Post-traumatic stress disorder (PTSD) is an extremely
debilitating condition that can occur 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.
Military troops who served in Vietnam and the Gulf Wars; rescue workers
involved in the aftermath 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 South Dakota floods, and hurricanes Hugo and Andrew; and
people who witnesses traumatic events are among the people who develop PTSD.
Families of victims can also develop the disorder.
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 one month.
How Common Is PTSD?
At least 4 percent of U.S. adults (5.7 million people) have PTSD during the
course of a 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.
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 longer.
What Treatments Are Available for PTSD?
Research has demonstrated the effectiveness of cognitive-behavioral therapy,
group therapy, and exposure therapy, in which the patient repeatedly relives
the frightening experience under controlled conditions to help him or her work
through the trauma, as well as medications that help ease the symptoms of
depression and anxiety and help promote sleep. Scientists are attempting to
determine which treatments work best for which type of trauma.
Do Other Physical or Emotional 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 diagnosed and treated as well.
Headaches, gastrointestinal 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,
through its education program, is encouraging 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 been abused 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.
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, which 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.
Research has shown that PTSD clearly alters a number of fundamental brain
mechanisms. Because of this, abnormalities have been detected in brain
chemicals that mediate coping behavior, learning, and memory among people with
the disorder. Recent brain imaging studies have detected altered metabolism
and blood flow as well as anatomical changes in people with PTSD.
The following are also recent research findings:
Some studies show that debriefing people very soon after a catastrophic event
may reduce some of the symptoms of PTSD. A study of 12,000 schoolchildren who
lived through a hurricane in Hawaii found that those who got counseling early
on were doing much better two years later than those who did not.
People with PTSD tend to have abnormal levels of key hormones involved in
response to stress. Cortisol levels are lower than normal and epinephrine and
norepinephrine are higher than normal. Scientists have also found that people
with this condition have alterations in the function of the thyroid and in
neurotransmitter activity involving serotonin and opiates.
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.
It used to be believed that people who tend to dissociate themselves from a
trauma were showing a healthy response, but now some researchers suspect that
people who experience dissociation may be more prone to PTSD.
Animal studies show that the hippocampus -- a part of the brain critical to
emotion-laden memories -- appears to be smaller in cases of PTSD. Brain
imaging studies indicate similar findings in humans. 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.
Research to understand the neurotransmitter system involved in memories of
emotionally charged events may lead to discovery of drugs that, if given
early, could block the development of PTSD symptoms.
Levels of CRF, or corticotropin releasing factor--the ignition switch in the
human stress response--seem to be elevated in people with PTSD, which may
account for the tendency to be easily startled. Because of this finding,
scientists now want to determine whether drugs that reduce CRF activity are
useful in treating the disorder.