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Posttraumatic stress disorder, or PTSD, is a condition resulting from a severely traumatic event outside the range of a person's normal experience.

What is going on in the body?

PTSD is a psychological and physiological reaction to a catastrophic event outside of the individual. Researchers have identified changes in the central and autonomic nervous systems in people with PTSD. Changes in hormone systems have also been identified.

• acute, in which symptoms last less than 3 months
• chronic, in which symptoms last longer than 3 months
• delayed, in which symptoms start at least 6 months after the actual trauma occurs

What are the signs and symptoms of the condition?

Symptoms of PTSD fall into three main categories. The first is reliving the event in one or more of the following ways:

• flashbacks, or reliving events as if they are occurring right now
• persistent memories of the event
• physical sensations when the event is recalled
• recurrent dreams of the event
• severe emotional responses to new events similar to the traumatic event

The second category involves a tendency to avoid reminders of the event. This tendency includes the following symptoms:

• avoidance of activities, places, or people that might bring the event to mind
• avoidance of thoughts, feelings, or talking about the event
• difficulty maintaining healthy family, social, or job relationships
• feelings of detachment or emotional distance from others
• loss of interest in daily activities
• a sense of a shortened future
• survivor guilt, that is, feeling guilty about surviving when others did not
• trouble recalling key parts of the event

The third category involves a higher level of arousal and anxiety than before the trauma. At this level, the following symptoms can occur:

• agitation, or feelings of restlessness
• chest pain
• difficulty concentrating
• dizziness
• an exaggerated startle response
• excessive sweating
• headache
• irritability
• memory loss
• nausea
• persistent anxiety

What are the causes and risks of the condition?

• child abuse
• high school violence, including shooting incidents
• imprisonment
• man-made disasters, such as bombings
• natural disasters, such as earthquakes
• plane crashes
• severe assault
• sexual abuse, including rape
• torture
• war

Not everyone exposed to such events will develop PTSD. It is not known why some individuals develop PTSD, though research done on wartime experiences shows that a strong sense of hope is protective. Having strong support systems reduces a person's risk of the disorder.

What can be done to prevent the condition?

Critical incident stress debriefing involves immediate counseling after the traumatic event. It may cut down on the chances of developing PTSD. The earlier counseling is started, the better the chances for success.

How is the condition diagnosed?

Diagnosis of PTSD begins with a medical history and physical exam. PTSD is diagnosed based on a person's symptoms. In addition, a major, extreme event must have taken place.

What are the long-term effects of the condition?

People with PTSD often have problems in their relationships with others. Marriage problems and high divorce rates are common. Job and legal problems also occur frequently in persons with the syndrome.

Alcoholism and drug abuse are significant among people with PTSD. Sleep disorders, trouble with anger, and suicide attempts are not uncommon.

What are the risks to others?

PTSD is not contagious and poses no risk to others.

What are the treatments for the condition?

Treatment of PTSD can help reduce symptoms in some individuals. Cognitive-behavioral therapy helps the individual change perceptions and attitudes about the trauma. Group therapy can be helpful, especially if others in the group suffered the same trauma.

Exposure therapy allows the person to repeatedly relive the frightening experience under controlled conditions. This can help him or her work through the trauma. People with PTSD often need treatment for depression or substance abuse. This needs to occur before measures directed at decreasing symptoms of PTSD can be effective.

Medicines used to treat PTSD include the following:

• azaspirones, such as buspirone (i.e., BuSpar)
• benzodiazepines, such as alprazolam (i.e., Niravam, Xanax) or lorazepam (i.e., Ativan), should be used selectively and with caution
• MAO inhibitors, such as phenelazine (i.e., Nardil)
• serotonin reuptake inhibitors (SSRIs), such as paroxetine (i.e., Paxil, Pexeva), fluoxetine (i.e., Prozac, Serafem), citalopram (i.e., Celexa), excitalopram (i.e., Lexapro) or sertraline(i.e., Zoloft)
• combination norepinephrine reuptake/serotonin reuptake inhibitors (NRI/SSRI) such as venlafaxine (i.e., Effexor) or duloxetine (i.e., Cymbalta)
• tricyclic antidepressants, such as amitriptyline (i.e., Elavil), doxepin (i.e., Sinequan), nortriptyline (i.e., Aventyl, Pamelor), imipramine (i.e., Tofranil), desipramine (i.e., Norpramin) or protriptyline (i.e., Vivactil)
• trazodone (i.e., Desyrel)
• bupropion (i.e., Wellbutrin, Zyban)

What are the side effects of the treatments?

Medicines used to treat PTSD can cause drowsiness, stomach upset, and allergic reactions.

What happens after treatment for the condition?

Chronic PTSD often persists for years. It usually becomes less intense and bothersome as time passes.

How is the condition monitored?

PTSD is monitored with regular visits to the healthcare professional, usually a psychiatrist. Blood tests may be done periodically to measure levels of medicines. Any new or worsening symptoms should be reported to the healthcare professional.