An older National
Center for PTSD Fact Sheet. It is still good information, even if somewhat dated. Visit the National Center's web
site ncptsd.va.gov
Thanks also to our new friend Ashley Henderson who suggests http://www.remilitary.com/article-ptsd.html as another valuable resource. Thanks Ashley.
aw
Posttraumatic Stress Disorder, or PTSD, is a psychiatric
disorder that can occur following the experience or witnessing
of life-threatening events such as military combat, natural
disasters, terrorist incidents, serious accidents, or violent
personal assaults like rape. People who suffer from
PTSD often relive the experience through nightmares and flashbacks,
have difficulty sleeping, and feel detached or estranged,
and these symptoms can be severe enough and last long enough
to significantly impair the person’s daily life.
PTSD is marked by clear biological changes as well as psychological
symptoms. PTSD is complicated by the fact that it frequently
occurs in conjunction with related disorders such as depression,
substance abuse, problems of memory and cognition, and other
problems of physical and mental health. The disorder is also
associated with impairment of the person’s ability to
function in social or family life, including occupational
instability, marital problems and divorces, family discord,
and difficulties in parenting.
Understanding PTSD
PTSD is not a new disorder. There are written accounts of
similar symptoms that go back to ancient times, and there
is clear documentation in the historical medical literature
starting with the Civil War, when a PTSD-like disorder was
known as "Da Costa’s Syndrome." There are
particularly good descriptions of posttraumatic stress symptoms
in the medical literature on combat veterans of World War
II and on Holocaust survivors.
Careful research and documentation of PTSD began in earnest
after the Vietnam War. The National Vietnam Veterans Readjustment
Study estimated in 1988 that the prevalence of PTSD in that
group was 15.2% at that time and that 30% had experienced
the disorder at some point since returning from Vietnam. (Studies
performed by Disabled American Veterans DAV showed that upwards
of 85% of Vietnam Veterans experienced PTSD to some degree.)
PTSD has subsequently been observed in all veteran populations
that have been studied, including World War II, Korean conflict,
and Persian Gulf populations, and in United Nations peacekeeping
forces deployed to other war zones around the world. There
are remarkably similar findings of PTSD in military veterans
in other countries. For example, Australian Vietnam veterans
experience many of the same symptoms that American Vietnam
veterans experience.
PTSD is not only a problem for veterans, however. Although
there are unique cultural- and gender-based aspects of the
disorder, it occurs in men and women, adults and children,
Western and non-Western cultural groups, and all socioeconomic
strata. A national study of American civilians conducted in
1995 estimated that the lifetime prevalence of PTSD was 5%
in men and 10% in women.
How does PTSD develop?
Most people who are exposed to a traumatic, stressful event
experience some of the symptoms of PTSD in the days and weeks
following exposure. Available data suggest that about 8% of
men and 20% of women go on to develop PTSD, and roughly 30%
of these individuals develop a chronic form that persists
throughout their lifetimes.
The course of chronic PTSD usually involves periods of symptom
increase followed by remission or decrease, although some
individuals may experience symptoms that are unremitting and
severe. Some older veterans, who report a lifetime of only
mild symptoms, experience significant increases in symptoms
following retirement, severe medical illness in themselves
or their spouses, or reminders of their military service (such
as reunions or media broadcasts of the anniversaries of war
events).
How is PTSD assessed?
In recent years, a great deal of research has been aimed at
developing and testing reliable assessment tools. It is generally
thought that the best way to diagnose PTSD—or any psychiatric
disorder, for that matter—is to combine findings from
structured interviews and questionnaires with physiological
assessments. A multi-method approach especially helps address
concerns that some patients might be either denying or exaggerating
their symptoms.
How common is PTSD?
An estimated 7.8 percent of Americans will experience PTSD
at some point in their lives, with women (10.4%) twice as
likely as men (5%) to develop PTSD. About 3.6 percent of U.S.
adults aged 18 to 54 (5.2 million people) have PTSD during
the course of a given year. This represents a small portion
of those who have experienced at least one traumatic event;
60.7% of men and 51.2% of women reported at least one traumatic
event. The traumatic events most often associated with PTSD
for men are rape, combat exposure, childhood neglect, and
childhood physical abuse. The most traumatic events for women
are rape, sexual molestation, physical attack, being threatened
with a weapon, and childhood physical abuse.
About 30 percent of the men and women who have spent time
in war zones experience PTSD. An additional 20 to 25 percent
have had partial PTSD at some point in their lives. More than
half of all male Vietnam veterans and almost half of all female
Vietnam veterans have experienced "clinically serious
stress reaction symptoms." PTSD has also been detected
among veterans of the Gulf War, with some estimates running
as high as 8 percent.
Who is most likely to develop PTSD?
1. Those who experience greater stressor magnitude and intensity,
unpredictability, uncontrollability, sexual (as opposed to
nonsexual) victimization, real or perceived responsibility,
and betrayal
2. Those with prior vulnerability factors such as genetics,
early age of onset and longer-lasting childhood trauma, lack
of functional social support, and concurrent stressful life
events
3. Those who report greater perceived threat or danger, suffering,
upset, terror, and horror or fear
4. Those with a social environment that produces shame, guilt,
stigmatization, or self-hatred
What are the consequences associated with PTSD?
PTSD is associated with a number of distinctive neurobiological
and physiological changes. PTSD may be associated with stable
neurobiological alterations in both the central and autonomic
nervous systems, such as altered brainwave activity, decreased
volume of the hippocampus, and abnormal activation of the
amygdala. Both the hippocampus and the amygdala are involved
in the processing and integration of memory. The amygdala
has also been found to be involved in coordinating the body's
fear response.
Psycho physiological alterations associated with PTSD include
hyper-arousal of the sympathetic nervous system, increased
sensitivity of the startle reflex, and sleep abnormalities.
People with PTSD tend to have abnormal levels of key hormones
involved in the body’s response to stress. Thyroid function
also seems to be enhanced in people with PTSD. Some studies
have shown that cortisol levels in those with PTSD are lower
than normal and epinephrine and norepinephrine levels are
higher than normal. People with PTSD also continue to produce
higher than normal levels of natural opiates after the trauma
has passed. An important finding is that the neurohormonal
changes seen in PTSD are distinct from, and actually opposite
to, those seen in major depression. The distinctive profile
associated with PTSD is also seen in individuals who have
both PTSD and depression.
PTSD is associated with the increased likelihood of co-occurring
psychiatric disorders. In a large-scale study, 88 percent
of men and 79 percent of women with PTSD met criteria for
another psychiatric disorder. The co-occurring disorders most
prevalent for men with PTSD were alcohol abuse or dependence
(51.9 percent), major depressive episodes (47.9 percent),
conduct disorders (43.3 percent), and drug abuse and dependence
(34.5 percent). The disorders most frequently co morbid with
PTSD among women were major depressive disorders (48.5 percent),
simple phobias (29 percent), social phobias (28.4 percent),
and alcohol abuse/dependence (27.9 percent).
PTSD also significantly impacts psychosocial functioning,
independent of comorbid conditions. For instance, Vietnam
veterans with PTSD were found to have profound and pervasive
problems in their daily lives. These included problems in
family and other interpersonal relationships, problems with
employment, and involvement with the criminal justice system.
Headaches, gastrointestinal complaints, immune system problems,
dizziness, chest pain, and discomfort in other parts of the
body are common in people with PTSD. Often, medical doctors
treat the symptoms without being aware that they stem from
PTSD.
How is PTSD treated?
PTSD is treated by a variety of forms of psychotherapy and
drug therapy. There is no definitive treatment, and no cure,
but some treatments appear to be quite promising, especially
cognitive-behavioral therapy, group therapy, and exposure
therapy. Exposure therapy involves having the patient repeatedly
relive 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 with sleep. The most widely used drug
treatments for PTSD are the selective serotonin re uptake
inhibitors, such as Prozac and Zoloft. At present, cognitive-behavioral
therapy appears to be somewhat more effective than drug therapy.
However, it would be premature to conclude that drug therapy
is less effective overall since drug trials for PTSD are at
a very early stage. Drug therapy appears to be highly effective
for some individuals and is helpful for many more. In addition,
the recent findings on the biological changes associated with
PTSD have spurred new research into drugs that target these
biological changes, which may lead to much increased efficacy.
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