Post Traumatic Stress Disorder — A normal reaction to an abnormal situation

We have heard a lot about Post Traumatic Stress Disorder, or PTSD, one of a group of Anxiety Disorders. It is at the same time over-diagnosed and often misunderstood. PTSD is a reaction to an extreme stressor that can affect anyone, given the right stressful situation.

People react differently to various stressors, but no one is immune to stress. In order for a diagnosis of PTSD to be made, a stressor that is outside the range of normal human experience must be identified. This can include extreme experiences such as active combat, rape, involvement in severe accidents, experiencing natural disasters such as earthquakes or tsunamis, severe personal abuse, etc. In all instances the stressor must be personally experienced and be severe, and the response to it involved fear, helplessness or horror.

In order for a diagnosis of PTSD to be made, symptoms must include the following:

1. Re-experiencing the traumatic stressful event, such as in recurrent distressing recollections or dreams, acting or feeling as if the event were recurring including a sense of reliving the experience, illusions, hallucinations and "flashbacks" to the event, intense distress at exposure to cues that symbolize or resemble an aspect of the event, and physiological reactivity (such as sweating) when exposed to such cues.
2. Persistent avoidance of stimuli that are associated with the traumatic stressful event such as avoiding talking or thinking about it, avoiding activities, places or people associated with it, inability to recall some important part of the event, diminished interest and participation in activities, feeling detached or estranged from others and a restriction in the range of affect or feeling such as experiencing joy or love.
3. Persistent symptoms of increased arousal (autonomic activity) such as insomnia, irritability or anger, difficulty concentrating, increased "jumpiness" or startle response, and hypervigilance or guardedness.

PTSD is a treatable disorder, affecting about 8% of the U.S. population at some time in their life. While the disorder is occasionally self-limiting, the most effective treatments have been the Cognitive Behavioral Therapies (CBT). Some antidepressant medications (Selective Serotonin Reuptakes Inhibitors or SSRI's) have been used, as have a combination of CBT and SSRI's. Group Therapy interventions have also been effective.

John Lowenfeld, Ph.D., ABPP
Clinical Psychologist