Posttraumatic Stress Disorder (PTSD)

Posttraumatic stress disorder refers to a persistent psychological disturbance that occurs following a traumatic event. This disorder can follow almost any distressing event, including a natural or manmade disaster, physical or sexual abuse, or an assault or a rape.

Psychological trauma accompanies the physical trauma and involves intense fear and feelings of helplessness and loss of control. Posttraumatic stress disorder can be acute, chronic, or delayed. When the precipitating event is of human design, the disorder is more severe and more persistent. Onset can occur at any age, even during childhood.

Causes

Posttraumatic stress disorder occurs in response to an extremely distressing event, including a serious threat of harm to the patient or his family, such as war, abuse, or violent crime. It may be triggered by sudden destruction of his home or community by a bombing, fire, flood, tornado, earthquake, or similar disaster. It may also occur after the patient witnesses the death or serious injury of another person by torture, in a death camp, by natural disaster, or by a motor vehicle or airplane crash.

Preexisting psychopathology can predispose some patients to this disorder, but anyone can develop it, especially if the stressor is extreme.

Signs and symptoms

The psychosocial history of a patient with posttraumatic stress disorder may reveal early life experiences, interpersonal factors, military experiences, or other incidents that suggest the precipitating event. Typically, the patient may report that his symptoms began immediately or soon after the trauma, although they may not develop until months or years later. In such a case, avoidance symptoms usually have been present during the latency period.

Symptoms include pangs of painful emotion and unwelcome thoughts; intrusive memories; dissociative episodes (flashbacks); a traumatic re-experiencing of the event; difficulty falling or staying asleep, frequent nightmares of the traumatic event, and aggressive outbursts on awakening; emotional numbing (diminished or constricted response); and chronic anxiety or panic attacks (with physical signs and symptoms).

The patient may display rage and survivor guilt, use of violence to solve problems, depression and suicidal thoughts, and phobic avoidance of situations that arouse memories of the traumatic event (such as hot weather and tall grasses for the Vietnam veteran).

Other symptoms include memory impairment or difficulty concentrating and feelings of detachment or estrangement that destroy interpersonal relationships. Some have physical symptoms, fantasies of retaliation, and substance abuse.

Diagnosis

People with PTSD often do not seek professional help because they don't recognize the link between their symptoms and the traumatic event they experienced. They also may avoid discussing the problem because dealing with anything related to the event makes them feel anxious or helpless.

Treatment

A therapist or mental health professional might recommend medications for your child or teenager. These medications can help alleviate serious symptoms of depression and anxiety, which can help your child cope with school and other daily living activities while treatment for PTSD continues. Explain to your child that medication is often used as a temporary measure to help until she feels better on her own.

Finally, group therapy or support groups can be beneficial because they help your child understand that she is not alone. Groups also provide a safe atmosphere in which to share feelings. Ask your child's therapist for specific referrals or suggestions for a group that is suited to her needs.

Prevention

Counseling and crisis intervention soon after the event are important for people who have experienced extremely stressful situations. They could help prevent longer-term forms of PTSD and should be part of public health responses to groups at risk, such as disaster victims.