| "I was raped when I was 25 years old. For a | | | | including World War II, Korean conflict, and |
| long time, I spoke about the rape as though | | | | Persian Gulf populations, and in United |
| it was something that happened to someone | | | | Nations peacekeeping forces deployed to other |
| else. I was very aware that it had happened | | | | war zones around the world. There are |
| to me, but there was just no feeling. | | | | remarkably similar findings of PTSD in |
| | | | military veterans in other countries. For |
| "Then I started having flashbacks. They kind | | | | example, Australian Vietnam veterans |
| of came over me like a splash of water. I | | | | experience many of the same symptoms that |
| would be terrified. Suddenly I was reliving | | | | American Vietnam veterans experience. |
| the rape. Every instant was startling. I | | | | |
| wasn't aware of anything around me, I was in | | | | PTSD is not only a problem for veterans, |
| a bubble, just kind of floating. And it was | | | | however. Although there are unique cultural- |
| scary. Having a flashback can wring you out. | | | | and gender-based aspects of the disorder, it |
| | | | occurs in men and women, adults and children, |
| "The rape happened the week before | | | | Western and non-Western cultural groups, and |
| Thanksgiving, and I can't believe the anxiety | | | | all socioeconomic strata. A national study of |
| and fear I feel every year around the | | | | American civilians conducted in 1995 |
| anniversary date. It's as though I've seen a | | | | estimated that the lifetime prevalence of |
| werewolf. I can't relax, can't sleep, don't | | | | PTSD was 5% in men and 10% in women. |
| want to be with anyone. I wonder whether I'll | | | | |
| ever be free of this terrible problem." | | | | How does PTSD develop? |
| | | | |
| Post-traumatic stress disorder (PTSD) is a | | | | Most people who are exposed to a traumatic, |
| debilitating condition that can develop | | | | stressful event experience some of the |
| following a terrifying event. Often, people | | | | symptoms of PTSD in the days and weeks |
| with PTSD have persistent frightening | | | | following exposure. Available data suggest |
| thoughts and memories of their ordeal and | | | | that about 8% of men and 20% of women go on |
| feel emotionally numb, especially with people | | | | to develop PTSD, and roughly 30% of these |
| they were once close to. PTSD was first | | | | individuals develop a chronic form that |
| brought to public attention by war veterans, | | | | persists throughout their lifetimes. |
| but it can result from any number of | | | | |
| traumatic incidents. These include violent | | | | The course of chronic PTSD usually involves |
| attacks such as mugging, rape, or torture; | | | | periods of symptom increase followed by |
| being kidnapped or held captive; child abuse; | | | | remission or decrease, although some |
| serious accidents such as car or train | | | | individuals may experience symptoms that are |
| wrecks; and natural disasters such as floods | | | | unremitting and severe. Some older veterans, |
| or earthquakes. The event that triggers PTSD | | | | who report a lifetime of only mild symptoms, |
| may be something that threatened the person's | | | | experience significant increases in symptoms |
| life or the life of someone close to him or | | | | following retirement, severe medical illness |
| her. Or it could be something witnessed, such | | | | in themselves or their spouses, or reminders |
| as massive death and destruction after a | | | | of their military service (such as reunions |
| building is bombed or a plane crashes. | | | | or media broadcasts of the anniversaries of |
| | | | war events). |
| Whatever the source of the problem, some | | | | |
| people with PTSD repeatedly relive the trauma | | | | How is PTSD assessed? |
| in the form of nightmares and disturbing | | | | |
| recollections during the day. They may also | | | | In recent years, a great deal of research has |
| experience other sleep problems, feel | | | | been aimed at developing and testing reliable |
| detached or numb, or be easily startled. They | | | | assessment tools. It is generally thought |
| may lose interest in things they used to | | | | that the best way to diagnose PTSD-or any |
| enjoy and have trouble feeling affectionate. | | | | psychiatric disorder, for that matter-is to |
| They may feel irritable, more aggressive than | | | | combine findings from structured interviews |
| before, or even violent. Things that remind | | | | and questionnaires with physiological |
| them of the trauma may be very distressing, | | | | assessments. A multi-method approach |
| which could lead them to avoid certain places | | | | especially helps address concerns that some |
| or situations that bring back those memories. | | | | patients might be either denying or |
| Anniversaries of the traumatic event are | | | | exaggerating their symptoms. |
| often very difficult. | | | | |
| | | | How common is PTSD? |
| PTSD affects about 5.2 million adult | | | | |
| Americans. 1 Women are more likely than men | | | | An estimated 7.8 percent of Americans will |
| to develop PTSD. 7 It can occur at any age, | | | | experience PTSD at some point in their lives, |
| including childhood, 8 and there is some | | | | with women (10.4%) twice as likely as men |
| evidence that susceptibility to PTSD may run | | | | (5%) to develop PTSD. About 3.6 percent of |
| in families. 9 The disorder is often | | | | U.S. adults aged 18 to 54 (5.2 million |
| accompanied by depression, substance abuse, | | | | people) have PTSD during the course of a |
| or one or more other anxiety disorders. 4 In | | | | given year. This represents a small portion |
| severe cases, the person may have trouble | | | | of those who have experienced at least one |
| working or socializing. In general, the | | | | traumatic event; 60.7% of men and 51.2% of |
| symptoms seem to be worse if the event that | | | | women reported at least one traumatic event. |
| triggered them was deliberately initiated by | | | | The traumatic events most often associated |
| a person-such as a rape or kidnapping. | | | | with PTSD for men are rape, combat exposure, |
| | | | childhood neglect, and childhood physical |
| Ordinary events can serve as reminders of the | | | | abuse. |
| trauma and trigger flashbacks or intrusive | | | | |
| images. A person having a flashback, which | | | | The most traumatic events for women are rape, |
| can come in the form of images, sounds, | | | | sexual molestation, physical attack, being |
| smells, or feelings, may lose touch with | | | | threatened with a weapon, and childhood |
| reality and believe that the traumatic event | | | | physical abuse. |
| is happening all over again. | | | | |
| | | | About 30 percent of the men and women who |
| Not every traumatized person gets full-blown | | | | have spent time in war zones experience PTSD. |
| PTSD, or experiences PTSD at all. PTSD is | | | | An additional 20 to 25 percent have had |
| diagnosed only if the symptoms last more than | | | | partial PTSD at some point in their lives. |
| a month. In those who do develop PTSD, | | | | More than half of all male Vietnam veterans |
| symptoms usually begin within 3 months of the | | | | and almost half of all female Vietnam |
| trauma, and the course of the illness varies. | | | | veterans have experienced "clinically serious |
| Some people recover within 6 months, others | | | | stress reaction symptoms." PTSD has also been |
| have symptoms that last much longer. In some | | | | detected among veterans of the Gulf War, with |
| cases, the condition may be chronic. | | | | some estimates running as high as 8 percent. |
| Occasionally, the illness doesn't show up | | | | |
| until years after the traumatic event. | | | | Who is most likely to develop PTSD? |
| | | | |
| People with PTSD can be helped by medications | | | | 1. Those who experience greater stressor |
| and carefully targeted psychotherapy. | | | | magnitude and intensity, unpredictability, |
| | | | uncontrollability, sexual (as opposed to |
| Ordinary events can serve as reminders of the | | | | nonsexual) victimization, real or perceived |
| trauma and trigger flashbacks or intrusive | | | | responsibility, and betrayal |
| images. Anniversaries of the traumatic event | | | | |
| are often very difficult. | | | | 2. Those with prior vulnerability factors |
| | | | such as genetics, early age of onset and |
| Posttraumatic Stress Disorder, or PTSD, is a | | | | longer-lasting childhood trauma, lack of |
| psychiatric disorder that can occur following | | | | functional social support, and concurrent |
| the experience or witnessing of | | | | stressful life events |
| life-threatening events such as military | | | | |
| combat, natural disasters, terrorist | | | | 3. Those who report greater perceived threat |
| incidents, serious accidents, or violent | | | | or danger, suffering, upset, terror, and |
| personal assaults like rape. People who | | | | horror or fear |
| suffer from PTSD often relive the experience | | | | |
| through nightmares and flashbacks, have | | | | 4. Those with a social environment that |
| difficulty sleeping, and feel detached or | | | | produces shame, guilt, stigmatization, or |
| estranged, and these symptoms can be severe | | | | self-hatred |
| enough and last long enough to significantly | | | | |
| impair the person's daily life. | | | | What are the consequences associated with |
| | | | PTSD? |
| PTSD is marked by clear biological changes as | | | | |
| well as psychological symptoms. PTSD is | | | | PTSD is associated with a number of |
| complicated by the fact that it frequently | | | | distinctive neurobiological and physiological |
| occurs in conjunction with related disorders | | | | changes. PTSD may be associated with stable |
| such as depression, substance abuse, problems | | | | neurobiological alterations in both the |
| of memory and cognition, and other problems | | | | central and autonomic nervous systems, such |
| of physical and mental health. The disorder | | | | as altered brainwave activity, decreased |
| is also associated with impairment of the | | | | volume of the hippocampus, and abnormal |
| person's ability to function in social or | | | | activation of the amygdala. Both the |
| family life, including occupational | | | | hippocampus and the amygdala are involved in |
| instability, marital problems and divorces, | | | | the processing and integration of memory. The |
| family discord, and difficulties in | | | | amygdala has also been found to be involved |
| parenting. | | | | in coordinating the body's fear response. |
| | | | |
| Understanding PTSD | | | | Psychophysiological alterations associated |
| | | | with PTSD include hyper-arousal of the |
| PTSD is not a new disorder. There are written | | | | sympathetic nervous system, increased |
| accounts of similar symptoms that go back to | | | | sensitivity of the startle reflex, and sleep |
| ancient times, and there is clear | | | | abnormalities. |
| documentation in the historical medical | | | | |
| literature starting with the Civil War, when | | | | People with PTSD tend to have abnormal levels |
| a PTSD-like disorder was known as "Da Costa's | | | | of key hormones involved in the body's |
| Syndrome." There are particularly good | | | | response to stress. Thyroid function also |
| descriptions of posttraumatic stress symptoms | | | | seems to be enhanced in people with PTSD. |
| in the medical literature on combat veterans | | | | Some studies have shown that cortisol levels |
| of World War II and on Holocaust survivors. | | | | in those with PTSD are lower than normal and |
| | | | epinephrine and norepinephrine levels are |
| Careful research and documentation of PTSD | | | | higher than normal. People with PTSD also |
| began in earnest after the Vietnam War. The | | | | continue to produce higher than normal levels |
| National Vietnam Veterans Readjustment Study | | | | of natural opiates after the trauma has |
| estimated in 1988 that the prevalence of PTSD | | | | passed. An important finding is that the |
| in that group was 15.2% at that time and that | | | | neurohormonal changes seen in PTSD are |
| 30% had experienced the disorder at some | | | | distinct from, and actually opposite to, |
| point since returning from Vietnam. | | | | those seen in major depression. The |
| | | | distinctive profile associated with PTSD is |
| PTSD has subsequently been observed in all | | | | also seen in individuals who have both PTSD |
| veteran populations that have been studied, | | | | and depression. |