Past Trauma: Treatments for Post-Traumatic Stress Disorder

by Food and Drug Administration (FDA)

January 18 marks the anniversary of a mighty adrenaline rush for Kellie Greene. She went sky diving on that day last year, in search of a high-flying thrill to overwhelm her traumatic anniversary memories of the rape she had endured exactly five years earlier.

"Sky-diving, you're screaming," says 34-year-old Greene, founder of the Orlando-based rape education group SOAR (Speaking Out About Rape), "but you're screaming because you're excited. 'Oh my God, I'm doing this!' The whole world is underneath you, and it's so amazing. It just looks like the Earth's standing still, not like you're falling toward it."

"Sky-diving, I controlled the adrenaline rush," Greene continues. "I had gotten tired of getting so anxious every year around that day. Now, it's no longer the date that I was raped, but the day I went sky diving."

It was on Jan. 18 in 1994 that a knife-wielding stranger raped Greene inside her own apartment as she returned there from the laundry room in her complex. The intruder smashed Greene on the head with a tea kettle as she opened the apartment door, paying no mind to her pleas, "Take my money. I have money!"

Since the day she was raped, Greene has battled mental demons previously unknown to her. "For someone who had been pretty normal her whole life and had never needed counseling, it was frightening to be so out of control with my feelings and not know why," Greene recalls. "I would cry uncontrollably at any time. It was just a sadness that was so heavy, some days I wouldn't even want to get out of bed. Not being able to organize my daily routine — deciding what to wear or what to eat — because those might be the wrong choices to make. I would lock myself in the house an hour before it got dark, and not answer the phone and not answer the door. I was afraid to drive places or to be alone. I wasn't able to sleep at night, then was so tired during the day it's all I did. There were bad flashbacks, too, but they were strange flashbacks because they were dark. It was just darkness."

The flashbacks, troublesome sleep, and other symptoms Greene experienced are not uncommon for someone who has lived through the stressful ordeal of rape. Her types of symptoms are among the tell-tale signs of post-traumatic stress disorder, or PTSD, a debilitating condition that can beset anyone who has felt fear, helplessness or horror during a traumatic event that caused or threatened to cause that person or someone else to die or be seriously injured.

"All of us have had experiences that are sufficiently upsetting that we go over and over them in our minds," says Thomas Laughren, M.D., head of the Food and Drug Administration's psychiatric drug products group. "But with PTSD, it's an order of magnitude worse. It can be a very severe kind of illness that limits people to an extent that is completely foreign to most of us."

About "Shell Shock"

In a given year, more than 10 million Americans (about 4 percent) will experience the life-disrupting symptoms of PTSD, which was first widely recognized during World War I and known as "shell shock" or "battle fatigue."

Like combat horrors, other "manmade" tragedies such as criminal assaults or sexual attacks can provoke PTSD symptoms, as can a fire, earthquake, or other natural disaster. Accidents — car and airplane crashes, for example — are also common precipitators of PTSD.

By definition, the disorder can only develop in response to a traumatic event, says Edna Foa, Ph.D., director of the University of Pennsylvania's Center for the Treatment and Study of Anxiety. It can't arise from other seriously stressful occurrences that are less extreme — losing a job, say, or going through a divorce.

And, while not all life stressors are traumatic enough to lead to a PTSD diagnosis (but instead might cause "generalized anxiety"), not everyone who experiences a trauma will develop post-traumatic stress disorder, either.

As many as 70 percent of American adults have been through at least one major trauma, according to the "Expert Consensus Treatment Guidelines for Post-Traumatic Stress Disorder: A Guide For Patients and Families," a guide written by Foa and others based on a survey of 100 PTSD experts. But, Foa explains, "Most people who go through a traumatic event may be more frightened and act more cautiously than they used to, but don't develop the disorder. That is, they don't get symptoms that would disrupt their daily life in a significant way and render them dysfunctional on some level."

Experts divide symptoms that rise to the level of PTSD into these main types:

Re-experiencing the traumatic event. Re-experiencing can refer to having intrusive memories of the ordeal, flashbacks when awake, recurring nightmares, and exaggerated emotional and physical responses to triggers that remind the person of the event. "Sometimes I've thought I was back in Vietnam. When you start dreaming, you can smell the flesh of your buddies burning," says veteran John Palmer Sr., who recalls being among 19 wounded survivors of a 1968 ambush by the North Vietnamese that killed the rest of his 59-strong battalion.

Avoidance. After a trauma, people may lose interest in and avoid certain activities, places, and thoughts and feelings related to the trauma. July 4th is "really hard" for 51-year-old veteran Palmer because the loud noises remind him of wartime. And Palmer avoided seeing the critically acclaimed "Saving Private Ryan." "I chose not to go," he explains, "even though some people thought it was pretty good ... if there could be anything good about it. Watching movies about the war bothers me, and I start having nightmares."

About the Author

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