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Post-Traumatic Stress Disorder

Last updated May 7, 2018

Approved by: Maulik P. Purohit MD MPH

Post-Traumatic Stress Disorder (PTSD) is a syndrome characterized by “re-experiencing” a traumatic event, and it includes a decreased responsiveness and avoidance of any event, associated with the trauma.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Battle Fatigue
  • Post-Vietnam Syndrome
  • Shell Shock

What is Post-Traumatic Stress Disorder? (Definition/Background Information)

  • Post-Traumatic Stress Disorder (PTSD) is a syndrome characterized by “re-experiencing” a traumatic event, and it includes a decreased responsiveness and avoidance of any event, associated with the trauma
  • The traumatic events causing PTSD could be military combat, accident, rape, assault, torture, severe burns, etc.
  • Symptoms of PTSD last for more than a month. The individuals, who are affected, may keep reliving the event. They may also avoid anything that reminds them of the event
  • Post-Traumatic Stress Disorders are treated by a combination of pharmacological and non-pharmacological therapies. Earlier the symptoms arise after the initial trauma, and sooner the therapy is initiated, better is the prognosis

Who gets Post-Traumatic Stress Disorder? (Age and Sex Distribution)

  • Post-Traumatic Stress Disorder can occur at any age. The lifetime prevalence is about 8%
  • Both young children and adults could be affected
  • Females may be at higher risk for PTSD, than males
  • No racial or ethnic predisposition is noted

What are the Risk Factors for Post-Traumatic Stress Disorder? (Predisposing Factors)

Following are the risk factors for Post-Traumatic Stress Disorder:

  • PTSD is caused by the exposure to a traumatic event that involved deaths, or death threats, or serious injuries, and which evoked intense fear, helplessness, or horror in the individuals, who experienced them
  • The severity and duration of trauma, personal characteristics and adaptive capacity of the individual, and availability of social support, are all factors that interact to influence any development of PTSD
  • Child abuse can result in late onset Post-Traumatic Stress Disorder
  • Some individuals may have a higher risk of PTSD, because of a genetic predisposition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Post-Traumatic Stress Disorder? (Etiology)

  • Generally, the cause of Post-Traumatic Stress Disorder is different in different age groups. These stressors are usually overwhelming and involve events, such as war, terrorism, rape, natural disasters, prison stay, and domestic abuse
  • Individuals with PTSD may have experienced the trauma personally, or they may have witnessed the event in a manner causing them to feel personally threatened and helpless (e.g. a child witnessing a parent being assaulted)
  • During young adulthood, the stress sources are usually found in marriage, parent-child relationship, employment, and financial issues
  • During middle age, these may be marital problems, problems related to aging parents, etc.
  • In old age, the stress factors could be health problems, retirement, and thoughts of death
  • The most common cause of PTSD in women is sexual assault; in men it is military combat

What are the Signs and Symptoms of Post-Traumatic Stress Disorder?

Signs and symptoms of Post-Traumatic Stress Disorder can be categorized into 3 different types. These include:

  • The individuals have nightmares or flashbacks of the event; the event seems to be happening again and again. The bad dreams may occur over and over again, thus disrupting ones’ daily activities. Such symptoms are called “re-experiencing symptoms”
  • Some may feel detached and start avoiding persons or places that are related to the event. A feeling of guilt, anxiousness, irritability, loss of interest, and low-energy, are also some of the signs and symptoms seen. Sometimes, an individual may have difficulty in remembering the traumatic event. Such symptoms are called “avoidance symptoms”
  • Some may experience physiologic hyperarousal, which includes startle reactions, intrusive thoughts, illusions, over-generalized associations, sleep problems, dreams about the event, impulsivity, concentration difficulties, and hyper alertness. These symptoms are called “hyperarousal symptoms”

In addition to the above symptoms, personality changes, depression, substance abuse, and suicide, may also be associated with PTSD.

How is Post-Traumatic Stress Disorder Diagnosed?

A healthcare provider, such as a psychiatrist or a psychologist, trained to diagnose and treat mental illnesses, should be consulted to diagnose a Post-Traumatic Stress Disorder. After a through consultative process, a diagnosis of PTSD is made. The following diagnostic factors may be used:

  • The main feature, helpful in correctly identifying the disorder, is in determining the time period, when the traumatic events occurred in relationship to the symptoms
  • PTSD is typically present for more than 1 month period, in contrast to acute stress disorder. In acute stress disorder, the symptoms last for over 2 days and a maximum period of 1 month, with respect to the traumatic event
  • Any depression and substance-abuse must be ruled out, since both worsen the diagnosis
  • To be diagnosed with PTSD, an individual must have all of the following, for at least a period of 1 month:
    • At least one ‘re-experiencing’ symptom
    • At least three ‘avoidance symptoms’
    • At least two ‘hyperarousal symptoms’
    • Symptoms that make it hard to go about one’s daily life - going to school or work, being with friends, and taking care of important tasks, etc.
  • A differential diagnosis would include depression, obsessive compulsive disorder, acute intoxication or withdrawal, malingering, and borderline personality disorder. These conditions should be ruled out, prior to a PTSD diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Post-Traumatic Stress Disorder?

Complications of Post-Traumatic Stress Disorder could include:

  • Depression: The individual may start feeling hopeless and helpless, having feelings of survival guilt. The individual might believe that he/she should have died. In such cases, the risks for suicides are even higher
  • High risk for alcoholism, smoking, substance abuse, and other forms of addiction
  • Negative effects on work, relationships, and day-to-day activities

How is Post-Traumatic Stress Disorder Treated?

Treatment of Post-Traumatic Stress Disorder includes the following techniques:

  • Group psychotherapy, social support systems, and pharmacotherapy
  • Psychotherapy after the traumatic events will allow for the development of coping techniques and acceptance of the event
  • Talk therapy is an interactive process between a person (or a group of persons) and a qualified medical professional. The therapy is usually brief, simple, and helping to work through the traumatic experience, which leads to a quicker recovery and rapid return to work or normal activities
  • Pharmacotherapy includes first line treatment with selective serotonin re-uptake inhibitors, like paroxetine and sertraline. The medicine prazosin is used for nightmares
  • Second generation antipsychotics (e.g. risperidone and olanzapine), or beta blockers like propranolol, may be helpful for some patients
  • Relaxation techniques and hypnosis have been proven to be helpful in PTSD patients
  • Clarifying the problem event, allows the patient to begin viewing it, within a proper context. This may facilitate the sometimes difficult decisions, the patient may eventually have to make

How can Post-Traumatic Stress Disorder be Prevented?

  • Trauma cannot be prevented, but counseling, treatment, and supportive therapy for Post-Traumatic Stress Disorder can be a great source of relief to the affected individuals
  • According to National Institute of Mental Health, having certain ‘resilience factors’ may reduce the risk of developing PTSD. These factors include:
    • Seeking out support from other people, such as family and friends
    • Finding a support group after a traumatic event
    • Feeling good about one’s own actions, in the face of danger
    • Having a coping strategy, or a way of getting through the bad event, and learning from it
    • Being able to act and respond effectively, despite feeling fear

What is the Prognosis of Post-Traumatic Stress Disorder? (Outcomes/Resolutions)

The prognosis for an individual with Post-Traumatic Stress Disorder is based on a combination of many factors. These include:

  • Response to early catharsis, psychotherapy oriented towards acceptance of the event, with expectation of a quick recovery, and a return to previous functional levels
  • Resolution may be delayed, if the response or actions of others (family, friends, and colleagues) to the patient's difficulties are thoughtless and harmful

Additional and Relevant Useful Information for Post-Traumatic Stress Disorder:

Funded by the National Institute of Mental Health (NIMH), researchers are currently studying, as to how individuals can create “safety memories” that could replace bad memories, which form after a trauma. This could help with treatment of Post-Traumatic Stress Disorder (PTSD), in the future.

Following are a list of resources (mentioned by NIMH) to get help with PTSD:

  • Mental health resources
  • Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
  • Health maintenance organizations
  • Community mental health centers
  • Hospital psychiatry departments and outpatient clinics
  • Mental health programs at universities or medical schools
  • State hospital outpatient clinics
  • Family services, social agencies, the clergy
  • Peer support groups
  • Private clinics and facilities
  • Employee assistance programs
  • Local medical, and/or psychiatric societies

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Jan. 6, 2014
Last updated: May 7, 2018