Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder characterized by chronic stress resulting from a traumatic stressor.

Stress disorders typically happen when a life threatening stressor is experienced or major changes in life happen. This can be anything like traumatic battlefield flashbacks, losing a loved one, or losing a house to a natural disaster.

Acute stress disorder (ASD) lasts from 2-30 days and is considered normal after a major stressor occurs. Typically, this is not considered an actual disorder that needs to be treated, as most cases of ASD resolve themselves within 30 days without need of therapy or interventions. PTSD can only be diagnosed at least 30 days after exposure to severe traumatic stressor; it's diagnosed if the anxiety from the stress isn't eliminated.

Symptoms

• Recurrence of intrusive thoughts for a period of time
  • Most common for women: rape
  • Most common for men: military experiences
• Emotional withdrawal
  • Can be dampened with mindfulness exercises
• Cognitive avoidance, numbing, dissociation
  • Tendency to minimize the traumatic stressor in an effort to cope
• Increased autonomous nervous system (ANS) arousal: vigilance, poor sleep, hot temper, startle reflex
  • Startle reflex is very exaggerated, might be very difficult to not startle someone with PTSD

Treatment

Finding meaning for trauma must be done by someone themselves, not by other people.

Cognitive behavioral therapy:

• De-condition fear associations to extinguish (example: smell the cologne of the person who raped a PTSD patient)
  • Teach relaxation response
  • Hierarchical exposure reduces cognitive avoidance, numbing
  • Teach lucid dreaming, rehearsing substitute dream content
• Restructure faulty cognitions (e.g. guilt)
• Increase adaptive coping behaviors

Adjunctive treatments:

• Treatment of depression, substance use, relationship problems
• SSRIs and benzodiazepines bring temporary symptom relief to ~75%

Over 50% of PTSD patients fully recover.