Further Reading

Posttraumatic Stress Disorder

What is Posttraumatic Stress Disorder?

Posttraumatic Stress Disorder (PTSD) is a disorder that can occur following the experience of, or witnessing of, life-threatening events such as military combat, natural disasters, terrorist incidents, motor vehicle or other serious accidents, or violent personal assaults, such as rape.

People who suffer from PTSD often re-live the experience through nightmares and flashbacks, have difficulty sleeping, and avoid things that remind them of the traumatic event. These symptoms can be severe enough and last long enough to impair the person’s daily life.

PTSD is marked by clear biological changes as well as psychological symptoms. It is complicated by the fact that it frequently occurs with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health.

The individual’s ability to function in social or family life is often affected; this can include occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

How does PTSD develop?

The disorder occurs in both men and women, adults and children, Western and non-Western cultural groups, and all socioeconomic strata.

Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure. Some of those individuals will develop the disorder, and some will develop a chronic form.

How is PTSD Assessed?

In recent years a great deal of research has been aimed at development and testing of reliable assessment tools. It is generally thought that the best way to diagnose PTSD — or any disorder, for that matter — is to combine findings from multiple sources, including structured interviews and questionnaires. Multiple methods are also helpful to address concerns that some individuals might be either denying or exaggerating their symptoms. Dr. Genest and Dr. MacGillivray are experts in PTSD assessment.

The diagnosis of PTSD is based upon the presence of three types of symptoms following a traumatic event.

Re-experiencing of the Traumatic Event

This can include recurrent and intrusive, distressing recollections, dreams, images or thoughts of the event, or acting or feeling as though the event were recurring.

Avoidance

This includes efforts to avoid thoughts, feelings, conversations, places, people, or activities associated with the event; inability to recall important aspects of the event; lack of interest in things; withdrawal; depressed mood.

Increased Arousal

This includes such symptoms as sleep disturbance, irritability or anger, difficulty with concentration, hyper-vigilance, or exaggerated startle response.

Any of the individual symptoms of PTSD may be present in other types of disorders or may not be an indication of a disorder. The presence of several of the above symptoms following a traumatic event or traumatic history (e.g., early abuse, repeated harassment) should, however, lead investigating the possibility of this or another disorder.

All of the above post-traumatic symptoms are normal shortly following a traumatic event. PTSD is diagnosed only when they persist longer than a month.

Who is Most Likely to Develop PTSD?

  • Those that experience greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual (as opposed to nonsexual) victimization, real or perceived responsibility, and betrayal.
  • Those with prior vulnerability factors, such as genetics, early age of onset and longer-lasting childhood trauma, lack of functional social support and concurrent stressful life events.
  • Those who report greater perceived threat or danger, suffering or being upset, terror, and horror or fear.
  • Those with a social environment that produces shame, guilt, stigmatization, or self-hatred.

What are the Consequences Associated with PTSD?

PTSD is associated with a number of distinctive neurobiological and physiological changes. The alterations associated with these changes include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.

PTSD is associated with increased likelihood of co-occurring disorders. The co-occurring disorders most prevalent for men with PTSD have been found to be alcohol abuse or dependence, major depressive episode, conduct disorder, and drug abuse and dependence. The disorders most frequently co-morbid with PTSD among women are major depressive disorder, simple phobia, social phobia, and alcohol abuse/dependence.

PTSD also makes a significant impact on psychosocial functioning, such as problems in family and other interpersonal relationships, employment, and involvement with the criminal justice system.

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are common in people with PTSD. Often, medical doctors treat the symptoms without being aware that they stem from PTSD.

What is the Course of PTSD?

Most people who are exposed to a traumatic stressor experience some of the symptoms of PTSD in the days and weeks following exposure. Among individuals who go on to develop PTSD, roughly 30 percent develop a chronic form that persists throughout an individual’s lifetime.

The course of chronic PTSD usually has periods of symptom exacerbation and remission or decrease, although for some individuals symptoms may persist at an unremitting, severe level. Some older veterans who report a lifetime of none or only mild symptoms have experienced symptom exacerbations following retirement, severe medical illness in themselves or their spouses, or exposure to reminders of their military service (such as reunions or media broadcasts of the anniversaries of war events).

How is PTSD Treated?

Trauma-focused cognitive-behavioural therapy is the treatment of choice for PTSD. This approach helps people to deal with the wide variety of impacts of traumatic experiences, and it often includes an element of graduated exposure, which reduces the fear response to traumatic memories.

There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD.

Some medications have been shown to be helpful. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is sometimes effective for PTSD.