Living With: PTSD (Posttraumatic Stress Disorder)

You may feel that you are on your own if you or a loved one has been diagnosed with Post-Traumatic stress disorder. However, PTSD is a common problem and many resources are available for people affected by this anxiety disorder. Approximately 5 percent of people in the United States suffer from PTSD, and 8 percent of the population has had PTSD at some point. PTSD is generally caused by a traumatic event and is twice as likely to affect women as it is to affect men. The treatments for PTSD are highly effective at helping the affected individual, especially with the support of family members.

Causes

PTSD is generally caused by personally experiencing or witnessing a traumatic event. This can include a single event such as a serious accident, assault or sudden death of a loved one. Repeated experiences during childhood can cause PTSD such as abuse or neglect. Combat situations like being tortured, taken hostage or imprisoned can also cause PTSD. Less severe forms of stress such as getting divorced, being fired from a job or failing in school don’t usually cause PTSD.

Diagnosis

A diagnosis of PTSD requires the patient to exhibit specific sets of symptoms that last for at least one month. These symptoms can be classified into three general categories. The patient may reexperience the traumatic event, which may take the form of flashbacks that occur while the patient is awake or nightmares when the patient is sleeping. The patient may also experience exaggerated physical or emotional reactions to events known as triggers. The second set of symptoms for PTSD is avoidance behavior of things that are related to the traumatic event. This also includes a loss of interest in related activities or feelings of detachment from other people. The third set of PTSD symptoms is an increased level of arousal, which includes sleeping difficulty, problems with concentration, irritability and an exaggerated startle response.

Types

PTSD may be divided into subtypes including acute, chronic and delayed PTSD. The symptoms of acute PTSD last between one to three months and seriously impair the patient’s ability to function. The diagnosis may be changed to chronic PTSD when the symptoms last for longer than three months. Chronic PTSD is less likely to improve without treatment than acute PTSD, and these patients should seek treatment immediately. Delayed PTSD occurs when the symptoms recur after being absent for at least several months. This recurrence often happens on the anniversary of the event that initially caused the PTSD or when the patient experiences a similar event.

Treatment

The treatments for PTSD may generally be divided into psychotherapy and medication. Some patients respond well to one treatment modality, while other patients require both modalities. Psychotherapy is usually the best treatment for PTSD when the symptoms are mild or when medication is contraindicated, as is the case in pregnant or lactating women. Some patients may have a medical condition that prohibits the use of psychoactive medication used to treat PTSD. Medication is more likely to be the preferred treatment for PTSD when the symptoms are severe or persistent. Patients who have other psychiatric problems may also benefit from medication, especially when psychotherapy has been ineffective by itself.

Psychotherapy

The most effective forms of treatment for PTSD include anxiety management, cognitive therapy and exposure therapy. Anxiety management teaches patients skills that will help them cope with the symptoms of PTSD. These include relaxation training, breathing retraining, positive thinking, assertiveness training and thought stopping. Cognitive therapy involves changing the patient’s irrational beliefs that interfere with psychological functioning and create emotional disturbances. Exposure therapy requires the patient to confront specific triggers that produce the symptoms of the PTSD. This can include psychological exposure in the form of memories or physical exposure to real situations. Play therapy can also be an effective psychotherapy for children with PTSD, in which children act out their anxiety with recreational activities.

Medication

Selective serotonin reuptake inhibitors are the preferred antidepressants for the medical treatment of PTSD. SSRIs currently available in the United States include Zoloft, Paxil, Prozac, Luvox and Celexa. Other antidepressants that may be prescribed when SSRIs are ineffective include Effexor. The next choice of medication for treating PTSD is the older tricyclic antidepressants such as Elavil, although they have more side effects than the newer drugs.

A psychiatrist may also prescribe mood stabilizers such as Depakote if the patient shows a limited response to antidepressants. Mood stabilizers are most often used to treat PTSD when the patient’s primary symptoms are prominent anger or irritability. Patients are also likely to receive mood stabilizers if they have bipolar disorder.

Antianxiety medications such as benzodiazepines can be used to treat PTSD when anxiety is its most dominant symptom. The primary choices include Valium, Xanax, Klonopin and Ativan. Benzodiazepines should only used on a short-term basis due to the potential of a dependence developing.

Family Support

Family members can be an important part of a patient’s recovery from PTSD if they are good listeners and provide emotional support. They must avoid the temptation to simply tell patients to get on with their lives. Patients usually have the best chance of recovering from PTSD when they receive encouragement from family members to share the memories of the traumatic event.

The family members of a PTSD patient can also help the patient get rid of the guilt they often feel by telling them they are not to blame and are not alone. Family members must also have realistic expectations about a patient’s recovery from PTSD, while encouraging patients to seek exposure to triggers. Support groups are also a common method of helping patients and family members deal with PTSD. These support groups are available through a variety of organizations.

For more on the topic of Living With PTSD, we’ve included the following expert consensus documents as reference materials:

• Guide for Patients and Families in pdf

View Resources

• UOregon – War zone stress reaction and PTSD
• IOM – PTSD treatment
• Mason – information about PTSD
• UIC – veterans with PTSD
• SDSU – The psychobiology and psychopharmacology of PTSD