Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD)is
an anxiety disorder that can develop after exposure to a terrifying
event or ordeal in which grave physical harm occurred or was threatened.
Traumatic events that can trigger PTSD include violent personal assaults
such as rape or mugging, natural or human-caused disasters, accidents,
or military combat. PTSD can be extremely disabling. Psychiatrists are
now discovering some victims of toxic mold, who have become gravely ill,
and have had to battle with their insurance companies and lost their
homes, moved from place to place, meanwhile taken care of other family
members; fit the same criteria as listed on the DSM IV.
Military troops who served in
the Vietnam and Gulf Wars; rescue workers involved in the aftermath of
disasters like the terrorist attacks on New York City and Washington,
D.C.; survivors of the Oklahoma City bombing; survivors of accidents,
rape, physical and sexual abuse, and other crimes; immigrants fleeing
violence in their countries; survivors of the 1994 California
earthquake, the 1997 North and South Dakota floods, and hurricanes Hugo
and Andrew; and people who witness traumatic events are among those at
risk for developing PTSD. Families of victims can also develop the
Fortunately, through research
supported by the National Institute of Mental Health (NIMH) and the
Department of Veterans Affairs (VA), effective treatments have been
developed to help people with PTSD. Research is also helping scientists
better understand the condition and how it affects the brain and the
rest of the body.
What Are the Symptoms of PTSD?
Many people with PTSD repeatedly
re-experience the ordeal in the form of flashback episodes, memories,
nightmares, or frightening thoughts, especially when they are exposed to
events or objects reminiscent of the trauma. Anniversaries of the event
can also trigger symptoms. People with PTSD also experience emotional
numbness and sleep disturbances, depression, anxiety, and irritability
or outbursts of anger. Feelings of intense guilt are also common. Most
people with PTSD try to avoid any reminders or thoughts of the ordeal.
PTSD is diagnosed when symptoms last more than 1 month.
How Common Is PTSD?
About 3.6 percent of U.S. adults
ages 18 to 54 (5.2 million people) have PTSD during the course of a
given year. About 30 percent of the 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, with some estimates running as high as 8 percent. It
is becoming more prevalent since victims toxic mold have been affected
and as people are having to deal with illness, anger, security, and loss
When Does PTSD First Occur?
PTSD can develop at any age,
including in childhood. Symptoms typically begin within 3 months of a
traumatic event, although occasionally they do not begin until years
later. Once PTSD occurs, the severity and duration of the illness
varies. Some people recover within 6 months, while others suffer much
What Treatments Are Available for PTSD?
Research has demonstrated the
effectiveness of cognitive-behavioral therapy, group therapy, and
exposure therapy, in which the patient gradually and repeatedly relives
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 promote
sleep. Scientists are attempting to determine which treatments work best
for which type of trauma.
Some studies show that giving
people an opportunity to talk about their experiences very soon after a
catastrophic event may reduce some of the symptoms of PTSD. A study of
12,000 school children who lived through a hurricane in Hawaii found
that those who got counseling early on were doing much better 2 years
later than those who did not.
Do Other Illnesses Tend to Accompany PTSD?
Co-occurring depression, alcohol
or other substance abuse, or another anxiety disorder are not uncommon.
The likelihood of treatment success is increased when these other
conditions are appropriately identified and treated as well.
complaints, immune system problems, dizziness, chest pain, or discomfort
in other parts of the body are common. Often, doctors treat the symptoms
without being aware that they stem from PTSD. NIMH encourages primary
care providers to ask patients about experiences with violence, recent
losses, and traumatic events, especially if symptoms keep recurring.
When PTSD is diagnosed, referral to a mental health professional who has
had experience treating people with the disorder is recommended.
Who Is Most Likely to Develop PTSD?
People who have suffered abuse
as children or who have had other previous traumatic experiences are
more likely to develop the disorder. Research is continuing to pinpoint
other factors that may lead to PTSD.
It used to be believed that
people who tend to be emotionally numb after a trauma were showing a
healthy response, but now some researchers suspect that people who
experience this emotional distancing may be more prone to PTSD.
What Are Scientists Learning From Research?
NIMH and the VA sponsor a wide
range of basic, clinical, and genetic studies of PTSD. In addition, NIMH
has a special funding mechanism, called RAPID Grants, that allows
researchers to immediately visit the scenes of disasters, such as plane
crashes or floods and hurricanes, to study the acute effects of the
event and the effectiveness of early intervention.
Studies in animals and humans
have focused on pinpointing the specific brain areas and circuits
involved in anxiety and fear, which are important for understanding
anxiety disorders such as PTSD. Fear, an emotion that evolved to deal
with danger, causes an automatic, rapid protective response in many
systems of the body. It has been found that the body's fear response is
coordinated by a small structure deep inside the brain, called the
amygdala. The amygdala, although relatively small, is a very complicated
structure, and recent research suggests that different anxiety disorders
may be associated with abnormal activation of the amygdala.
The following are also recent
- In brain imaging studies,
researchers have found that the hippocampus—a part of the brain
critical to memory and emotion—appears to be different in cases of
PTSD. Scientists are investigating whether this is related to
short-term memory problems. Changes in the hippocampus are thought to
be responsible for intrusive memories and flashbacks that occur in
people with this disorder.
- People with PTSD tend to have
abnormal levels of key hormones involved in response to stress. Some
studies have shown that cortisol levels are lower than normal and
epinephrine and norepinephrine are higher than normal.
- When people are in danger,
they produce high levels of natural opiates, which can temporarily
mask pain. Scientists have found that people with PTSD continue to
produce those higher levels even after the danger has passed; this may
lead to the blunted emotions associated with the condition.
- Research to understand the
neurotransmitter systems involved in memories of emotionally charged
events may lead to discovery of medications or psychosocial
interventions that, if given early, could block the development of