New Thinking for an Age-Old Condition: PTSD
Since the dawn of time, humankind has realized that there were negative consequences to experiencing overwhelming stressful situations. For example, reactions to wartime trauma have many names: soldier’s heart, shell shock, combat fatigue and, since the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980), Posttraumatic Stress Disorder (PTSD).
Service men and women aren’t the only people who can experience overwhelmingly traumatic situations, however, so since June is PTSD Awareness Month, now is a good time to give an update on some of the newer evidence surrounding Posttraumatic Stress reactions, including PTSD.
The good news is that, although up to 80 percent of people will experience a significant traumatic event in their lifetime, the likelihood of developing PTSD is actually less than 7 percent in the U.S.
First, let’s talk a bit about some of the statistics surrounding trauma. The good news is that, although up to 80 percent of people will experience a significant traumatic event in their lifetime, the likelihood of developing PTSD is actually less than 7 percent in the U.S. Most people with PTSD are not soldiers; women are affected at a higher rate than men and, not surprisingly, experience more traumatic events that can lead to a higher likelihood of developing PTSD.
However, military personnel, especially those who have suffered traumatic brain injury, provide a lot of insight into our developing understanding of PTSD. For example, a recent article in the New York Times Magazine looks at the science that supports the theory that PTSD may involve more physical damage leading to psychological effects; scarring in the brain caused by blasts disrupts the “brain’s centers for sleep, cognition and other classic brain-injury trouble spots.”
As our understanding of PTSD evolves, the American Psychiatric Association updates its criteria. The APA’s DSM-5 (2013) includes changes in the diagnostic criteria for Acute Stress Disorder (ASD) and PTSD. One important change was moving ASD and PTSD from the Anxiety Disorder category and placing them in a new category – Trauma- and Stress-Related Disorders. The DSM-5 focuses on the symptoms of PTSD – acknowledging that PTSD is indeed a condition – rather than just a reaction of the individual upon experiencing a stressor.
DSM-5 categorizes symptoms
Signs and symptoms usually begin within three months of the trauma but can occur later. They must be present for at least a month to be considered PTSD; less than one month may be ASD. (Children may exhibit PTSD differently, and the DSM-5 has a subcategory of symptoms for children under 6 years of age.) Symptoms are described within categories, examples of which are as follows:
- Re-experiencing: Flashbacks or nightmares
- Avoidance: Avoiding situations that may trigger memories as well as emotional numbing and guilt
- Arousal/reactivity: Being easily startled, feeling “on edge”
- Cognitive/mood changes: Loss of interest, depression and difficulty remembering features of the traumatic event
Evidence-based treatments provide hope
For people living with PTSD symptoms, there is hope. Below are some evidence-based treatments, including psychotherapy and medication.
- Prolonged Exposure (PE) Therapy: A type of Cognitive Behavioral Therapy that involves habituation of symptoms, which encompasses talking about the trauma repeatedly until the memories are less upsetting or experiencing situations usually avoided to relearn there is no longer any danger present. PE is an extremely effective treatment.
- Cognitive Behavioral Therapy (with or without EMDR) can also be effective. Eye Movement Desensitization and Reprocessing (EMDR) involves focusing on distractions, such as hand movements while discussing the traumatic event.
- Virtual Reality therapies are cutting-edge treatments being used in which technology helps the person work through traumatic events. The use of avatars is also being tried to help people deal with daily situations, by learning positive coping strategies.
- Medications can also be helpful, including SSRI antidepressants such as Zoloft (sertraline) and Paxil (paroxetine). Prazosin (a hypertension medicine) can help with nightmares associated with PTSD. Medications that are not effective and even detrimental include the antianxiety medications called benzodiazepines as they can lead to addiction.
- Other strategies investigated to lessen the potential impact of trauma include resiliency-building techniques and “stress inoculation,” both sometimes used prior to combat situations.
Virtual Reality therapies are cutting-edge treatments being used in which technology helps the person work through traumatic events. The use of avatars is also being tried to help people deal with daily situations, by learning positive coping strategies.
In summary, many people experience at least one traumatic life event, but only a fraction will develop diagnosable PTSD. Symptoms that fall short of the full diagnosis – Posttraumatic Stress – are also important and real. The good news is that the science is keeping up with PTSD through improved screening, diagnosis and treatments, and of course, a better understanding of the condition itself.