Post-traumatic stress disorder (PTSD)( updated Oct 2006)

Post-traumatic stress disorder, is a condition that follows a traumatic event. Usually, this event involves a serious life-threatening experience, in which someone believes that they are at risk of serious danger or they witness someone else in serious danger. People with PTSD have feelings of intense fear and helplessness in response to the traumatic event. Symptoms of PTSD fall into three main categories.

The first is re-living the event in one or more of the following ways:

• memories of the event.
• recurrent dreams of the event.
• sensations that the event is reoccurring. These sensations can include: illusions or misinterpreting things you see or hear as something else, hallucinations, or seeing or hearing things that are not there, and flashbacks, or reliving events as if they are occurring now
• severe emotional upset at cues similar to experiences in the actual event.
• physical sensations that recall the event. This can occur after exposure to outside cues or after internal memories.

The second category of symptoms are connected to a tendency to avoid reminders of the event, which can result in:

• guilt at surviving when others did not, which is known as survivor guilt.
• trouble making and keeping healthy family, social or job relationship.
• avoidance of thoughts, feelings, or talk about the event.
• avoidance of activities, places or people that might bring the event to mind.
• trouble recalling key parts of the event.
• loss of interest in daily activities.
• feelings of detachment or emotional distance from others. This could include trouble feeling love or affection.
• a sense of a shortened future. This might involve refusal to think or plan for the future.

The third category of symptoms is associated with a higher level of arousal and anxiety than before the trauma, and can result in:

• problems sleeping. This can include trouble falling asleep or staying asleep or early morning waking.
• irritability and trouble managing anger.
• problems with memory and concentration.
• an exaggerated startle response, or being set off by surprising events.
• persistent anxiety.
• somatic or body symptoms. These may include headache, nausea, sweating, chest pain or dizziness.
• agitation, or feelings of restlessness.
• less ability to tolerate or control emotions.
• self-destructive behaviour. This may include alcohol and drug abuse, suicide attempts or acting out.
• feeling of being separate from yourself or from the world, called dissociative symptoms.

PTSD is caused by exposure to excessive stress or trauma. Events that spark the condition are not normally part of most people's life experience. Examples would include sexual assault, torture, child abuse, exposure to war, natural disaster, motor vehicle accidents, armed hold ups and other forms of severe assault. Not everyone exposed to such events will develop PTSD. It is not known why some individuals develop PTSD. The persons individual perception of threat and danger seems to be very important in the development of PTSD. Some times repeated exposure to traumatic events lead to the development of PTSD much later down the track, which may seem unrelated to events that occurred many years prior.

Counselling after a traumatic event (debriefing) may cut down on the chances of developing PTSD although this is a controversial area of research. The earlier treatment is started, the better the chances for lessening or eliminating symptoms of the condition. PTSD is diagnosed based on a person's symptoms. A major, extreme event must have taken place. A doctor will do a thorough examination to make sure symptoms do not stem from a medical source. Medical procedure or infact, being diagnosed with a serious medical illness such as cancer can also lead to the development of PTSD.

People with PTSD often have problems in their relationships with others. Marriage problems and high divorce rates are common. Job and legal problems also occur frequently in persons with the syndrome. Alcohol and drug abuse are significant among people with this disorder, as well.

Various treatments have been shown to be useful in treating PTSD. In particular, cognitive-behavioural therapy and eye movement desensitisation and reprocessing (EMDR) have demonstrated significant efficacy.

People with PTSD often need treatment for depression or substance abuse. This needs to occur before measures directed at decreasing symptoms of PTSD can be effective.

Antidepressant medications, may help limit symptoms. Short term use of antianxiety drugs, such as lorazepam or alprazolam, are useful during periods of severe symptoms, but must not be used long term due to their addictive properties.

Chronic PTSD often persists for years, usually it is a condition that fluctuates over years. It usually becomes less intense and bothersome as time passes.

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