Imagine seeing a fellow soldier killed by a roadside bomb.  Or searching through the rubble of the World Trade Center for survivors.  Or being sexually assaulted.  You’re probably even trying to push those images out of your head as you read this.  Some people find it impossible to stop thinking about traumatic experiences.  They may have recurring nightmares.  Fear and anxiety could begin to interfere with every aspect of life.

It was called Soldier’s Heart in the Civil War.  Since then, it’s gone by such names as Shell Shock, Battle Fatigue and Post-Vietnam Syndrome.  Now we call it post-traumatic stress disorder, PTSD.  And we know that it affects people other than those who’ve been to war.

Anyone who’s been through an experience that involved physical harm or the threat of it can develop PTSD.  Causes include mugging, rape, torture, child abuse, car accidents and natural disasters. 

After a trauma, you may startle easily and be constantly on guard.  You might become emotionally numb or lose interest in things you used to enjoy.  You may have trouble feeling affectionate.  You could become irritable, aggressive or even violent.  It’s common to avoid situations that remind you of the incident and to have trouble sleeping. 

These normal responses to horrific events usually become better over time.  Most people don’t forget what has happened to them, but they can eventually put the incident in the back of their minds.  They carry on with their day-to-day lives and don’t go on to develop PTSD.

For some people, however, the symptoms don’t fade away.  Their anxieties become so overwhelming that they are no longer able to focus on their daily lives.

“Not all traumatic responses are PTSD,” says Dr. Meena Vythilingam of the Mood and Anxiety Disorders Program at NIH’s National Institute of Mental Health (NIMH).  “It becomes PTSD in a small subgroup, when these symptoms persist over a month, cause extreme distress or interfere with the ability to function at work, school or home.”

People with PTSD can’t stop thinking about the traumatic experience during the day and have nightmares about it when they sleep.  Some people actually relive the event by vividly re-experiencing the sounds, smells or feelings of the original trauma.  These are called flashbacks.

Memories, thoughts, feelings or even flashbacks of a trauma can be triggered by ordinary things, such as a door slamming or a car backfiring on the street.  To avoid being reminded of the trauma, people with PTSD might refuse to talk about it and stop going places that remind them of it.

PTSD is considered a chronic anxiety disorder.  It affects both men and women.  Men are more likely to be exposed to traumatic events, and about 5-6% of them develop PTSD.  Women are more likely to develop PTSD after being exposed to a traumatic event, however, with 8-14% developing PTSD.  The chance of developing PTSD is highest after sexual trauma.

“PTSD is a brain disorder.  It is not caused by a moral weakness or a character flaw,” Vythilingam explains.  “There are well-documented changes in the function and structure of the brain regions mediating fear and memory in PTSD.”

If you don’t get treatment, PTSD can persist for years.  In fact, it never fades for about 30% of those who aren’t treated.  PTSD goes hand in hand with depression.  People with PTSD also often abuse drugs and alcohol.

Vythilingam says that there is no one treatment for PTSD.  Studies have found that both medications and psychotherapy (talk therapy), during which a therapist helps you to face your fears, can be effective. 

New strategies for developing better PTSD treatments will come from a better understanding of the chemical and structural changes in the brain that are associated with PTSD.  Currently, NIMH is funding several brain imaging studies to gain insight into the changes that take place in the brain during PTSD.

NIMH is also now recruiting for volunteers to participate in a clinical trial to test a potential new medication for PTSD.  Called an NK1 antagonist, the drug is designed to block the activity of substance P, a pain-related chemical that is produced by the central nervous system during times of anxiety.  Vietnam veterans with PTSD, for example, produce higher levels of substance P when they view scenes related to combat.  Substance P works in the brain through a receptor called NK1.  Researchers consider this interaction a prime target for PTSD treatment.

In the pilot study, researchers will test this experimental drug in a small group of people.  If the compound proves promising, it will then be tested in larger groups.  The trial is taking place at NIH’s Clinical Center in Bethesda, MD and at Mount Sinai Medical Center in New York City.  If you’re interested in participating, go to www.clinicaltrials.gov/ct/show/NCT00383786?order=2 or call 866-627-6464 (TTY: 1-866-411-1010).  You can find information about other clinical trials at http://patientinfo.nimh.nih.gov/.

The important thing to remember about PTSD is that if you suspect you or someone you know has it, don’t hesitate to seek help.  Vythilingam says, “You should not feel you should have to walk alone after a traumatic event.”