Posttraumatic Stress Disorder
Posttraumatic stress disorder is an anxiety disorder caused by exposure to an overwhelming traumatic event, in which the person later repeatedly reexperiences the event.
Experiences that threaten death or serious injury can affect people long after the experience is over. Intense fear, helplessness, or horror can haunt a person.
Traumatic events may involve having been threatened with death or serious injury or witnessing violence against another person. Examples include engaging in military combat, experiencing or witnessing sexual or physical assault, or being affected by a disaster, either natural (for example, a hurricane) or man-made (for example, a severe automobile accident). Sometimes symptoms do not begin until many months or even years after the traumatic event took place (delayed onset). If posttraumatic stress disorder has been present for 3 months or longer, it is considered chronic.
Posttraumatic stress disorder affects at least 8% of people sometime during their life, including childhood (see Section 23, Chapter 286). Many people who undergo or witness traumatic events, such as combat veterans and victims of rape or other violent acts, experience posttraumatic stress disorder.
In posttraumatic stress disorder, the traumatic situation is reexperienced repeatedly, usually in nightmares or flashbacks. Intense distress often occurs when the person is exposed to an event or situation that reminds him of the original trauma. Examples of such reminders are anniversaries of the traumatic event; seeing a gun after being pistol-whipped during a robbery; and being in a small boat after a near-drowning accident.
The person persistently avoids things that are reminders of the trauma. He may also attempt to avoid thoughts, feelings, or conversations about the traumatic event and avoid activities, situations, or people who serve as reminders. Avoidance may also include memory loss (amnesia) for a particular aspect of the traumatic event. The person has a numbing or deadening of emotional responsiveness and symptoms of increased arousal (such as difficulty falling asleep or being easily startled). Symptoms of depression are common, and the person shows less interest in previously enjoyed activities. Feelings of guilt are also common.
Treatment
Treatment of posttraumatic stress disorder involves psychotherapy (including exposure therapy) and drug therapy. Because of the often intense anxiety associated with traumatic memories, supportive psychotherapy plays an especially important role in treatment. The therapist is openly empathic and sympathetic in recognizing the person's psychologic pain. The therapist reassures the person that his response is valid but encourages him to face his memories (as a form of exposure therapy). The person also is taught ways to control anxiety, which helps to modulate and integrate the painful memories into his personality.
Insight-oriented psychotherapy can help people with feelings of guilt understand why they are punishing themselves and help rid them of guilty feelings.
Antidepressants appear to provide some benefit, especially selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs).
Chronic posttraumatic stress disorder may not disappear but often becomes less intense over time even without treatment. Nevertheless, some people remain severely handicapped by the disorder.
| 
