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Post-traumatic stress disorder (PTSD) is an extremely
debilitating condition that can occur after exposure to a
terrifying event or ordeal in which grave physical harm occurred or
was threatened. Traumatic events that can trigger PTSD include
violent personal assaults such as rape or mugging, natural or
human-caused disasters, accidents, or military combat.
Military troops who served in Vietnam and the Gulf Wars; rescue
workers involved in the aftermath of the Oklahoma City Bombing;
survivors of accidents, rape, physical and sexual abuse, and other
crimes; immigrants fleeing violence in their countries; survivors
of the 1994 California earthquake, the 1997 South Dakota floods,
and hurricanes Hugo and Andrew; and people who witness traumatic
events are among the people who develop PTSD. Families of victims
can also develop the disorder.
Fortunately, through research supported by the National
Institute of Mental Health (NIMH) and the Department of Veterans
Affairs (VA), effective treatments have been developed to help
people with PTSD. Research is also helping scientists better
understand the condition and how it affects the brain and the rest
of the body.
What Are the Symptoms of
PTSD?
Many people with PTSD repeatedly re-experience the ordeal in the
form of flashback episodes, memories, nightmares, or frightening
thoughts, especially when they are exposed to events or objects
reminiscent of the trauma. Anniversaries of the event can also
trigger symptoms. People with PTSD also experience emotional
numbness and sleep disturbances, depression, anxiety, and
irritability or outbursts of anger. Feelings of intense guilt are
also common. Most people with PTSD try to avoid any reminders or
thoughts of the ordeal. PTSD is diagnosed when symptoms last more
than one month.
How Common Is
PTSD?
At least 3.6% of U.S. adults (5.2 million Americans) have PTSD
during the course of a year. About 30 percent of the men and women
who have spent time in war zones experience PTSD. One million war
veterans developed PTSD after serving in Vietnam. PTSD has also
been detected among veterans of the Persian Gulf War, with some
estimates running as high as 8 percent.
When Does PTSD First
Occur?
PTSD can develop at any age, including in childhood. Symptoms
typically begin within 3 months of a traumatic event, although
occasionally they do not begin until years later. Once PTSD occurs,
the severity and duration of the illness varies. Some people
recover within 6 months, while others suffer much longer.
What Treatments Are Available
for PTSD?
Research has demonstrated the effectiveness of cognitive-behavioral
therapy, group therapy, and exposure therapy, in which the patient
repeatedly relives the frightening experience under controlled
conditions to help him or her work through the trauma. Medications
have also been shown to help ease the symptoms of depression and
anxiety and help promote sleep. Scientists are attempting to
determine which treatments work best for which type of trauma.
Do Other Physical or Emotional Illnesses Tend to Accompany PTSD?
Depression, alcohol or other substance abuse, or anxiety disorders
are not uncommon, co-occurrences for people with PTSD. The
likelihood of treatment success is increased when these other
conditions are appropriately diagnosed and treated as well.
Headaches, gastrointestinal complaints, immune system problems,
dizziness, chest pain, or discomfort in other parts of the body are
also common. Often, doctors treat the symptoms without being aware
that they stem from PTSD. NIMH, through its education program, is
encouraging primary care providers to ask patients about
experiences with violence, recent losses, and traumatic events,
especially if symptoms are recurring. When PTSD is diagnosed,
referral to a mental health professional who has had experience
treating people with the disorder is recommended.
Who Is Most Likely to Develop
PTSD?
People who have been abused as children or who have had other
previous traumatic experiences are more likely to develop the
disorder. Research is continuing to pinpoint other factors that may
lead to PTSD.
What Are Scientists Learning
From Research?
NIMH and the VA sponsor a wide range of basic, clinical, and
genetic studies of PTSD. In addition, NIMH has a special funding
mechanism, called RAPID Grants, which allows researchers to
immediately visit the scenes of disasters, such as plane crashes or
floods and hurricanes, to study the acute effects of the event and
the effectiveness of early intervention.
Research has shown that PTSD clearly alters a number of
fundamental brain mechanisms. Because of this, abnormalities have
been detected in brain chemicals that mediate coping behavior,
learning, and memory among people with the disorder. Recent brain
imaging studies have detected altered metabolism and blood flow as
well as anatomical changes in people with PTSD.
The following are also recent
research findings:
- Some studies show that debriefing people very soon after a
catastrophic event may reduce some of the symptoms of PTSD. A study
of 12,000 schoolchildren who lived through a hurricane in Hawaii
found that those who got counseling early on were doing much better
two years later than those who did not.
- People with PTSD tend to have abnormal levels of key hormones
involved in response to stress. Cortisol levels are lower than
normal and epinephrine and norepinephrine are higher than normal.
Scientists have also found that people with this condition have
alterations in the function of the thyroid and in neurotransmitter
activity involving serotonin and opiates.
- When people are in danger, they produce high levels of natural
opiates, which can temporarily mask pain. Scientists have found
that people with PTSD continue to produce those higher levels even
after the danger has passed; this may lead to the blunted emotions
associated with the condition.
- It used to be believed that people who tend to dissociate
themselves from a trauma were showing a healthy response, but now
some researchers suspect that people who experience dissociation
may be more prone to PTSD.
- Animal studies show that the hippocampus -- a part of the brain
critical to emotion-laden memories -- appears to be smaller in
cases of PTSD. Brain imaging studies indicate similar findings in
humans. Scientists are investigating whether this is related to
short-term memory problems. Changes in the hippocampus are thought
to be responsible for intrusive memories and flashbacks that occur
in people with this disorder.
- Research to understand the neurotransmitter system involved in
memories of emotionally charged events may lead to discovery of
drugs that, if given early, could block the development of PTSD
symptoms.
- Levels of CRF, or corticotropin releasing factor -- the
ignition switch in the human stress response -- seem to be elevated
in people with PTSD, which may account for the tendency to be
easily startled. Because of this finding, scientists now want to
determine whether drugs that reduce CRF activity are useful in
treating the disorder.
The content of this fact sheet was adapted from material
published by the National Institute of Mental Health.
For additional resources, please call 1-800-969-NMHA.
NMHA's Campaign for America's Mental Health works to raise
awareness that mental illnesses are common, real and treatable
illnesses and ensure that those most at-risk receive proper, timely
and effective treatment. Click
here for more information.
The Campaign is made possible
through unrestricted educational grants from the following
corporations:
Founding Sponsor - Eli Lilly and Company
Campaign Sponsors - Abbott Laboratories, Bristol-Myers Squibb
Company, Bristol-Myers Squibb Foundation, Eli Lilly and Company,
Forest Laboratories, Inc., Organon Inc., Pfizer Inc, and
Wyeth-Ayerst Pharmaceuticals
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