AAMFT Consumer Update

Post-Traumatic Stress Disorder
 

Post-Traumatic Stress Disorder (PTSD) is a psychiatric diagnosis for people who have endured a highly stressful and frightening experience and who are experiencing distress caused by memories of that experience. It is as if a person is "possessed" by memories of an experience and just cannot let go. Because anxiety is the major sign of PTSD, it is classified as an anxiety disorder. Other anxiety disorders are phobias, panic disorders, and generalized anxiety.

The good news is that it is highly treatable when diagnosed early. The bad news is that it is often missed by examining physicians and mental health professionals, or it is misdiagnosed as some other condition that is more neurobiochemical in nature. But there is no drug cure for PTSD.

What causes PTSD?

Catastrophe/traumatic events are the cause of PTSD. These events are sudden, overwhelming, and often dangerous, either to one’s self or significant others(s), such as a car wreck, natural disaster, dangerous accident, war combat, robbery at gunpoint, or a near drowning; the person affected felt intense fear, helplessness, or horror either at the time or immediately afterwards. Close friends, family members, and professionals helping those who survive such catastrophes can also be affected by trauma. These helpers, because of their empathy and compassion for the person in harm’s way, can be traumatized in the course of providing help.

A catastrophe or traumatic event is a source or cause of stress that most people experience. The stress experienced during or immediately after the traumatic event or catastrophe is traumatic stress. Similarly, the stress that is associated with the traumatic event/catastrophe and that is experienced well afterwards is post-traumatic stress. It is defined as a set of conscious and unconscious behaviors and emotions associated with dealing with the memories of the stressors of the catastrophe.

How can you tell if it’s PTSD?

Most people who have been exposed to a catastrophe experience both traumatic and post-traumatic stress reactions. Most are able to survive and cope well; only a small percentage of people develop PTSD.

Authorities recognize four features that all those with PTSD tend to exhibit at some time during their illness: the person (a) has been exposed to a traumatic event; (b) re-experiences the most traumatic aspects of the event; (c) makes efforts to cope with these symptoms by avoiding exposure to reminders; and (d) is on edge, unable to relax, and unable to think about the event without being obsessed.

Is it possible that there can be a delayed reaction to the traumatic event?

Yes. There are three types of PTSD: acute, delayed, and chronic. Acute PTSD is when the above symptoms last between one and 3 months after the trauma. Chronic PTSD is when the symptoms last for at least 3 months following the trauma. Delayed PTSD is when symptoms do not show up for at least 6 months after the trauma. This is often found with adult survivors of childhood traumas.

What are other effects of trauma?

When PTSD is detected, other symptoms and characteristics are found too. This is why PTSD is so often misdiagnosed. Among the major sets of symptoms are phobia and general anxiety (especially among former POWs and hostages and natural disaster survivors), substance abuse, depression, psychosomatic complaints, an altered sense of time (especially among children), grief reactions and obsessions with death (especially among those who survived a trauma in which someone could have died), feeling guilty, and increased interpersonal conflicts. For some who have PTSD, these other features go away once the PTSD symptoms are eliminated through treatment.

What kind of help is there for PTSD?

Both drugs and psychotherapy can be helpful. The most effective treatment approaches are called "cognitive-behavioral" because they focus both on the way traumatized persons view the trauma and on their resulting behavior. Exposure therapy includes systematic desensitization (training to relax in the face of frightening reminders of the trauma) and imaginable, in-vivo techniques such as flooding or the process of putting the client back into the trauma psychologically. The most effective treatment for PTSD includes a variety of anxiety management training strategies. Some of these include Rational Emotive Therapy, various kinds of relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques. Innovative therapists are successful in combining various techniques to fit the trauma and the patient’s unique requirements.

Families are the best setting to help those who suffer from this stress disorder. Families know when a member is acting differently than before the traumatic event. A therapist may work with you or your family member with PTSD to remember the trauma and reprocess the information and mourn losses. This also means that you will learn self-soothing techniques and ways to limit the distress during and between sessions. Your therapist will help you disconnect from the trauma so that reminders do not arouse distress. In doing so, the therapist will help you reconnect to life now and in the future without being haunted by the trauma. Sometimes this transition to life without the trauma is harder than expected.

The reconnecting is especially important: once you are desensitized from the burdens caused by the traumatic event, family therapy enables you to turn your attention to the future. You will attempt to learn from the traumatic events and make needed changes in your personal life and relationships, especially love relationships.

What types of drugs might be used in treatment?

For some clients, drug treatment is a useful supplement to effective psychotherapy approaches. Drugs such as imipramine, amitriptyline, phenelzine, fluoxetine, and propranolol may provide temporary symptom relief for general anxiety, depression, insomnia, and related problems.

So there is hope for me and my family?

Family therapy offers an extraordinary and useful resource for helping families survive a major traumatic event. Social scientists have documented the remarkable and consistent patterns of emotional recovery from a wide variety of traumatizing events. There is a large number of treatment approaches available today. It is impossible to prevent traumatic events but family therapy can help promote recovery more quickly, and enable family members to get back to what they do best: love each other.

Consumer Resources

Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases, and Coping. By R. M. Sapolsky. Second edition. New York: Freeman (1998). Funny and useful review of the research on how and why we feel stress and where in our body we store memories. Hint: It’s not just in the brain.

Relaxation Dynamics: Nine World Approaches to Self-Relaxation. By J. C. Smith. Champaign, Illinois: Research Press (1985). This classic book is one of the first and best explanations of the relaxation response. Since self-soothing and stress management skills are required for most PTSD treatments, this book helps the client choose the best method of stress management to serve them well throughout treatment.

Grief, Death, and Dying. By T. Rando. Champaign, IL: Research Press (1984). This classic has guided the modern conceptualization of death and dying and led to the rebirth of thanatology. Written for the public, she provides a systematic explanation of why we respond to the death of a loved one, most often a family member. Modern views are that the death of a loved one is often traumatic, depending upon the circumstances (e.g., gruesomeness) of the death that was in itself traumatic.

The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth. By G. R. Schiraldi. Los Angeles: Lowell House (2000). This book was written for everyone who cares about the traumatized. It includes a set of chapters on managing symptoms that cannot be cured through psychotherapy, faith, family, and other media.

Trauma and Recovery. By J. L. Herman. New York: Basic Books (1992). This book has inspired my people to search for ways that trauma show up in current life and the strategies for making sense of the emotions and beliefs.

Burnout in Families: The Systemic Costs of Caring. By C. R. Figley (Ed.). Boca Raton: CRC Press (1988). Though written by academics who use research findings in their explanations, it is one of the first to talk about how hard it is to live with someone with PTSD. In addition to testimonials, this book includes a large number of research-based assertions about the costs and joys of loving and living with a traumatized person.

Trust After Trauma: A Guide to Relationships for Survivors and Those Who Love Them. By A. Matsakis. Oakland, CA: New Harbinger (1998). Similar to her earlier book, I Can’t Get Over It: A Handbook for Trauma Survivors, her book holds the reader’s hand in guiding them through an understanding of the process and sorting out what is a drama from what is a trauma.

Life after Trauma: A Workbook for Healing. By D. Rosenbloom, M. B. Williams, & B. E. Watkins. New York: Guilford (1999). Another self-help book for the traumatized, with little emphasis on the secondary impact (on family and friends).

The text for this brochure was written by Charles R. Figley, Ph.D