Post-Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis for people who have endured a highly stressful and frightening experience and who are experiencing distress caused by memories of that experience. It is as if a person is "possessed" by memories of an experience and just cannot let go. Because anxiety is the major sign of PTSD, it is classified as an anxiety disorder. Other anxiety disorders are phobias, panic disorders, and generalized anxiety.

The good news is that it is highly treatable when diagnosed early. The bad news is that it is often missed by examining physicians and mental health professionals, or it is misdiagnosed as some other condition that is more neurobiochemical in nature. But there is no drug cure for PTSD.

Catastrophe/traumatic events are the cause of PTSD. These events are sudden, overwhelming, and often dangerous, either to one’s self or significant others(s), such as a car wreck, natural disaster, dangerous accident, war combat, robbery at gunpoint, or a near drowning; the person affected felt intense fear, helplessness, or horror either at the time or immediately afterwards. Close friends, family members, and professionals helping those who survive such catastrophes can also be affected by trauma. These helpers, because of their empathy and compassion for the person in harm’s way, can be traumatized in the course of providing help.

A catastrophe or traumatic event is a source or cause of stress that most people experience. The stress experienced during or immediately after the traumatic event or catastrophe is traumatic stress. Similarly, the stress that is associated with the traumatic event/catastrophe and that is experienced well afterwards is post-traumatic stress. It is defined as a set of conscious and unconscious behaviors and emotions associated with dealing with the memories of the stressors of the catastrophe.

Most people who have been exposed to a catastrophe experience both traumatic and post-traumatic stress reactions. Most are able to survive and cope well; only a small percentage of people develop PTSD.

Authorities recognize four features that all those with PTSD tend to exhibit at some time during their illness: the person -

• has been exposed to a traumatic event;
• re-experiences the most traumatic aspects of the event;
• makes efforts to cope with these symptoms by avoiding exposure to reminders; and
• is on edge, unable to relax, and unable to think about the event without being obsessed.

Signs and symptoms of post-traumatic stress disorder may begin within few weeks a traumatic event and in some cases the PTSD symptoms may occur only years after the event. Post-traumatic stress disorder symptoms are commonly grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).
Symptoms of intrusive memories may include:

• Flashbacks, or reliving the traumatic event for minutes or even days at a time
• Upsetting dreams about the traumatic event

Symptoms of avoidance and emotional numbing may include:

• Trying to avoid thinking or talking about the traumatic event
• Feeling emotionally numb
• Avoiding activities you once enjoyed
• Hopelessness about the future
• Memory problems
• Trouble concentrating
• Difficulty maintaining close relationships

Symptoms of anxiety and increased emotional arousal may include:

• Irritability or anger
• Overwhelming guilt or shame
• Self-destructive behavior, such as drinking too much
• Trouble sleeping
• Being easily startled or frightened
• Hearing or seeing things that aren't there

Post-traumatic stress disorder symptoms may come and go. In general, during times of higher stress or when you experience reminders of what you went through, you are more prone to have post-traumatic stress disorder symptoms.

When PTSD is detected, other symptoms and characteristics are found too. This is why PTSD is so often misdiagnosed. Among the major sets of symptoms are phobia and general anxiety (especially among former POWs and hostages and natural disaster survivors), substance abuse, depression, psychosomatic complaints, an altered sense of time (especially among children), grief reactions and obsessions with death (especially among those who survived a trauma in which someone could have died), feeling guilty, and increased interpersonal conflicts. For some who have PTSD, these other features go away once the PTSD symptoms are eliminated through treatment.

There are three types of PTSD: acute, delayed, and chronic. Acute PTSD is when the above symptoms last between one and 3 months after the trauma. Chronic PTSD is when the symptoms last for at least 3 months following the trauma. Delayed PTSD is when symptoms do not show up for at least 6 months after the trauma. This is often found with adult survivors of childhood traumas.

The most effective treatment approaches are called "cognitive-behavioral" because they focus both on the way traumatized persons view the trauma and on their resulting behavior. Exposure therapy includes systematic desensitization (training to relax in the face of frightening reminders of the trauma) and imaginable, in-vivo techniques such as flooding or the process of putting the client back into the trauma psychologically. The most effective treatment for PTSD includes a variety of anxiety management training strategies. Some of these include Rational Emotive Therapy, various kinds of relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques. Innovative therapists are successful in combining various techniques to fit the trauma and the patient’s unique requirements.

Families are the best setting to help those who suffer from this stress disorder. Families know when a member is acting differently than before the traumatic event. A therapist may work with you or your family member with PTSD to remember the trauma and reprocess the information and mourn losses. This also means that you will learn self-soothing techniques and ways to limit the distress during and between sessions. Your therapist will help you disconnect from the trauma so that reminders do not arouse distress. In doing so, the therapist will help you reconnect to life now and in the future without being haunted by the trauma. Sometimes this transition to life without the trauma is harder than expected.

The reconnecting is especially important: once you are desensitized from the burdens caused by the traumatic event, family therapy enables you to turn your attention to the future. You will attempt to learn from the traumatic events and make needed changes in your personal life and relationships, especially love relationships.

PTSD treatment benefits:

• Ability to lead a more normal life
• Improved relationships
• Ability to function more effectively on a day-to-day basis

Eye Movement Desensitization and Reprocessing (EMDR) is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies.

EMDR is a fairly new therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma. While talking about your memories, you'll focus on distractions like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes. Studies have shown that it may help you have fewer PTSD symptoms. But research also suggests that the eye movements are not a necessary part of the treatment.

The EMDR technique is most effective when used in conjunction with other traditional methods of therapy in treating these and many other emotional disorders. EMDR therapy can help clients replace their anxiety and fear with positive images, emotions and thoughts.

Here are some of the reasons why you may want to seek help. Seek help because:

Early treatment is better

Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.

PTSD symptoms can change family life

PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.

PTSD can be related to other health problems

PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD you could also improve your physical health.

It may not be PTSD

Having symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms for other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. And, different problems have different treatments.

While it may be tempting to identify PTSD for yourself or someone you know, the diagnosis generally is made by a mental-health professional. This will usually involve a formal evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems.

Family therapy offers an extraordinary and useful resource for helping families survive a major traumatic event. Social scientists have documented the remarkable and consistent patterns of emotional recovery from a wide variety of traumatizing events. There is a large number of treatment approaches available today. It is impossible to prevent traumatic events but family therapy can help promote recovery more quickly, and enable family members to get back to what they do best: love each other.

• National Center for Post Traumatic Stress Disorder
  802-296-5132
• International Society for Traumatic Stress Studies
  847-480-9028
• SAMHSA National Center for Trauma-Informed Care

(Part of this text was written by Charles R. Figley, Ph.D)