Post-Traumatic Stress Syndrome

Post-traumatic stress syndrome is a psychiatric disorder that arises from having endured an event that is outside the range of usual human experience. In the past, it was referred to as shell shock, and was associated mostly with war. Now, it is generally recognized that any devastating event -- a flood, earthquake, plane crash, rape, assault, accident, or fire -- can precipitate the syndrome in susceptible persons.

Post-traumatic stress disorder can occur at any age, but the very young and the aged appear to be the most vulnerable, presumably because they have less ability to cope and adjust to trauma. For example, one study found that 80 percent of young children who have suffered severe burns experience post-traumatic stress symptoms one to two years after the injury, compared with 30 percent of adults. Another survey indicated that 12 percent of women and 6 percent of men in the United States have experienced post-traumatic stress at some time in their lives. Among the women, half the cases resulted from having been raped or otherwise sexually molested, while combat duty was the major cause among men.

Persons suffering from post-traumatic stress repeatedly relive the event in disturbingly realistic dreams, hallucinations, or flashbacks. Often, these flashbacks are triggered by sights, sounds or smells associated with the trauma. Many such persons maintain a constant state of vigilance to avoid stimuli that are likely to trigger a flashback. They are often irritable and given to outbursts of uncontrollable anger. They may have difficulty sleeping and be unable to concentrate. Any situation that resembles an aspect of the event can set off a fight or flight response. For example, a survivor of a plane crash may experience sudden sweating, rapid heartbeat, and mounting fear whenever a plane flies overhead.

Others may withdraw and appear unresponsive to their environment, taking little interest in important or pleasurable activities and feeling detached or estranged from loved ones and friends. Feelings of survivor guilt are not uncommon when the trauma involved the death of others.

It is not known why some people develop the syndrome while others who shared the same experience do not. One recent hypothesis holds that hormonal factors may be responsible; another attributes the symptoms to withdrawal from high levels of endorphins and other opium-like body chemicals that are released during the flashbacks.

Diagnostic Studies and Procedures

To diagnose the disorder, the American Psychiatric Association notes that, in addition to persistently reliving the event, at least three of the following must be present for at least one month:

• Avoidance of thoughts and feelings associated with the trauma.
• Avoidance of activities or situations likely to trigger recall of the event.
• Amnesia of the event.
• Lack of interest in normal activities.
• Feelings of detachment.
• Restricted range of feelings or emotions, such as an inability to love.
• Gloomy outlook for the future. Two of the following conditions must also be present:
  • Insomnia.
  • Irritability or angry outbursts.
  • Difficulty in concentrating.
  • Excessive vigilance.
  • Exaggerated startle response.

Medical Treatments

Treatment varies depending upon the symptoms and their severity, but a combination of medication and psycho-therapy appears to work best.

Tricyclic antidepressant drugs such as amitriptyline (Elavil), imipramine (Tofranil), and phenelzine (Nardil) may be prescribed to help reduce anxiety and depression. In severe cases marked by violent or agitated behavior, antipsychotic medications such as hatoperidol (Haldol) or thiothixene (Navane) may be used for a brief lime. If the patient is suicidal or self-destructive, hospitalization might be necessary.

Short-term cognitive psychotherapy may he advised for helping the patient develop effective coping techniques. Group and family therapy could also prove helpful, especially if the traumatic event is one that affected a large number of people, such as a flood.

Alternative Therapies

Art, Dance, and Drama Therapy. Under the guidance of a qualified therapist, these arts can be effective in helping post-traumatic stress patients come to grips with the devastating event and to express fears or thoughts they might not be able to verbalize. These modalities are especially helpful in the treatment of children.

Meditation, Relaxation therapies, especially meditation, self-hypnosis, and biofeedback training, can help ease anxiety.

Self-Treatment

It is important to acknowledge and discuss the experience, rather than trying to forget or ignore it. Sometimes spending time talking about it with a supportive family member or friends can help integrate the event effectively. It is also wise to try to resume normal activities as soon as possible.

Joining a support group of people who have survived a similar experience may also help. Such groups have proved especially beneficial for rape victims and Vietnam veterans.

Other Causes of Post-Traumatic Symptoms

Panic attacks and other manifestations of an anxiety disorder can cause symptoms similar to those of post-traumatic stress, as can certain phobias