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About PTSD (Post Traumatic Stress Disorder)

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Post-traumatic stress disorder (PTSD)

What is post-traumatic stress disorder?

Post-traumatic stress disorder, also known as

PTSD, is among only a few mental disorders that are triggered by a disturbing outside event, quite unlike other psychiatric disorders such as depression.

Many people experience individual traumatic events ranging from car and airplane accidents to sexual assault and domestic violence. Other experiences, including those associated with natural disasters, such as hurricanes, earthquakes and tornadoes, affect multiple people simultaneously. Dramatic and tragic events occur, and with media exposure such as we have today, even people not directly involved might be affected. Simply put, PTSD is a state in which you ‘can't stop remembering’.

In about 1 out of 10 people, the traumatic event causes a cascade of psychological and biological changes known as post-traumatic stress disorder. Wars throughout the ages often triggered what some people called "shell shock", in which returning soldiers were unable to adapt to life after war. Although each successive war brings about renewed attention on this syndrome, it wasn't until the Vietnam War that PTSD was first identified and given this name. Now, mental health providers such as psychiatrists, psychologists, and other health care professionals can attempt to understand people’s responses to these traumatic events and help them recover from the impact of the trauma.

Although the disorder must be diagnosed by a mental health professional, symptoms of PTSD are clearly defined. To be diagnosed with PTSD, you must have been in a situation in which you were afraid for your safety or your life, or you must have experienced something that made you feel fear, helplessness or horror.

The worse the trauma, the more likely a person will develop PTSD, and the worse the symptoms. The most severely affected people are unable to work, have trouble with relationships and have great difficulty parenting their children.

Research has shown that PTSD changes the biology of the brain. MRI (magnetic resonance imaging) and PET (positron emission tomography) scans show changes in the way memories are stored in the brain. PTSD is an environmental shock that changes your brain, and scientists do not know if it is reversible.

  • About 1 in 4 people who experience a life-threatening or frightening event will suffer from PTSD. A large study in the United States found that about 1 in 10 women and 1 in 20 men experience PTSD at some point in their lives. A higher proportion of people who are raped develop PTSD than those who suffer any other traumatic event. Because women are much more likely to be raped than men (9% versus less than 1%), this helps explain the higher prevalence of PTSD in women than men. About half of all people who are raped experience PSTD.
  • Some 88% of men and 79% of women with PTSD also have another psychiatric disorder. Nearly half suffer from major depression, 16% from anxiety disorders, and 28% from social phobia. They also are more likely to have risky health behaviours such as alcohol abuse, which affects 52% of men with PTSD and 28% of women, while drug abuse is seen in 35% of men and 27% of women with PTSD.
  • Since its identification during the Vietnam War there have been a number of reports made on the effects of war, recording between 6% and 30% of all veterans suffering from PTSD.
  • People who are exposed to the most intense trauma are the most likely to develop PTSD. The higher the degree of exposure to trauma, the more likely you are to develop PTSD. So, if something happens to you more than once or if something occurs to you over a very long period of time, the likelihood of developing PTSD is increased.
  • Sometimes people who have heart attacks or cancer develop PTSD.
  • Refugees (e.g., people who have been through war conditions in their native country or fled from conflict) may develop PTSD and will often go years without treatment.
  • New mothers may develop PTSD after an unusually difficult delivery. Also, patients who regain partial consciousness during surgery under general anaesthesia may also be at risk for developing PTSD.

Causes of post-traumatic stress disorder

When you are afraid, your body activates the "fight or flight" response - a reference to our prehistoric ancestors facing a predator. In reaction, your body releases adrenaline, which is responsible for increasing blood pressure and heart rate and increasing glucose to muscles (to allow you to run away quickly in the face of immediate danger). However, once the immediate danger (which may or may not have actually existed) is gone, the body begins a process of shutting down the stress response, and this process involves the release of another hormone known as cortisol.

If your body does not generate enough cortisol to shut down the flight or stress reaction, you may continue to feel the stress effects of the adrenaline. Trauma victims who develop post-traumatic stress disorder often have higher levels of other stimulating hormones (catecholamines) under normal conditions in which the threat of trauma is not present. These same hormones rise again when the person is reminded of the trauma.

Physically, your body also increases your heart rate. After a month in this heightened state, with stress hormones elevated, you may develop further physical changes, such as heightened hearing. This cascade of physical changes, one triggering another, suggests that early intervention may be the key to heading off the effects of post-traumatic stress disorder.

Post-traumatic stress disorder symptoms

Although terrorism may cause the symptoms of PTSD in people directly involved, most people are resilient and won’t have serious lingering effects. They will have memories, certainly, but will go on to live their lives without debilitating fear.

No one knows who will develop long-term effects. Seek medical care if you suspect you or someone you know has after-effects that aren’t going away a few weeks after a traumatic event. Flashbacks, emotional detachment and jumpiness are the behaviours to watch for in loved ones, co-workers, friends and family.

  • Flashbacks: Imagine experiencing the most terrifying horror movie you’ve ever seen playing over and over in your mind. You can’t make the images go away. These are the flashbacks so commonly associated with PTSD and usually are thought of in connection with combat veterans in war.

Survivors of September 11, for example, may keep seeing the plane hitting the building, hearing the sound of the crash or reliving their desperate escape, and these images may occur either while the person is asle
ep (
or awake.

Flashbacks take the person out of reality. They are truly living the experience over again. Holocaust survivors are one example of a group of people with a common horrifying experience. Many of them experienced flashbacks of wartime Berlin and being herded to concentration camps when they heard the sound of police-car sirens more than 30 years later.

  • Emotional detachment: Emotional detachment is a second symptom of PTSD, which is often not as obvious outwardly to anyone other than the person experiencing it. For these people, their emotional systems are over active. They have a hard time being a loving family member. They avoid activities, places and people associated with the traumatic event. They are simply drained emotionally and have trouble functioning every day.A parent who is emotionally detached, or numb, might be unable to cope with raising children.
  • The children, in turn, may develop poor social relationships, as was seen with some children of Holocaust survivors. They can’t form loving bonds. This is the second generation of fallout from PTSD on a mass scale.
  • Jumpiness: Any sudden noise might startle you, but for someone with PTSD that noise would make them practically "jump out of their skin" (known as hyperactive startle reflex). These people might overreact to small things and have difficulty concentrating, which would affect their job performance. They may always be looking around as if searching their environment for danger (this is hypervigilance). Trouble falling asleep or staying asleep in this high state of arousal is also a common consequence.

Medical care

Talk about it: Early on, grief counselling can be helpful. Cognitive psychotherapy in which a trained mental health professional helps the traumatised person talk through the distressing event is also supportive. Dealing with the thoughts and emotions with a counsellor is important.

Exposure therapy is a form of cognitive behavioural therapy used to treat post-traumatic stress disorder. In this therapy, you are gradually helped to process your memories or cues associated with your traumatic experience. In other words, the therapist helps you deal with the memories - a process you may not be able to do yourself, even though you relive the memories yourself.

Medication: Many people with PTSD are also severely depressed. Taking antidepressants, such as mirtazapine and paroxetine may help relieve some of the symptoms and help people to get the best from the psychological treatments.

With medication or counselling and usually both, the film inside a person’s head stops playing and fades with time. Symptoms may get better without treatment too.

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