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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 an extremely stressful event involving the threat of death or extreme bodily harm, such as a sexual assault, physical violence, and military combat. It can occur in the wake of a car crash, fire, earthquake, or other natural disaster; or any sudden, disruptive event.

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 is as if one's normal stress response is locked into permanent overdrive. Those with PTSD often have difficulty functioning in everyday life, and symptoms can persist for more than a month.

PTSD has probably existed throughout human history. It was first thought only to affect soldiers; during World War I, it was known as “shell shock.” 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.

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 percentage will develop post-traumatic stress disorder; among veterans of combat, rates of the disorder range from 10 to 30 percent.

What Are the Symptoms of PTSD?

Those with PTSD suffer from classic anxiety symptoms, such as insomnia and worry. They are constantly vigilant and 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 was happening again. That original traumatic event is recalled spontaneously, in flashbacks of memory so intense that the situation truly seems to be recurring. The same panic, dread, and terror originally evoked are usually present.

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, or apathy and 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.

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

What Happens in the Brain?

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.

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.

Treatment for PTSD

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 experience and modify the emotional force of the memory.

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.

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