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Back to Psychiatry Diseases
Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD), formerly and colloquially
called shell shock (this is a World War One term), battle fatigue (World
War II), and operational exhaustion (Korean War), is a term for the
psychological consequences of exposure to stressful, life-threatening
and traumatic experiences. Symptoms include nightmares and flashbacks,
sleep abnormalities, extreme distress resulting from personal
"triggers", and emotional detachment with the possibility of
simultaneous suffering of other psychiatric disorders. Experiences
likely to induce the condition include rape, combat exposure, and
childhood physical abuse. Unlike brief reactive psychosis, PTSD is a
chronic condition.
PTSD is distinguished from normal grief and adjustment with traumatic
events in that the normal emotional effects of traumatic events will
tend to subside after several months or years, while in PTSD the
emotional effects are ongoing. Most people who experience traumatic
events will not have PTSD.
In earlier times and even today, shell shock has been regarded as simple
cowardice, an unwillingness to put one's welfare at risk when danger is
at hand. The modern psychological evaluation disagrees strongly. Shell
shock is a mental condition in which the individual involved is
perilously close to a break from reality, usually by succumbing to any
of several neuroses or psychoses.
PTSD was first recognized in combat veterans following many historical
conflicts; the term "shell shock" dates to World War I. At first, the
medical community believed that shell shock resulted directly from the
stress caused by the noise of repeated shell explosions. The modern
understanding of the condition dates to shortly after the Vietnam War.
PTSD may be experienced following any traumatic experience or series of
experiences that do not allow the victim to readily recuperate from the
detrimental effects of stress. It is believed that of those exposed to
traumatic conditions, around 9% will experience some symptoms. In
peacetime, 30% of those that suffer will go on to develop a chronic
condition; in wartime, the levels of disorder are believed to be
somewhat higher.
PTSD is treated by psychotherapy (cognitive-behavioral therapy, group
therapy, and exposure therapy are popular) and drug therapy (Prozac,
Effexor, Seroquel, and Zoloft). Talk therapy may prove useful, but only
insofar as the individual victim is enabled to come to terms with the
trauma suffered and successfully integrate the experiences in a way that
does not further damage the psyche. PTSD may co-occur with depression.
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Treatment of trauma
Two controversial techniques for the treatment of trauma are EMDR and
TIR:
EMDR (Eye Movement Desensitization and Reprogramming) is a technique
developed by Dr. Francine Shapiro, in which the client supposedly uses
the movement of his or her eyes to access the traumatic event and allow
the integration of emotions and sensations that occurred during the
traumatic event.
TIR (Traumatic Incident Reduction) is a less well known technique for
reducing and eliminating the effects of a traumatic event. TIR is more
of a graduated exposure technique that is controlled by the client. In
TIR the client retells the trauma and releases the emotions held in
check. In addition the client remembers the event and allows the
conscious mind to process any decisions, intentions and cognitive
distortions that might have occurred during or after the trauma.
Practitioners who have been trained in both EMDR and TIR report that TIR
is safer because it is focused on a single event and EMDR can
occasionally trigger several events and multiple emotions. Interviews
with these practitioners have suggested that, while they continue to use
both techniques, TIR is the preferred intervention for known traumatic
events where the client wants insight and understanding about the event
and the aftereffects of the trauma.
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