, being seriously injured in an accident, seeing someone seriously injured or killed, or being the victim of a natural disaster. In the study, researchers asked individuals if they had experienced any of the following PTSD symptoms for more than one month: reliving the experience through recurrent dreams, preoccupations or flashbacks; withdrawal or loss of interest in important things; being unable to experience or express emotions; trouble sleeping, concentrating or having a short temper; avoiding places or things that reminded one of the original horrible event. The researchers found that impairment, the number of co-existing anxiety disorders, the rate of co-existing major depression, and suicidal thoughts increased significantly with each incremental increase in PTSD symptoms. Higher numbers of symptoms were associated with greater impairment and more suicidal thoughts. The study concludes that given the broad public health implications of these findings, more efforts are needed to identify and treat people with partial PTSD symptoms. "We need to care more about the individual and how much the symptoms interfere with his ability to enjoy life and be productive than whether or not he or she meets full criteria for a particular diagnosis," says Dr. Blanco. He adds that early treatment probably results in better outcomes, although research is needed to determine which treatments are most effective in the early stages of PTSD. |
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