Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may develop after experiencing or witnessing a traumatic, violent, or life-threatening event. Traumatic events may be natural or human caused. Natural events may include earthquakes, hurricanes, or medical illnesses; human-caused events may include military combat, child sexual or physical abuse, rape, torture, domestic battering, or physical assault. Some of these traumatic events may occur at one point in time or may be ongoing, with repeated exposure to the trauma. PTSD often goes undiagnosed for a variety of reasons, particularly if the traumatic events are not readily apparent or occurred in the past. If untreated, PTSD may lead to other social issues such as alcohol and drug abuse, suicidality, and violence directed at loved ones or others, which in turn may affect an individual’s family situation, diminish job or school performance, and increase social isolation.
PTSD is a debilitating condition that can affect anyone at any age and has significant consequences for well-being and functioning. Data from the National Comorbidity Survey show an estimated lifetime prevalence of PTSD of 7.8 percent for adults between the ages of 15 and 54. Women are more than twice as likely as men (10.4 percent compared to 5 percent) to develop PTSD at some point in their lives. Prevalence rates of PTSD among children and adolescents range from 3 to 14 percent in community samples. Among children who have experienced specific stressors, however, the prevalence rates are much higher. For example, 35 percent of children diagnosed with cancer and 58 percent of children who experienced both physical and sexual abuse meet the criteria for PTSD.
Veterans are also at high risk for PTSD. For example, studies of combat veterans from the Vietnam War estimate a lifetime prevalence of PTSD of 19 percent. Veterans returning from Iraq and Afghanistan since 2002 have sought mental health treatment at higher rates than those returning from other deployments, such as Bosnia. More than 3 months after returning from Iraq, 17 percent of veterans reported mental health problems and 12 percent met the criteria for PTSD. Given the number of troops deployed to Iraq and Afghanistan in recent years, the number of veterans with PTSD will likely increase significantly.
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, PTSD symptoms are evident in three clusters: reexperiencing, avoidance, and increased arousal. Reexperiencing symptoms may appear as intrusive and persistent flashback memories, nightmares, or frightening recurring thoughts, particularly when exposed to triggering events or objects associated with the trauma. Avoidance symptoms include emotional numbness and persistent efforts to avoid stimuli associated with the trauma. Increased arousal symptoms include sleep disturbance, irritability, difficulty concentrating, hypervigilance, and exaggerated startle response that did not exist before the trauma. It is important to note that children and adolescents may have different responses to trauma depending on their developmental stage, and their symptoms may change over time.
Although PTSD symptoms often begin within 3 months of the trauma, some individuals experience delayed onset, where symptoms appear months or even years after the trauma and may reoccur. With delayed onset, the symptoms develop more than 6 months after the traumatic experience, and the prognosis is often worse. The development of PTSD depends on the severity and duration of exposure to the trauma and a complex array of risk and protective factors that may affect the individual’s response to the trauma.
Complete recovery occurs within 3 months for about half of those diagnosed with PTSD; however, many individuals have symptoms lasting longer than 12 months after the trauma. Co-occurring disorders such as major depressive disorder and alcohol or other substance abuse often accompany PTSD. Patients sometimes visit their primary care physician with symptoms such as headaches, gastrointestinal problems, immune system problems, chest pain, or dizziness. In these instances, the underlying cause of the physical symptoms may be PTSD but may not be discovered without a thorough exploration of the patient’s psychosocial history. Once properly identified, PTSD is usually treated with cognitive-behavioral therapy to help individuals change their thoughts and actions and learn new coping skills to manage the symptoms that may be affecting their quality of life. Depending on the duration and severity of the symptoms, some combination of individual psychotherapy to address the symptoms, peer support groups, and medication is effective in treating PTSD.
Studies show that after the traumatic event, a crucial early intervention is education for the survivor and family about PTSD and the possible effects that trauma reactions may have on them. This allows for recognition that PTSD is a medical disorder that occurs under extreme traumatic stress and opens the pathway for effective treatment. Early diagnosis, assessment, and treatment are essential to diminishing the effects of trauma. Research has shown that crisis intervention immediately after a traumatic event may reduce some symptoms and possibly prevent the development of the disorder. After the September 11, 2001, attacks on the World Trade Center, the New York State Office of Mental Health provided free crisis counseling services to people in New York City and the surrounding counties, including those not typically served by public mental health services. This flexibility on the part of the state mental health agency allowed many more individuals to receive help than would normally have been possible. Although prediction of such traumatic events is not possible, preparation by local, state, and federal governmental agencies to quickly respond can be effective to mitigate the effects of trauma.
- American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text rev. Washington, DC: American Psychiatric Association.
- Foa, Edna B., Terence M. Keane, and Matthew J. Friedman, eds. 2000. Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: Guilford.
- Institute of Medicine Subcommittee on Posttraumatic Stress Disorder of the Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. 2006. Posttraumatic Stress Disorder: Diagnosis and Assessment. Washington, DC: National Academies Press.
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