What is post-traumatic stress disorder?
Post-traumatic stress disorder
Among the thousands of people who volunteered their help in the hours following the terrorist attacks on the World Trade Center on 11 September 2001 were many doctors. What they experienced was so distressing that, when approached by researchers 18 months later, most preferred to keep their thoughts to themselves. A few, however, did agree to talk. Lynn de Lisi collected their accounts:
One particular physician, a female psychiatrist … experienced survivor guilt, and [felt] that she needed to be doing more. At the time of the interview, she still felt somewhat removed from other people and irritable, and had upsetting reminders that lingered.
Another physician said he drank twice as much alcohol after September 11 than before. He worked at a triage unit close to the World Trade Center site volunteering about 10 hours per day…. He stated that his worst memory was seeing people jump out of the towers.
One physician was a staff psychiatrist on an inpatient unit who worked longer hours after the attacks. His alcohol intake increased after the attacks and at the time of the interview he still admitted to being preoccupied with painful images intruding on his thoughts. He still avoided participating in activities that would remind him of the events.
But it wasn’t necessary to be directly involved for psychological problems to develop. Many Americans, even those living far from New York City, were profoundly shaken. Two months after 11 September, 17% of the 1,300 people contacted across the US in one survey reported associated post-traumatic stress symptoms. (Scale up that representative sample and you arrive at a total of 45 million people suffering serious psychological distress as a result of the attacks.) With the passing of time, the number of people reporting symptoms declined. Three years later, when 1,950 individuals were contacted by the same researchers, 4.5% were affected.
Overall, the people most likely to develop problems were those who had:
• personally witnessed the attacks;
• watched live television coverage;
• experienced traumatic events in their childhood, or after 11 September;
• suffered previously from a psychological disorder.
What is post-traumatic stress disorder?
Given the magnitude of the horror inflicted upon New Yorkers on 11 September, it’s hardly surprising that many people — and especially those directly affected by the atrocity — subsequently developed severe psychological problems. But post-traumatic stress disorder (PTSD) is usually triggered by more commonplace disasters. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) defines a traumatic event as one in which:
the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
Examples of such trauma include serious traffic accidents, sexual assault, physical attack, violent robbery or mugging, the sudden death of a loved one, military combat, torture, natural disasters, and being diagnosed with a potentially fatal illness.
PTSD is marked by three types of symptoms (that must persist for more than a month):
• Reliving the traumatic event. This can take the form of nightmares or flashbacks, when the person feels that they are right back in the midst of the horror. Thoughts of the trauma constantly recur, no matter how doggedly the person tries to forget. Distressing memories can be sparked by the smallest things — perhaps a particular sound or smell, a place, or the look on someone’s face.
• Avoiding any reminder of the traumatic event/feeling numb. The memory of the trauma is so upsetting that sufferers will go to any lengths to avoid triggering it. They try to suppress thoughts of the event; they steer clear of people and places that could remind them of what happened; and they don’t want to talk about their experiences. People with PTSD often report that they are emotionally ’numb’ — at least to positive emotions like happiness. And they may try to deaden the anxiety and depression they feel by using alcohol or drugs. (Some experts argue that numbness is sufficiently different from avoidance to be regarded as a symptom category in its own right.)
• Feeling constantly on edge. This is what psychologists call a state of hyperarousal, and it means being always anxious, irritable, and tense. People with PTSD are constantly on the alert for any reminder of the trauma: it dominates their world, day and night (sleep problems are a typical symptom of PTSD).
As with all psychiatric diagnoses, however, many people may develop symptoms that aren’t sufficiently severe, persistent, or numerous to meet the official criteria, but which cause much distress nonetheless. And some researchers have questioned the DSM’s interpretation of what constitutes a trauma, suggesting that negative life events such as chronic illness, divorce, or unemployment can generate at least as many symptoms of PTSD as rape, assault, accidents, and so on.