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Shadows from the past: Understanding post-traumatic stress disorder

November 1, 1999
Web posted at: 12:07 PM EST (1707 GMT)

In this story:

Who gets PTSD?

PTSD treatment


By Ronald Pies, M.D.

(WebMD) -- The woman was desperate, afraid. She heard voices in her head and feared she was going crazy. "The world means to do me harm," she told her psychiatrist. "Someone might want to kill me."

But the woman hearing these voices wasn't crazy. As she soon revealed in the course of her therapy, the voice she heard was that of a family member who had abused her. Rather than losing her mind, the woman was suffering from post-traumatic stress disorder (PTSD), a condition that afflicts 8 percent of Americans, according to a survey reported in the December 1995 Archives of General Psychiatry.

Doctors have known about PTSD since at least the Civil War, and have developed many treatments in recent years. While some have proven successful, others -- including a popular new therapy, Eye Movement Desensitization and Re-processing (EMDR) -- are controversial.

In World War I, PTSD was known as "shell shock," and combat is still the most common trigger for PTSD in men. Yet twice as many women as men suffer from the disorder, and for them the trauma is most often a form of sexual abuse or attack.

The trauma leaves its mark in various ways. Some victims suffer from nightmares and flashbacks. Others become emotionally detached or apathetic. Some feel unreasonably irritable or have trouble sleeping. And many have combinations of these symptoms.

Who gets PTSD?

Some people are more likely to suffer from PTSD than others -- for example, people separated from their parents during childhood, or those with a family history of anxiety.

The mind-set of the individual may also make a difference. For example, a study reported in the November 1997 issue of Psychological Medicine looked at PTSD rates among torture victims in Turkey. This study found that rates were lower in those who became politically active in the aftermath of their experience -- suggesting that people who refuse to be passive victims may fare better after trauma.

PTSD treatment

The first treatment consideration for PTSD sufferers is safety. They must feel that they are in a safe, supportive environment before therapy can succeed. Working with a mental health professional is the first step, but not every therapist is experienced in treating PTSD, and an untrained or pushy therapist can make matters worse. It's often best to get a referral from a family doctor or from a professional organization such as the American Psychiatric Association.

Various types of talk therapy can help control anxiety and restore self-esteem. It's also important to address depression or substance abuse, which often accompany PTSD.

More and more therapists are using EMDR to treat their PTSD patients. The technique involves pairing rapid back-and-forth eye movements with new ways of thinking about the trauma. While Dr. Francine Shapiro, who first introduced the treatment in 1989, isn't quite sure how it works, one theory is that it stimulates the left and right halves of the brain to communicate with each other, reintegrating the patient's split-off memories and feelings.

Several researchers have questioned whether EMDR is any more effective than previous therapies, such as cognitive behavior therapy, in which victims are gradually reintroduced to the conditions that originally caused the trauma. One head-to-head comparison of the two techniques, reported in the January-April Journal of Anxiety Disorders, found cognitive behavior therapy to be more effective.

Medication may also be helpful in treating PTSD. The prescriptions of first choice are usually serotonin-boosting antidepressants like Prozac.

The woman who heard voices began her recovery when she first came to see that it was the trauma from her past -- not mental illness -- that was afflicting her present.

Copyright 1999 webmed, Inc. All rights reserved.

WebMD Live Chat Transcript: Post-traumatic stress disorder: Old and new
WebMD Chat Transcript: Post-traumatic stress disorder

The PTSD Resource Center
National Institute of Mental Health Anxiety Site
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