Post-Traumatic Stress Disorder

What Is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that develops in response to experiencing or witnessing an extremely stressful event involving the threat of death or extreme bodily harm, such as a sexual assault, physical violence, and military combat. It can occur in the wake of a car crash; a fire, an earthquake, or other natural disaster; or any sudden, disruptive event.

It is characterized by vivid, intrusive memories of the precipitating event, hypervigilance and reactivity to possible threats, nightmares that can destroy sleep, and mood disturbances. Those suffering from PTSD often report feeling anxious or scared even in the absence of danger. It may manifest primarily in anxiety-like symptoms, or in emotional numbness or dysphoria, or in anger and aggression, or some combination of those states. It is as if the normal stress response is locked into always-on overdrive. Those with PTSD often have difficulty functioning in everyday life, and symptoms persist for more than a month.

Although the disorder has likely existed since the dawn of human experience, it was originally thought to affect only soldiers; during World War I it was known as “shell shock.” PTSD was officially recognized as a mental health disorder in 1980. In the United States, about 3.5 percent of adults have the disorder. About half of them recover within three months. For some, the condition becomes chronic.

Treatment usually centers around talk therapy, but new forms of treatment on the near horizon combine talk therapy and medication in novel—and very promising—ways for the 50 percent of sufferers whose symptoms are not relieved by existing approaches. Studies suggest that it may even be possible to prevent PTSD from occurring, especially in high-risk situations.

Some studies estimate that as much as half of the population will experience a traumatic  event at some point in their lives. Of those, a small number will develop post-traumatic stress disorder. Even among veterans of combat, who have often been exposed to a barrage of life-threatening situations, rates of the disorder range from 10 to 30 percent, studies show.

What Are the Signs and Symptoms of PTSD?

Those with PTSD suffer from classic anxiety symptoms, such as insomnia and worry. They are constantly vigilant, alert to possible dangers. Typically, they have an exaggerated startle response. Unexpected sound or movement can provoke a strong, violent reaction, as if the precipitating danger were happening again in all its original immediacy

The traumatic event is recalled spontaneously, in flashbacks of memory so intense the situation seems to be recurring. The same panic, dread, and terror originally evoked are usually present.

Anxiety is not the only form of distress sufferers manifest. Disrupted mood is common. Sufferers often feel the guilt and shame typical of depression, or apathy and detachment from others. They may also regard others with suspicion and display hostility to them. Sufferers can find it difficult to trust anyone.

To avoid reminders of the trauma, which occur randomly, many with PTSD withdraw from the normal activities of life altogether. Some seek relief by consuming alcohol or other drugs.

For more information on symptoms, causes, and treatment see our Diagnosis Dictionary.


Trauma, Stress, Depression, Therapy, Anger

What Happens in the Brain?

Understanding what trauma does to the brain is critical for the development of effective ways to treat PTSD, and it has become a major focus of research. In PTSD, the stress circuitry in the brain goes awry. There is disrupted communication between several brain centers. These include the amygdala, which normally monitors incoming perceptions and red-flags threats, putting systems on high alert and setting off the stress response; the prefrontal cortex, or executive control center of the brain, which normally senses when a threat is over and dampens amygdala activity; and the hippocampus, where memories are stored and retrieved.

In PTSD, researchers find, the prefrontal cortex is underactivated and the amygdala is overactivated. There is evidence that a core problem lies in the connections between individual nerve cells, or synapses; there is a deficit in connectivity, limiting communication between nerve cells. As a result, those who have PTSD lose psychological flexibility; they stay stuck in their over-the-top response pattern and their memories resist the modification that normally occurs over time.

Research shows that some people are at higher risk than others for PTSD. Most vulnerable are persons who have a history of trauma exposure or mental difficulties. Having little social support or recurrent ongoing life stress are also risk factors. Physical impairment and job loss add to the risk.



Treatment and Recovery from PTSD

Psychotherapy, particularly exposure therapy and cognitive reappraisal therapy, has proved one of the most reliable treatments for PTSD. The goal is to restore cognitive flexibility, so that sufferers can talk about their bad experience and modify the emotional force of the memory.

Now under clinical investigation is the use of drugs that boost the power of psychotherapy by directly increasing nerve-cell connections. Among them is the anesthetic ketamine, sometimes known as the club drug Special K; it is already approved for use in treating severe depression. When given (by injection) in concert with a specific program of psychotherapy, it significantly speeds recovery from PTSD, accomplishing in days what might otherwise take months.

Another very promising path is psychedelic-assisted therapy with MDMA, also known as Ecstasy or Molly. When given to PTSD patients just before a therapy session, researchers find, it dramatically speeds up the therapeutic process. It allows even those with chronic PTSD to talk about deeply disturbing events and regain control of their own reactivity.

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