DISORDER

About Your Diagnosis
Posttraumatic distress disorder (PTSD) applies to a situation in which a individual has been exposed to a traumatic event that involves actual or threatened death or serious injury, or a threat to the physical integrity of the patient or others. You may have experienced this event or merely witnessed it. In addition, if your response to this event involved fear, helplessness, or horror, you may later develop PTSD.

Living With Your Diagnosis
Frequently the traumatic event occurs again in your mind as flashbacks or memories, images, thoughts, or perceptions. These trauma flashbacks can occur at any time, and you are unable to voluntarily resist them. In addition, an individual with PTSD also generally has recurring distressing dreams of the event. During one of these flashbacks or dreams, you may feel you are actually reexperiencing the event again and may tell your physician, “It is like I’m back in the same situation.” You will often have physical findings such as sweating, rapid heartbeat, and rapid respirations. As a result of fear
of recurrence of these symptoms, you will often avoid stimuli that are associated with the trauma. For instance, if your PTSD is related to Vietnam era activities, you may avoid individuals of Asian descent, or may avoid airports where helicopters might be found. Occasionally, there is some amnesia or loss of memory about certain parts of the trauma. Other manifestations can include a decreased interest and participation in activities, a tendency to isolate yourself from previously established friends and family, an inability to trust or show loving feelings, trouble falling or staying asleep, extreme episodes of anger and rage, trouble concentrating, a feeling that someone is always watching you (hypervigilence), and a heightened sense of startle. The event that triggers PTSD is most likely to be one that occurs outside the range of normal human experience. For instance, Vietnam War service is associated with PTSD, as are survival from natural disasters and from sexual assault (rape or incest). Posttraumatic stress disorder can occur in conjunction with other psychiatric disorders, such as phobias, anxiety disorders, and depression. Approximately 50% of individuals with PTSD will recover, and approximately 50% have a persistent, chronic form of the illness still present 1 year later.

Treatment
Treatment of PTSD is aimed at helping individuals gain some control over their impulses. This is often done by involvement in peer support groups composed of other disease sufferers, often those who experienced the same kind of traumatic event. There are also certain medications that are used to treat PTSD. At present, the most common drugs used are the tricyclic antidepressant drugs, such as imipramine. However, the monoamine oxidase (MAO) inhibitor drugs such as Nardil are also used, as well as the serotonin drugs such as Prozac, Zoloft, and Paxil. These medications do have side effects. The tricyclic antidepressants may cause blurred vision, dizziness, constipation, dry mouth, and lower blood pressure. The serotonin drugs may cause diarrhea, nausea and vomiting, and sexual dysfunction. Patients receiving the MAO inhibitor drugs require a special diet; they cannot drink Chianti wine or eat fava beans and aged cheeses. Also patients
taking MAO inhibitors must avoid certain medications such as Demerol and epinephrine, and should not use stimulants such as cocaine or take OTC drugs like Valerian Root. Occasionally symptoms of PTSD will also respond to drugs such as the antihypertensive, propranolol (Inderal). Cognitive therapy is also very important in the treatment of PTSD. Cognitive therapy involves trying to change the way you think so you will feel better. Usually, the more an individual tells someone about the event, the less tearful and anxious they will be. This is known as debriefing. Other traditional antianxiety techniques such as meditation, progressive muscle relaxation, imagery, and biofeedback are also helpful. Some PTSD sufferers experience rage attacks, and anger control training may be helpful. There also is some evidence that chronic pain and PTSD are commonly associated, and there have been situations in which PTSD has occurred after serious physical injuries such as burns, head injury, or multiple fractures. The lack of a supportive family or religious structure to allow for adaptation to trauma can also increase the likelihood of PTSD. The Vietnam era veterans who returned to the United States were not given the typical support that had been shown veterans of World War I and World War II; in fact, their behavior was criticized because it was an unpopular war. The lack of a supportive network for returning Vietnam veterans probably increased their likelihood of developing PTSD.
The DOs
It is very important to try to minimize stress. This can be done by the usual stress management techniques. Exercise is very important, and as with all anxiety conditions, you want to avoid drugs such as caffeine and other stimulants because they will increase anxiety symptoms. It is also important early on in PTSD for the individual to avoid situations that might produce flashbacks to a traumatic event. Although in some cases this may be impossible, often certain locations and certain events can be avoided without significant disruption of the patient’s lifestyle.

The DON’Ts
Because PTSD is an anxiety syndrome, there is a high incidence of overuse of alcohol and other drugs, and a fairly high incidence of misuse of antianxiety drugs such as Valium, Librium, and Xanax. Thus, you should avoid becoming overly dependent on these medications. Because of the potential for episodes of uncontrolled rage and anger, family members of patients with PTSD need to consider whether it is wise to have weapons around the house.

When to Call Your Doctor
You should call your doctor if you notice an exacerbation of the anxiety symptoms associated with PTSD, if you notice feelings of homicide or suicide, or uncontrolled rage, and if you notice any psychotic features, especially paranoia. You should also contact your physician if you begin to develop any of the physical symptoms associated with PTSD such as asthma or ulcer disease (hypertension also associated with PTSD but usually has no symptoms).

Websites:
Traumatic Stress Home page:
http://www.long-beach.va.gov/ptsd/stress.htm/