POST-TRAUMATIC STRESS DISORDER _PTSD_

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					                      POST-TRAUMATIC STRESS DISORDER
                             Barney Greenspan, Ph.D.

The top U.S. commander in Iraq says we       In PTSD, stress hormones like
may be looking at a substantial pullout      adrenaline scorch a painful event deep
by this spring. American troops will be      into long-term memory. Lab studies
coming home, trying to find their            show such hormones normally improve
footing, remembering what they would         memory in animals. They seem to
prefer to forget. At home they may fight     overshoot the mark in PTSD. People get
against disenchantment, dislocation and      very edgy and fearful, prone to
the pervasive feeling among their            nightmares or flashbacks. They
families and friends that they should just   desperately want to avoid reminders of
forget about the horrors they have           their shock, even to the point of feeling
witnessed and get on with their lives. It    numb. PTSD happens more often in
is a difficult segue from battlefield to     women, in cases of multiple traumas and
home front.                                  in people with depression. Here is a
                                             psychological condition touched off
The percentage of those wounded on the       because of concrete, external events, not
battlefields who have survived is the        something hidden in the dim recesses of
highest in the history of combat, in part    the mind. It could theoretically happen
because of advances in body armor, in        to anyone, even the hardiest and
part because of sophisticated on-site        soundest of mind. It is not your fault!
medical facilities. The result is that
there will be a group of Iraq-war vets       Dr. Richard Rahe of Tacoma,
with catastrophic injuries: multiple         Washington studied POW’s returning
amputations, head trauma, horrendous         from Vietnam, Beirut hostages and
burns. They may need medical                 political prisoners in Bosnia. He
intervention for the rest of their lives.    differentiates Acute Stress Reaction that
                                             resolves in days or weeks after the
That is not even counting those who          trauma from Chronic Stress Reaction
come home with serious mental health         that persists for months (but may still
issues. The Army’s Surgeon General           resolve in some instances) and
reported (August 2005) that three to four    recommends not diagnosing PTSD until
months after their return 30% of soldiers    6 to 12 months after the trauma. Acute
had problems ranging from depression to      Stress Reaction is characterized by
full-blown post-traumatic stress disorder    panic, disorientation, hyper-arousal and
(PTSD). In American wars, PTSD has           emotional lability. Chronic Stress
been called soldier’s heart (Civil War),     Reaction includes exhaustion, lack of
shell shock (WW I), combat (or battle)       humor, lack of direction, paranoia and
fatigue and war neurosis (WW II) and         isolation.
post-Vietnam syndrome. PTSD was first
accepted as a distinct psychological         Collectively, Acute and Chronic Stress
condition in 1980 at the urging of           Reactions and PTSD, occurring after
Vietnam veterans.                            combat, are often referred to as “combat
stress reactions.” These reactions are       . Feelings of detachment or
increasingly being recognized as normal      estrangement from others and an
reactions to abnormal conditions. Early      inability to have loving feelings.
identification and intervention have been    . Markedly diminished interest or
shown to be helpful in reducing long         participation in activities that once were
term disabling symptoms.                     an important source of satisfaction.
                                             . In young children, delayed or
PTSD has expanded to encompass more          developmental retrogression in such
frequent swerves along life’s road – car     areas as toilet mastery, motor skills and
crashes, house fires, rape, mugging,         language.
physical-sexual-emotional-verbal abuse,      . Hopelessness about the future – no
a sudden death or severe family illness,     hope of a family life, career or living to
witnessing a disaster or even learning of    old age.
one. Such trauma can result in a             . Physical and psychological
defining psychological experience that       hypersensitivity (not present before the
evokes feelings of panic, grief and          trauma) with at least two of the
helplessness. Trauma of great                following reactions: trouble sleeping,
magnitude typically shatters a person’s      impulsive anger, difficulty
basic assumption about the world and         concentrating, exaggerated startle
personal safety, often leaving one feeling   response to noise, and physiological
alienated and distrustful, or else overly    reaction to situations that remind the
clinging. During the past five years, the    person of the traumatic event. These
number of cases among veterans (mostly       physiological reactions may include an
from combat) has exploded nationally by      increase in blood pressure, a rapid heart
almost 80% to 215,871 last year. About       rate, rapid breathing, muscle tension,
30% of the men and women who have            nausea and diarrhea.
spent time in war zones experience
PTSD. One million war veterans               SIGNS AND SYMPTOMS
developed PTSD after serving in              PTSD is an anxiety disorder that is
Vietnam.                                     triggered by memories of a traumatic
                                             event – an event that directly affected
OVERVIEW                                     the person or an event that was
Signs and symptoms of PTSD typically         witnessed. The disorder commonly
appear within three months of the            affects survivors of traumatic events,
traumatic event. However, in some            such as sexual assault, physical assault,
instances, they may not occur until years    war, torture, a natural disaster, an
after the event. They may include:           automobile accident, an airplane crash, a
. Flashbacks and distressing dreams          hostage situation or a death camp.
associated with the traumatic event.         PTSD also can affect rescue workers at
. Distress at anniversaries of the trauma.   the site of an airplane crash, hurricane or
. Efforts to avoid thoughts, feelings and    a mass shooting. It can affect someone
activities associated with the trauma.       who witnessed a tragic accident.
Not everyone involved in a traumatic        COMPLICATIONS
event experiences PTSD. However, the        Having PTSD may place you at a higher
disorder affects more than 5 million        risk of:
adults each year in the United States.      . Depression, which has many of the
PTSD is twice as common in women as         same signs and symptoms as PTSD
it is in men.                               . Drug abuse
                                            . Alcohol abuse
RISK FACTORS                                . Eating disorders
The severity of the traumatic event, and    . Divorce
how long the event lasted, appear to be
factors in the development of this          Treatment may involve a combined
disorder. Other factors that may            approach including medications and
increase the likelihood of developing       psychotherapy designed to help gain
PTSD include:                               control of anxiety. My next essay will
. A previous history of depression, panic   address treatment by mental health
disorder or generalized anxiety disorder    professionals (medications and
. A previous history of physical or         psychotherapy), coping skills and some
sexual abuse                                web-site resources.
. A family history of anxiety
. Early separation from parents
. Being part of a dysfunctional family
. Alcohol abuse
. Drug abuse

				
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