what is posttraumatic stress disorder?

Posttraumatic stress disorder (PTSD) begins, as the name implies, in the aftermath of a trauma. Typical traumas faced by men include war, and in the past this condition was known as shell shock, battle fatigue, combat neurosis, or war trauma. Women are often victims of traumas such as rape and sexual abuse, which may also lead to posttraumatic stress disorder. Thus PTSD is by no means limited to times of war; various kinds of trauma occur commonly in civilian life (see examples below).

The person may experience the traumatic event directly, may witness an event that involves other people, or may learn about a traumatic event that happened to a family member or close personal friend. The event involves the actual or perceived threat of serious injury or death to the person or others. In addition, the person who experienced, witnessed, or learned of the traumatic event, reacts to it with intense fear, helplessness or horror.

Traumatic events can include, but are not limited to, the following:

• human violence (e.g. rape, physical assault, domestic violence, kidnapping, gand violence or violence associated with military combat)
• natural disasters (e.g. floods, earthquakes, tornadoes, or hurricanes)
• accidents involving injury or death
• sudden, unexpected death of a family member or friend
• diagnosis of a life threatening illness

Three groups of symptoms can be seen in people suffering from posttraumatic stress disorder: 1) re-experiencing symptoms, 2) avoidant and numbing symptoms, and 3) hyperarousal symptoms.

Re-experiencing symptoms include ways in which the person persistently re-experiences the traumatic event. This may include intrusive memories or recurrent dreams of the traumatic event, and acting or feeling as if the event were recurring (flashbacks). Reminders of the event may lead to intense psychological discomfort or to physical arousal.

Avoidant symptoms are ways in which the person tries to avoid anything associated with the traumatic event. Part of these symptoms may also include a "numbing" effect, where the person's general response to people and events is deadened. Such symptoms may include being unable to remember aspects of the trauma, showing a limited range of emotion, and having a sense of a foreshortened future.

Hyperarousal symptoms include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance (being on the watch for danger), and an exaggerated startle response (for example, jumping when one hears a sudden noise).

When children have PTSD, symptoms in these three categories are expressed in different ways. For example, children may re-experience the traumatic event through repetitive play (e.g. a child who witnessed a robbery may re-enact the robbery again and again using his or her toys).

PTSD can begin soon after the trauma, or there may be a delayed onset (that is, symptoms beginning 6 months or more after the trauma). PTSD is termed "chronic" if symptoms have lasted for 3 months or longer.

Who gets Posttraumatic Stress Disorder?
PTSD is a disorder that affects people of all ages and from all social, economic, and ethnic backgrounds. The prevalence of PTSD is as high as 6% in a country such as the United States, and it may be higher in a violent society such as South Africa. It should be emphasized that most people who are exposed to traumatic events do not develop PTSD. Furthermore, many people with some symptoms (such as difficulty falling asleep) after a trauma show gradual improvement with time. PTSD tends to be more intense and lasts longer when the traumatic event involves human violence, and the likelihood of developing PTSD increases with the severity, length, and proximity of exposure to the traumatic event. Family history of PTSD, previous traumatic experiences, and other existing mental disorders may also play a role in vulnerability to developing PTSD.

Consequences of Posttraumatic Stress Disorder
PTSD may be a chronic and debilitating disorder. People with PTSD may suffer tremendous distress, and the disorder may impact negatively on their work, family, and social functioning. Serious depression and substance abuse are particularly common in people with PTSD. There may also be an increased risk of other anxiety or psychiatric disorders. It is important to recognize that people with PTSD often have physical symptoms. Such people may go to general practitioners with a variety of physical complaints rather than with specific psychological symptoms.