Traumatic Stress Disorder, once called shell shock, is a psychiatric condition that can develop after experiencing or witnessing life-threatening or traumatic events. Military action is the most commonly discussed experience that can lead to this disorder, but it can occur after natural disasters, terrorist incidents, accidents or violent assaults.
This disorder has likely been around as long as there have been human beings who experience traumatic situations, but the majority of research began after the Vietnam War.
Common symptoms in PTSD include traumatic ‘flashbacks’ to the event – these are often experienced as nightmares or waking dreams where the affected individual relives the event. Difficulty sleeping and feelings of detachment from the world are also common in PTSD.
Sometimes, individuals with PTSD avoid situations that remind them of the original traumatic event because they feel that exposure to these situations or places will trigger flashbacks and unwanted emotions. In addition, close relationships are also sometimes avoided.
Aside from intrusive symptoms and avoidance, individuals with PTSD also experience hyperarousal symptoms. They often act as if they are constantly threatened by the past experience and can become suddenly irritable or explosive with no warning or provocation.
Difficulty concentrating, insomnia and an exaggerated startle reaction all make it difficult for sufferers to cope. Often, substance abuse occurs in an attempt to self-medicate and this can further impair impulse control or increase the risk of suicide.
Symptoms usually begin within three months of the traumatic event, but can sometimes start much later and can either lessen with time or remain as a chronic condition serious enough to cause serious problems in daily life.
Most people experiencing PTSD will experience periods when the symptoms increase or persist as well as periods of remission or lessening.
Between 50 and 90 per cent of the population may be exposed to traumatic experiences, but most do not develop PTSD. In fact, although most people do experience some symptoms in the initial days and weeks following the event, only eight per cent of men and 20 per cent of women will develop the condition.
Also, of that small number only 30 per cent will go on to develop a chronic form of PTSD that will last throughout life.
As with most psychiatric conditions, the exact cause is not known. However, given the known triggering circumstances, it is thought that some individuals have a biological or genetic vulnerability to the condition.
In order to effectively treat PTSD a physician will first conduct appropriate screening to make an accurate diagnosis. The individual’s level of functioning, safety and risk of suicide or harm to self or others must also be taken into account.
It is very common for PTSD to co-exist with other psychiatric and physical health problems or substance abuse. These can complicate treatment and should be identified and dealt with.
Generally, a combination of psychotherapy and medication can be effective in treating PTSD.
Cognitive behaviour therapy, group or family therapy and exposure therapy involving the patient reliving the frightening experience under controlled conditions are all valid treatment methods. Eye movement desensitization (EMDR) is also commonly recommended. It seems to be effective but the eye movement component may not be necessary or sufficient. Its effectiveness may be related to the components of the technique common to other exposure-based cognitive therapies.
Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants are the most commonly used medications in treating PTSD and more research is needed in order to identify other safe and effective ways to treat this disturbing condition.
If you think you are suffering from PTSD, there is help available. Speak to your doctor.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.