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Post Traumatic Stress Disorder (PTSD)

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or
dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers
many split-second changes in the body to help defend against danger or to avoid it. This “fight-
or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone
will experience a range of reactions after trauma, yet most people recover from initial symptoms
naturally. Those who continue to experience problems may be diagnosed with PTSD. People
who have PTSD may feel stressed or frightened even when they are not in danger.

Pathophysiology

PTSD frequently leads to changes in the anatomy and neurophysiology of the brain. Reduced
size of the hippocampus is probably both a predisposing factor and a result of trauma. The
amygdala, which is involved in processing emotions and modulating the fear response, seems to
be overly reactive in patients with PTSD. The medial prefrontal cortex (mPFC), which exhibits
inhibitory control over the stress response and emotional reactivity of the amygdala, appears to
be smaller and less responsive in individuals with PTSD. [7, 8, 9, 10]

Alterations in neurohormonal and neurotransmitter functioning have also been found. Individuals
with PTSD tend to have normal to low circulating levels of cortisol despite their ongoing stress
and elevated levels of Corticotropin Releasing Factor (CRF)

Epidemiology

Symptoms of PTSD most often begin within three months of the event. In some cases, however,
they do not begin until years later. The severity and duration of the illness vary. Some people
recover within six months, while others suffer much longer. Persistent re-experiencing of the
event: intrusive thoughts related to the traumatic event, nightmares or distressing dreams,
persistent or recurrent involuntary memories, dissociation (including flashbacks) and intense,
negative emotional or physiological reaction on exposure to reminders (traumatic triggers).
Types of events that can lead to PTSD include:

 serious road accidents

 violent personal assaults, such as sexual assault, mugging or robbery

 a traumatic birth

 prolonged sexual abuse, violence or severe neglect

 witnessing violent deaths

 military combat

 being held hostage

 terrorist attacks

 natural disasters, such as severe floods, earthquakes or tsunamis

 a diagnosis of a life-threatening condition

 an unexpected severe injury or death of a close family member or friend

diagnosis

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or
psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

 At least one re-experiencing symptom

 At least one avoidance symptom

 At least two arousal and reactivity symptoms

 At least two cognition and mood symptoms

Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to
ensure treatment is tailored to your individual needs.
Your GP will often carry out an initial assessment, but you'll be referred to a mental health
specialist for further assessment and treatment if you have had symptoms of PTSD for more than
4 weeks or your symptoms are severe.

There are a number of mental health specialists you may see if you have PTSD, such as a
psychologist, a community psychiatric nurse or a psychiatrist.

Treatment

The main treatments for post-traumatic stress disorder (PTSD) are psychological therapies
and medication.

Doctors use certain antidepressant medications to treat PTSD -- and to control the feelings of
anxiety and its associated symptoms including selective serotonin reuptake inhibitors (SSRIs)
Mood stabilizers, and atypical antipsychotics.

Psychotherapy for PTSD involves helping the person learn skills to manage symptoms and
develop ways of coping. Therapy also aims to teach the person and his or her family about the
disorder, and help the person work through the fears associated with the traumatic event. A
variety of psychotherapy approaches are used to treat people with PTSD, including:

 Group therapy may be helpful by allowing the person to share thoughts, fears, and
feelings with other people who have experienced traumatic events.

 Family therapy may be useful because the behavior of the person with PTSD can have
an affect on other family members

 Psychodynamic therapy focuses on helping the person examine personal values and the
emotional conflicts caused by the traumatic event.

 Cognitive behavioral therapy, which involves learning to recognize and change thought
patterns that lead to troublesome emotions, feelings, and behavior.
 Prolonged exposure therapy, a type of behavioral therapy that involves having the
person re-live the traumatic experience, or exposing the person to objects or situations
that cause anxiety. This is done in a well-controlled and safe environment. Prolonged
exposure therapy helps the person confront the fear and gradually become more
comfortable with situations that are frightening and cause anxiety. This has been very
successful at treating PTSD.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and
seeking professional help is often the only way of effectively treating PTSD.

It's possible for PTSD to be successfully treated many years after the traumatic event occurred,
which means it's never too late to seek help.

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being
unable to stop thinking about what's happened. Fear, anxiety, anger, depression, guilt — all are
common reactions to trauma. However, the majority of people exposed to trauma do not develop
long-term post-traumatic stress disorder.

Getting timely help and support may prevent normal stress reactions from getting worse and
developing into PTSD. This may mean turning to family and friends who will listen and offer
comfort. It may mean seeking out a mental health professional for a brief course of therapy.
Some people may also find it helpful to turn to their faith community.

Support from others also may help prevent you from turning to unhealthy coping methods, such
as misuse of alcohol or drugs.