Presented by Kelly R. Chrestman, Ph.D., March 12, 2007

Definition of “trauma”. According to the American Psychiatric Association, trauma involves witnessing or experiencing “actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others”.

Many people who experience trauma react with horror, terror and helplessness. It is normal to feel disbelief and shock, to withdraw or shut down. Usually, after several months these symptoms go away. People who have Post-Traumatic Stress Disorder (PTSD) continue to experience these symptoms.

People with PTSD may avoid everything that reminds them of the trauma; e.g. the person who was attacked in a parking lot feels he cannot go to any parking lot. At first he may feel relief in having avoided a trigger that reminds him of the trauma. However, this becomes self-perpetuating and may expand to more places he cannot go and more people he cannot trust. He may begin to avoid everything. He may retreat altogether, startle easily, and often has sleep disturbances. Many who have PTSD experience additional problems such as panic disorder, depression, phobias, delusions/psychotic features (e.g. flashbacks), and/or dissociative identity disorder.

Characteristics of trauma that increase the risk for PTSD

  • Traumas most likely to cause PTSD are rape for women and war experience for men.
  • Trauma is more likely to occur if the event was
    • physical (e.g. gunshot wound vs gun pointed at a person)
    • uncontrollable
    • unpredictable
    • prolonged
    • repeated, or
    • when something was lost (e.g. spouse, house) or
    • when the person feels guilty that s/he didn’t do something to prevent the trauma

Characteristics of people who are at higher risk of developing PTSD
Many people experience trauma but do not get PTSD. People who have the following characteristics are more likely to develop PTSD after trauma:

  • previous trauma experience
  • psychiatric illness (which also increases the risk of experiencing trauma) or anything that makes the person more vulnerable
  • family history of PTSD or anxiety disorder
  • substance abuse, especially if the person is high
  • poor social support
  • low education status

Treatment for PTSD

People who continue to experience symptoms of PTSD beyond 3 months usually need treatment. Fortunately, several studies indicate that PTSD can be treated successfully within a relatively short period of time.

Cognitive Behavioral Therapy has demonstrated good results. This approach is based on the observation that people who develop PTSD have responded to the trauma with inaccurate thoughts and perceptions (e.g. nothing feels safe anymore). Through therapy people can address their faulty thinking and begin to confront the things they are avoiding (afraid of), first by re-telling the story repeatedly and later through exposure (e.g. physically going to the place the client is avoiding with the therapist). Often treatment can be completed within 10 to 15 visits. The success rate in treating PTSD through Cognitive Behavioral Therapy is ~80%.

Some people do not respond to therapy, at which point medication may be indicated. The typical medications prescribed for PTSD are the same as those used to treat depression and anxiety.