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Lloyd I. Sederer, MD Headshot

Traumatic Stress Disorder

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A person who has undergone a trauma is someone who has experienced, witnessed, or was confronted with an event involving actual or threatened death (or serious injury) to self or others.

At the time of the trauma, that person felt intense fear, helplessness, or horror. However, responses to these situations are varied: Not everyone exposed to a severe traumatic event will develop acute stress disorder (ASD) or post-traumatic stress disorder (PTSD).

ASD always comes on soon after the traumatic event, while PTSD emerges after a month or lies dormant for months or even years before symptoms occur. PTSD is the more persistent and severe response to trauma, and ASD always precedes it. This means that detection of ASD provides opportunities for early intervention to stop the progression to PTSD. Military forces and disaster-response teams around the world are searching for the best interventions to do so.

What kinds of events may cause ASD or PTSD? A traumatic event as one that threatens the life of (or causes serious injury to) a person or other people around that person. These include:

• Natural disasters, such as earthquakes, tsunamis, hurricanes, fires, floods, and tornadoes
• Human-made disasters, like terrorist attacks or arson
• War, particularly instances involving atrocities or horrific deaths of fellow soldiers or civilians
• Crime, including torture (all too common among refugees), rape, and physical or sexual abuse

As we see in the news, three young women have been rescued after 10 years of what must have been horrific and persistent abuse. They have been exposed to the types of stresses that produce traumatic conditions.

What Might Acute Stress Disorder Look Like?

A clear and major stress has happened to someone. He or she survived a serious accident, was directly exposed to a horrific natural disaster, or was assaulted. The person is deeply shaken and can't stop thinking about the event. He or she may have difficulty sleeping and may be "jumpy" or irritable. Taking care of everyday business is hard and socializing is no longer fun. The person may smoke or drink more and withdraw from others.

Symptoms include dissociation (where someone feels and appears very distant or shut off from what is going on), re-experiencing the event, anxiety and arousal, avoidance, and emotional distress; these symptoms impair functioning at school or work and within the family. For the diagnosis to be made, the condition must come on within four weeks of the trauma and last more than a couple of days. If significant symptoms persist for longer than a month, it's likely that the ASD has progressed to PTSD.

What Might PTSD Look Like?

A person was exposed to a life-threatening or horrific event, which may have happened in recent months or may have happened in the past -- even years ago. You see that person become inward, isolated, and preoccupied, with difficulty concentrating on and completing tasks. Some people will startle very easily at something as minor as the sound of a door closing or a telephone ringing. Some will be highly vigilant, as if a sniper were on a rooftop nearby. If you can get the person to talk about what is happening, he or she will describe feeling scared, numb, or both. Images of the trauma erupt into the person's conscious mind, sometimes without a clear trigger. Sleep is terribly restless and full of anxious dreams. Alcohol and drug abuse is very common, and if a person smokes cigarettes he or she will smoke a lot more. Suicidal thoughts are common. PTSD symptoms must persist for over a month for the diagnosis to be made.

A well-validated screening tool is the PTSD Checklist (a civilian version can be found at http://www.mirecc.va.gov/docs/visn6/3_PTSD_CheckList_and_Scoring.pdf). A version also exists for military personnel.

What can be done?

Good care for a person with a traumatic disorder includes:

• Reducing the severity of symptoms using effective treatments like crisis counseling, medications, and therapy
• Preventing or lessening trauma-worsening, co-occurring disorders by early identification and treatment of these conditions -- the most common being depression and alcohol and substance use
• Enhancing functioning in adults and promoting normal development in children and adolescents by aiding individuals to return to daily routines and resume functioning as soon as possible
• Striving to prevent relapse by understanding triggers of trauma and acquiring skills to manage them

And perhaps the most important and most challenging:

• Helping a person search for meaning and reparative beliefs about the traumatic event to try to put the horrific experience into perspective and master the potentially disabling reactions to it.

Trauma is ubiquitous in our world. Sometimes, however, its magnitude is so profound or persistent that, while recovery is possible, a person's life is forever changed.

Dr. Sederer is the author of The Family Guide to Mental Health Care and Adjunct Professor at the Columbia/Mailman School of Public Health.

www.askdrlloyd.com

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

For more by Lloyd I. Sederer, M.D., click here.

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