Post-traumatic Stress Disorder (PTSD):
Symptoms, Types and Treatment
Post-traumatic stress disorder (PTSD) is an extreme stress response to a traumatic event that threatens your safety or makes you feel helpless. If you have PTSD, you may believe that you’ll never get over what happened or feel normal again. But with treatment and the support of your loved ones, you can overcome your symptoms, reduce the painful memories, and move on with your life.

What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after you’ve gone through a traumatic experience, usually one that has caused or threatened death or severe injury. Most people associate PTSD with battle-scarred soldiers, and indeed, military combat is the most common cause of PTSD in men. But any catastrophic life experience—a hurricane, a mugging, a horrific accident—can trigger the disorder, especially if the event is perceived as unpredictable and uncontrollable.

Traumatic events that can lead to PTSD include:

War
Natural disaster
Car or plane crash
Terrorist attack
Rape
Kidnapping
Violent assault
Sexual or physical abuse

PTSD can affect those who personally experience the catastrophe, those who witness it, and those who pick up the pieces afterwards, including emergency workers and law enforcement officers. It can even occur in the friends or family members of those who went through the actual trauma.

Symptoms of post-traumatic stress disorder (PTSD)
PTSD develops differently from person to person. If you’ve lived through a traumatic incident, your symptoms may appear within hours or days of the event, or they may take weeks, months, or even years to develop. Symptoms can arise suddenly, gradually, or come and go over time.

There are three main types of PTSD symptoms: re-experiencing the traumatic event, avoiding reminders of the trauma, and symptoms of hyperarousal or heightened anxiety. In the days or months following a traumatic event, you may find yourself alternating between re-experiencing the event and avoiding reminders of it, with symptoms of increased arousal as the common backdrop.

Re-experiencing the traumatic event
The most disruptive symptoms of PTSD involve the flashbacks, nightmares, and intrusive memories of the traumatic event. You may be flooded with horrifying images, sounds, and recollections of what happened. You may even feel like it’s happening again. These symptoms are sometimes referred to as intrusions, since they involve memories of the past that intrude on the present.

If you have PTSD, you may re-experience the traumatic event or intrusion in several ways:

Intrusive memories of the traumatic event
Bad dreams about the traumatic event
Flashbacks or a sense of reliving the event
Feelings of intense distress when reminded of the trauma
Physiological stress response to reminders of the event (pounding heart, rapid breathing, nausea, muscle tension, sweating)
These distressing symptoms can appear at any time, sometimes seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event: a noise, an image, certain words, a smell.

Examples of PTSD Triggers
For an auto accident survivor: The smell of gasoline
For a combat veteran: The sound of a helicopter or firecrackers
For a rape victim: The sight of a person suddenly appearing around the corner
For a carjacking victim: The song that was playing on the radio at the time of the assault
The intrusions or flashbacks that result from these PTSD triggers are terrifying, disorienting, and unpleasant. The natural response is to protect yourself by avoiding them. This leads to the second major cluster of PTSD symptoms.

Symptoms of avoidance
Symptoms of avoidance are prominent in PTSD. You may persistently avoid situations that remind you of the traumatic event you experienced, minimize the event’s significance, or push all thoughts of it out of your mind. Avoidance can also take the form of detachment and apathy.

Symptoms of avoidance include:

Avoiding thoughts, feelings, or conversations associated with the trauma
Avoiding activities, places, or people that remind you of the trauma
Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached or estranged from other people
Feeling emotionally numb, especially toward loved ones
Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)
Symptoms of increased arousal
PTSD can cause you to feel and react as if you’re constantly in danger. In this state of chronic hyperarousal, your mind and body is on constant red alert, making it impossible to fully relax, be productive, or enjoy life.

The PTSD symptoms of increased arousal and anxiety include:

Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance, or being constantly “on guard”
An exaggerated startle response, or jumpiness
Other common symptoms of PTSD
In addition to the PTSD symptoms of intrusion, avoidance, and hyperarousal, you may also experience a number of other distressing symptoms. If you survived an event that killed others, you may feel guilt that you lived while others died. You may also blame yourself for what happened or suffer from feelings of shame and hopelessness. You may also experience an array of physical symptoms linked to PTSD, including headaches, stomach problems, and chest pain.

Over the long-term, PTSD can also lead to many complicating problems, including depression, panic attacks, and other psychological issues. Substance abuse is another common complication, especially if you’re turning to alcohol and drugs in an attempt to handle the symptoms of PTSD.

Symptoms of PTSD in children and adolescents
In children—especially those who are very young—the symptoms of PTSD can be different than the symptoms in adults. Symptoms in children include:

Fear of being separated from parent
Losing previously-acquired skills (such as toilet training)
Sleep problems and nightmares without recognizable content
Somber, compulsive play in which themes or aspects of the trauma are repeated
New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters).
Acting out the trauma through play, stories, or drawings.
Aches and pains with no apparent cause
Irritability and aggression
Post-traumatic stress disorder (PTSD) causes and risk factors
Most people who live through a traumatic or life-threatening event experience some symptoms at first, such as anger, shock, and anxiety. However, not everyone goes on to develop PTSD. While it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that appear to increase a person’s vulnerability to it.

Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.

Other risk factors for PTSD include:
Previous traumatic experiences, especially in early life
Family history of PTSD or depression
History of physical or sexual abuse
History of substance abuse
History of depression, anxiety, or another mental illness
High level of stress in everyday life
Lack of support after the trauma
Lack of coping skills

Getting help for post-traumatic stress disorder (PTSD)
If you think that you or a loved one has PTSD, it’s important to seek help right away. This is particularly important if your symptoms are interfering with your work or home life. The faster PTSD is diagnosed and treated, the better the long-term outlook. There are many places you can turn for help, including your family doctor or a mental health professional such as a psychiatrist or counselor.

Unfortunately, many people with PTSD don’t seek out the treatment they need. Some resist treatment because they’re worried what others will think or believe that they should be able to get over the problem on their own. Others aren’t ready to face the trauma and the strong emotions associated with it.

Why Should I Seek Help for PTSD?
Early treatment is better
Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.

PTSD symptoms can change family life
PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.

PTSD can be related to other health problems
PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.

Source: National Center for PTSD

If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.

Finding a therapist for PTSD
When looking for a therapist for PTSD, seek out mental health professionals who specialize in the treatment of trauma and PTSD. Beyond credentials and experience, it’s important to find a therapist who makes you feel comfortable and safe, so there is no additional fear or anxiety about the treatment itself. Finding the right treatment provider can take time, but a good place to start is with your doctor. You may also want to ask trusted friends or family members for recommendations. You can also call a local mental health clinic, psychiatric hospital, or counseling center.

Help for U.S. Veterans with PTSD
If you’re a veteran suffering from PTSD or trauma, you can turn to your local VA hospital or Vet Center for help. Vet Centers offer free counseling to combat veterans and their families. To find out more about the resources and benefits available to you, you can also call the VA Health Benefits Service Center at 1-877-222-VETS.

Click here for a nationwide directory of facilities for veterans, including VA hospitals and Vet Centers.
Source: U.S. Department of Veterans Affairs

Treatments for post-traumatic stress disorder (PTSD)
Treatments for PTSD relieve symptoms by helping you deal with the trauma you’ve experienced. Rather than avoiding the trauma and any reminder of it, you’ll be encouraged in treatment to recall and process the event that caused your PTSD. In treatment for PTSD, you’ll also:

Explore your thoughts and feelings about the trauma
Work through feelings of guilt, self-blame, and mistrust
Learn how to cope with and control intrusive memories
Address problems PTSD has caused in your life and relationships
In addition to offering an outlet for emotions you may have been bottling up, treatment for PTSD will also help restore your sense of control and reduce the powerful hold the memory of the trauma has on your life.

Cognitive-behavioral therapy for post-traumatic stress disorder (PTSD)
Cognitive-behavioral therapy is believed to be the most beneficial treatment for PTSD. There are several types of cognitive-behavioral therapies.

Exposure therapy - According to a October 2007 report issued by the Institute of Medicine, there is strong evidence for the effectiveness of exposure therapy in PTSD treatment. Exposure therapy for PTSD involves carefully and gradually “exposing” yourself to thoughts, feelings, and situations that remind you of the trauma. Often, you’ll start by focusing on a memory that is upsetting but still manageable, then slowly work your way up to more upsetting memories in a process known as systematic desensitization. As you think about and re-experience these memories in a safe, controlled environment, they will start to feel less intense and overwhelming.
Cognitive restructuring – In cognitive restructuring, the focus of treatment is to identity upsetting thoughts about the traumatic event–particularly thoughts that are distorted and irrational—and replace them with more accurate, balanced views. For example, you may blame yourself for failing to save a fallen comrade, even if you did everything you could. Cognitive restructuring would help you challenge this troubling thought and learn to look at what happened in a healthier way.
EMDR (Eye Movement Desensitization and Reprocessing) – EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. For example, in EMDR therapy you might talk about the traumatic event while following your therapist’s finger back and forth with your eyes. Eye movements and other bilateral forms of stimulation are thought to work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress, leaving only frozen emotional fragments which retain their original intensity. Once EMDR frees these fragments of the trauma, they can be integrated into a cohesive memory and processed.
To learn more, see EMDR Therapy: A Guide to Making An Informed Choice.

Finding a Cognitive-Behavioral Therapist for PTSD
Click here to find a therapist who specializes in cognitive-behavioral therapy. You can narrow your search to therapists who specialize in the treatment of PTSD.

Source: Association for Behavioral and Cognitive Therapies

Other therapies for post-traumatic stress disorder (PTSD)
In addition to cognitive-behavioral therapy, you may also benefit from other PTSD treatments, including individual psychotherapy, family therapy, or group therapy. Since PTSD affects both you and those close to you, family therapy can be especially productive. Family therapy can help your loved ones understand what you’re going through. It can also help everyone in the family communicate better and work through relationship problems.

Medication treatment for post-traumatic stress disorder (PTSD)
Medication is sometimes prescribed to people with PTSD, usually to relieve symptoms of depression or anxiety. The SSRIs, a type of antidepressant that includes drugs such as Prozac and Zoloft, are the medications most commonly used for PTSD. The SSRIs do not cure PTSD, but they may help you feel less sad, worried, and on edge.

Coping with post-traumatic stress disorder (PTSD)
Recovery from PTSD is a gradual, ongoing processing. Healing doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many things you can do to cope with residual symptoms or reduce your anxiety level.

Positive ways of coping with PTSD include:

Learning about trauma and PTSD.
Joining a PTSD support group
Practicing relaxation techniques
Confiding in a person you trust
Spending time with positive, supportive people
Avoiding alcohol and drugs

Anxiety

Introduction
Anxiety is defined as “mental uneasiness” or “distress arising from fear of what may happen.” It has several different manifestations. Individuals suffering from panic disorder experience recurrent, unexpected panic attacks. Those with generalized anxiety disorder (GAD) chronically worry too much about a variety of things, and experience symptoms such as restlessness, agitation, or feeling keyed up, muscle tension, fatigue, irritability, and trouble with concentration and sleep. Persons suffering from social anxiety disorder experience extreme fear and avoidance of social and/or performance situations.

Anxiety disorders, as a group, are the most common mental illness in America. More than 19 million American adults are affected by these debilitating illnesses each year. Children and adolescents can also develop anxiety disorders. Anxiety is currently perhaps the most fashionable idiom in the parlance of American psychiatry and medicine. It is used almost synonymously with stress which in turn has been associated with everything from increased risk of heart attack and cancer to the common cold. The general consensus within the medical community is that anxiety can in many instances, be a causative factor in physical illness as well as exacerbate it.

Context
Seven separate studies of 220 hospitalized psychiatric inpatients. All were controlled scientific studies employing measures of anxiety with known reliability and validity. There are four replications using the state anxiety scale ( STAI-S) and three using the tension/anxiety factor on the Profile of Mood States ( POMS-T/A). Most of the studies were for fifteen days-Monday through Friday over a period of three weeks. The TMAS (Taylor Manifest Anxiety Scale) study was for ten days only and the IPAT (Institute for Personality and Ability Testing) for six. Studies using the STAI-S used five or six thirty minute sessions whereas one of the POM-T/A studies used CES for thirty minutes a day over ten days and two others at a rate of one forty minute session per day for fifteen days

Graphical Interpretation
The red bar represents the patients’ scores on the anxiety measure before CES treatment (PRE); the blue bar, their score after CES therapy (POST).

Results
The findings of all tests conducted were consistent: Most patients responded positively to CES treatment within the first week or ten days; the more entrenched forms of anxiety, within ten days to three weeks. Resultant post CES test scores shows improvement ranging from approximately 30 percent to almost 65 percent. The variation was due to different anxiety scales measuring different facets of anxiety, only some of which are shared in common. In one study, investigators deliberately used patients with low suggestibility levels and compared them with those with high suggestibility levels. No differences were found, thus ruling out a placebo effect.

The net result of these studies shows CES to be a predictably effective treatment for anxiety and related disorders as measured by these scales. There has never been a controlled study of anxiety in which CES patients did not improve more significantly than did the controls.

Depression

Depression is the state in which the individual feels sad, helpless, and disinterested in life. Clinical depression affects mood, mind, body, and behavior. Depression is the most frequently seen psychiatric disorder among both hospitalized inpatients and those in outpatient psychiatric care. Research has shown that in the United States about 19 million people—one in ten adults-experience depression each year, and nearly two-thirds do not get the help they need.

There are many kinds of depression, several with deep underlying psychiatric causes. Short of biochemical analysis, however, they are usually difficult to differentiate. Psychological testing can rate depressive states according to intensity but cannot differentiate causative factors. Despite the variations in etiology of depressive states, however, treatments are very similar.

Context
Five studies employing three different measures and 189 different patients suffering from depression. All were in treatment facilities, either psychiatric or chemical dependency. Each of the studies was conducted under controlled conditions; one, double-blind, four, single-blind.

Graphical Interpretation
Under each set of bars is the psychological test used to measure depression in each study including a general average of all results. The red bar shows patients’ scores before using CES—the higher the bar, the greater the depression. The blue bar shows the level of depression after using CES.

Results
There have been three replications of findings on the Profile of Mood States, Depression-Dejection factor, and two replications using the Zung Self-rating Depression Scale (POMS-D and ZSDS, respectively on the graph). All yielded similar results. The movement on the ZSDS scale is less because one study was for one week and the second, for ten days. The studies which ran over a span of three weeks, however, provide evidence of an even more dramatic decline in depression.

All three tests yielded congruent results—an average reduction of approximately 50% in the depression raw scores measured before and after CES treatment. All types of depression responded dramatically to CES. CES showed itself to be effective in treating the lighter reactive type within a week or ten days and the deeper seated variety in three weeks.

Because those with deep-seated depression tend to view CES as a modern “miracle,” and expect instantaneous relief, they can actually become more depressed initially while using CES unless the therapist specifically tells them that at least three weeks of treatment are required. With this added clinical support, even the most deep-seated depressions responded well. The study controlled for possible placebo effects did not show any. There has never been a reduction in the scores of sham CES treated controls.

As in the anxiety studies, while some depression studies were “sacrificed” in the attempt to discover how much treatment was necessary to correct the various intensities of depression, there has never been a controlled scientific study in which CES was not shown to significantly improve reactive depression in a week to ten days and deep seated depression within three weeks. All types of depression studied so far, have responded dramatically to CES treatment.

These Brain Waves May Tame Fibromyalgia
(continued)
continued…
 
And 90% of the treated patients reported that their quality of life had improved as a result of treatment, while 20% of the patients who were in the fake treatment group said their quality of life had declined.
 
These results are almost too good, says Robert S. Katz, MD.
 
“Fibromyalgia is a very challenging condition from the standpoint of treatment,” says Katz, associate professor of medicine at Rush Medical School, in Chicago. “I would be very impressed with a treatment that had a 50% improvement, but 90% makes me very skeptical.”
 
Some other treatments have claimed equally impressive initial results, Katz says, but the improvement is seldom long-lasting.
 
“I would like to see some findings on the long-term results of this treatment,” he says. Even in the short term, Lichtbroun’s findings “need to be reproduced by other investigators before we can consider recommending this treatment,” he adds.
 
Lichtbroun says he, too, would like to see the findings replicated in another study. Until then, he says, he is offering all his fibromyalgia patients “one free treatment with the devices.”
 
Offering a freebie treatment is important because the electrotherapy devices range in price from $400 to $700, he says. “Some insurance companies will pay for the device, but many won’t, and so the patient has to pay for it.”

Biochemical Origin of Pain

Pain researchers propose that Fibromyalgia and other pain syndromes should be reclassified and treated based on their unique inflammatory profiles. Pain researchers are wanting it to be made known that the origin of all pain is inflammation and the inflammatory response. The biochemical mediators of inflammation include cytokines, neuropeptides, growth factors and neurotransmitters.

They all agree that whether the pain is acute pain, chronic pain, peripheral pain, central pain, or neuropathic pain, it is all coming from the same origin - inflammatory responses.

Pain researchers are proposing that treatment of pain syndromes should be based on the following principles:

1. Determination of the inflammatory profile of the pain syndrome;

2. Inhibition or suppression of production of the appropriate inflammatory mediators, e.g. with inflammatory mediator blockers or surgical intervention where appropriate;

3. Inhibition or suppression of neuronal afferent and efferent (motor) transmission, e.g. with anti-seizure drugs or local anesthetic blocks;

4. Modulation of neuronal transmission, e.g. with opioid medication.

The L.A. Pain Clinic has successfully treated a variety of pain syndromes by using the above principles. According to the article,

“This theory of the biochemical origin of pain is compatible with, inclusive of, and unifies existing theories and knowledge of the mechanism of pain including the gate control theory, and theories of pre-emptive analgesia, windup and central sensitization.”

These Brain Waves May Tame Fibromyalgia
By Peggy Peck

May 1, 2001 — As many as six million Americans are living with fibromyalgia, and in most cases they are living with the constant, unrelenting symptoms of the condition: widespread pain in muscles and joints, sleep disturbances, irritable bowel syndrome, and anxiety, to name a few. But very positive results from a new study suggest that sending mini-currents of electricity through the brain — a procedure called cranial electrotherapy stimulation –may provide relief from some of these symptoms.
 
Alan S. Lichtbroun, MD, says he learned about the electrotherapy technique while searching for better treatments for his many fibromyalgia patients.
 
“This technique is gaining wide acceptance at chronic pain treatment centers,” says Lichtbroun, assistant professor at Robert Wood Johnson Medical School, in East Brunswick, N.J. “At first I looked at this device very skeptically — and even now I am beginning to see some patients who had a marked response at the beginning are gradually beginning to deteriorate — so again I wondered if the machine had lost its power. But what I’ve found is that patients eventually lose their incentive to use the machine, and less frequent use appears to mean a return of symptoms.”
 
The machine Lichtbroun refers to is the Alpha-Stim CES device made by Electromedical Products International Inc., of Mineral Wells, Texas. Patients using the device clip electrodes to their earlobes, which transmit low levels of electricity back and forth, through the head.
 
In the study, published in the April issue of the Journal of Clinical Rheumatology, 20 patients were assigned to two groups, one that got cranial electrotherapy stimulation and another that got fake devices clipped to their ears that didn’t transmit electricity. Because the electric currents are so low they cannot be felt as they pass through the brain, participants didn’t know whether or not they received active stimulation.
 
Both groups were told to use the devices for an hour a day for three weeks.
 
For therapeutic use, patients are taught how to use the devices so that “they can undergo the treatment in their own homes, at a time that is convenient for them,” says Lichtbroun.
 
That’s a big advantage over some other approaches, such as massage, because it doesn’t require “special appointments or a trip outside the home,” he points out.
 
The results of the electrotherapy treatment were “very surprising,” says Lichtbroun.
 
Physicians determine how severe a case of fibromyalgia is by testing “tender points” — areas of highly localized pain. The study participants who had real electrotherapy treatment had a 28% improvement in tender-point scores and a 27% improvement in the amount of general pain they felt.
 
But most surprising, says Lichtbroun, was that only 5% of the treated patients reported having sleep disturbances after treatment, compared with 60% who had sleep problems before beginning electrotherapy treatments.

Biochemical Origin of Pain

Pain researchers propose that Fibromyalgia and other pain syndromes should be reclassified and treated based on their unique inflammatory profiles. Pain researchers are wanting it to be made known that the origin of all pain is inflammation and the inflammatory response. The biochemical mediators of inflammation include cytokines, neuropeptides, growth factors and neurotransmitters.

They all agree that whether the pain is acute pain, chronic pain, peripheral pain, central pain, or neuropathic pain, it is all coming from the same origin - inflammatory responses.

Pain researchers are proposing that treatment of pain syndromes should be based on the following principles:

1. Determination of the inflammatory profile of the pain syndrome;

2. Inhibition or suppression of production of the appropriate inflammatory mediators, e.g. with inflammatory mediator blockers or surgical intervention where appropriate;

3. Inhibition or suppression of neuronal afferent and efferent (motor) transmission, e.g. with anti-seizure drugs or local anesthetic blocks;

4. Modulation of neuronal transmission, e.g. with opioid medication.

The L.A. Pain Clinic has successfully treated a variety of pain syndromes by using the above principles. According to the article,

“This theory of the biochemical origin of pain is compatible with, inclusive of, and unifies existing theories and knowledge of the mechanism of pain including the gate control theory, and theories of pre-emptive analgesia, windup and central sensitization.”