Post Traumatic Stress Disorder (PTSD) is estimated to affect about 7% of Americans, and about 15-20% of Americans deployed to Afghanistan or Iraq. It’s a brain disorder, not a psychological problem. But psychology originates in the brain, so it turns out the best treatment for PTSD is a psychological one – psychotherapy.
PTSD starts with, not surprisingly, a traumatic experience. In the civilian world, that could be an assault, an accident, or an exposure to something horrific or frightening. Military members who experience combat encounter horrific and threatening experiences regularly. But getting out of combat duty is not easy.
“You mean there’s a catch?”
“Sure there’s a catch,” Doc Daneeka replied. “Catch-22. Anyone who wants to get out of combat duty isn’t really crazy.”
There was only one catch and that was Catch-22, which specified that a concern for one’s own safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn’t, but if he was sane, he had to fly them. If he flew them, he was crazy and didn’t have to; but if he didn’t want to, he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle.
~Joseph Heller; Catch 22
Not everyone exposed to a trauma will wind up with PTSD. We’re not sure why some people seem to be immune, but it is probably a combination of resistant genes, exceptionally good mental health, and just the right kind of psychological support at just the right time after exposure.
Some object to the term “disorder”, fearing that it stigmatizes a reaction that almost any sane person would have in the face of horrific trauma. But it’s not the initial reaction that constitutes the “disorder” of PTSD. Instead, it’s the ongoing and terribly disruptive symptoms that can go on for decades, or even an entire lifetime, that justify the official description.
Symptoms may include:
Avoidance of reminders (triggers). A veteran avoided concrete highway barriers because it reminded him of the concrete T-walls that surrounded his compound in Iraq.
Emotional numbing can occur such that friends and family may comment that the sufferer is not emotionally available, or frequently checked out. She may feel detached from others, and not be able to enjoy pleasurable activities, including sex. Aspects of the trauma may be forgotten (repressed.)
Re-experiencing of the traumatic experience can be very distressing. Children may act these memories out without conscious awareness of the actual memory. The memories may come flooding back in dreams, or in daytime flashbacks. The flashbacks can be triggered by loud noises or sudden, unexpected movements, other sights or smells.
Hyper-arousal can lead to angry or irritable outbursts with little or no provocation, poor sleep quality, poor concentration.
“You know, everybody dies. My parents died. Your father died. Everybody dies. I’m going to die too. So will you. The thing is, to have a life before we die. It can be a real adventure having a life”
~John Irving; The World According to Garp
The first step to getting better is, of course, to get a good evaluation. If PTSD is the diagnosis, the most effective treatment is psychotherapy – a talking treatment.
Certain kinds of psychotherapy are proven to be more effective for PTSD. The most effective therapeutic approaches include exposure therapy, cognitive processing therapy, medication enhanced psychotherapy, and mindfulness based psychotherapy. Most real world psychotherapies are a mix of these approaches, but your therapist should be trained in these techniques.
Not many medications have been demonstrated to be helpful. The SSRI and SNRI medications are often helpful. Prazosin has been shown to decrease the severity of nightmares. Medications to avoid include benzodiazepines and alcohol.
Thomas A Grugle MD 