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Pronunciations monoamine oxidase inhibitors selective serotonin reuptake inhibitors serotonin

Posttraumatic stress disorder is characterized by recurrent, intrusive recollections of an overwhelming traumatic event.

• Events that threaten death or serious injury can cause intense, long-lasting distress.
• Affected people may relive the event, have nightmares, and avoid anything that reminds them of the event.
• Treatment may include psychotherapy (supportive and exposure therapy) and antidepressants.

Experiencing or witnessing traumatic events that threaten death or serious injury can affect people long after the experience is over. Intense fear, helplessness, or horror experienced during the traumatic event can haunt a person.

Events that can lead to posttraumatic stress disorder include the following:

• Engaging in combat
• Experiencing or witnessing sexual or physical assault
• Being affected by a disaster, either natural (for example, a hurricane) or man-made (for example, a severe automobile accident)

Sometimes symptoms do not begin until many months or even years after the traumatic event took place. If posttraumatic stress disorder has been present for 3 months or longer, it is considered chronic.

Posttraumatic stress disorder affects at least 8% of people sometime during their life, including childhood (see Mental Health Disorders: Posttraumatic Stress Disorder). Many people who undergo or witness traumatic events, such as combat veterans and victims of rape or other violent acts, experience posttraumatic stress disorder.

Symptoms

In posttraumatic stress disorder, people have frequent, unwanted memories replaying the traumatic event. Nightmares are common. Sometimes events are relived as if happening (flashbacks). Intense distress often occurs when people are exposed to an event or situation that reminds them of the original trauma. Examples of such reminders are anniversaries of the traumatic event, seeing a gun after being pistol-whipped during a robbery, and being in a small boat after a near-drowning accident.

People persistently avoid things that are reminders of the trauma. They may also attempt to avoid thoughts, feelings, or conversations about the traumatic event and avoid activities, situations, or people who serve as reminders. Avoidance may also include memory loss (amnesia) for a particular aspect of the traumatic event. People have a numbing or deadening of emotional responsiveness and symptoms of increased arousal (such as difficulty falling asleep, being vigilant for warning signs of risk, or being easily startled). Symptoms of depression are common, and people show less interest in previously enjoyed activities. Feelings of guilt are also common. For example, they may feel guilty that they survived when other people did not.

Treatment

Treatment involves psychotherapy (including exposure therapy) and drug therapy. Because of the often intense anxiety associated with traumatic memories, supportive psychotherapy plays an especially important role in treatment. The therapist is openly empathic and sympathetic in recognizing the psychologic pain. The therapist reassures people that their response is valid but encourages them to face their memories (as a form of exposure therapy). They are also taught ways to control anxiety, which help modulate and integrate the painful memories into their personality.

Insight-oriented psychotherapy can help people who feel guilty understand why they are punishing themselves and help rid them of guilty feelings.

Antidepressants appear to provide some benefit. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) are especially helpful.

Chronic posttraumatic stress disorder may not disappear but often becomes less intense over time even without treatment. Nevertheless, some people remain severely handicapped by the disorder.

Last full review/revision August 2007 by John H. Greist, MD; James W. Jefferson, MD