Post-traumatic stress disorder affects a wide range of people, not just soldiers

Between 5% and 10% of all men and 7% to 14% of all women experience the problem, but there are effective treatments available

BYKATIE CHARLES

NEW YORK DAILY NEWS

Published: Sunday, July 14, 2013, 2:00 AM

Updated: Sunday, July 14, 2013, 2:00 AM

Dr. Rachel Yehuda says, "More than half of all people in the United States are exposed to the kind of event that can give you PTSD."

THE SPECIALIST:Dr. Rachel Yehuda

The director of the traumatic stress studies division at Mount Sinai and the director of mental health at the James J. Peters VA Medical Center, Dr. Rachel Yehuda specializes in posttraumatic stress disorder. She has been working with trauma survivors for over 20 years.

WHO’S AT RISK

Posttraumatic stress disorder, or PTSD, is perhaps best known as a mental health condition that many soldiers experience after war, but it’s a problem that stretches far beyond the military to affect 5%-10% of all men and 7%-14% of all women in this country.

“PTSD is a disorder in which the patient responds to a watershed event by not being able to recover from its emotional impact,” says Yehuda. “The direct cause is exposure to adversity, and the more trauma people experience, the more likely they are to have PTSD.”

Traumatic exposure is extremely common. “More than half of all people in the United States are exposed to the kind of event that can give you PTSD, and more than a quarter are exposed more than once,” says Yehuda. “Because so many persons experience trauma, PTSD is one of the most common mental health conditions in this country.”

There are a set of common symptoms most people experience after a traumatic event. “When tragedy strikes, almost everyone will feel very shaken up, and for at least a few days there can be nightmares, flashbacks and the inability to sleep or concentrate,” says Yehuda. “PTSD is a disorder where those symptoms continue for weeks, months and sometimes years.”

Not everyone exposed to trauma develops PTSD, and some groups are at higher risk than others. “You’re considered at risk if you have a family history of PTSD or other mood and anxiety disorders, if you’ve had adverse childhood experiences, or if you have a tendency to dissociate or panic,” says Yehuda. “While PTSD has historically been under-detected, there’s a lot more awareness now, and we have increasingly effective treatment. In the future, it’s possible that we’ll be able to reduce the prevalence of PTSD.”

SIGNS AND SYMPTOMS

Traumatic events catalyze the body into a fight-or-flight mode. “It’s very physiological — your heart races, you go into survival mode until the body gets a safety signal and starts to shut down the physiological response,” says Yehuda. “But for people who develop PTSD, their physiology will remain activated just below the threshold, so when they have reminders of the event, their biology cranks up as if they were engaging in fight or flight.” While another person might remember that they felt fear, a person with PTSD relives the fear response in their brain and body.

One of the behavioral effects of PTSD is that people try to avoid the triggers that fire their stress response. “They start restricting their exposure and limiting their lives, which is one of the reasons PTSD can be very disabling,” says Yehuda. “If someone is still having nightmares and distressing, intrusive thoughts one to three months after a trauma, they are probably well on their way to developing chronic PTSD — and should consult a doctor.”

TRADITIONAL TREATMENT

PTSD is a disorder that is treatable and often curable. “People who develop PTSD can recover from it, either spontaneously or with treatment,” says Yehuda. “And there’s a very good chance that it can be prevented altogether if it’s treated early.” In other cases, patients experience no symptoms for years, until something happens to them or to another person that triggers a setback and symptoms.

The traditional course of treatment for PTSD is a combination of psychotherapy (talk therapy) or cognitive behavioral therapy (CBT) and anti-depressant medications. “Typically, a person would go to a therapist or psychiatrist and would talk about the traumatic experience and try to process the event,” says Yehuda. “This process can take a while because sometimes people need to feel very comfortable with the therapist before they’re ready to discuss the details of the trauma.” These treatments work especially well for adult onset as the result of a single trauma, but they don’t work for everyone.

Chronic PTSD as the result of multiple traumas is more difficult to treat. “PTSD is a disorder that doesn’t just affect the mind, it also affects the body,” says Yehuda. “These patients are more likely to develop medical illness more rapidly, which means that there’s something about the biologic or hormonal changes that are rewiring the person to make them more susceptible to the path to illness.” Big lifestyle changes in terms of diet, exercise and stress management are necessary to combat this susceptibility.

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What is Post-traumatic Stress Disorder (PTSD)?

When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.

PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

PTSD affects about 7.7 million American adults, but it can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families.

Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events.

Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD

Risk factors for PTSD include:

  • Living through dangerous events and traumas
  • Having a history of mental illness
  • Getting hurt
  • Seeing people hurt or killed
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

Signs & Symptoms

PTSD can cause many symptoms. These symptoms can be grouped into three categories:

1. Re-experiencing symptoms

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts.

Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing.

2. Avoidance symptoms

  • Staying away from places, events, or objects that are reminders of the experience
  • Feeling emotionally numb
  • Feeling strong guilt, depression, or worry
  • Losing interest in activities that were enjoyable in the past
  • Having trouble remembering the dangerous event.

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyperarousal symptoms

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping, and/or having angry outbursts.