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Post-traumatic stress disorder (PTSD)
From MayoClinic.com
Special to CNN.com

Introduction

Post-traumatic stress disorder is an anxiety disorder that's triggered by your memories of a traumatic event — an event that directly affected you or an event that you witnessed.
The disorder commonly affects survivors of traumatic events, such as sexual assault, physical assault, war, torture, a natural disaster, an automobile accident, an airplane crash, a hostage situation or a death camp. Post-traumatic stress disorder also can affect rescue workers at the site of an airplane crash or a mass shooting. It can affect someone who witnessed a tragic accident.
Not everyone involved in a traumatic event experiences post-traumatic stress disorder. However, the disorder affects more than 5 million adults each year in the United States. Post-traumatic stress disorder is twice as common in women as it is in men.
Treatment may involve a combined approach including medications and behavior therapy designed to help you gain control of your anxiety.

Signs and symptoms

Signs and symptoms of post-traumatic stress disorder typically appear within three months of the traumatic event. However, in some instances, they may not occur until years after the event and may include:

<LI class=doublespace>Flashbacks and distressing dreams associated with the traumatic event. <LI class=doublespace>Distress at anniversaries of the trauma. <LI class=doublespace>Efforts to avoid thoughts, feelings and activities associated with the trauma. <LI class=doublespace>Feelings of detachment or estrangement from others and an inability to have loving feelings. <LI class=doublespace>Markedly diminished interest or participation in activities that once were an important source of satisfaction. <LI class=doublespace>In young children, delayed or developmental retrogression in such areas as toilet training, motor skills and language. <LI class=doublespace>Hopelessness about the future — no hope of a family life, career or living to old age.
Physical and psychological hypersensitivity — not present before the trauma — with at least two of the following reactions: trouble sleeping, anger, difficulty concentrating, exaggerated startle response to noise, and physiological reaction to situations that remind you of the traumatic event. These physiological reactions may include an increase in blood pressure, a rapid heart rate, rapid breathing, muscle tension, nausea and diarrhea.

Risk factors

The severity of the traumatic event and how long the event lasted appear to be factors in the development of this disorder. Other factors that may increase the likelihood of developing post-traumatic stress disorder include:

A previous history of depression or other emotional disorder
A previous history of physical or sexual abuse
A family history of anxiety
Early separation from parents
Being part of a dysfunctional family
Alcohol abuse
Drug abuse

When to seek medical advice

It's normal to undergo a wide range of feelings and emotions after a traumatic event. The feelings you experience may include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating patterns, or bouts of crying that come easily. You may have recurrent thoughts or nightmares about the event. If you have these disturbing feelings for more than a month, if they're severe or if you feel you're having trouble getting your life back under control, consider seeing your doctor or a mental health professional.

Screening and diagnosis

Your doctor or mental health professional likely will ask you to describe the signs and symptoms you're experiencing — what they are, when they occur, how intense they are and how long they last. This will help your doctor or therapist learn more about your condition. Your doctor may also ask you to describe the event that triggered your symptoms to try to get a sense of how intense the event was and how it affected you. You may encounter some of the symptoms of post-traumatic stress disorder after a traumatic event, but you may not necessarily have a diagnosis of post-traumatic stress disorder. Diagnosing the condition requires that the symptoms be present longer than one month.

Complications

Having post-traumatic stress disorder may place you at a higher risk of:

Depression, which has many of the same signs and symptoms as post-traumatic stress disorder
Drug abuse
Alcohol abuse
Eating disorders
Divorce

Treatment

Your doctor or a mental health professional may suggest a combination of medications and behavior therapy to treat post-traumatic stress disorder. The objectives of treatment are to reduce your emotional distress and the associated disturbances to your sleep and daily functioning, and to help you better cope with the event that triggered the disorder.
Medications

<LI class=doublespace>Selective serotonin reuptake inhibitors (SSRIs). These antidepressants act on the chemical serotonin, the neurotransmitter in your brain that helps brain cells (neurons) send and receive messages. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), fluvoxamine and venlafaxine (Effexor XR). These medications can help control anxiety as well as depression. <LI class=doublespace>Tranquilizers. Medications such as clonazepam (Klonopin) and lorazepam (Ativan) may decrease feelings of anxiety. <LI class=doublespace>Cognitive-behavior therapy. This treatment teaches you effective ways of managing thoughts or situations that remind you of the trauma you've experienced. You and your psychotherapist can draw up a list of situations or memories that cause anxiety. You gradually expose yourself to more anxiety-provoking thoughts and situations while learning that your body calms itself through a process called habituation. Repeated exposure to sources of anxiety diminishes your fear so that you no longer need to avoid certain situations and thoughts. The goal of this therapy is to promote a sense of recovery and a feeling of mastery over your anxiety. <LI class=doublespace>Stress management training. This approach also involves learning to manage your anxiety through relaxation. You work with the help of a therapist to develop skills to decrease your preoccupation with negative thoughts and the sense of being overwhelmed by the traumatic event.
Cognitive therapy. You identify, with your therapist's help, distorted thoughts and beliefs that arouse psychological stress. You learn ways you can view and cope with a traumatic event differently, and you learn alternative beliefs about the event and the impact it has on your life. There is special emphasis on learning to develop a sense of mastery and control of your thoughts and feelings.

Treatment of post-traumatic stress disorder with behavior therapy can be effective, and the prognosis for long-term success is good.

Coping skills

If distress caused by a past traumatic event persistently affects your life, seeing your doctor is a necessary first step along a course of professional treatment. But you can take actions to help yourself cope:

<LI class=doublespace>Follow your doctor's instructions carefully. Although it may take a while to feel the effects of therapy, hang in there. You'll be better off in the long run. <LI class=doublespace>Take care of yourself. Get enough rest, eat a balanced diet, exercise, and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety. Don't turn to alcohol or unprescribed drugs for relief. <LI class=doublespace>Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus.
Talk to someone. Share your problems with a friend or counselor who can help you gain perspective. Ask your doctor about support groups in your area for people who have post-traumatic stress disorder.