Post-Traumatic Stress Disorder

Post-traumatic Stress Disorder

How to Win the Battle

Brakes squeal, a flash of chrome slices through your peripheral vision, and an ear-splitting "BLAM!" says you've just been hit by another car.

The jolt knocks your vehicle onto the shoulder, where your tires slide over gravel. A headlight and fender crumple into the guard rail. Metal screams against metal, but eventually the car stops. And from within the sudden well of silence that surrounds the driver's seat, you dazedly look through the windshield to see what happened to the other guy.

It's a picture you'll never forget. After knocking you off the road, the other guy smashed into a pickup. And he wasn't wearing a seat belt.

Traumatic events such as rape, earthquakes, warfare and automobile crashes in which there are deaths or life-threatening injuries have a way of etching themselves on our consciousness and popping up to haunt us for weeks, months and perhaps years thereafter.

They can make us afraid to visit places that are somehow identified with the event, and they can make us short-tempered, irritable and jumpy. A mother who has witnessed the drowning of a child may never go near a pool. A cashier who was beaten and robbed may speak rudely to customers. Or a woman who escaped from a burning house may jump out of her skin every time someone lights a match.

These are some of the symptoms of post-traumatic stress disorder (PTSD). But vivid memories of a past traumatic event that affect behavior aren't always PTSD, says Naomi Breslau, Ph.D., director of psychiatric research at Henry Ford Health Sciences Center in Detroit and professor of psychiatry at Case Western Reserve University in Cleveland. PTSD is actually a psychiatric disorder defined by a cluster of six or more symptoms, including re-experiencing the trauma, emotional numbness, avoidance, depressed mood, sleep and concentration problems and nervousness. Symptoms must go on for more than one month and cause distress or impairment in social, work or other important areas of a person's life.

Only a small percentage of people will develop PTSD as defined in psychiatry. Often these people have other risk factors, which can include depression and anxiety, before the trauma occurs.

"The concept of post-traumatic stress disorder was first identified in war as 'shell shock' or 'combat fatigue,' " says Dr. Breslau. Men exposed to battlefield horrors in which they saw humans sliced, burned and blown to smithereens returned home jumping at shadows, unable to respond to their wives and kids and haunted by the battles left behind.

But today we know that PTSD is not limited to the battlefield or even to men. It can affect anyone who has witnessed, experienced or even heard about a violent event.

A Woman's Vulnerability

PTSD is not uncommon. Studies show that sometime in their lives, approximately 40 percent of all men and women experience violent events that can lead to the problem, and approximately 25 percent of them will subsequently develop the disorder.

In a study of more than 1,000 men and women in the Detroit area, Dr. Breslau found that 80 percent of those who had been raped developed PTSD. Twenty-four percent of those whose life had been threatened also developed the problem, as did 23 percent of those who had seen someone killed or seriously hurt, 22 percent of those who had been physically assaulted, 21 percent of those who had been told of the sudden death or accident of a close relative or friend and 11 percent of those who had a sudden injury or serious accident.

Women were most at risk.

"Even if you disregard rape, we found that women were twice as likely overall to react to traumatic events with post-traumatic stress disorder as men," says Dr. Breslau. And women who had been clinically depressed before the event were 11 times more likely to experience the disorder than those who were not.

"We don't know a whole lot about why women are more at risk," she adds. But "there might be some special vulnerability of women that we don't yet understand."

Trying to Forget

Although studies indicate that anywhere from one-third to one-half of all those who develop PTSD will get better within three to six months of the traumatic event without any help, that still leaves a lot of women in pain. And no one can figure out in advance whose symptoms will diminish and whose will get worse.

That's why Dr. Breslau suggests the following strategies should you find yourself the survivor of a traumatic event such as rape or assault.

Get professional help. "If a woman has been raped or attacked, she should see a psychologist or psychiatrist right away," says Dr. Breslau. She can talk about the experience and clarify what happened. It will not only lessen the likelihood of developing the disorder, it will help keep her from getting into any of the avoidance behavior--avoiding people, places and things that are reminders of the event--that so often becomes a problem.

To find someone who specializes in treating PTSD, check with your local hospital, medical center or university for a clinic that is specifically set up to deal with anxiety disorders or trauma.

Treat any coexisting problems. Since women who have a history of depression are the ones most likely to develop PTSD, a key strategy in keeping the disorder at bay is to treat the depression through therapy or with antidepressants, says Dr. Breslau.

Don't avoid anything. Once you've either seen or experienced a traumatic event, it's natural to want to avoid places, people and situations that remind you of the incident or of your own vulnerability. But don't let yourself do it, says Dr. Breslau. Once you allow yourself to avoid one thing, you start avoiding others. The next thing you know, you're so afraid of everything that you spend your life cowering in your home.

Inoculate yourself against stress. Should you develop PTSD, there are several treatment strategies your therapist may suggest, including exposure, a technique in which you repeatedly relive the traumatic event from the safety of your therapist's office until you can think of it without getting upset, and stress inoculation training, a technique that includes correcting mistaken thinking, muscle relaxation and deep breathing.

A study at the Medical College of Pennsylvania in Philadelphia of 45 rape survivors who suffered from PTSD found that supportive counseling reduced symptoms by 26 percent. Nine therapy sessions using the exposure technique reduced symptoms 40 percent, and nine sessions of stress inoculation training reduced symptoms by 55 percent.

Three months later, women in the study who had used exposure techniques were found to have the fewest symptoms. In a later study, the combination of exposure and stress inoculation training was found to be more effective than either treatment alone. Three months after treatment, 90 percent of clients improved significantly.

Check with your therapist to see which technique--or combination of techniques--is right for you.