Past Trauma: Post-Traumatic Stress Disorder : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 3)

Emotional detachment. Foa's patients have told her, "I'm not the person I used to be. I don't trust people. I can't feel loving anymore." One of her patients, who had been injured in an explosion at his factory that killed many others, was "like a zombie emotionally," Foa says. The man's daughter complained, "He's not there for us. All he cares about is himself, and indulging in his own misery."

Increased arousal. This symptom can show itself in difficulty sleeping, irritability or angry outbursts, difficulty concentrating, and unusually startled reactions in certain situations. Palmer says, "When I first came back [from Vietnam], people were afraid to be around me. I got in a lot of trouble, drinking and fighting, and I didn't really care."

People can have wide-ranging reactions to a certain stressor. Some people will have no long-lasting effects, while on the other end of the spectrum, people can have problems that last for months or years. The symptoms must last for at least a month, however, to be classified as post-traumatic stress disorder.

While symptoms usually begin immediately after a trauma or within the following few weeks, sometimes they can show up months or years later. Many of the World War II prisoners of war that Veterans Administration counselor James Boehnlein, M.D., talks with have had stable lives — were married long-term, raised children, and worked steadily — and developed delayed PTSD symptoms after they retired and when people their age began to die of natural causes. "Their losses brought back memories of their wartime sadness and loss," Boehnlein explains, "and they would start having nightmares of combat experience and being prisoners of war."

So far, science can't predict precisely how a certain individual will react to a traumatic event. But certain factors can provide clues about the likelihood and severity of PTSD:

How severe and long-lasting was the trauma? The more intense and long-lasting the traumatic experience, the more likely it is that the victim will develop PTSD.

How close was the person to the trauma, and how dangerous did it seem?Foa's patient who was injured in the factory explosion was more vulnerable to PTSD than if he had been across the street, merely heard the bang, and only later found out about the explosion's tragic consequences. Foa cites one recent study that found that women who perceived their lives were in danger during a rape had 2.5 times the incidence of PTSD than did others who didn't fear for their lives during the rape.

Has the person been traumatized in the past, and if so, how many times? One of Foa's patients didn't develop PTSD until the third sudden death in her circle of friends and acquaintances. The third time, "that was it," says the therapist. "Now she's thinking, 'What's next? Next it will be me.'"

Was the trauma inflicted by other people? PTSD is more likely after a rape or other manmade trauma than after an earthquake, hurricane, flood, or other naturally occurring disaster. Psychologically, it seems to matter whether the trauma is intentionally aimed at the victim or is random and suffered by many people together.

What is the person's coping style — does he or she tend to stay enraged? And, does the person get support from friends and family, or negative reactions? People are less likely to have PTSD, elaborates Foa, if they think about the trauma, talk to other people about it, and let go of their anger over the incident. Foa encourages people to face the trauma: "Talk to someone you trust, write about it, do anything but push it away." And, she says, if the symptoms still cause suffering after several months, professional help should be sought.

But many people don't seek professional help for their condition, according to mental health experts. Possible reasons cited in the PTSD expert consensus guidelines: Sufferers may feel withdrawn, guilty and mistrustful and naturally want to avoid dealing with unpleasant feelings, and they may not even realize they have a problem or that it can be treated.

But PTSD is treatable — with medication, psychotherapy, or both.

Like many trauma victims, at first Greene was reluctant to seek professional treatment. "I was afraid if I told anyone how out of control I was really feeling, they would commit me to a mental institution." When Greene did finally confide in a therapist, he explained that her symptoms were a common reaction to a traumatic event and she wasn't going insane. Greene learned to manage her anxiety by breathing deeply and counting until she felt calm. And her doctor prescribed Zoloft (sertraline hydrochloride), the first FDA-approved drug for PTSD.

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