Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder, once known as "shell shock" and later "combat (or battle) fatigue," is now universally recognized as occurring as a result of exposure to an extremely traumatic stressor. Not all who experience the trauma develop it, but all who develop the disorder have each suffered a personal trauma, such as:

  • the threat of death
  • the threat of, or actual, serious injury to one's self
  • witnessing the death or serious injury of another
  • learning about the unexpected and/or violent death, serious injury--or the threat of death or injury--to a significant other.

It can occur at any age, including childhood. Some examples of events that can precipitate a post-traumatic stress disorder are:

  • war
  • natural disasters (e.g., a catastrophic tornado, earthquake)
  • rape
  • an auto accident involving death and/or severe injury
  • being a hostage and/or victim of torture
  • being robbed at gunpoint.

Symptoms associated with the disorder usually develop within the first three months after the traumatic event, but the symptoms can also be delayed for months or even years. The person's response to the event involves intense fear, helplessness, and/or horror; for children, the response involves disorganized and agitated behaviors. To be diagnosed with this disorder, the symptoms must last longer than one month, and the symptoms must not be present before the traumatic event. To be considered a "chronic" condition, the symptoms must last longer than three months. These persistent symptoms include:

  • difficulty falling or staying asleep
  • irritability or explosive outbursts of anger
  • difficulty concentrating
  • hyper-vigilance
  • an exaggerated startle response

Shortly after the traumatic event, one individual may react by being afraid to be alone; conversely, another may isolate and become withdrawn. Individuals with post-traumatic stress disorder experience intrusive and disturbing memories of the event in the form of thoughts or images, flashbacks, dreams/nightmares. Spontaneous recollections of the trauma also can be "triggered" by

experiences in the here-and-now. At such times, an individual may act or feel as if the traumatic event is recurring and is being relived. There is always intense psychological distress from internal or external triggers that resemble or symbolize the whole, or part, of the event.

With post-traumatic-stress-disorder, there can be a "numbing" response to the trauma, which may occur soon after the event. Unlike the individual who has intrusive and vivid memories of the event, another may be unable to recall all or important parts of the experience. There may also be a feeling of detachment and/or estrangement from others. Often, an individual who experiences PTSD will avoid anything associated with, or resembling, the event.

Experiencing intense symptoms and being overwhelmed with memories (or the constant fear of suddenly being overwhelmed with memories) can interfere with personal relationships and work, and usually prevent enjoyment of once-pleasurable activities. Individuals with PTSD find it difficult to express the emotions they feel. They also may alternate between feeling flooded by emotion and an inability to feel or express any emotion at all.

Not everyone requires treatment for PTSD. If one has relatively good coping skills and a reliable support system (friends and/or family), and if the stress is acute (a response to a recent event), it is possible for the symptoms to resolve within the first month. However, those with PTSD also may have experienced earlier losses or chaotic situations, and the current stress is compounded by these earlier, unresolved events. Survivor's guilt can be another complication. This kind of guilt occurs when one is in the position of surviving a catastrophic event that causes loss of life (even if one is injured).

The inability to work out grief and anger over injury and loss (whether due to one or more events) means the trauma can continue to affect one's feelings and behavior--often without being aware of it. Severe depression, anxiety, and even suicidal thinking can result from the inability to resolve painful feelings from a trauma. At such times, it is important to seek help and find a therapist who is experienced in working with post-traumatic stress.

Marleen Norman, LCSW, is a psychotherapist in San Francisco. Go to her homepage for more information or to contact her.

National Insitute of Mental Health is another site to visit.