Posttraumatic stress disorder
What is Posttraumatic Stress Disorder (PTSD)?
PTSD can occur following exposure to an event that is, or is perceived to be threatening to the well being of oneself or another person. This can include being the victim of an assault, being in a disaster, or being in combat. People often have upsetting thoughts or reactions after going through such an event (e.g., disturbing thoughts or memories, easily startled or jumpy, problems sleeping or concentrating), but if these problems don’t go away a person might have PTSD. There are a number of criteria that taken together help us to determine if someone has PTSD (American Psychiatric Association, 1994)
- Re-experiencing the event in the form of intrusive thoughts, nightmares, flashbacks to the traumatic event, and psychophysiological reactivity to cues of the traumatic event,
- Avoidance of thoughts, people, and places that resemble the traumatic event, emotional numbing, and an absence of emotional attachments
- Symptoms of hyperarousal, including heightened startle sensitivity, sleep problems, attentional difficulties, hypervigilence, and the presence of irritability and anger
If a person is experiencing symptoms that are interfering in their life following a traumatic event they should be encouraged to seek help.
How common is PTSD?
US Civilians: Two large scale population studies completed in the US examined the prevalence of PTSD. The National Comorbidity Survey (NCS; Kessler et al., 1994) was conducted between September 1990 and February 1992 and comprised a nationally representative sample of 5,877 Americans aged 15 to 54 years. The results estimated a lifetime prevalence rate for PTSD to be 7.8% in the general population with women (10.4%) being twice as likely as men (5%) to have PTSD at some point during their lives. The traumatic events most often associated with PTSD in men were rape, combat exposure, childhood neglect, and childhood physical abuse. For women, the most common events associated with PTSD were childhood physical abuse, sexual molestation, rape, physical attack, and being threatened with a weapon. The National Comorbidity Study Replication (NCS-R; Kessler et al., 2004) was conducted between February 2001 and April 2003 and comprised a nationally representative sample of 5,692 Americans age 18 and older. The results estimated a lifetime prevalence of PTSD at 6.8% (9.7% of women and 3.6% of men).
US Military: Individuals who are engaged in military combat are at significant risk for exposure to traumatic events and the subsequent development of PTSD. The National Vietnam Veterans Readjustment Survey (NVVRS; Kulka et al., 1990a, 1990b) estimated the prevalence and effects of PTSD in the Vietnam War veteran’s population. The analyses indicated that 15.2% of all male Vietnam theatre veterans met criteria for current PTSD. PTSD was significantly higher in participants who had been exposed to combat and other war zone stressors. Among Vietnam theater veteran women 8.5% of the 7,200 women who served met criteria for current PTSD. Seal, Bertenthal, Miner, Sen, and Marmar (2007) studied 103,788 OEF/OIF veterans to assess the proportion of veterans seen at VA facilities who received mental health and/or psychosocial diagnoses. The single most common mental health diagnosis was PTSD which was coded in 52% of those receiving mental health diagnoses and 13% of all OEF/OIF veterans in the study population.
Risk and Resiliency Factors
- Age: Among veterans of active duty service, those who were younger (age, 18 to 24 years) had significantly increased risk of mental health and PTSD diagnoses (Seal et al., 2007).
- Being a woman: The risk for developing PTSD in women was twice that of men even when the type of trauma was taken into account (Breslau Chilcoat, Kessler, Peterson, & Lucia,1999).
- Number of Exposures: Degree of combat exposure and the number of traumatic stressors experienced appears to predict PTSD (Hoge et al., 2004).
- The availability of social support and personal hardiness appear to be the most important factors with the potential of providing resiliency to those who have experienced a traumatic event (Friedman, Resick & Keane, 2007).
Treatment of PTSD
Numerous investigations substantiate the efficacy of Cognitive Behavioral Therapy (CBT) for PTSD in a wide range of populations, including survivors of motor vehicle accidents, sexual assault, and military trauma (Keane et al., 2000). While there are other treatment approaches for PTSD (i.e., EMDR), evidence for their effectiveness is lacking. There are 2 “evidence-based” psychological treatments that are recommended for the treatment of PTSD; Prolonged Exposure and Cognitive Processing Therapy.
- Prolonged Exposure (PE): Some studies suggest that PE, which involves repeated imaginal exposure to the traumatic memory and repeated in vivo exposure to safe situations that were previously avoided, is one of the most efficient and efficacious treatment techniques. It is based on the idea that people learn to fear and avoid thoughts, feelings, and situations that remind them of a past traumatic event. Avoidance a way to cope with the fears makes them seem more powerful. By talking about the trauma repeatedly with a therapist, a patient can learn to get control of their thoughts and feelings about the trauma.
- Cognitive Processing Therapy (CPT): CPT is a cognitively based treatment that helps patient find a new way to handle distressing thoughts. By using the skills learned in CPT, a patient can learn why recovery from traumatic events has been challenging. CPT helps a patient learn how going through a trauma changed the way he/she looks at the world, self, and others. The way we think and look at things directly affects how we feel and act. There are a number of trials that provide the evidence base for CPT across trauma populations, including female adult survivors of child sexual abuse (Chard, 2005), incarcerated adolescents with PTSD (Ahrens & Rexford, 2006), and male and female refugees (Schulz, Resick, Huber, & Griffin, 2006).