Dangers of Post Traumatic Stress Disorder

PTSD is a cluster of symptoms that we see that can occur either immediately after a traumatic event, or it can occur even years after a traumatic event occurs. Those individuals that suffer from PTSD have either witnessed a traumatic event themselves, been part of it such as military personnel in combat, or has been present when a traumatic event has occurred to somebody else such as someone who has witnessed a car accident, or a young child who witnessed domestic violence in the home. PTSD symptoms can also occur after just hearing about a very traumatic or violent event that occurred to a loved one, or a family member. This commonly refers to loss of a family member for young children, or people of any age. The four kinds of symptom areas that we see would be:

Re-experiencing the trauma whether it is in a flashback, in which they feel that they are actually involved in the trauma. They can see things and hear things just as they did in the traumatic event, or in the form of nightmares, or just intrusive thoughts about the event.

The second symptom cluster that we see is avoidance, avoidance of people, places and things that remind them of the traumatic event, or avoidance of the unpleasant thoughts related to the traumatic event itself. A third cluster of traumatic events that we see is hyper arousal, or just increased arousal overall. The person can be easily startled. Commonly we have veterans who return from war, if they hear a car backfire, or a firecracker go off they interpret those sounds as a gunshot and will throw themselves to the ground so that would be an example of being very easily startled. They have difficulty relaxing, always kind of feel like they are tense, or on edge. They have difficulty sleeping, and they can have bouts of irritability or anger that appeared to come out of nowhere. As related to the part of hyper arousal, these are some of the cluster of symptoms that we see.

The last cluster of symptoms that we see can be just as debilitating as the other ones. It is difficulties with changes in cognition; difficulty with memory, forgetfulness, or changes in mood, so that can be just lack of pleasure, and not being able to enjoy things in life they used to enjoy, being in a state of anhedonia, being dysphoric, hopeless. It is just an inability to feel happiness. These are some of the things we come across in terms of mood and cognition changes. So these are the four areas we focus on evaluating and diagnosing PTSD.

The symptoms can occur immediately after a combat or they can take a while to occur. Some symptoms will occur sooner than others and some will take maybe even years to develop. Generally we see an avoidance of any type of trigger that would remind them of combat, like avoidance of watching the news, sometimes avoidance of people altogether, so they may isolate themselves to their home, avoid going to public places, or crowded public places, particularly malls, or areas in which they cannot immediately control their environment. If they would go into restaurants or other public areas they would need to be in the back where they can see all of their surroundings around them so that they feel like they are in control. Often times they have very poor sleep habits, so they will stay awake all night, because that is the period where they feel threatened and they may sleep during the day or they may not sleep at all. Often times they will self-medicate using alcohol, or drugs to diminish or to numb those intrusive thoughts, or those flashbacks. It can be very difficult for them initially to enter back into civilian life that that is where we really see a lot of the symptoms, but they can come up even later in life, sometimes even decades later.

The PTSD symptoms manifests in veterans gradually. It varies from individual to individual. The most common scenario would be that we see sleep disturbances and hyper vigilance almost immediately. They would return from combat and have those symptoms. While they are still in combat they are still in a fight-or-flight kind of mode, and they may not realize the symptoms until they come back into civilian life and then their sleep is disrupted, the avoidance of public places and nightmares would be some of the first things we come across.

One of the most important things when we are talking about treatment of PTSD is timing. The psychiatrist wants to identify it as early as possible and treat it as quickly as possible. For instance, with veterans they often have an immediate post deployment interview with a health professional, whether it is a psychiatrist, or primary care physician, or a nurse practitioner when they are exiting their deployment and that is very important, but it is also very important for them to have a follow-up screening. So, three or four months out from combat (in case with veterans), this could be related to anybody who has been exposed to a traumatic event, because as highlighted before, some of the symptoms takes weeks, months, or even years to develop, but difficulty with that is if someone has developed PTSD and is suffering from say avoidance of thoughts about this or avoidance of interacting with people it may be difficult to do that follow-up screening with veterans, or with children, or adults who have witnessed any type of traumatic event, but ideally immediately after the event after they feel secure in their environment and then at least three or four months out as a second screening.

PTSD was first recognized in World War I and it was first called as shell shock at that time. Same cluster of symptoms were recognized, but different name. After World War II that was when it was first called as post traumatic stress disorder occurred and picked up prevalence in terms of awareness in the Vietnam War and that is really when most of the emerging studies came out on the actual entity of PTSD in the late 60, and early 70.

People do not recognize that it can show up in younger adults and children as well. The prevalence of traumatic events unfortunately, in children and adolescents is very high. So studies show up to 40 to 45% of children will be exposed to traumatic event during their lifetime. It is going to make sense that they are going to suffer from PTSD as well. Children are seen to have more resilience at times than adults, and may not develop PTSD at the same prevalence, but certainly they do. In very young children it can be very difficult to detect because the symptoms are not the ones that were highlighted earlier with re-experiencing phenomenon, the avoidance, and the mood symptoms. Generally we see aggression in their behavior. For instance, if they had been potty trained, or toilet trained they may start wetting their bed at night time. They may be overly clingy with adults, or their caretakers, and their behavior may regress altogether where they do not do things they used to be able to do for themselves, and of course their mood can change as well, but it is not the classic dysphoria, or depressed mood and lack of enjoyment that we see in adults. They may become more clingy, more irritable, or agitated and generally we will see in their play, it may take on a more aggressive or more agitated demeanor. With adolescents, they are more similar to adults in the way that they display their PTSD symptoms. Big difference is that they can be more irritable and more revenge-seeking in terms of wanting to get even for the trauma occurring to them, but otherwise they present very similar as adults, so they would have the avoidance and then re-experiencing the hyper arousal and the mood symptoms that go along with PTSD.

With elderly we see many times resurgence and even an increase in the expression of PTSD symptoms and they are very similar to those in adults that we had dealt with earlier, but sometimes they are increased because of a number of factors. They tend to be more isolated. They do not have as much of a social support network that they may have whey they were younger, retirement and that change in life role that comes with retirement can be a big trigger. They may have sort of delved into work when they were younger, and now they have more time to think about and the traumatic event that occurred, as often times we can see an increase in the PTSD symptoms, or resurgence of PTSD symptoms in the elderly because of their change in life function and often times it is associated with poor physical conditions, sometimes a loss of income or lower income and the big one I think being less of a social connectedness with retirement in old age.

We are going to see an increase in the reports of the numbers of PTSD. This is actually increasing the percentage of people who are affected by PTSD it is difficult to state. Most people who are going to be affected by the newscast of natural disasters or mass killings have an underlying pre-dispositional already meaning that they may have already experienced a trauma and have had PTSD in the past, or having anxiety, or underlying depression. Those are the people it is going to affect most. As per the American Psychiatric Association, exposure to media itself unless it intimately affects our community, or our own sense of safety within our media surroundings does not increase PTSD, but from a clinical perspective we are going to see PTSD expression more because people who have an underlying PTSD symptoms, or anxiety and depression are going to feel the burden of this constant 24-hour monitoring of different traumatic events around the world.

The likelihood of an untrained person meaning not a fire fighter, police officer, or first responder who firsthand witnesses this is very high, particularly within the first two or three months upwards of 50%, or more. Fortunately, individuals tend to be resilient and so that number will taper off greatly by three to six months, but we are looking at at least half the percentage of people who witnesses this first hand will develop PTSD symptoms by a three-month time-frame.

Treatment in general PTSD follows a line of both psychotherapy or talk therapy and medication, but of course that is going to vary depending on the age and the severity. First and foremost when an individual undergoes a traumatic event there has to be what we call a first response, or first aid. We have to help the patient feel that they are safe in their environment and eliminate any obstacles to that safety such as providing shelter, food, and things of that nature. Once the dust settles so to speak they are out of the immediate time-frame of hardness, and it is very important for them to undergo, talk therapy. Some people will be very resistant to therapy, especially initially, and that is understandable. It goes along with part of the symptoms of avoidance of thoughts of the traumatic event so that may need to be revisited at three months out or six months out if the person is not willing to engage in therapy right after the incident. In young children we often engage in play therapy, so instead of talk therapy we would play with them with a dollhouse, or have them re-enact the events, and you do not ask them to re-enact. You play with them and they will start to re-enact it and you help them come up with a better solution instead of the traumatic outcome, a more pleasant outcome. In older adolescents, adults and the elderly talk therapy is going to be the mainstay of treatment there and there is a specialized cognitive behavioral therapy for trauma, and that is what most commonly employed. Medications can be very helpful as well; particularly antidepressants, which help to improve the mood and decrease those cognitive, and mood symptoms that we talk about also help the hyper arousal and improves the sleep, and often times other types of medications are used as needed depending upon their individual symptoms.

Combat veterans would avoid loud crowded noisy areas if they were in combat in the Middle East and that is where they would not employ different techniques.

If we are constantly bombarding ourselves and our body starts to feel threatened then we are at an increased risk. We do experience trauma to develop PTSD and so for small children in adolescence the news needs to be filtered and in smaller increments 24 hours a day.

PTSD can be a chronic disorder and so some may have symptoms until they die. In others the symptoms will be more acute and within three to six months they will certainly lessen. The numbers of people who respond to PTSD is difficult to gauge largely because people who have PTSD do not always follow through with their treatment, but I would say that a significant symptom reduction can be expected in at least 50 to 75% of patients who initially present with PTSD.

If your loved one is suffering from PTSD symptoms, the first thing you have to do is to ensure their immediate safety. In a combat veteran for instance that may be removing guns from the home or removing any other type of risk factors for self-harm, or harm to others. The second step would be to contact a mental health professional.