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Symptoms

Post traumatic stress disorder (PTSD) or “injury” can occur after you have been through a traumatic event. A traumatic event is something terrible and scary that you see, hear about, or that happens to you, like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Adult sexual or physical assault
  • Serious accidents, like a car or plane wreck
  • Witnessing a terrifying event
  • Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

During a traumatic event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If your reactions don’t go away over time and they disrupt your life, you may have PTSD. There is hope and help.

How does PTSD develop?

Most people who go through a trauma have some symptoms at the beginning. Only some will develop PTSD over time. It isn’t clear why some people develop PTSD and others don’t.

Whether or not you develop PTSD depends on several factors:

  • How intense the trauma was or how long it lasted
  • If you were injured or lost someone important to you
  • How close you were to the event
  • How strong your reaction was
  • How much you felt in control of events
  • How much help and support you got after the event

What are the symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may lay dormant and appear months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you should consult with a VA Doctor about PTSD.  If you have never been to the VA Hospital, your first move would be to contact your County Veteran Service Officer (CVSO) who will initiate your application and get you into the VA Medical Center database system.

There are four types of symptoms of PTSD:

    1. Reliving the event (also called re-experiencing symptoms) You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.

    2. Avoiding situations that remind you of the event You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.

    3. Feeling numb You may find it hard to express your feelings. Or, you may not be interested in activities you used to enjoy. This is another way to avoid memories.

    4. Feeling keyed up (also called hyper-arousal) You may be jittery, or always alert and on the lookout for danger. This is known as hyper-arousal.

Can children have PTSD?

Children can have PTSD too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

  • Children age birth to 5 may get upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom
  • Children age 6 to 11 may act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
  • Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, guilt or despair
  • Depression or anxiety
  • Drinking or drug abuse problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce
  • Anger or violence towards others
  • Fear of rejection
  • Hyper-vigilance
  • Trusting others
  • Invasion of personal space

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

Will I get better?

“Getting better” means different things for different people, and not everyone who receives treatment or therapy will be “cured.” Even if you continue to have symptoms, however, treatment can help you cope. Your symptoms don’t have to interfere with your everyday activities, work, and relationships. You may very well have good days and not so good days, but getting help will definitely help you understand the symptoms and triggers so you will be able to better handle them when they occur.

What treatments are available?

If you have been diagnosed with PTSD, dealing with the past can be difficult. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you manage your life better.  People close to you should know what you are going through, but they do not need to know the details. There are two main types of treatment, psychotherapy (sometimes called counseling) and medication. Sometimes people combine psychotherapy and medication to obtain greater benefits. If your symptoms have been sustained for a long period of time, there is a prolonged exposure therapy (PE) that veterans can look into.

Animal Assisted Therapy: 

Researchers are accumulating evidence that bonding with dogs has positive biological effects, such as elevated levels of the hormone Oxytocin. Oxytocin improves trust, which in turn promotes the ability to interpret facial expressions, assists in overcoming paranoia and other pro-social effects – the exact opposite of PTSD symptoms. Oxytocin is also known as the “feel good” hormone.  You know this by how you feel when you pet your dog and your dog looks into your eyes.  This is why animal assisted therapy has increased dramatically in recent years.

An in depth article by Miranda Olff, PhD, Willie Langeland, PhD, Anke Witteveen, PhD, and Damiaan Denys, MD, PhD explains in detail how animal assisted therapy and the use of dogs in treating PTSD can see a significant decrease in depression, anxiety and fear while improving social interaction.

Although cognitive-behavioral therapy (CBT) is an effective treatment for post traumatic stress disorder (PTSD), many patients fail to attain remission with CBT.  The authors above propose augmentation of CBT with Oxytocin in the treatment of PTSD. Oxytocin has a combination of Pharmacologic effects that result in a “sense of safety” for the patient, which is a prerequisite to successful treatment of PTSD. They suggest a dual explanatory mechanism as to why Oxytocin may be effective: through a reduction of fear response (decreasing Amygdala activation, inhibiting fear response, and enhancing extinction learning) and through an increase of social interaction (activating social reward-related brain regions increasing engagement in the therapeutic alliance). Given that PTSD is marked by deficits in anxiety/stress regulation and in social functioning, and that Oxytocin is implicated in both of these areas, Oxytocin seems a likely candidate for treatment of patients with PTSD. Further clinical studies of the therapeutic value of Oxytocin are indicated.  Published on 08/15/2010 in CNS Spectrums First in Applied Neuroscience web site, A Psychobiological Rationale for Oxytocin in the Treatment of post traumatic Stress Disorder is a very detailed research article anyone wanting to know more on how Oxytocin and animal assisted therapy work so well together should read.  Here is a link to this article.  Read More 

Psychotherapy for PTSD

Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:

  • Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are different types of CBT such as cognitive therapy and exposure therapy.
  • One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings.
  • Another type is Prolonged Exposure (PE) therapy where you talk about your trauma repeatedly until memories are no longer upsetting. You also go to places that are safe, but that you have been staying away from because they are related to the trauma.
  • A similar kind of therapy is called eye movement desensitization and reprocessing (EMDR). This therapy involves focusing on sounds or hand movements while you talk about the trauma.

Medications for PTSD

Medications can be effective too. A type of drug known as a selective serotonin re-uptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma. Many find that Sertraline helps with anxiety and Trazidone helps with a better night’s sleep. The best advice you can get is from your VA doctor.

IMPORTANT: Benzodiazepines and atypical anti-psychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms.
Source: Department of Veterans Affairs

The following chart shows many of the most common symptoms veterans will experience.

PSD Chart for Persons with PTSD PTSD Symptoms Chart
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The Use of psychiatric Service Dogs in the Treatment of Veterans with PTSD
PRINCIPAL INVESTIGATOR: Craig Love, Ph.D.
REPORT DATE:  2FWREHU 2009
PREPARED FOR:  U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland  21702-5012


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