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PTSD is primarily an anxiety disorder and should not be confused with normal grief and adjustment after traumatic events. For most people, the emotional effects of traumatic events will tend to subside after several months. If they last longer than that then consideration should be given to diagnosing a psychiatric disorder. Most people who experience traumatic events will not have PTSD. PTSD may have a delayed onset of years or even decades and may be triggered by a life event such as the death of someone close or the diagnosis of a serious medical condition. Once PTSD reaches the criteria for diagnosis the untreated course is generally for some worsening and then stability of the level of symptomatology over many years.
PTSD like symptoms were first recognized in combat veterans following many historical conflicts however the modern understanding of the condition dates to the 1980s. PTSD may be experienced following any traumatic experience or series of experiences which satisfy the criteria and that do not allow the victim to readily recuperate from the detrimental effects of stress. It is believed that of those exposed to traumatic conditions, around 9% will experience some symptoms. In peacetime, 30% of those that suffer will go on to develop a chronic condition; in wartime, the levels of disorder are believed to be somewhat higher.
Symptoms can include general restlessness, insomnia, aggressiveness, depression, dissociation with reality, emotional detachment, or nightmares. Amplification of other underlying psychological conditions may also occur. Young children suffering from PTSD will often enact aspects of the trauma through their play, and may often have nightmares that lack any recognizable content.
PTSD is usually treated by a combination of psychotherapy (cognitive-behavioral therapy, group therapy, and exposure therapy are popular) and drug therapy ( Prozac, Effexor, Seroquel, and Zoloft). Talk therapy may prove useful, but only insofar as the individual sufferer is enabled to come to terms with the trauma suffered and successfully integrate the experiences in a way that does not further damage the psyche. Forbes et al. (2001)1 have shown that a technique of "rewriting" the content of nightmares through imagery rehearsal so that they have a resolution can not only reduce the nightmares but also other symptoms. The US FDA recently approved a clinical protocol that combines the drug MDMA ("Ecstasy") with talk therapy sessions.
PTSD may be comorbid with other psychiatric disordersThe Scream, the famous painting commonly thought of as depicting the experience of mental illness. A mental illness is a psychiatric disorder that results in a disruption in a person's thinking, feeling, moods, and ability to relate to others. Mental illn with depression and substance abuse being the most common.
There have been scores of other treatments suggested for the treatment of PTSD. Two of these controversial techniques are eye movement desensitization and reprogramming (EMDR) and traumatic incident reduction (TIR).
EMDR is a technique developed by Dr. Francine Shapiro, in which the therapist induces eye movements in the client which is meant to access the traumatic event and allow the integration of emotions and sensations that occurred during the traumatic event. Critics claim that EMDR is no more effective than CBT and that it derives its benefits from the therapist client interaction and not the eye movements.
TIR is a less well known technique for reducing and eliminating the effects of a traumatic event. TIR is more of a graduated exposure technique that is controlled by the client. In TIR the client retells the trauma and releases the emotions held in check. In addition the client remembers the event and allows the conscious mind to process any decisions, intentions and cognitive distortions that might have occurred during or after the trauma. Practitioners who have been trained in both EMDR and TIR report that TIR is safer because it is focused on a single event and EMDR can occasionally trigger several events and multiple emotions. Interviews with these practitioners have suggested that, while they continue to use both techniques, TIR is the preferred intervention for known traumatic events where the client wants insight and understanding about the event and the aftereffects of the trauma.
Another possible factor in PTSD is that a persistence of depressive symptoms may be caused by an underlying biochemical disorder associated with insulin resistance (hypoglycemia) that can be treated by a hypoglycemic diet.
In animal research , a part of the brain call the amygdala has been shown to be needed to form fear memories. From brain imaging studies, the amygdala has also been shown to be active in human fear. Disfunction of the amygdala may be involved in PTSD. Further animal and clinical research into the amygdala and fear conditioning may provide additional treatments for the condition.
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