Post-traumatic stress disorder, which is also known as PTSD, is a serious mental health condition characterized by flashbacks, intense fear, nightmares, depression, anger, and other symptoms. The condition is triggered by a traumatic event, which can include a variety of experiences, including being in combat for a veteran to being sexually abused for a child. Not everyone who experiences something traumatic will develop PTSD.
For those who do, treatments are available to help manage symptoms and regain control over negative feelings, troubling memories and dreams, and flashbacks. Various types of psychotherapy are most commonly used to treat PTSD, but medications are sometimes used. Antidepressants, anti-anxiety drugs, and a drug that may help suppress nightmares are all used to treat PTSD in some individuals.
What is PTSD?
Post-traumatic stress disorder is a condition that occurs after the experience of a traumatic event. Not everyone develops the condition, even those involved in the same traumatic experience. A trauma can be anything that an individual finds shocking, dangerous, or frightening. The extreme fear experienced during a traumatic event triggers a physiological response in the body, sometimes called “fight or flight.”
The “fight or flight” response is the brain’s way of protecting an individual from harm. It triggers a flood of hormones that prepares the body to either fight back against something perceived as dangerous or to run away from it, two different survival strategies. This is typical in any kind of potentially traumatic situation, but for most people the effects wear off soon and the person will recover. Some people continue to experience symptoms related to reacting to a dangerous situation long after the trauma has passed. This is PTSD and why some people develop it and others do not is not well understood.
What constitutes a traumatic situation that may trigger PTSD depends on an individual. Military veterans have high rates of PTSD from experiencing things like roadside bombs, seeing friends killed, and being in other high-stress and life-threatening situations. Other triggers may be natural disasters, like tornadoes, car or airplane accidents, physical violence, like assault or rape, domestic abuse, or seeing someone else go through a frightening and traumatic experience.
Signs and Symptoms of PTSD
When the symptoms of PTSD will begin depends on the individual. PTSD may develop just weeks after a trauma or long as years after the traumatic incident. The symptoms of PTSD are often severe enough to interfere with ordinary activities, like work or school, and to disrupt relationships. There are several categories of symptoms:
- Intrusive thoughts and memories. A characteristic of PTSD is the reliving of the trauma. These are recurring, intrusive, and uncontrollable memories of the original event. When the re-experience feels as if it is actually happening, it is called a flashback. This can be especially distressing. Nightmares about the event may also occur and any of these intrusive thoughts are typically accompanied by strong emotions and distress.
- Avoidance. PTSD also tends to cause a person to avoid anything that brings back thoughts or memories of the trauma. To avoid memories, a person may avoid certain places or people, but also will avoid thinking or talking about anything related to the event.
- Arousal symptoms. PTSD causes changes emotions and a heightened state of arousal. Arousal means that someone with PTSD may be on alert for danger or harm and may be easily frightened or surprised as a result. PTSD can make a person feel very tense, angry, and on edge. This may lead to angry outbursts, irritability, difficulty concentrating, and trouble sleeping. It may also cause destructive behaviors like drug or alcohol abuse.
- Mood. PTSD also affects mood. It can cause feelings of depression, shame, guilt, and worthlessness. A person may lose interest in activities he or she once enjoyed and may have a lot of negative feelings.
A diagnosis of PTSD requires that a person have at least one intrusive memory symptoms, one avoidance symptom, two arousal/emotional symptoms, and two mood symptoms within a one-month period. Some people will experience many more, but this is the minimum diagnostic requirement.
Children may also experience PTSD, but their symptoms may not be the same as what is seen in adults. Older children and teens may have similar symptoms, but young children are more likely to exhibit other signs: extra clinginess, not talking, wetting the bed, or acting out the traumatic experience.
Veterans and PTSD
PTSD is often talked about in context with veterans of the wars in Iraq and Afghanistan, although veterans of other wars have been affected as much if not more. Rates of PTSD are higher among veterans than in any other demographic. In the general population of the U.S. about seven to eight percent of people will be diagnosed with PTSD at some point during their lives. Estimates are that between 11 and 20 percent of combat veterans in Iraq or Afghanistan has experienced PTSD. Approximately 12 percent of veterans of the Gulf War in the 1990s developed PTSD, and about 15 percent of Vietnam War veterans have had PTSD.
PTSD is caused by a traumatic event, but why one person may react by developing PTSD and another not isn’t clear. There are some risk factors that make some people more likely to develop PTSD. Of course, experiencing a traumatic event is a risk factor, and the more trauma—and greater intensity of trauma—someone experiences the greater the risk of developing PTSD. Other factors that can increase the risk include having another mental illness, like anxiety or depression, having a substance abuse problem, having family members with mental health issues, or not having a strong social support system. People who experience trauma and actively seek out support and have positive coping strategies already in place are less likely to develop PTSD after the event.
The goal of treating PTSD is to give a patient the skills needed to change negative emotions, cope with symptoms, and manage mood. Psychotherapy is the most common type of treatment for PTSD, but this may be supplemented with prescription medications or treatments for complications of the condition, such as substance abuse or depression.
Cognitive behavioral therapy is a strategy in which a therapist helps a patient learn to recognize their own negative thought patterns, to stop them, and to change them into more positive thoughts and emotions. Many patients with PTSD will also undergo exposure therapy, which involves facing what is frightening. This is useful in helping patients learn to cope with what they have been trying to avoid and with nightmares and flashbacks. It is done in a way that is safe and productive.
PTSD Medications and Their Risks
While therapy remains the main treatment for PTSD in most patients, many are given medications as well. These include antidepressants to stabilize mood and relieve symptoms of depression, while also sometimes helping to improve sleep quality and the ability to concentrate. Anti-anxiety medications can be used to relieve severe anxiety in someone with PTSD. Prazosin is a drug that may be given to help suppress nightmares.
Antidepressants can help, but the come with risks. These medications, which include Lexapro, Prozac, Paxil, Celexa, and others, must be used strictly as prescribed, for instance. Stopping use too suddenly can lead to a serious withdrawal syndrome that causes dangerous and uncomfortable symptoms. Antidepressants may also cause suicidal thoughts in younger patients and have been linked to birth defects. Anti-anxiety medications, like Xanax, can be risky because they come with a potential for abuse. Someone abusing these drugs may experience withdrawal when trying to stop and may become addicted.
Prazosin is an alpha-blocker and has not been approved to treat PTSD nightmares. Some doctors prescribe it for this off-label use because there is evidence that it can help. The approved use for prazosin is to treat high blood pressure. Common side effects of this drug include dizziness, nausea, headaches, weakness, and tiredness. Less common, but still possible are diarrhea, edema, vomiting, constipation, vertigo, nervousness, depression, a rash, and congestion. When using prazosin for PTSD, studies show that it must be given in high doses to be effective. This can increase the risk of side effects and make them more intense.
PTSD is a very serious mental health condition that can have devastating impacts if not treated. If you or someone you love shows signs of this disorder, seek medical help right away. Untreated PTSD can lead to severe depression, substance abuse, and even suicide. Although there are always risks of using prescription medications to treat a disease like PTSD, sometimes the risks are worth the benefits. Therapy is also a very effective treatment for this condition and has saved lives.