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