Questions & Answers About Post Traumatic Stress Disorder

What is Post Traumatic Stress Disorder (PTSD)?
When an individual is exposed to an event or circumstance that involves threatened death or serious injury, and/or which evokes intense fear and helplessness, he or she may develop three categories of persistent symptoms: 1) re-experiencing symptoms, e.g., intrusive recollections, flashbacks, nightmares; 2) avoidance symptoms, e.g., avoiding that which reminds one of the event, amnesia, feelings of detachment; 3) hyperarousal symptoms, e.g., sleep difficulties, irritability, difficulty concentrating, hypervigilance.

Who is most vulnerable to PTSD?
It’s not always easy to know. In the case of the terrorist attacks, for instance, we would expect those who were directly affected to be most vulnerable. But there are predisposing factors. Someone who is already stressed, lacks support systems, or has had a prior trauma is more likely to develop the condition than one who has not.

Are children of any age vulnerable?
Yes. One mother recently experienced her daughter becoming angry and expressing self-hurting thoughts, as well as becoming disorganized and panicky, just from hearing the news broadcasts of the September 11 events. The mother wisely sought therapy for her child. The symptoms in children are not always as clear as for adults. If your child expresses any disconcerting thoughts or experiences any marked changes in behavior, a professional consult may be a good idea.

What are the initial signs of PTSD?
The initial indications vary, and are usually diagnosed during the first month as “Acute Stress Disorder” rather than PTSD as such. Some patients who experience a severe trauma suffer from anxiety, intrusive recollections and difficulty sleeping or nightmares. Others can’t return to the activity they were doing when the incident occurred. On the other hand, some may act as if “nothing is wrong” and the only sign of a problem is that he or she may become uncommunicative or avoid social contact. Such individuals often avoid detection and can develop very severe problems later.

If someone is suffering from PTSD, what kind of help is available?
Contact a mental health professional and get an evaluation. You may need a brief period of psychotherapy. The research suggests that getting help with PTSD soon after onset can limit or prevent future problems from arising. As time goes on, the affected individual and his or her therapist can determine whether further treatment is needed. Medication can sometimes be useful.

If counseling or therapy is recommended, what kind of therapist do you look for?
There are two criteria: objective and subjective, or personal. The therapist should be properly accredited and licensed. He or she should have had training in the treatment of trauma. The “intangibles” are also important. Compassion, humanness, awareness of one’s own potential for vulnerability and an inner resilience are important qualities in treating trauma. 

How can you find a good therapist in your area?
Ask a friend who has had a successful psychotherapy experience. You can also contact a reputable mental health organization, medical center, or professional society such as the American Group Psychotherapy Association (212-477-2677), and the local and national associations of psychiatrists, social workers, psychologists, or nurse practitioners. Group therapy has proven extremely beneficial in many trauma cases; AGPA also has a searchable  online database of Certified Group Psychotherapists.

Can PTSD be treated with prescription drugs?
Medications such as anti-depressants and tranquilizers can help, but counseling and support groups are often needed as well. Medication alone does not successfully treat PTSD, especially over the long run. A combination of counseling and support plus medications is often most effective.

How long does PTSD last?
It can last a brief time or become chronic. It can go into remission and then recur, even years later. It can also escalate into other disorders such as panic attacks, severe depression and substance abuse.

When there is a large-scale catastrophe such as the terrorist attacks, school violence, a hurricane or a disease epidemic such as AIDS, what can communities do to attend to the psychological needs of those affected?
Providing education about typical trauma treatment is useful. Making a range of professional services available is also helpful. A community needs to come together and offer support in various ways. Memorial services, support groups, accurate information and a gradual re-building of shattered lives are very important. Oklahoma City is an excellent example of a community that rallied around its survivors, the families and the grieving to promote a healing process.

What is Critical Incident Stress Management (CISM) and when is it needed?
CISM is a professionally provided intervention, often offered to emergency workers and sometimes to victims and their families, to address the immediate stress and symptoms of a crisis situation. It is usually needed when a significant number of people are directly impacted, and especially when it is essential that they continue to function in the face of a difficult aftermath.

What is Psychological First Aid and when is it needed?

PFA is the endorsed early intervention in the aftermath of trauma and disaster. It involves providing a compassionate and supportive presence in the immediate aftermath of a significant event. It is aimed at addressing basic needs and reducing psychological distress by normalizing reactions, providing an attuned empathic presence, and supporting existing coping skills.  It facilitates connection to natural networks, continued support, follow-up and referral to higher levels of care when needed. Group Psychological First Aid (GPFA) is the application of PFA to a group and is the intervention of choice when a naturally cohesive group has experienced the event together and finds comfort in one another’s presence; as might be true for first responders or fellow students following a school shooting.

How should parents help their children cope with their fears and anxieties resulting from learning of the terrorist attacks and their aftermath?
You should allow them to verbalize their feelings and express them in drawings and other “non-verbal” constructive activities. Many children wrote letters to the firemen and others affected by the attacks on the World Trade Center. Help children understand that they are safe and cared about. Provide explanations that are simple and understandable to them at their particular age. Be a good listener and observer.

Could someone who was not directly affected by the attacks develop PTSD?
Yes. Many, if not most, Americans have “mild” forms of PTSD from the September 11 incidents. This is a normal reaction to such traumatic events. Some have had trouble sleeping; others may be having trouble focusing on daily tasks. Strictly speaking, this is not a “disorder” and will usually improve. Someone with a prior trauma may have a recurrence of significant PTSD symptoms just from the images he or she sees on television, etc. “Delayed” PTSD is not uncommon from the terrorist attacks; sometimes the symptoms develop long after the actual trauma.

How should people address their fears of possible future attacks by terrorists?
Talk about your fears and concerns -- don’t keep them inside where they’ll just build up. Don’t panic. Learn and implement what can genuinely help reduce the risks for you and your family.

How can those who have lost someone close to them tell if their grief is “normal” and when it is becoming a psychological illness that requires treatment?
Grief is a kind of “normal illness” whereby the body and mind heal from a loss. Therefore, a grieving person may have symptoms like trouble concentrating and sleeping, memory problems, feeling as if life is meaningless or a general lack of enthusiasm for daily living. If these or other symptoms don’t gradually subside, or if the symptoms continue to seriously interfere with daily activity for many weeks, then professional help is necessary.

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