POST-TRAUMATIC STRESS DISORDER (PTSD)

See also MHANYS Fact Sheet "Coping With Disaster and Trauma"

Life-disrupting traumatic events take many forms. The event could be natural, such as surviving an earthquake or tornado; or it could be human-caused, such as rape, a workplace shooting or bombing. The threat of harm, or witnessing serious harm or violent death come to another person, can create as serious psychological distress as if one was actually harmed him- or herself. Long-term abuse, such as childhood physical, mental, or sexual abuse; domestic abuse; prolonged torture; being held hostage; or imprisoned in a prisoner-of-war camp or concentration camp, can cause a tremendous amount of sustained traumatic stress for a person.

Many survivors do recover from a traumatic event by utilizing their own skills for coping, and with the help of an understanding support system of family and friends, and caring listeners whom the survivor can talk to about his or her experiences. Others benefit additionally from mental health counseling.

Some survivors, however, find it difficult to get beyond powerful negative emotions brought about by the traumatic event. They may feel a great deal of anger, insecurity, and/or shame which they may direct against themselves thinking they should have behaved differently during the event, or they may direct these feelings against those they hold responsible for the event. They may feel that they should be able to 'handle it' on their own and are ashamed to reach out to others for help. They may try to repress disturbing memories and anguish, or may attempt to escape negative feelings through drug or alcohol use or other unhealthy coping strategies.

When individuals who have experienced a traumatic event do not have a healthy outlet for, or appropriate ways of coping with, negative emotional reactions to the event, stress builds up. Consequent fears, worry, doubt, or pessimism can drive up one's level of tension and anxiety. Individuals who already experience anxiety may find the situation exacerbated.

Stress can manifest itself as physical symptoms, called 'psychosomatic illness'. Gastric distress, headaches and other otherwise unexplainable aches and pains, dizziness, trembling, feelings of suffocating, nausea, a pounding or rapid heartbeat, or a tightness in the chest that can feel much like a heart attack, can all be brought about by stress. Stress and anxiety can also trigger panic attacks, in which physical symptoms may occur along with extremely strong negative thoughts and emotions. During a panic attack an individual may feel an overwhelming sense of imminent danger. One may feel an intense urge to flee, fear of losing control or that one was "losing one's mind", feel detached from self or surroundings, or feel that one was going to die.

When symptoms of stress and anxiety persist for longer than four weeks following a traumatic event a person may be diagnosed with Post Traumatic Stress Disorder (PTSD). In some cases, the symptoms of stress that characterize PTSD may emerge months after the event, as unresolved distressing emotions eventually overwhelm a person's psychological defenses.

One does not have to have all of the symptoms listed below to be diagnosed with PTSD, but if emotional distress continues to disrupt life, to interfere with interpersonal relations, or to impair one's ability to function at work, socially, at home, or in general, a survivor of a traumatic event should be evaluated for PTSD by a mental health professional.

Symptoms of PTSD in adults include:

• Recurrent and intrusive distressing recollections of the event, or recurring nightmares of the event
• "Flashbacks" or having the sense of reliving the experience
• Intense distress, fear, helplessness, or horror in response to cues that trigger recollections of the event
• Efforts to avoid thoughts, feelings, or conversations associated with the traumatic event
• Efforts to avoid activities, places, or people that trigger recollections of the event
• Developing phobias of situations, activities or objects that serve as reminders of the event
• "Blocking out" memories of the event or an inability to recall aspects of the event
• Loss of interest or diminished interest in previously-enjoyed activities
• Feelings of detachment, estrangement, or alienation from others
• Feelings of guilt for having survived the event when others died, or feeling guilt over things one had to do in order to survive
• Emotional "numbing"
• Sense of a foreshortened future (e.g. not expecting to have a career, marriage, children, normal lifespan)
  
• Difficulty falling asleep or staying asleep
  
• Irritability or outbursts of anger
  
• Difficulty concentrating
  
• Hypervigilance
  
• Exaggerated startle response

(taken from DSM-IV)

Certain factors may intensify a case of PTSD, or place a person at greater risk of developing it following a traumatic event.

• Significant stressors going on in one's life - such as divorce, family conflict, death of a loved one, or loss of a job - just prior to a traumatic event
• Exposure to a traumatic event earlier in life, including having been abused as a child
• Severity of the traumatic event
• Duration of the traumatic event
• Proximity to the traumatic event (i.e. whether it happened to you or you witnessed it.)
• Poor coping skills for stress in general
• Lack of support from one's social network, or stigmatization
• Feelings of shame or blame connected to the traumatic event
• Some evidence suggests that human-caused trauma - such as torture, abuse, rape, or assault - may increase the severity or duration of PTSD more so than natural disasters.

PTSD & Children and Adolescents

Children and adolescents are vulnerable to stress, just as adults are. Exposure to traumatic events and prolonged exposure to highly stressful situations can lead to anxiety disorders including Post-Traumatic Stress Disorder. The symptoms of PTSD in children, however, differ from those of adults.

Very young children, including infants and toddlers, often express their feelings of stress in non-verbal ways. In very young children symptoms include lack of interest social activities and general listlessness. They may withdraw from social situations. Things that formerly interested them, or other things and activities that would normally interest a very young child may no longer engage them. An increase in more generalized fears not necessarily related to the trauma, such as separation anxiety or stranger anxiety, excessive whining, too much crying or too little crying, and - if the child is speaking - verbal statements expressing sadness, may all be signals of a stress disorder.

Preschool- and school-aged children may lose interest in things and activities they once enjoyed, and may withdraw from social activities. They may re-enact the traumatic event or some aspect of it repeatedly in their play or their artwork. They may complain of otherwise unexplainable physical maladies, such as stomachaches or headaches. They may frequently express sadness or pessimism. Older children may express morbid or even suicidal thoughts. Younger children may revert to behaviors they had grown out of, such as bed-wetting or thumb-sucking. School-age children exposed to trauma may engage in "omen formation," in which a child stays on the alert for omens or warning signs of another traumatic occurrence, in an effort to be able to 'save' him- or herself from future trauma. Other symptoms can include restlessness, excessive worrying, changes in sleep-patterns, significant changes in weight - loss or gain, tearfulness, aggressiveness, and becoming easily frustrated.

Adolescents' symptoms generally resemble those of adults. Changes at school, such as drop in grades or behavioral problems, may arise from a stress disorder. Social isolation, low self-esteem, extreme sensitivity to criticism or rejection - real or imagined, self-destructive behavior, and/or difficulties in interpersonal relationships may all be connected to PTSD.

These symptoms may sound rather vague, and it is important to note marked and sustained changes in behavior in children following a traumatic experience, rather than trying to match behaviors to a list of symptoms.

If you suspect a child may be experiencing PTSD, it is important to seek an evaluation from a qualified mental health professional knowledgeable in treating children. PTSD often co-occurs with clinical depression or other mental health disorders. Older children may also begin abusing drugs or alcohol, as is common with adults with PTSD. A mental health professional will be able to create a comprehensive treatment plan addressing all the needs of the child.

Treating PTSD
Effective treatment plans vary from individual to individual. Receiving counseling from a mental health professional and/or participating in a self-help group can be very effective in helping one deal with emotionally painful and negative aftereffects of a traumatic event. Therapies such as cognitive-behavioral therapy (CBT) and brief psychodynamic psychotherapy can help someone with PTSD confront negative emotions and reactions brought about by a traumatic event, and provide healthier ways of dealing with trauma and stress. Medications can relieve symptoms of anxiety and depression and sleep disturbances that frequently co-occur with PTSD.

The symptoms caused by PTSD need not be permanent responses trauma. One should contact a mental health professional for an evaluation if symptoms of stress and anxiety following a traumatic event are impairing one's ability to function in any aspect of day-to-day life. The longer it is left untreated the more difficult it can be to treat. Post-Traumatic Stress Disorder is treatable. While it may be unrealistic to expect that one's life will ever "be the same" again, it is entirely possible to regain a normal life and greatly improve one's ability to deal with stress and trauma.

The following online resources were consulted in putting together this Fact Sheet:

The National Center for Post-Traumatic Stress Disorder offers a tremendous amount of information on PTSD at their Website, http://www.ncptsd.org

"Post-Traumatic Stress Disorder" http://www.nmha.org/infoctr/factsheets/34.cfm - National Mental Health Association

"Post Traumatic Stress Disorder" http://www.nami.org/helpline/ptsd.html - National Alliance for the Mentally Ill

"Managing Traumatic Stress: Tips for Recovering From Disasters and Other Traumatic Events" http://helping.apa.org/therapy/traumaticstress.html - American Psychological Association

See other Information Center Fact Sheets.

The Mental Health Association in New York State, Inc. is a 501(c)(3) not-for-profit organization, with 33 local affiliate MHAs serving 54 counties. MHANYS is working to ensure available and accessible mental health services for all New Yorkers.