PTSD: A Growing Epidemic

Years of war in Afghanistan and Iraq have brought post-traumatic stress disorder (PTSD ) among military personnel to the attention of the American people as never before. But PTSD is also found among survivors of natural disasters, victims of crime, and many others who have experienced traumatic events.

Post-traumatic stress disorder (PTSD) may develop after a terrifying ordeal involving physical harm or the threat of physical harm. You don't have to be physically hurt to get PTSD. You can get it after you see others—a friend, a family member, even a stranger—harmed or threatened.

War veterans brought PTSD to public attention. But PTSD can stem from traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes. The majority of people exposed to such events experience some symptoms of distress (sleep problems, jumpiness). Most fully recover in a few weeks or months. PTSD is currently the subject of many research studies that are funded by the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH).

People with PTSD may become emotionally numb, especially in relation to people with whom they used to be close. They may lose interest in things they used to enjoy. They may startle easily or be irritable, become aggressive, and may have trouble falling asleep and staying asleep. They avoid situations that remind them of the original incident, and often find anniversaries of the incident to be very difficult.

PTSD symptoms seem to be worse if they were triggered deliberately by another person, as in a mugging or rape. Most PTSD sufferers repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings. They are often triggered by ordinary occurrences, such as a door slamming, a car backfiring, or being in a place that looks like where the trauma took place. A person having a flashback is likely to feel the emotions and physical feelings that occurred when the incident happened despite no longer being in danger.

Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within three months of the incident, but occasionally may only emerge years later. They must last more than a month to be considered PTSD. The condition varies from person to person. Some people recover within months, while others have symptoms for much longer. In some people, the condition becomes chronic.

PTSD and the Military

Today, hundreds of thousands of service men and women and recent military veterans have seen combat. Many have been shot at, seen their buddies killed, or witnessed death up close. These are types of events that can lead to PTSD.

The U.S. Department of Veterans Affairs estimates that PTSD afflicts:

• Almost 31 percent of Vietnam veterans
• As many as 10 percent of Gulf War (Desert Storm) veterans
• 11 percent of veterans of the war in Afghanistan
• 20 percent of Iraqi war veterans

Neuroscience and PTSD Treatments

Dr. Barbara Rothbaum believes current research is leading to better treatment of PTSD and may one day help to prevent it. Rothbaum is Professor in Psychiatry and Director of the Trauma and Anxiety Recovery Program at the Emory University School of Medicine. She notes that the Institute of Medicine recently reported that only exposure treatment, a type of therapy in which PTSD patients confront their traumatic memories through talking, has sufficient evidence to recommend it.

With funding from NIMH, she is studying how D-cycloserine, an antibiotic, affects how Iraq war veterans experience fear. "We know how fear is turned on and off, where in the brain it occurs, and what drugs facilitate or inhibit it," she says. "D-cycloserine has been shown to reduce fear and make exposure therapy go faster."

Also with NIMH support, Dr. Rothbaum is beginning to look at ways to change traumatic memories before they are consolidated in the brain, and perhaps prevent PTSD altogether. Her new study will focus on intervening to help rape victims in the emergency room.

"I do think there are things we can do in the immediate aftermath of a trauma that can help," she says.