What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a condition that can happen after you see or are involved in an event involving physical harm. The event usually involves a risk of injury or death to the person or to someone else. The person with PTSD may have only seen the event and not been in danger themselves. The stressful event may be:

• Physical or sexual abuse
• Violence, such as war, shootings, terrorist attacks, or robbery
• A severe accident
• The death of a loved one
• A natural disaster, such as a flood, earthquake, hurricane, tornado, or fire

What is the cause?

It is not known why one person will have PTSD after a trauma like a robbery, rape, battle, or severe car accident while another person may not. Things that increase the risk for PTSD after such an event include:

• A family or personal history of mental illness
• Long-term or repeated exposure to stressful events
• The severity of the stressful event
• Lack of family and social support after the event
• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• People with this disorder may have physical changes in their brain.

PTSD can start at any age.

What are the symptoms?

Symptoms may start right after the stressful event or may start 3 or more months later. When stressful events, such as abuse, keep happening, the symptoms may come on slowly and get worse over time.

There are 3 types of PTSD symptoms.

1. You act or feel like the event is happening again (flashbacks). You may:
   • Daydream or have repeated thoughts, emotions, and images of the event
   • Have nightmares about the event
   • Have panic attacks when things happen that remind you of the stressful event
2. You avoid things related to the stressful event. You may:
   • Avoid conversations, thoughts, or places that remind you of the event
   • Forget parts of the event
   • Feel and act very distant and detached from others
   • Show fewer emotions or show more sudden and extreme emotional reactions, such as anxiety, panic, anger, or guilt
   • Feel hopeless about the future
3. You are physically alert all or most of the time. You may:
   • Have trouble falling or staying asleep
   • Be very irritable or have angry outbursts
   • Have trouble concentrating or staying focused
   • Be startled or jump at sudden or loud noises
   • Feel very suspicious and be on guard all the time

You may also feel very fearful, helpless, angry, or sad. You may feel guilty, thinking that you somehow caused the event or could have prevented it. You may deny what happened. Anniversaries of the event can often cause a flood of emotions and bad memories.

Some of these symptoms are normal after a stressful event. For most people, these symptoms stop within a month after the stressful event. If you have PTSD, you keep having these symptoms for months or years.

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms, medical and family history, and any medicines you are taking. Your provider will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

PTSD can be successfully treated with therapy, medicine, or both.

Therapy

• Cognitive behavioral therapy (CBT) is a way to help you identify and change views you have of yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn new ways to think and act.
• Eye movement desensitization and reprocessing (EMDR) helps you cope with feelings and thoughts about distressing past events. You move your eyes back and forth, usually following the therapist’s hand or pen, while you recall the event. Over time, you become less upset about the event.
• Exposure and response prevention therapy helps you confront your fears by gradually increasing your exposure to them. This process also involves learning ways to relax, such as breathing exercises. With help from your therapist, you learn to overcome your anxiety.
• Family therapy is often very helpful. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family to make changes.

Medicine

Several types of medicines can help. Your healthcare provider will work with you to select the best one for you. You may need to take more than one type of medicine.

Other treatments

Learn ways to relax, such as deep breathing, mental imaging, or relaxing muscle groups one at a time. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.

How can I take care of myself?

• Get support. Talk with your family and friends. Consider joining a support group.
• Learn ways to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example, take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs. Exercise according to your healthcare provider’s instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. Take all medicines as directed by your provider or therapist. It is very important to take your medicine even when you are feeling and thinking well. Without the medicine, your symptoms may not improve or may get worse. Talk to your provider if you have problems taking your medicine or if the medicine doesn’t seem to be working.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.
• Get emergency care if you or a loved one has serious thoughts of suicide, violence, or harming others. Seek immediate help if you have severe chest pain or trouble breathing.
• You can get more information from:
  • National Institute of Mental Health
    866-615-NIMH (6464)
    http://www.nimh.nih.gov/
  • Mental Health America
    800-969-NMHA (6642)
    http://www.mentalhealthamerica.net/
  • National Center for Post Traumatic Stress Disorder
    (802) 296-6300
    http://www.ptsd.va.gov/