Posttraumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that follows a terrifying event. Often, people with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. PTSD, once referred to as shell shock, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person's life or the life of someone close to him or her. 

The person has experienced or witnessed or was confronted with an unusually traumatic event that has both of these elements:

The event involved actual or threatened death or serious physical injury to the person or to others,
 
and

The person felt intense fear, horror or helplessness

The person repeatedly relives the event in at least 1 of these ways:

Intrusive, distressing recollections - thoughts, images.
Repeated, distressing dreams.
Through flashbacks, hallucinations or illusions, acts or feels as if the event were
recurring.
Marked mental distress in reaction to internal or external cues that symbolize or
resemble the event.
Physiological reactivity - such as rapid heart beat, elevated blood pressure in response to these cues.

The person repeatedly avoids the trauma-related stimuli and has numbing of general responsiveness (absent before the traumatic event) as shown by 3 or more of:

Tries to avoid thoughts, feelings or conversations concerned with the event.
Tries to avoid activities, people or places that recall the event.
Cannot recall an important feature of the event.
Marked loss of interest or participation in activities important to the patient.
Feels detached or isolated from other people.
Restriction in ability to love or feel other strong emotions.
Feels life will be brief or unfulfilled (lack of marriage, job, children).

At least 2 of the following symptoms of hyperarousal were not present before the traumatic event:

Insomnia (initial or interval)
Irritability
Poor concentration
Hypervigilance
Increased startle response

The above symptoms have lasted longer than one month.

These symptoms cause clinically important distress or impair work, social or personal functioning.

Important Gender Differences:

The most common precipitating events for PTSD in women were rape and physical assault (33.8% and 32.3% of reported events, respectively).

For men, seeing someone seriously hurt or killed and physical assault were the most prevalent (25.3% and 20.3%). Women and men were equally likely to have been exposed to trauma.

Women, however, were more likely than men to meet criteria for lifetime and current PTSD.

Adjusting for gender differences, subjects who were severely dependent on cocaine were
more likely than moderately dependent subjects to meet lifetime criteria for PTSD.

PTSD also was more prevalent in subjects with a history of major depression, antisocial
personality disorder, and cannabis dependence, but not alcohol dependence.

Associated Features:

Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Addiction

Differential Diagnosis:

Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which he/she needs to rule out to establish a precise diagnosis.

Adjustment Disorder
Brief Psychotic Disorder.
Conversion Disorder.
Major Depressive Disorder.
Acute Stress Disorder
Obsessive-Compulsive Disorder
Schizophrenia
Mood Disorder With Psychotic Features
Delirium
Substance-Induced Disorders
Psychotic Disorders Due to a General Medical Condition
Malingering

Cause:

PTSD can occur at any age as it is dependent upon the experience of a traumatic event. Such events include:

Military Combat
Violent Criminal Attacks
Sexual Assaults
Serious Accidents
Life threatening natural disasters

The cause is not known, but psychological, genetic, physical, and social factors may contribute to it. In studies of Vietnam war veterans, those with strong support systems were less likely to develop PTSD than those without or poor support systems and   PTSD develops immediately after they experience the traumatic event. However, in other people, signs of the disorder do not develop until several weeks, months, or even years after the event.

Treatment:

Individual or group therapy, in addition to some medications, may be used in the treatment of PTSD. 

Counseling and Psychotherapy [ See Therapy Section ]:

Although psychodynamic psychotherapy is commonly used to treat the disorder, its effectiveness is controversial. Recently Exposure Therapy as part of a Cognitive Behavioral approach and/or EMDR Therapy (Eye Movement Desensitization and Reprocessing Therapy) have in many case been the treatment of choice. Therapy therefore helps those with post-traumatic stress disorder work through the traumatic event that caused the condition.

Pharmacotherapy [ See Psychopharmacology Section ] :

Certain antidepressant medications and mild tranquilizers are sometimes prescribed to help lessen some of the painful symptoms associated with PTSD.

There are also strong indications that the atypical antipsychotic Olanzapine (Zyprexa) aids in stabilizing the mood and reducing flashbacks in combat veterans suffering from PTSD.