Download Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD)
Introduction
Post-traumatic stress disorder is a type of anxiety disorder that's triggered by an extremely traumatic event. You
can develop post-traumatic stress disorder (PTSD) when a traumatic event happens to you or when you see a
traumatic event happen to someone else. Many people who are involved in traumatic events or witness them have
a brief period of difficulty adjusting and coping. But with time and some healthy coping methods, such traumatic
reactions usually get better on their own. In some cases, though, the symptoms can get worse or last for months or
even years. Sometimes, they may even completely disrupt your life. In these cases, you may have post-traumatic
stress disorder. Post-traumatic stress disorder may affect survivors of such traumatic events as sexual or physical
assault, war, torture, a natural disaster or an airplane crash. Post-traumatic stress disorder also can affect rescue
workers at the site of mass casualties or other tragedies. These kinds of events may cause intense fear,
helplessness or horror. It's important to get treatment as soon as possible to help prevent PTSD from getting
worse.
Signs and symptoms
Signs and symptoms of post-traumatic stress disorder typically begin within three months of a traumatic event. In
a small number of cases, though, PTSD symptoms may not occur until years after the event. Post-traumatic stress
disorder symptoms may include:















Flashbacks, or reliving the traumatic event for minutes or even days at a time
Shame or guilt
Upsetting dreams about the traumatic event
Trying to avoid thinking or talking about the traumatic event
Feeling emotionally numb
Irritability or anger
Poor relationships
Self-destructive behavior, such as drinking too much
Hopelessness about the future
Trouble sleeping
Memory problems
Trouble concentrating
Being easily startled or frightened
Not enjoying activities you once enjoyed
Hearing or seeing things that aren't there
Post-traumatic stress disorder symptoms can come and go. You may have more symptoms during times of higher
stress or when you experience symbolic reminders of what you went through. For example, some people whose
PTSD symptoms had been gone for years saw their symptoms come back again with the terrorist attacks in the
U.S. on Sept. 11, 2001. When you have PTSD, you may relive the traumatic event numerous times. You may
have upsetting memories. Or you may see reminders wherever you go. You may hear a car backfire and relive
combat experiences, for instance. Or you may see a report on the news about a rape, and feel again the horror and
fear of your own assault.
Causes
Researchers are still trying to better understand what causes someone to get post-traumatic stress disorder. As
with most mental illnesses, post-traumatic stress disorder is probably caused by a complex mix of:





Biology and genetics
Your life experiences
Your temperament
Changes in the natural chemicals in your brain
Risk factors
Although researchers don't know exactly what causes post-traumatic stress disorder, they do know some of the
risk factors involved, or the things that make you more likely to get PTSD. People of all ages can have posttraumatic stress disorder. It's relatively common among adults, with about 7 percent to 8 percent of the population
having PTSD at some point in their lives. In any given year, about 5 million U.S. adults have PTSD. Post
traumatic stress disorder is especially common among those who have served in combat, and it's sometimes called
"shell shock," "battle fatigue" and "combat stress."
Kinds of traumatic events
People with PTSD most often experience one or more of these four types of traumatic events:




Seeing someone being killed or badly injured
Living through a fire, flood or natural disaster
Living through a life-threatening accident
Having been in combat
But many other traumatic events also can lead to post-traumatic stress disorder, including rape, mugging, robbery,
assault, civil conflict, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, childhood
physical abuse or neglect, sexual molestation, being threatened with a weapon, terrorist attacks, and other extreme
or life-threatening events.
Increasing your risk
Not everyone who experiences these kinds of traumatic events goes on to develop post-traumatic stress disorders.
Some factors that may make you more likely to get PTSD after a traumatic event include:







The traumatic event is especially severe or intense.
The traumatic event was long-lasting.
Having an existing mental health condition.
Lacking a good support system of family and friends.
Having family members with PTSD.
Having family members with depression.
When to seek medical advice
It's normal to have a wide range of feelings and emotions after a traumatic event. The feelings you experience
may include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating patterns, or bouts of crying
that come easily. You may have recurrent nightmares or thoughts about the event. This doesn't mean you have
post-traumatic stress disorder. But if you have these disturbing feelings for more than a month, if they're severe or
if you feel you're having trouble getting your life back under control, consider talking to your health care
professional. It's important to get treatment as soon as possible when symptoms begin because that can help
prevent PTSD symptoms from getting worse. If you don't get treatment, PTSD symptoms may become disabling.
You may be wracked by guilt about surviving when others didn't. Or you may feel guilty because you think you
could have done something more to help. Your relationships may suffer, and you may have conflicts that result in
a breakup. You may not be able to do your job as well as you normally can. In some cases, symptoms may be so
severe that you need emergency help, especially if you're thinking about harming yourself or someone else. If
possible, call 911 or other emergency services, or ask a supportive family member or friend for help.
Screening and diagnosis
Post-traumatic stress disorder is diagnosed based on signs and symptoms and a thorough psychological
evaluation. Your doctor or mental health professional will ask you to describe the signs and symptoms you're
experiencing — what they are, when they occur, how intense they are and how long they last. Your doctor also
might ask you to describe the event that led up to your symptoms. You may also have a physical exam to check
for any other medical problems. To be diagnosed with PTSD, someone must meet criteria spelled out in the
Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American
Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance
companies to reimburse for treatment. For post-traumatic stress disorder to be diagnosed, several criteria must be
met, including:







You experienced or witnessed an event that involved death or serious injury, or the threat of death or
serious injury
Your response to the event involved intense fear, horror or a sense of helplessness
You relive experiences of the event, such as having distressing images and memories, upsetting dreams,
flashbacks or even physical reactions
You try to avoid situations or things that remind you of the traumatic event or feel a sense of emotional
numbness
You feel as if you're constantly on guard or alert for signs of danger, which may make you have trouble
sleeping or concentrating
Your symptoms last longer than one month
The symptoms cause significant distress in your life or interfere with your ability to go about your normal
daily tasks
Complications
Post-traumatic stress disorder can disrupt your whole life, from your job to your relationships to your enjoyment
of everyday activities. Having PTSD also may place you at a higher risk of other mental health problems,
including:





Drug abuse
Alcohol abuse
Eating disorders
Suicidal thoughts and actions
Treatment
Treatment of post-traumatic stress disorder can be very effective and help you regain a sense of control over your
life. With successful treatment, you can also feel better about yourself and learn ways to cope if any symptoms
arise again. Post-traumatic stress disorder treatment often includes both medications and psychotherapy. This
combined approach can help improve your symptoms and teach you skills to cope better with the traumatic event
and its aftermath.
Medications
Several types of medications can help symptoms of post-traumatic stress disorder get better. Antidepressants can
help symptoms of both depression and anxiety. They can also help improve sleep problems and improve your
concentration. Anti-anxiety medications also can improve feelings of anxiety and stress. Which medications are
best for you depends on your specific symptoms and situation. You and your doctor will work together to find
medications that work well and have the fewest side effects. It may take a few tries. But you may see an
improvement in your mood and other symptoms within a few weeks. Be sure to tell your health care professional
about any side effects or problems you have with the medications, as you may be able to try something different.
Psychotherapy
Several forms of therapy may be used to treat both children and adults with post-traumatic stress disorder. Which
form is best for you, depends on your symptoms and situation. You may try one type and then a different type of
therapy, or combine elements of several. You may also try individual therapy, group therapy or both. Group
therapy can offer a way to connect to others going through similar experiences. Some types of therapy used in
PTSD treatment include:


Cognitive therapy
Cognitive behavior therapy

Exposure therapy
All these approaches can help you gain control of the fear and distress that happen after a traumatic event. They
can help you learn more about why you have certain feelings and thoughts, and how to replace them with more
positive and realistic thinking. You may also gain skills in stress management and healthy coping. Through
psychotherapy, you learn ways to cope so that you don't feel overwhelmed by thoughts and feelings related to
your traumatic experience. The type of therapy that may be best for you depends on a number of factors that you
and your health care professional can discuss. Medications and psychotherapy also can help you if you've
developed other problems related to your traumatic experience, such as depression, anxiety, alcohol or substance
abuse. You don't have to try to handle the burden of PTSD on your own.
Prevention
After surviving a traumatic event, most people are unable to stop thinking about what's happened. Fear, anxiety,
anger, depression, guilt — all are common reactions to trauma. Although you may not want to talk about it to
anyone or you don't want to even think about what's happened, getting support can help you recover. This may
mean turning to supportive family and friends who will listen and offer comfort. It may mean that you seek out a
mental health professional for a brief course of therapy. Some people also may find it helpful to turn to their faith
community or a pastoral crisis counselor. However you choose to get support and help, research shows that doing
so can help prevent normal stress reactions from getting worse and developing into post-traumatic stress disorder.
Getting support may also help prevent you from turning to unhealthy coping methods, such as alcohol use.
Researchers are still learning more about how best to combine medical and psychiatric help for survivors of
trauma. Some research shows that tending to both medical and mental health needs immediately after extreme
trauma can head off severe symptoms later.
Coping skills
If distress caused by a traumatic event affects your life, seeing your health care professional is an important first
step. But you can take actions to help yourself cope as you continue with treatment for post-traumatic stress
disorder. Things you can do include:







Follow your health professional's instructions. Although it may take a while to feel benefits from
therapy or medications, most people do begin to feel better within a few weeks. Remind yourself that it
takes time. Healing won't come overnight. Following your treatment plan will help move you forward.
Take care of yourself. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid
caffeine and nicotine, which can worsen anxiety.
Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may
be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to refocus.
Talk to someone. Stay connected with supportive and caring family, friends, faith leaders or others. You
don't have to talk about what happened, if you don't want to. Just sharing time together with loved ones
can offer healing and comfort.
Consider a support group. Many communities have support groups geared for specific situations. Ask
your health care professional for help finding one, look in your local phone book, or contact your
community's social services system.
Make a resolution. For many people, living through a traumatic event becomes a turning point to make
positive changes in their lives and grow emotionally and psychologically. For instance, some people who
live through a serious car accident caused by someone under the influence of alcohol may resolve to
combat drinking and driving.
Last Updated: 04/12/2007
© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single
copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic,"
"MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the tripleshield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.
Definition
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying
event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger
PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
Among those who may experience PTSD are military troops who served in the Vietnam and Gulf Wars; rescue
workers involved in the aftermath of disasters like the terrorist attacks on New York City and Washington, D.C.;
survivors of the Oklahoma City bombing; survivors of accidents, rape, physical and sexual abuse, and other
crimes; immigrants fleeing violence in their countries; survivors of earthquakes, floods, and hurricanes; and
people who witness traumatic events. Family members of victims also can develop the disorder. PTSD can occur
in people of any age, including children and adolescents. An estimated 5.2 million American adults ages 18 to 54,
or approximately 3.6 percent of people in this age group in a given year, have PTSD (Narrow et al., 1998). About
30 percent of Vietnam veterans developed PTSD at some point after the war (Robins & Regiew, 1991). The
disorder also has been detected among veterans of the Persian Gulf War, with some estimates running as high as 8
percent (The NIMH Genetics Workgroup, 1998). More than twice as many women as men experience PTSD
following exposure to trauma (Regier et al., 1998).
Depression, alcohol or other substance abuse, or other anxiety disorders frequently co-occur with PTSD. The
likelihood of treatment success is increased when these other conditions are appropriately diagnosed and treated
as well. Complex PTSD (sometimes called "Disorder of Extreme Stress") is found among individuals who have
been exposed to prolonged traumatic circumstances, especially during childhood, such as childhood sexual abuse.
Developmental research is revealing that many brain and hormonal changes may occur as a result of early,
prolonged trauma, and contribute to difficulties with memory, learning, and regulating impulses and emotions.
Combined with a disruptive, abusive home environment that does not foster healthy interaction, these brain and
hormonal changes may contribute to severe behavioral difficulties (such as impulsivity, aggression, sexual acting
out, eating disorders, alcohol/drug abuse, and self-destructive actions), emotional regulation difficulties (such as
intense rage, depression, or panic) and mental difficulties (such as extremely scattered thoughts, dissociation, and
amnesia). As adults, these individuals often are diagnosed with depressive disorders, personality disorders or
dissociative disorders. Treatment often takes much longer, may progress at a much slower rate, and requires a
sensitive and structured treatment program delivered by a trauma specialist.
Symptoms
Many people with PTSD repeatedly re-experience the ordeal especially when they are exposed to events or
objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also
experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or outbursts of anger.
Feelings of intense guilt are also common. Most people with PTSD try to avoid any reminders or thoughts of the
ordeal. PTSD is diagnosed when symptoms last more than one month. Symptoms associated with reliving the
traumatic event:













Having bad dreams or nightmares about the event or something similar
Behaving or feeling as if the event were actually happening all over again (these are known as
"flashbacks")
Having a lot of emotional feelings when reminded of the event
Having a lot of physical sensations when reminded of the event (e.g. heart races, pounds, or "misses a
beat"; sweating, difficulty breathing, feeling faint, feeling a loss of control)
Symptoms related to avoidance of reminders of the traumatic event:
Avoiding thoughts, conversations, or feelings about the event
Avoiding people, places, or activities that associated with the event
Having difficulty remembering some important part of the event
Changes frequently made after the event:
Loss of interest in things that once were considered important
Feeling "detached" from people and finds it difficult to trust people
Feeling emotionally "numb" and finds it hard to have loving feelings even toward those who are
emotionally close
Difficulty falling or staying asleep






















Irritable and angry
Difficulty concentrating
Feeling that one is not going to live very long and there is no reason to plan for the future
Feeling easily startled
Always "on guard"
Medical or emotional problems:
Stomach problems
Intestinal problems
Gynecological problems
Weight gain or loss
Chronic pain (e.g. back, neck, in women-pelvic area)
Problems getting to sleep
Problems staying asleep
Headaches
Skin rashes and other problems
Irritability, "short fuse", "quick temper", other anger problems
Nightmares
Depression
Lack of energy, chronic fatigue
Alcoholism and other substance use problems
General anxiety
Anxiety (panic) attacks
Causes
Research is continuing to reveal factors that may lead to PTSD. People who have been abused as children or who
have had other previous traumatic experiences are more likely to develop the disorder. In addition, it used to be
believed that people who tend to be emotionally numb after a trauma were showing a healthy response; but now
some researchers suspect that people who experience this emotional distancing may be more prone to PTSD.
Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in
anxiety and fear, which are important for understanding anxiety disorders such as PTSD. Fear, an emotion that
evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. It has
been found that the fear response is coordinated by a small structure deep inside the brain, called the amygdala.
The amygdala, although relatively small, is a very complicated structure, and recent research suggests that
posttraumatic stress disorder may be associated with abnormal activation of the amygdala.
Once fear is conditioned in the amygdala, it is virtually indelible. However, the neural mechanisms from the
amygdala to the hippocampus and to cortical regions, such as, the frontal lobes allow its suppression until
triggered. Fear rapidly returns when the individual is re-exposed to the trauma related material. An increase in
stressors seems to differentially affect the fear inducing and the fear inhibiting pathways. High stress levels
decrease the capacity of the inhibitory pathway to suppress fear, and increase the ability of conditioned fear
pathways to induce it. Thus, the fear induced by re-exposure of traumatic material indicates a failure of inhibition
on the part of the hippocampus, and is evidence that the traumatic episode is not integrated as a narrative, spatiotemporal event in autobiographical memory. Furthermore, the heightened sensitivity of exposure of PTSD
patients to trauma-related material, or traumatic imagery, results in an increase in fearfulness in response to
stimuli which were not truly life threatening.
Studies using MRI in PTSD have measured volume of the hippocampus, a brain structure involved in learning
and memory. This line of research was prompted by studies in animals showing that high levels of cortisol seen in
stress are associated with damage to the hippocampus. Patients with combat-related PTSD had an 8 percent
decrease in right hippocampal volume when compared with controls. Deficits in free verbal recall tasks were
associated with this decrease. A decrease of 12 percent in left hippocampal volume was found in patients with a
history of PTSD related to severe childhood physical and sexual abuse. Reduced hippocampal volume was
associated with dissociative symptoms in women who had a history of childhood sexual abuse. People with PTSD
tend to have abnormal levels of key hormones involved in response to stress. When people are in danger, they
produce high levels of natural opiates, which can temporarily mask pain. Scientists have found that people with
PTSD continue to produce those higher levels even after the danger has passed; this may lead to the blunted
emotions associated with the condition. Some studies have shown that cortisol levels are lower than normal and
epinephrine and norepinephrine are higher than normal. Norepinephrine is a neurotransmitter released during
stress, and one of its functions is to activate the hippocampus, the brain structure involved with organizing and
storing information for long-term memory. This action of norepinephrine is thought to be one reason why people
generally can remember emotionally arousing events better than other situations. Under the extreme stress of
trauma, norepinephrine may act longer or more intensely on the hippocampus, leading to the formation of
abnormally strong memories that are then experienced as flashbacks or intrusions. Since cortisol normally limits
norepinephrine activation, low cortisol levels may represent a significant risk factor for developing PTSD.
Treatment
Treatment for PTSD typically begins with a detailed evaluation, and development of a treatment plan that meets
the unique needs of the survivor. Generally, PTSD-specific-treatment is begun only when the survivor is safely
removed from a crisis situation. For instance, if currently exposed to trauma (such as by ongoing domestic or
community violence, abuse, or homelessness), severely depressed or suicidal, experiencing extreme panic or
disorganized thinking, or in need of drug or alcohol detoxification, addressing these crisis problems becomes part
of the first treatment phase. Other strategies for treatment include:




Educating trauma survivors and their families about how persons get PTSD, how PTSD affects survivors
and their loved ones, and other problems that commonly come along with PTSD symptoms.
Understanding that PTSD is a medically recognized anxiety disorder that occurs in normal individuals
under extremely stressful conditions is essential for effective treatment.
Exposure to the event via imagery allows the survivor to re-experience the event in a safe, controlled
environment, while also carefully examining their reactions and beliefs in relation to that event.
Examining and resolving strong feelings such as anger, shame, or guilt, which are common among
survivors of trauma
Teaching the survivor to cope with post-traumatic memories, reminders, reactions, and feelings without
becoming overwhelmed or emotionally numb. Trauma memories usually do not go away entirely as a
result of therapy, but become manageable with new coping skills.
Medications
A number of medications that were originally approved for treatment of depression have been found to be
effective for posttraumatic stress disorder. If your doctor prescribes an antidepressant, you will need to take it for
several weeks before symptoms start to fade. So it is important not to get discouraged and stop taking these
medications before they've had a chance to work. Some of the newest antidepressants are called selective
serotonin reuptake inhibitors, or SSRIs. These medications act in the brain on a chemical messenger called
serotonin. SSRIs tend to have fewer side effects than older antidepressants. People do sometimes report feeling
slightly nauseated or jittery when they first start taking SSRIs, but that usually disappears with time. Some people
also experience sexual dysfunction when taking some of these medications. An adjustment in dosage or a switch
to another SSRI will usually correct bothersome problems. It is important to discuss side effects with your doctor
so that he or she will know when there is a need for a change in medication.
Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram are among the SSRIs commonly prescribed PTSD.
These medications are started at a low dose and gradually increased until they reach a therapeutic level. Similarly,
antidepressant medications called tricyclics are started at low doses and gradually increased. Tricyclics have been
around longer than SSRIs and have been more widely studied for treating anxiety disorders. They are as effective
as the SSRIs, but many physicians and patients prefer the newer drugs because the tricyclics sometimes cause
dizziness, drowsiness, dry mouth, and weight gain. When these problems persist or are bothersome, a change in
dosage or a switch in medications may be needed.
Psychotherapy
Cognitive-behavioral therapy (CBT) involves working with cognitions to change emotions, thoughts, and
behaviors. Exposure therapy, is one form of CBT unique to trauma treatment which uses careful, repeated,
detailed imagining of the trauma (exposure) in a safe, controlled context, to help the survivor face and gain
control of the fear and distress that was overwhelming in the trauma. In some cases, trauma memories or
reminders can be confronted all at once ("flooding"). For other individuals or traumas it is preferable to work
gradually up to the most severe trauma by using relaxation techniques and either starting with less upsetting life
stresses or by taking the trauma one piece at a time ("desensitization").
Along with exposure, CBT for trauma includes learning skills for coping with anxiety (such as breathing
retraining or biofeedback) and negative thoughts ("cognitive restructuring"), managing anger, preparing for stress
reactions ("stress inoculation"), handling future trauma symptoms, as well as addressing urges to use alcohol or
drugs when they occur ("relapse prevention"), and communicating and relating effectively with people ("social
skills" or marital therapy). Eye Movement Desensitization and Reprocessing (EMDR) is a relatively new
treatment of traumatic memories which involves elements of exposure therapy and cognitive behavioral therapy,
combined with techniques (eye movements, hand taps, sounds) which create an alteration of attention back and
forth across the person's midline. While the theory and research are still evolving with this form of treatment,
there is some evidence that the therapeutic element unique to EMDR, attentional alteration, may facilitate
accessing and processing traumatic material.
Group treatment is often an ideal therapeutic setting because trauma survivors are able to risk sharing traumatic
material with the safety, cohesion, and empathy provided by other survivors. As group members achieve greater
understanding and resolution of their trauma, they often feel more confident and able to trust. As they discuss and
share coping of trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to
focus on the present rather than the past. Telling one's story (the "trauma narrative") and directly facing the grief,
anxiety, and guilt related to trauma enables many survivors to cope with their symptoms, memories, and other
aspects of their lives.
Brief psychodynamic psychotherapy focuses on the emotional conflicts caused by the traumatic event,
particularly as they relate to early life experiences. Through the retelling of the traumatic event to a calm,
empathic, compassionate and non-judgmental therapist, the survivor achieves a greater sense of self-esteem,
develops effective ways of thinking and coping, and more successfully deals with the intense emotions that
emerge during therapy. The therapist helps the survivor identify current life situations that set off traumatic
memories and worsen PTSD symptoms.
Psychiatric disorders commonly co-occurring with PTSD
Psychiatric disorders commonly co-occurring with PTSD include: depression, alcohol/substance abuse, panic
disorder, and other anxiety disorders. Although crises that threaten the safety of the survivor or others must be
addressed first, the best treatment results are achieved when both PTSD and the other disorder(s) are treated
together rather than one after the other. This is especially true for PTSD and alcohol/substance abuse.
References
Bremner, J.D., Randall, P.R., Scott, T.M., Bronen, R.A., Delaney, R.C., Seibyl, J.P., Southwick, S.M., McCarthy,
G., Charney, D.S., & Innis, R.B. (1995). MRI-based measurement of hippocampal volume in posttraumatic stress
disorder. American Journal of Psychiatry, 152, 973-981.
Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year
prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census
estimated residential population age 18 to 54 on July 1, 1998. Unpublished.
Stein, M.B., Koverola, C., Hanna, C., Torchia, M.G., & McClarty, B. (1997). Hippocampal volume in women
victimized by childhood sexual abuse. Psychological Medicine, 27, 951-959.
LeDoux J. Fear and the brain: where have we been, and where are we going? Biological Psychiatry, 1998; 44(12):
1229-38.
Last Updated: 20021010
Copyright © 1991-2007 Sussex Publishers. All rights reserved.
Helping a Family Member Who Has Post-Traumatic Stress Disorder
Overview
When someone has post-traumatic stress disorder (PTSD), it changes family life. The person with PTSD may act
differently and get angry easily. He or she may not want to do things you used to enjoy together. You may feel
scared and frustrated about the changes you see in your loved one. You also may feel angry about what's
happening to your family, or wonder if things will ever go back to the way they were. These feelings and worries
are common in people who have a family member with PTSD. It is important to learn about PTSD so you can
understand why it happened, how it is treated, and what you can do to help. But you also need to take care of
yourself. Changes in family life are stressful, and taking care of yourself will make it easier to cope.
How can I help?
You may feel helpless, but there are many things you can do. Nobody expects you to have all the answers. Here
are ways you can help:
 Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand
what your family member is going through. The more you know, the better you and your family can
handle PTSD.
 Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy,
and you can be there for support.
 Tell your loved one you want to listen and that you also understand if he or she doesn't feel like talking.
 Plan family activities together, like having dinner or going to a movie.
 Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for
health and helps clear your mind.
 Encourage contact with family and close friends. A support system will help your family member get
through difficult changes and stressful times.
Your family member may not want your help. If this happens, keep in mind that withdrawal can be a symptom of
PTSD. A person who withdraws may not feel like talking, taking part in group activities, or being around other
people. Give your loved one space, but tell him or her that you will always be ready to help.
How can I deal with anger or violent behavior?
Your family member may feel angry about many things. Anger is a normal reaction to trauma, but it can hurt
relationships and make it hard to think clearly. Anger also can be frightening. If anger leads to violent behavior or
abuse, it's dangerous. Go to a safe place and call for help right away. Make sure children are in a safe place
as well. It's hard to talk to someone who is angry. One thing you can do is set up a time-out system. This helps
you find a way to talk even while angry. Here's one way to do this.
 Agree that either of you can call a time-out at any time.
 Agree that when someone calls a time-out, the discussion must stop right then.
 Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal.
 Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other
what time you will come back.
 While you are taking a time-out, don't focus on how angry you feel. Instead, think calmly about how you
will talk things over and solve the problem. After you come back:
 Take turns talking about solutions to the problem. Listen without interrupting.
 Use statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing.
 Be open to each other's ideas. Don't criticize each other.
 Focus on things you both think will work. It's likely you will both have good ideas.
 Together, agree which solutions you will use.
How can I communicate better?
You and your family may have trouble talking about feelings, worries, and everyday problems. Here are some
ways to communicate better:







Be clear and to the point.
Be positive. Blame and negative talk won't help the situation.
Be a good listener. Don't argue or interrupt. Repeat what you hear to make sure you understand, and ask
questions if you need to know more.
Put your feelings into words. Your loved one may not know you are sad or frustrated unless you are clear
about your feelings.
Help your family member put feelings into words. Ask, "Are you feeling angry? Sad? Worried?"
Ask how you can help.
Don't give advice unless you are asked.
If your family is having a lot of trouble talking things over, consider trying family therapy. Family therapy is a
type of counseling that involves your whole family. A therapist helps you and your family communicate,
maintains good relationships, and cope with tough emotions. During therapy, each person can talk about how a
problem is affecting the family. Family therapy can help family members understand and cope with PTSD. Your
health professional or a religious or social services organization can help you find a family therapist who
specializes in PTSD.
How can I take care of myself?
Helping a person with PTSD can be hard on you. You may have your own feelings of fear and anger about the
trauma. You may feel guilty because you wish your family member would just forget his or her problems and get
on with life. You may feel confused or frustrated because your loved one has changed, and you may worry that
your family life will never get back to normal. All of this can drain you. It can affect your health and make it hard
for you to help your loved one. If you're not careful, you may get sick yourself, become depressed, or burn out
and stop helping your loved one. To help yourself, you need to take care of yourself and have other people help
you.
Care for yourself
 Don't feel guilty or feel that you have to know it all. Remind yourself that nobody has all the answers. It's
normal to feel helpless at times.
 Don't feel bad if things change slowly. You cannot change anyone. People have to change themselves.
 Take care of your physical and mental health. If you feel yourself getting sick or often feel sad and
hopeless, see your doctor.
 Don't give up your outside life. Make time for activities and hobbies you enjoy. Continue to see your
friends.
 Take time to be by yourself. Find a quiet place to gather your thoughts and "recharge."
 Get regular exercise, even just a few minutes a day. Exercise is a healthy way to deal with stress.
 Eat healthy foods. When you are busy, it may seem easier to eat fast food than to prepare healthy meals.
But healthy foods will give you more energy to carry you through the day.
 Remember the good things. It's easy to get weighed down by worry and stress. But don't forget to see and
celebrate the good things that happen to you and your family.
Get help
During difficult times, it is important to have people in your life who you can depend on. These people are your
support network. They can help you with everyday jobs, like taking a child to school, or by giving you love and
understanding.
You may get support from:
 Family members.
 Friends, coworkers, and neighbors.
 Members of your religious or spiritual group.
 Support groups.
 Doctors and other health professionals.
Credits
Author
Kate Copsey
Editor
Roya Camp
Associate Editor
Terrina Vail
Primary Medical Reviewer
Steven L. Schneider,
- Family Medicine
MD
Specialist Medical Reviewer Tina Esther Bronner,
- Internal Medicine
MD
Hamblen,
PhD
Specialist Medical Reviewer Jessica
- Post Traumatic Stress Disorder
Kushner,
Specialist Medical Reviewer Mara
- Mental Health Care
Last Updated
CSW
February 12, 2007
Author: Kate Copsey
Medical Review: Steven L. Schneider, MD - Family Medicine
Tina Esther Bronner, MD - Internal Medicine
Jessica Hamblen, PhD - Post Traumatic Stress Disorder
Mara Kushner, CSW - Mental Health Care
Last Updated: 02/12/2007
© 1995-2007, Healthwise, Incorporated, P.O. Box 1989, Boise, ID 83701. ALL RIGHTS RESERVED.
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the
decisions you make based on this information.