Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that develops after exposure to a traumatic event, such as a violent attack, an accident or a natural disaster. The person may experience the traumatic event directly, may witness an event that involves other people or may learn about a traumatic event that happened to a family member or close friend.

Whether the traumatic event is experienced, witnessed or learned of, one of the defining characteristics of PTSD is that the event involves the actual or perceived threat of serious injury or death to the person or others. In addition, the person who experienced, witnessed, or learned of the traumatic event, reacts to it with intense fear, helplessness or horror.

Traumatic events can include, but are not limited to, the following:

• Human violence (e.g., rape, physical assault, domestic violence, kidnapping or violence associated with military combat)
• Natural disasters (e.g., floods, earthquakes, tornadoes or hurricanes)
• Accidents involving injury or death
• Sudden, unexpected death of a family member or friend
• Diagnosis of a life threatening illness

It should be emphasized that most people who are exposed to traumatic events do not develop PTSD. Furthermore, many people with symptoms (such as difficulty falling asleep) after a trauma show gradual improvement with time. However, in some cases, PTSD symptoms continue and negatively impact on the person’s life (for example, impairing work, studies or relationships with others). In such cases, PTSD may be present.

Persons with PTSD display three types of symptoms :

• Intrusive re-experiencing symptoms are when a person has memories, flashbacks or nightmares of the event(s).
• Avoidant or numbing symptoms are when a person withdraws from people or activities that are reminders of the traumatic event.
  Hyperarousal symptoms are when a person is easily startled, irritable, on edge or has trouble falling asleep.
  

When children have PTSD, symptoms are expressed in different ways. For example, children may re-experience the traumatic event through repetitive play (e.g., a child who witnessed a robbery may reenact the robbery again and again using her toys).

Scientists have suggested that PTSD tends to be more intense and lasts longer when the traumatic event involves human violence. They have also found good evidence that the likelihood of developing PTSD increases with the severity, length and proximity of exposure to the traumatic event.

According to The American Psychiatric Association’s official diagnostic manual, a person has chronic PTSD if symptoms last for three months or longer. When PTSD symptoms last less than three months, this is considered acute PTSD. It may also be noted that in some people, PTSD symptoms can begin long after the traumatic event. This is termed delayed-onset PTSD.

Psychotherapy for PTSD

Psychotherapy for PTSD

Of the various types of psychotherapy, the one most widely accepted as useful for PTSD is cognitive-behavioral psychotherapy (CBT). CBT is a relatively structured kind of psychotherapy. It involves teaching the patient specific techniques within a limited number of sessions (with “homework exercises” between sessions). The therapist and patient clearly agree on the goals of the therapy.

Specific techniques in therapy for PTSD include exposure and cognitive restructuring. Other techniques, such as relaxation, self-talk and assertiveness training may also be used. Exposure therapy involves gradually facing the thoughts and memories of the traumatic event or situations (places where the event occurred) that make one anxious. This can be done by using imaging techniques or by actually returning to the place where one had an accident. Exposure should be gradual and done with the help of an experienced clinician.

Cognitive restructuring involves identifying irrational (but understandable) patterns of thought, feeling and behavior that emerge after a traumatic event. The person gradually learns to substitute new thoughts (for example, a raped women who sees all men as untrustworthy may revise perceptions of some men), and so to develop new emotional and behavioral patterns (for example, learning to date again or discovering how to enjoy sex again).

Medications for PTSD

To simplify a great deal, two kinds of medications are often prescribed for anxiety disorders such as PTSD. The first group (technically known as benzodiazepines, but more commonly referred to as minor tranquilizers, sleeping tablets, or anti-anxiety medications) provide rapid relief of anxiety, but are also associated with dependence. When the person rapidly discontinues medication, there is an increase in anxiety symptoms.

The second group are called antidepressants, a term that is somewhat inaccurate since these agents are widely prescribed for relief of anxiety. These agents may need to be taken for several weeks (4-8 weeks or longer in the case of PTSD) before a decrease in symptoms is noticed. However, these medications are not associated with dependence, and can therefore be discontinued relatively easily.

In general, there is far more evidence for the use of antidepressants in PTSD than for the use of benzodiazepines. There is even a small amount of data indicating that although the benzodiazepines can provide immediate relief of symptoms, over the long haul they can exacerbate PTSD. The antidepressants are particularly useful in patients who also suffer from depression (although they can be useful even in the absence of depression). They are also useful when there is a history of abuse of alcohol or other substances (as benzodiazepines are often avoided in such patients).

There is a range of other medications that may also be useful in certain patients. These include anticonvulsant medications, neuroleptics and other classes of medication. In general, such medications should be prescribed for PTSD only by a specialist psychiatrist. Specialists may prescribe two medications at the same time for people with PTSD who fail to respond to various single medications.

What's Related

• Frequently Asked Questions about PTSD
• Myths and Facts about PTSD
• Differential Diagnosis of PTSD Symptoms
• Who is Typically Diagnosed with PTSD?
• Associated Conditions of PTSD
• What Causes PTSD?
• Types of PTSD
• Facts about PTSD
• Symptoms and Diagnosis of PTSD
• An Overview of Post-Traumatic Stress Disorder (PTSD)