Paging Dr. Frischer - Post-traumatic stress disorder

Post-traumatic stress disorder. It has gone by many names-battle fatigue or gross stress reaction after WWII, combat fatigue or shell shock after WW1, and even soldier's heart after the Civil War. We've become familiar with the term PTSD since the war in Vietnam, although it certainly isn't limited to war. It has likely been around since the dawn of time. In fact, the Greek historian Herodotus described an Athenian soldier who appeared to be uninjured from battle, but became permanently blind after witnessing the death of a fellow soldier. This took place in 490 BCE!Many of those who go through traumatic events, war-related or not, have difficulty adjusting and coping afterwards. Some victims will heal on their own, but for many the symptoms worsen and may dominate their life. PTSD symptoms may come and go. They may be exacerbated by stress in general, or by a specific reminder. They typically start in the first three months following the traumatic event, however in some cases, the memory is suppressed to such an extent that symptoms may not appear for years. In order to be diagnosed with PTSD, symptoms must last for over one month, and symptoms are grouped into three categories: - Symptoms of intrusive memories may include upsetting dreams about the traumatic event, and flashbacks. - Symptoms of avoidance and emotional numbing may include avoiding thinking about or speaking of the traumatic event, feeling emotionally numb, avoiding activities that were once enjoyed, hopelessness about the future, memory problems, trouble concentrating, and difficulty maintaining close relationships. - Symptoms of anxiety and increased emotional arousal may include irritability or anger, overwhelming guilt or shame, self-destructive behavior such as drinking, trouble sleeping, being easily startled or frightened, and hearing or seeing things that aren't there. Not everyone is susceptible to PTSD. Although most of us encounter some sort of trauma over a lifetime, research suggests that 4-8% of those in the general population develop PTSD. Vulnerability to PTSD presumably stems from an interaction of biology, developmental experiences, and the severity of the trauma. You are most likely to suffer from PTSD if you are female, experience intense or long-lasting trauma, experienced other trauma earlier in life, have other mental health problems, such as anxiety or depression, lack a good support system of family and friends, have close relatives with mental health problems (including PTSD), or have been abused or neglected as a child. PTSD can be caused by physical trauma, psychological trauma, or a combination of both. Examples include combat exposure, rape, childhood neglect and physical abuse, sexual molestation, being threatened with a weapon or physically attacked (including robbery and mugging), car accident, civil conflict, natural disaster, terrorist attack, and life-threatening medical diagnosis. PTSD can disrupt life, affecting jobs, relationships, and day-to-day enjoyment of routine activities. It increases the risk of having other mental health problems, such as depression, drug abuse and alcohol abuse, eating disorders, and suicidal thoughts and actions. It can even increase the risk of getting cardiovascular disease, chronic pain, autoimmune diseases such as rheumatoid arthritis and thyroid disease, and musculoskeletal conditions. When we are in danger, it's natural to feel afraid. Fear triggers split-second changes in the body, as we prepare to either defend ourselves or to avoid the danger. This "fight-or-flight" mechanism is a healthy reaction that normally serves to protect us. With PTSD, however, this reaction is changed or damaged, and we don't respond to fear in a rational, useful manner. A traumatic event causes an overactive adrenaline response, which creates persisting neurological patterns in the brain. These patterns can continue long after the initial triggering event, and we become hyper-responsive to future situations, feeling stressed or frightened even when we're no longer in danger. Recommended PTSD treatment currently combines psychotherapy and support groups with medication, including anti-depressant, anti-anxiety, and antipsychotic drugs. The term "compassion fatigue" was coined to describe the experience of those close to a loved one with PTSD. The emotional and mental health of the caregiver can be severely taxed. It's common for caregivers to find themselves avoiding the victim's attempts to talk about the trauma or their feelings. In order to take care of yourself and others, make certain that your own mental health is a priority. Eat right, exercise and rest. Find a way to take time alone or with friends, doing activities that help you recharge. If you become aware of a friend or loved one whose behavior has suddenly changed, be a compassionate listener and if necessary, help them find professional help. If they are suffering from PTSD, early intervention may save them years of misery. Good health to you all! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: August 11, 2011 - Volume 10 - Issue 17