Q.What is  Post Traumatic Stress Disorder PTSD?

    A.  Not long ago, post traumatic stress disorder, PTSD, was known as  "shell shock" or "battle fatigue."  The older terms came into popular use during World War II.   Back then, PTSD was thought to affect only combat veterans.  Now, scientist know that, in fact, survivors of atrocities such as the Holocaust, torture, rape, domestic violence, child abuse, war, natural disasters, catastrophic illnesses, and  accidents, are susceptible to post traumatic stress disorder, PTSD.

       In medicine, the word "Post" is used as a prefix meaning behind or after.  The word "Traumatic or Trauma" refers to a catastrophic or horrific event.  It usual involves actual injury or threatened death.  The term "disorder"  has to do with a pathological condition of the mind or body.

      Posttraumatic Stress Disorder is a complex health condition that can develop in response to a traumatic experience – a life-threatening or extremely distressing situation that causes a person to feel intense fear, horror or a sense of helplessness. PTSD can cause severe problems at home or at work. Anyone can develop PTSD – men, women, children, young and old alike. Fortunately, PTSD is treatable. 

     It was once thought that PTSD was limited to direct victims of trauma.  It is now known that even  witnesses of traumatic events can suffer PTSD. Such trauma can result in a defining psychological experience that evokes feelings of panic, grief and helplessness. Trauma of great magnitude shatters a person's basic assumption about the world and personal safety, leaving the person feeling alienated and distrustful, or else overly clinging.

     PTSD Features.  It should be noted that a trauma is qualitatively different from the "stressors" associated with everyday "life events." The primary difference between a trauma and more or less normal "life events" is one of degree or magnitude.  For example, Traumas include: physical injury or wound caused by external force or violence,  earthquakes, massive flooding,  wars and extreme brutality.  While "stresses" are limited to common "life events" such as divorce, failure, illness, job changes, dislocation,  unexpected wealth or fortune and so on.

     Who gets PTSD.  Not everyone who survives a traumatic event will succome to PTSD.  Differences in reactions seem to depend on individual ability to cope with catastrophic stress.  Consequently, different people handle it differently.  Some seem to shake it off with little or no apparent effects;  while others develop the full-blown syndrome with may symptoms.

     Flashbacks and nightmares, avoidance behaviors and emotional numbing characterize the syndrome. In fact, scientists now believe that PTSD is relatively common. An estimated 3 to 10 percent of American's are thought to suffer from PTSD.

    Delayed on-set of PTSD.  While most victims  exhibit signs of PTSD immediately following a disaster; others may not become symptomatic for  many months or even years after a disaster.  In any event, PTSD can become a chronic psychiatric disorder that persists for decades and in some cases; last a lifetime.

     Causes of  PTSD. PTSDis caused by an experience of loss and is usually linked to an extraordinary situation. A diagnosis of PTSD is usually limited to those who have actually lived through a traumatic experience.

    Symptoms.  Other diagnostic criterion for PTSD, include 1) intrusive memories or vivid flashbacks of the experience, 2) avoidance behaviors, 3) hyperarousal symptoms, and 4) persistence of these symptoms for at least one month. 

      Intrusive symptoms might include daytime fantasies, traumatic nightmares, and even vivid breaks with reality. When such symptoms of "re-experiencing" occur, people naturally try to avoid or suppress them.  In extreme cases, the individual refuse to leave the house out of fear of coming across reminders of the trauma. 

      Some victims avoid all situations that might remind them of the trauma.  And, sometimes they even manage to avoid or blunt their emotions as well.  Many times such blunting interferes with or prevents  close ties with family and friends. 

    Typically, PTSD victims suffer from insomnia and irritability, as well as from hypervigilance. Such symptoms are thought to result from a condition known as  hyperarousal. Victims often show an exaggerated startle reaction, which is due to actual neurobiological changes within the nervous system. 

      PTSD victims may also have trouble concentrating or remembering current information. And, because of their chronic hyperarousal, do poorly at school, work, and in relationships. People with PTSD often try to resolve conflicts by withdrawing emotionally, or even by becoming violent.  And, because theycan't tolerate strong emotions they become adept at ignoring their feelings. This emotional numbing makes it difficult for them to participate meaningfully in relationships. 

     What To Do.    Patients with PTSD generally suffer a trio of general symptoms: reliving of the traumatic event in the form of flashbacks or nightmares; emotional numbing; and heightened states of arousal, like jumpiness and irritability. Most people experience some form of post-trauma stress for at least a month or two after an event. But if those acute problems become chronic, a person should seek treatment.

      Therapy can help restore confidence and belief in the world as a "safe" place.  However, to be effective , it should  be  started  soon after the trauma.  A  PTSD check up might be in order when symptoms last longer than a month following a severe trauma.

      The Clinician-Administered PTSD Scale (CAPS), a structured interview assessing adults for the 17 DSM-IV PTSD symptoms

      The Child and Adolescent Version of the Clinician-Administered PTSD Scale (CAPS-CA), a structured clinical interview designed to be a developmentally-adjusted counterpart to the CAPS for adults. 

      The Traumatic Events Screening Inventory - Child (TESI-C), an interview to elicit a child's report of exposure to potentially traumatic experiences
 ptsd@dartmouth.edu