Symptoms and Complications
The most noticeable signs in a person suffering from PTSD are introversion and joylessness. People with this syndrome are unable to take pleasure from things they might have enjoyed in the past. They avoid the company of others and become generally more passive than before. They wish to avoid anything that will trigger memories of the traumatic event. A person with PTSD might drift out of a conversation and appear distant and withdrawn. This is known among soldiers as a "thousand-yard stare." This is a sign that unpleasant memories have returned to haunt them.
Having trouble sleeping is almost inevitable in this syndrome. Nightmares are common, and even when someone with PTSD is not thinking about the event, sleep is often disturbed. A common symptom among veterans is nocturnal myoclonus, a sudden spasm of the whole body while sleeping or drifting off into sleep. It lasts for about a fraction of a second, but may occur several times in a single night. Often people with PTSD will sleep through such a spasm, but their partner may not. Children with PTSD may have many nightmares, yet those dreams may not contain anything that's obviously related to the original trauma.
Psychiatrists speak of three symptoms that define PTSD - intrusion, avoidance, and hyperarousal. Intrusion is the inability to keep memories of the event from returning. Avoidance is an attempt to avoid stimuli and triggers that may bring back those memories. Hyperarousal is similar to jumpiness. It may include insomnia (trouble sleeping), a tendency to be easily startled, a constant feeling that danger or disaster is nearby, an inability to concentrate, extreme irritability, or even violent behavior.
Depression is very likely to go hand in hand with PTSD, and in severe cases, suicide is a real danger. People with this syndrome, as with any psychiatric illness, are more likely than average to abuse alcohol or drugs. Psychiatrists see this as an attempt to self-medicate the condition, but naturally the drugs involved are very unlikely to improve the situation.
Making the Diagnosis
The diagnosis of PTSD is based on four specific features that must be present for at least one month:
- an objective component (the traumatic event) and a subjective component (the person's reaction of fear, horror, or helplessness)
- re-experiencing symptoms after the trauma - intrusive thoughts or recollections, recurrent dreams of the trauma, flashbacks of the trauma
- avoidance or "numbing" symptoms - avoiding thinking about the trauma, avoiding people or places that remind you of the trauma, inability to remember specifics about the trauma, detachment, or inability to see a positive future
- arousal symptoms - insomnia, irritability, decreased concentration, hypervigilance, or exaggerated startle response
These symptoms must also cause significant distress or interfere with a person's daily life and functioning.
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Treatment and Prevention
Treatment can be effective for PTSD and involves psychological intervention as well as medications.
The main psychological treatment to treating PTSD is cognitive-behavioral therapy. This means examining the thought processes associated with the trauma, the way memories return, and how people react to them. PTSD often fades over time, even without treatment, and the goal of therapy is to accelerate that natural healing process.
Because the horror may fade over time, being confronted with memories of the trauma when in a safe situation may help a person over time to become less frightened or depressed by those memories. This is called desensitization, which is often combined with cognitive behavioral therapy. Psychological treatments are particularly helpful for the "re-experiencing symptoms" and any social or vocational impairment caused by PTSD.
Medications used in treatment are serotonin reuptake inhibitor (SSRIs). Most people with PTSD will benefit from taking antidepressant medications, whether or not they have clinical depression accompanying their PTSD. These medications are particularly helpful in treating the avoidance and arousal symptoms as well as any anxiety and depression. Other medications (e.g., those that help balance mood and reduce mood swings, or antipyschotics) may also help to relieve symptoms.
Paul Ballas, DO, Attending Psychiatrist, Friends Hospital, Philadelphia PA. Review provided by VeriMed Healthcare Network.