From her window a girl witnesses an old man―a neighbor who has been living next to her home for many years now―commit suicide with a pistol.A soldier watches in bewilderment, as a helicopter carrying his fellow soldiers crashes and goes up in flames. Nobody survives the crash.
A boy has to endure lifesaving but painful medical procedures.
In a dark alley a young woman is threatened with rape but at the last minute manages to escape.
A father witnesses his son slip and fall from the roof of their house, breaking multiple bones in his body.
In the above section we saw numerous examples of events that have the potential to traumatize people. A common psychological disorder associated with the experience of trauma is post-traumatic stress disorder (PTSD).
PTSD refers to a constellation of symptoms (such as intrusive memories, guilt, insomnia, etc) that a person might experience after witnessing one or a series of life-threatening events.
What kind of events? Traumatic reactions have been linked to the experience of war, mass violence (e.g., Oklahoma City bombings), natural disasters (e.g., Hurricane Katrina), fires, transportation and motor vehicle accidents, torture, physical and sexual assault, spouse and child abuse, and other disturbing situations.
Some people, such as emergency workers, because of their occupation (which includes frequent exposure to traumatic situations), have an added risk of developing PTSD.
Many people are surprised to learn that PTSD is a fairly new diagnosis. As I mentioned in my interview with Dr. Schnurr, PTSD did not exist before 1980:¹
Historically, most doctors (except military psychiatrists) assumed that exposure to horrific events in war could result only in temporary stress reactions, but this view changed following Vietnam, when some psychiatrists insisted that many veterans still suffered from severe stress-related symptoms long after having returned from the war….These psychiatrists argued…that the same kind of stress reaction occurred in survivors of other highly stressful events such as “rape, natural disaster, or confinement in a concentration camp.” Eventually these efforts led to a new diagnosis, called PTSD, being included in DSM-3.
According to the current edition of APA’s diagnostic manual, DSM-5,² the diagnostic criteria for PTSD include, for instance:
- Exposure to real or threatened violence, injury, or death
- Repeated re-experiencing of the trauma (e.g., as flashbacks)
- Avoidance of trauma-related feelings or thoughts
- Irritability and hypervigilance
- Negative feelings and assumptions about the world or oneself
In case you have experienced trauma and, having read the above criteria, feel that you have some of the above symptoms, you might want to visit this website. That link takes you to a very short screening tool, called Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).
PC-PTSD-5 helps identity people who might have PTSD. Remember, this is only a screening tool, and not intended to diagnose.
If your results indicate potential PTSD, you can follow up with your health provider for more in-depth testing.
A number of treatments are available for PTSD.
Medications commonly prescribed for PTSD include the ones in the selective serotonin reuptake inhibitors (SSRIs) class.
SSRIs are assumed to work by increasing the levels of serotonin (a chemical messenger which helps neurons communicate) in the brain. SSRIs that are considered effective for PTSD include sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil).¹
Venlafaxine (Effexor) also appears to be effective,¹ though it belongs to a newer class of antidepressants called selective serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications increase the availability of not only serotonin but also another chemical messenger called norepinephrine.
Effective psychological treatments for trauma are also available. According to Dr. Paula P. Schnurr, the treatments with the “best evidence” are prolonged exposure therapy (PE), Cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR).¹
PE involves imaginal and real life exposure to situations that have been avoided because of their associations with the trauma. CPT is more focused on changing beliefs that have become exaggerated as a result of the trauma (e.g., I can not control anything in life). Finally, EMDR aims to help the patient process traumatic memories (e.g., by focusing on a memory while following the repetitive hand movements of the therapist visually).
In short, both pharmacological and psychological treatments available for PTSD and can help.
p.s. Let me know if you need more information on anything I have discussed today.
1.Emamzadeh, A. (2017). Exploring the History & Treatment of PTSD: An Interview with Dr. Paula P. Schnurr. Psych Central. Retrieved from http://psychcentral.com/lib/exploring-the-history-treatment-of-ptsd-an-interview-with-dr-paula-p-schnurr/
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author