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Post-Traumatic Stress Disorder

What Is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that develops in response to experiencing or witnessing a traumatic event involving the threat of death or extreme bodily harm. Examples of traumatic events that can trigger PTSD include sexual assault, physical violence, and military combat. PTSD can also occur in the wake of a motor vehicle accident, a natural disaster (e.g., fire, earthquake, flood), a medical emergency (e.g., having an anaphylactic reaction), or any sudden, disruptive incident.

What Is Post-Traumatic Stress Disorder?

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PTSD has likely existed throughout human history. During World War I, it was known as “shell shock” and was first thought only to affect soldiers. PTSD was officially recognized as a mental health disorder in 1980. In the United States, about 3.5 percent of adults may have the disorder. About half recover within three months, but for many others, the condition becomes chronic.

Anyone who has survived a traumatic experience can develop PTSD symptoms. PTSD is characterized by vivid, intrusive memories of the precipitating event, hypervigilance and reactivity to possible threats, nightmares, and mood disturbances. Those suffering from PTSD often report feeling anxious or scared even in the absence of danger. The condition may manifest in anxiety-like symptoms, emotional numbness or dysphoria, anger and aggression, or some combination of those states. It can feel like the person’s normal stress response is locked into permanent overdrive, and they often find it difficult to function normally in everyday life.

How common is PTSD?

Some studies estimate that as much as half of the population will experience a traumatic event at some point in their lives. Of those, only a small percentage will develop post-traumatic stress disorder; among veterans of combat, the rates of the disorder range from 10 to 30 percent.

What are the risk factors for PTSD?

Research shows that some people are at higher risk than others for PTSD. Most vulnerable are persons who have a history of trauma exposure or mental difficulties. Having little social support or recurrent ongoing life stress are also risk factors. Physical impairment and job loss add to the risk.

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What Are the Symptoms of PTSD?

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Those with PTSD suffer from classic anxiety symptoms, such as insomnia and worry. They are hypervigilant and constantly alert to possible dangers. Typically, they have an exaggerated startle response. Unexpected sound or movement can provoke a strong, violent reaction, as if the precipitating danger were happening again. That original traumatic event can be recalled spontaneously in flashbacks of memory so intense that someone can feel like they are living through the situation again in the present. They may even feel the same panic, dread, and terror that were originally evoked.

Anxiety is not the only form of distress sufferers experience. Disrupted mood is common, and people often feel the guilt and shame typical of depression. Some people with PTSD may suffer apathy or detachment from others. They may also regard others with suspicion and display hostility. Sufferers may find it difficult to trust anyone.

To avoid reminders of the trauma, which tend to occur randomly, many with PTSD withdraw from the normal activities of life altogether. Some seek relief by consuming alcohol or other drugs. There is no guarantee that PTSD symptoms will go away on their own or lessen with time, but there are resources that can help people regain a good quality of life.

For more information on symptoms, causes, and treatment of PTSD, see our Diagnosis Dictionary.

Can you prevent PTSD?

While there is no way to completely predict or control whether someone will develop PTSD, researchers on a quest to cure PTSD observe that some advance preparation can be protective. For example, stress-inoculation therapy, which uses imagery and video simulations to expose people to a progression of challenging circumstances, can help individuals develop coping skills. This training seeks to develop cognitive flexibility and a sense of control over one’s own stress response, both skills that can boost resilience in the face of trauma.  

Can women get PTSD from childbirth?

The birth of a child is generally considered to be joyous and natural. No one wants to think about post-traumatic stress disorder occurring as a result of childbirth. Nevertheless, between 4.6 and 6.3 percent of mothers develop “postpartum post-traumatic stress disorder” or PP-PTSD after successfully giving birth. Risk factors include a difficult birthing experience (e.g., physical pain, hormone changes, excessive weight and blood loss, and sleep deprivation), unplanned cesarean sections, the use of instruments such as forceps, and pre-existing mental health concerns. Among other longer-term implications, PP-PTSD can make it more difficult for mothers to bond with their infants during those vital first few months.  

PTSD and the Human Brain

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Understanding what trauma does to the brain is critical for the development of effective treatments for PTSD, and has become a major focus of research. In PTSD, the stress circuitry in the brain goes awry, disrupting communication between several brain centers. These include the amygdala, which normally monitors incoming perceptions and red-flags threats, putting systems on high alert and setting off the stress response; the prefrontal cortex, or executive control center of the brain, which normally senses when a threat is over and dampens amygdala activity; and the hippocampus, where memories are stored and retrieved.

In PTSD, researchers find, the prefrontal cortex is underactivated and the amygdala is overactivated. There is evidence that a core problem lies in the connections between individual nerve cells, or synapses; there is a deficit in connectivity, limiting communication between nerve cells. As a result, individuals with PTSD lose psychological flexibility: They stay stuck in an over-the-top response pattern, and their memories resist the modification that normally occurs over time.

What brain regions are involved in PTSD?

PTSD is a “whole-brain” disorder that involves the brain circuits of fear, stress, and anxiety. The amygdala (which controls the fight-or-flight response) becomes hyperactive. Meanwhile, the pre-frontal cortex (the CEO or executive functioning center of the brain) grows sluggish or lacks sufficient neural connections with the amygdala to calm down the fear response. The hippocampus (the verbal memory center) tends to be smaller and yet more active in response to perceived threats in people with PTSD.  

How does PTSD affect normal brain functioning?

In response to an overactive amygdala and underactive pre-frontal cortex, the brain releases more norepinephrine in the presence of perceived danger. This can affect brain functioning in several ways, such as hyperarousal, hypervigilance, and increased wakefulness and sleep disruption. PTSD sufferers may also find that when they are emotionally triggered, they have less control over their reactive anger and impulsive behaviors. This emphasis on the negative emotions of fear and anger can decrease someone’s positive feelings and create problems at work and in personal relationships.

Treatment for PTSD

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Therapy and Medication

Treatment for PTSD usually centers around talk therapy, but new forms of treatment are being developed that combine talk therapy and medication in new and promising ways for the 50 percent of sufferers whose symptoms are not relieved by current strategies. Studies suggest that it may even be possible to prevent PTSD from occurring, especially in high-risk situations.

Psychotherapy, particularly exposure therapy and cognitive reappraisal therapy, has proved to be one of the most reliable treatments for PTSD. The goal is to restore cognitive flexibility so that sufferers can talk about their bad experiences and modify the emotional force of the memory.

Psychedelic-Assisted Psychotherapy

The use of drugs that boost the power of psychotherapy by directly increasing nerve-cell connections is currently under clinical investigation. Among those drugs is the anesthetic ketamine, sometimes known as the club drug Special K; it is already approved for use in treating severe depression. When given (by injection) in concert with a specific program of psychotherapy, it has been shown to significantly speed recovery from PTSD, accomplishing in days what might otherwise take months.

Another promising path is psychedelic-assisted therapy with MDMA, also known as Ecstasy or Molly. When given to PTSD patients just before a therapy session, researchers find, it dramatically speeds up the therapeutic process. It allows even those with chronic PTSD to talk about deeply disturbing events and regain control of their reactivity.

How does psychedelic-assisted treatment for PTSD work?

Psychedelics like MDMA (also known as ecstasy or Molly) can help patients with PTSD reconsolidate traumatic memories. PTSD sufferers get unpredictable flashbacks to the traumatic event and often re-live the same stress, fear, and other negative emotions as if they are happening in real-time. Using a psychedelic like MDMA in combination with therapy may facilitate the recovery process for people with PTSD, allowing them to get the emotional distance from their traumatic memories that they need in order to process them and heal.   

What is mantram repetition therapy for PTSD?

Mantram repetition therapy is a type of mindfulness therapy that involves repeating a “mantram”—a meaningful word or phrase—in order to calm down and be more present. Mantram repetition appears to be a promising additional therapy for post-traumatic stress disorder. It enables PTSD sufferers to slow down and direct their attention in more healthy directions without having to engage with their traumatic memories.

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