Did You Know?

There are many types of post-traumatic stress disorder


June is Post-Traumatic Stress Disorder (PTSD) Awareness Month. The Mayo Clinic defines post-traumatic stress disorder as "a mental health condition that's triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event."

Many laypersons think of PTSD as something exclusive to military personnel or people who have experienced combat in some way. In reality, there are different types of PTSD and there is a wide range of symptoms.

Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don't have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with daily functioning, chances are that PTSD is present.

Post-traumatic stress disorder symptoms may start within three months of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions.

Symptoms can vary in intensity over time. The more general stress there is, the more PTSD symptoms will present themselves when triggered. For example, hearing a car backfire could trigger the memory of a traumatic combat experience. Or, seeing a report on the news about a sexual assault could trigger traumatic memories of a personal assault.

There are five main types of post-traumatic stress disorder: normal stress response, acute stress disorder, uncomplicated PTSD, comorbid PTSD and complex PTSD.

  • Normal stress response occurs when healthy adults who have been exposed to a single discrete traumatic event in adulthood experience intense bad memories, emotional numbing, feelings of unreality, being cut off from relationships or bodily tension and distress.

    Such individuals usually achieve complete recovery within a few weeks. Often a group debriefing experience is helpful. Debriefings begin by describing the traumatic event. They then progress to exploration of survivors’ emotional responses to the event. Next, there is an open discussion of symptoms that have been caused by the trauma. Finally, there is education in which survivors’ responses are explained and positive ways of coping are identified.
  • Acute stress disorder is characterized by panic reactions, mental confusion, dissociation, severe insomnia, suspiciousness, and being unable to manage even basic self care, work, and relationship activities. Relatively few survivors of single traumas have this more severe reaction, except when the trauma is a lasting catastrophe that exposes them to death, destruction, or loss of home and community. Treatment includes immediate support, removal from the scene of the trauma, use of medication for immediate relief of grief, anxiety, and insomnia, and brief supportive psychotherapy provided in the context of crisis intervention.
  • Uncomplicated PTSD involves persistent re-experiencing of the traumatic event, avoidance of stimuli associated with the trauma, emotional numbing, and symptoms of increased arousal. This type of PTSD may respond to group, psychodynamic, cognitive-behavioral, pharmacological, or combination approaches.
  • Comorbid PTSD with other psychiatric disorders is actually much more common than uncomplicated PTSD. PTSD is usually associated with at least one other major psychiatric disorder such as depression, alcohol or substance abuse, panic disorder, and other anxiety disorders. The best results are achieved when both PTSD and the other disorder(s) are treated together rather than one after the other. This is especially true for PTSD and alcohol or substance abuse. The same treatments used for uncomplicated PTSD should be used for these patients, with the addition of carefully managed treatment for the other psychiatric or addiction problems.
  • Complex PTSD (sometimes called “Disorder of Extreme Stress”) is found among individuals who have been exposed to prolonged traumatic circumstances, especially during childhood, such as childhood sexual abuse. These individuals often are diagnosed with borderline or antisocial personality disorder or dissociative disorders. They exhibit behavioral difficulties (such as impulsivity, aggression, sexual acting out, eating disorders, alcohol or drug abuse, and self-destructive actions), extreme emotional difficulties (such as intense rage, depression, or panic) and mental difficulties (such as fragmented thoughts, dissociation, and amnesia). The treatment of such patients often takes much longer, may progress at a much slower rate, and requires a sensitive and highly structured treatment program delivered by a team of trauma specialists.






Treatment
There are two primary types of treatment for post-traumatic stress disorder: psychotherapy and medications. Most people who experience post-traumatic stress disorder undergo some type of psychotherapy (most commonly either cognitive-behavioral therapy or group psychotherapy, or combination of the two).

Medications are nearly always used in conjunction with psychotherapy. While medications may treat some of the symptoms commonly associated PTSD, they will not relieve a person of the flashbacks or feelings associated with the original trauma.

The most commonly prescribed class of medications for PTSD (and the one approved by the U.S. Food and Drug Administration) are the selective serotonin re-uptake inhibitor (SSRI) antidepressants. Research shows that this group of medicines tends to decrease anxiety, depression, and panic associated with PTSD in many people. These types of antidepressants may also help reduce aggression, impulsivity, and suicidal thoughts that can occur in people with PTSD.

This class of antidepressants generally takes 6 to 8 weeks to work, so patience is needed when taking them. Many people don’t always respond to the first type of antidepressant tried, so another antidepressant may be required if the first one is ineffective.

A relapse of posttraumatic stress disorder is less likely if antidepressants are prescribed for at least a year. Antidepressants are particularly useful in patients who also suffer from depression. They are also useful when there is a history of abuse of alcohol or other substances.

There are a variety of other medications often prescribed to try and help reduce the symptoms associated with PTSD. The most common alternative to antidepressants are the atypical antipsychotics. These medications seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions).

There are many other medications used to manage PTSD, including mood stabilizers, minor tranquilizers and anti-anxiety pills. Some of these medications can provide immediate relief of symptoms, but with extensive usage, can actually exacerbate PTSD. In general, medications should be prescribed for PTSD only by a psychiatrist.