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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
As Dr. Mark Goulston tells his patients who suffer from post-traumatic stress disorder (PTSD), "The fact that you're still afraid doesn't mean you're in any danger. It just takes the will and the way for your heart and soul to accept what the logical part of your mind already knows." In Post-Traumatic Stress Disorder For Dummies, Dr. Goulston helps you find the will and shows you the way. A traumatic event can turn your world upside down, but there is a path out of PTSD. This reassuring guide presents the latest on effective treatments that help you combat fear, stop stress in its tracks, and bring joy back into your life. You'll learn how to: * Identify PTSD symptoms and get a diagnosis * Understand PTSD and the nature of trauma * Develop a PTSD treatment plan * Choose the ideal therapist for you * Decide whether cognitive behavior therapy is right for you * Weight the pros and cons of PTSD medications * Cope with flashbacks, nightmares, and disruptive thoughts * Maximize your healing * Manage your recovery, both during and after treatment * Help a partner, child or other loved one triumph over PTSD * Know when you're getting better * Get your life back on track Whether you're a trauma survivor with PTSD or the caregiver of a PTSD sufferer, Post-Traumatic Stress Disorder For Dummies, gives you the tools you need to win the battle against this disabling condition.
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Veröffentlichungsjahr: 2011
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Post-Traumatic Stress Disorder For Dummies
by Mark Goulston, MD
Post-Traumatic Stress Disorder For Dummies®
Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com
Copyright © 2008 by Wiley Publishing, Inc., Indianapolis, Indiana
Published simultaneously in Canada
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Library of Congress Control Number: 2007936459
ISBN: 978-0-470-04922-8
Manufactured in the United States of America
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About the Author
Mark Goulston, MD, received his medical degree from Boston University, completed his psychiatry training at the UCLA Neuropsychiatric Institute, and is a Fellow of the American Psychiatric Association.
He has been a UCLA Assistant Clinical Professor of Psychiatry for more than 20 years, and in 2004–05, he was selected as one of America’s Top Psychiatrists by the Washington, D.C.–based Consumers’ Research Council. He is the co-author of Get Out of Your Own Way: Overcoming Self-Defeating Behavior (Perigee, 1996) and The 6 Secrets of a Lasting Relationship: How to Fall in Love Again . . . and Stay There (Perigee, 2002). He’s also the author of Get Out of Your Own Way at Work . . . and Help Others Do the Same (Perigee, 2006).
Dr. Goulston has written the nationally syndicated Knight Ridder/Tribune college newspaper column “Relationships 101” and regular columns for EMMY Magazine and Fast Company. In addition, he served as the Parenting Coach and Couples Coach at Time Warner’s ParentTime site and iVillage and was the lead life-skills coach at LifeScape. He has taught or lectured at UCLA, USC, and Pepperdine University. Dr. Goulston has also served on the boards of Free Arts for Abused Children and the American Foundation of Suicide Prevention.
Because of his special interest in suicide prevention and teenage violence, Dr. Goulston has trained FBI and police hostage negotiators and has been frequently called upon to address these and other issues on CNN, ABC, NBC, CBS, Fox, and BBC news programs and in the print media, including the New York Times,Los Angeles Times, Newsweek,Time magazine, Wall Street Journal,Harvard Business Review, and USA Today.
For more information, please visit his Web site at www.markgoulston.com.
Dedication
To the soldiers, firefighters, and police officers and their families who have sacrificed so much to create peace on Earth, that this book may help them regain peace of mind.
Author’s Acknowledgments
I am fortunate to have been taught, influenced, and inspired by some of the brightest and most caring individuals in the field of mental health, including Drs. Wilfred Bion, Herbert Linden, Lars Lofgren, Karl Menninger, Robert Pynoos, Robert Stoller, Louis Jolyon West, Carl Whitaker, and Peter Whybrow. Their collective wisdom serves as the magnetic north on my compass, and I feel blessed that I could turn to them in person and later on in memory to guide me in trying to ease the suffering of the thousands of people I have seen in my career.
I am especially grateful to Dr. Edwin Shneidman, one of the pioneers in the study of suicide and founder of the American Association of Suicidology. From this teacher, mentor, and now dear friend, I learned more about bringing hope to the hopeless than from any other individual.
On a different note, I am eternally grateful to the late Dr. William MacNary, who as Dean of Students at Boston University School of Medicine safely shepherded me during my medical school training through one of the most difficult and traumatic times in my professional life. My subsequent career and dedication to helping those in difficulty have been an effort to pass on to my patients the kindness that Dean MacNary showed me when I most needed it.
With regard to this book, I am thankful for the enthusiastic support of my agents Bill Gladstone and Ming Russell of Waterside Productions, the steadfast input of my acquisitions editor Tracy Boggier and my project editor Kristin DeMint at Wiley, the polishing done by copy editor Danielle Voirol, and deft assistance with this manuscript by Alison Blake.
I also appreciate the patience and support (and tolerance, especially during those tight deadlines) of my wife, Lisa; my three children, Lauren, Emily, and Billy; and my business partners, Keith Ferrazzi and Peter Winick at the consulting company Ferrazzi Greenlight, through which I do much of my consulting and coaching work.
Finally, I am indebted to the individuals, families, and couples who have entrusted me with the hurt and horror from their lives and in doing so enabled me to help them walk out of the darkness and into the light.
Publisher’s Acknowledgments
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Acquisitions, Editorial, and Media Development
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Contents
Title
Introduction
About This Book
Conventions Used in This Book
What You’re Not to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : The Basics of PTSD
Chapter 1: The Invisible Epidemic of PTSD
The Diagnosis of PTSD: A Serious Matter That Requires Serious Intervention
A Little Background on PTSD
Stats on PTSD: The Numbers Game
Trauma Triggers: The Most Common Causes of PTSD
Adding It Up: The Costs of Untreated PTSD
Chapter 2: Aftershocks: When the Past Won’t Stay in the Past
Looking Closely at Trauma
Understanding the Three Levels of Reactions to Trauma
Considering Factors That Influence a Person’s Response to Trauma
The Role That Triggers Play
Chapter 3: Spotting the Clues: Signs and Symptoms of PTSD
The Traumatized Person’s Reality: Three Core Symptoms
The Result of Long-Term Trauma: Symptoms of Complex PTSD
Body Language: Aches and Pains That May Accompany PTSD
Psychological Disorders That Sometimes Hitch a Ride with PTSD
A Whole Different Ballgame: PTSD Symptoms in Children and Teens
Chapter 4: First Response: Preventive Treatments for PTSD
Immediate Treatments Intended to Reduce PTSD Risk
A Good Track Record for the First Few Weeks: Early CBT
Self-Help Strategies: Simple, Safe, and Often Successful
Part II : Getting a Diagnosis and Drafting a Plan
Chapter 5: Getting Answers: Finding Out Whether You Have PTSD
A Quick Quiz: Identifying Your Symptoms
A Reality Check: Assessing the Severity of Your Symptoms
Facing Your Fears: Seeking Professional Help
Preparing for Your Visit to the Doctor: What to Do, What to Bring
Getting a Diagnosis: What Your Doctor Will Do
Taking the Next Step: What to Do If Your Doctor Says You Have PTSD
Chapter 6: Building Your Treatment Team
Taking the Whole-Person Approach
Considering Your Options
Finding a Therapist
Making Sure You Meet Your Match
Working with Your Therapist
Chapter 7: Setting the Stage for Recovery: The First Steps toward Healing
Making Sure You’re Safe
Ditching the Negative Nellies Who Can Sabotage Recovery
Facing Substance Abuse Issues
Addressing Any Coexisting Mental Disorders
A Few Final Details: Getting Your Ducks in a Row
Getting Acquainted with Your Therapist
Part III : Choosing the Right Treatment Approach
Chapter 8: Putting PTSD in Its Place with Cognitive Behavioral Therapy (CBT)
Understanding What CBT Is All About
Figuring Out Whether CBT Is a Good Match for You
The ABCs of CBT
Variations on a Theme: Offshoots of CBT
Chapter 9: The Role of Medication in Treating PTSD
Why Pop a Pill for PTSD?
Accounting for Both Sides of the Scale
Knowing How PTSD Drugs Work
Surveying Medications Used to Treat PTSD Symptoms
Speak Up! Asking Questions before You Take a Medication
Taking Meds Wisely
Chapter 10: Additional Paths to Wellness: Drawing on the Power of Mind and Body
Seeing Your Trauma through New Eyes: Psychological Approaches
Enlisting Your Body to Help Heal Your Mind
Considering Supplementary Therapies: What’s Best for You?
Part IV : Healing and Rebuilding during and after Treatment
Chapter 11: The Journey Back: What to Expect
Recovery in a Nutshell: What Will and Won’t Change
Outlining the Process: Stages of Healing
The Therapy Timeframe
The Ups and Downs of Therapy
Setting a New Course If a Therapist Isn’t Working Out
Graduation Day: Saying Goodbye When You Achieve Your Therapy Goals
Bracing Yourself for Relapses While Peacefully Moving Along
Chapter 12: Helping Yourself Heal Your Body, Mind, and Soul
Regaining Your Physical Health and Strength
Simplifying and Organizing Your Life
Rediscovering Physical Intimacy and Sexuality
Enjoying Life’s Pleasures
Following Through on Your Wellness Plans
Chapter 13: Caring for Your Loved Ones While They Care for You
Stepping Outside Your World: Common Feelings Your Loved Ones Face
Seeing How Secondhand Stress Plays Out in Adults
Helping Your Loved Ones Help You
Seeking Outside Help through Family Therapy
Little People, Big Hurt: How PTSD Affects Your Children
Chapter 14: Getting Your Life Back on Track
Taking Stock of Your Life As You Enter the Future
Healing Relationships That PTSD Frayed
Thinking about Work and Finances
Recognizing the Positive Effects of Your Experience
Part V : Stepping In: When You’re Not the One Who’s Suffering
Chapter 15: Getting Help for a Child with PTSD
Recognizing the Nuances: Normal Childhood Behavior versus PTSD
Deciding Whether to Consult a Pediatrician
Enlisting the Help of a Doctor: The Order of Events
Knowing Why and How Treating Children Differs from Treating Adults
Understanding Common Treatments for Children and Teens with PTSD
Seeking Out a Therapist and Starting Therapy
Helping Your Child Heal outside the Therapist’s Office
Getting School, Family, and Friends in the Treatment Loop
Chapter 16: Supporting a Loved One with PTSD
The Biggest Struggle: Coping Strategies for Caregivers
Special Guidance for Partners of People with PTSD
Special Guidance for Parents of Adults with PTSD
When the Sufferer Is Your Friend or a Member of Your Extended Family
Part VI : The Part of Tens
Chapter 17: The Ten Most Common Myths about PTSD
PTSD Isn’t Real
Only Soldiers Get PTSD
People with PTSD Are Weak
Time Heals All Wounds
Therapy Will Dissolve All Your Troubles
Blocking Traumatic Memories Is Easier than Facing Them
It Can’t Be PTSD — It’s Been Too Long
PTSD Causes Violence
You Deserve to Feel Bad for Making Mistakes When Your Trauma Happened
You Don’t Have the Time or Money for Therapy
Chapter 18: Ten Ways to Recognize that You’re Getting Better
You Avoid a Blowup or Meltdown
You Become an Optimist
You Turn “I Can’t” into “I Can”
You Widen Your Circle of Friends
You Feel Another Person’s Pain or Joy
You Say, “I Like You” — to Yourself
You Take a Leap of Faith
You Enjoy Skipping Down Memory Lane
You Wake Up with the Sun
You Get Back into the Swing of Things
Appendix: PTSD Resources
Emergency Phone Numbers
Web Sites
Self-Help Reading Material
Books for Children and Teens
Documentaries on PTSD in Veterans
: Further Reading
Introduction
Life is an unpredictable adventure, and it can slip you some pretty big shocks now and then. Often these jolts are exciting, and although they may rattle you briefly, they make for great stories and add richness to your life. But sometimes events can pull the rug out from under you, leaving you feeling shocked, terrified, unsheltered, and alone. These experiences can shake you to your core, altering your feelings about yourself, other people, and the world around you. Consider these people’s words:
A combat survivor says, “The old me died in that war. I don’t recognize the person I am now.”
A woman who survived a rape says, “People say I’m cold and unfeeling now. They don’t know that inside, I’m falling apart.”
A heart attack survivor says, “I feel so lost. It’s like I see my old life in the distance, but I can’t find my way back to it.”
All these people have post-traumatic stress disorder (PTSD). They’re scared, angry, and sad — and they have every reason to be. A traumatic life event turned their lives upside down, transforming their once safe and happy world into a terrifying and alien place they fear they’ll never escape.
The most important message of this book is this: There is a road out of this terrible place. The fact that you’re still afraid doesn’t mean you’re in any danger. It just takes the will and the way for your heart and soul to accept what the logical part of your mind already knows.I’ve been treating patients with PTSD for more than two decades, and the vast majority of them make the journey back to wellness. Often, it’s not an easy journey — or a short one. But there is help, there is hope, and there is a better future ahead. In short, there’s life after PTSD — and a good one, I might add. In this book, I explain how to set your course for that brighter future.
About This Book
I have piles of academic books on PTSD, but they’re pretty dry reading. My goal in this book is to cut through all those fancy words and give you the basic facts you really need about what PTSD is and how you can overcome it. I also lighten these pages with a few jokes because I figure you have a sense of humor and can use a good laugh — even though you and I both know that PTSD is a very serious matter.
If you’re a trauma survivor with PTSD, this book clearly lays out the steps you can take to reclaim your life and your future. In addition to giving you info about a wide range of therapy approaches, I offer advice on self-help steps that can aid in taming your PTSD symptoms.
If you’re caring for a person fighting PTSD, you can find the tools you need to play an active part in your loved one’s recovery. Because partners and parents play an especially powerful role in helping a person heal from PTSD, I cover the roles of these very important people in depth. In addition, I offer helpful advice for extended family members and friends.
Whether you’re battling PTSD yourself or caring for someone who’s facing this challenge, you can begin these pages with a sense of hope — because the fight against PTSD is a battle you can win.
Conventions Used in This Book
If you have PTSD (or are struggling to cope along with someone who does) you’re probably feeling more than a little frazzled. To make the process of gathering information as simple as possible for you, I use the following tools throughout the book to help you navigate through the text quickly and easily.
When I introduce a new term, I put it in italics to highlight it — and if it’s medical jargon (which I avoid as much as possible), I offer a plain-English explanation.
I use boldface to set off important keywords and numbered steps.
I use monofont to indicate useful Web sites. If a Web address breaks across two lines of text, I don’t add an extra hyphen or any spaces, so just type exactly what you see.
What You’re Not to Read
I hope you find every part of this book valuable — but don’t feel like you need to read every word. Instead, pick and choose the material that suits your needs.
For instance, if you’re not into the scientific nitty-gritty about PTSD, you can skip any text marked with the Technical Stuff icon. You can also pass over the sidebars if you’re pressed for time — but consider giving these gray boxes a quick glance because they contain lots of useful advice and inspiring stories about others who’ve walked the path that you or your loved one is on. And of course, feel free to ignore sections that don’t have anything to do with your life; for instance, skip the chapter on PTSD in children if you’re interested only in adult PTSD.
Foolish Assumptions
In writing this book, I kept a clear picture of you, the reader, in mind. Therefore, I had to assume a few things about you and your needs:
You’re relatively new to PTSD. Maybe you’re newly diagnosed or wondering whether you have the disorder — or maybe you’re a relative or friend who’s hoping to help a person who’s struggling with PTSD.
If you have PTSD, you want to know all your options so you can have an active say in your treatment plan.
You’re willing to face your problem head-on and seek help if you do have PTSD.
You want to know that there’s real help for the pain you’re suffering. (And yes — there is!)
How This Book Is Organized
Post-Traumatic Stress Disorder For Dummies is organized into six parts and 18 chapters. Here’s a quick look at each part.
Part I: The Basics of PTSD
In Chapter 1, you find a quick overview of the history of PTSD, the major causes of this disorder, and the numbers of people it affects. Chapter 2 gives you the lowdown on what trauma is and describes the factors that can put you at extra risk for developing PTSD. Next, in Chapter 3, I describe the key symptoms of PTSD and talk about other disorders — such as depression and substance abuse problems — that often complicate the PTSD picture. In addition, I describe the very different symptoms that kids with PTSD can show.
Chapter 4 tackles a very different topic: what experts know (and don’t know) about preventing PTSD. In this chapter, I talk about what does and doesn’t help when you’re trying to stop PTSD before it starts. I also offer info about new drug treatments that show promise in short-circuiting the brain changes that can trigger PTSD symptoms.
Part II: Getting a Diagnosis and Drafting a Plan
Maybe you’re wondering whether you have PTSD — or maybe you already have a diagnosis but you’re not sure where to go from here. Either way, you can find answers to your questions in this part.
In Chapter 5, I offer a self-test to help you determine whether your symptoms point to PTSD, and I provide advice on getting a diagnosis if they do. Chapter 6 describes how and where to locate good therapists and tells you the questions you should ask before deciding whether a particular therapist is right for you. And Chapter 7 talks about the steps you can take before therapy to make sure you get optimal results when you start treatment.
Part III: Choosing the Right Treatment Approach
Today’s treatments are highly effective in reducing the pain of PTSD, but a treatment that works like a charm for one person can miss the mark with another. When you know the range of treatments available for PTSD, you can choose the approach that works best for you.
In this part, I describe a wide variety of approaches to treating PTSD. Chapter 8 talks about cognitive behavioral therapy (CBT), the most widely used therapy for PTSD. Chapter 9 describes the drug treatments that sometimes play an important role in recovery, and Chapter 10 describes a host of additional therapies and offers some stats on how helpful they are.
Part IV: Healing and Rebuilding during and after Treatment
The most important person on your recovery team is you — and in this part, I describe the steps you can take to keep your progress on track. First, I talk about what you can expect from therapy and how to maximize your results. Next, I offer a cornucopia of ways to enhance your mental and physical health, stop stress in its tracks, erase the hidden agendas that hold you back, and enjoy life’s pleasures (including intimacy and sexuality) again. I also talk about how to get back into the stream of life — jobs, friendships, life goals — when you get PTSD under control.
However, you’re not the only important person involved in your recovery. That’s why I also talk about the ways in which PTSD strains family ties — and the steps you can take to make those bonds strong again.
Part V: Stepping In: When You’re Not the One Who’s Suffering
Maybe you’re reading this book because you’re worried about a child who’s showing signs of PTSD. If so, you can find a wealth of information in Chapter 15 about the treatments you can call on to help your child heal. You can also get tips on making family and friends a part of your child’s recovery plan.
On the other hand, you may be reading this book because you’re a good friend of a person with PTSD and you want to find ways to help. If so, check out Chapter 16 for practical advice about the do’s and don’ts of supporting someone who’s struggling to break free from PTSD’s grip.
Part VI: The Part of Tens
Knowing the facts about PTSD can help you dispel false ideas that can get in the way of healing. That’s why Chapter 17 outlines the ten most common myths about PTSD and gives you the true story about each one. In Chapter 18, I clue you in on some of the subtle and not-so-subtle signs of healing that you can anticipate as time goes by.
Following the Part of Tens, you can find a helpful appendix listing Web sites, books, documentaries, and other resources that can help you turn the tide against PTSD.
Icons Used in This Book
One handy device that For Dummies books use is the icon — a symbol in the margin that lets you quickly spot the types of information that interest you. In this book, I use the following icons:
This icon highlights an important bit of information that you won’t want to forget.
The Tip icon marks practical advice that can be part of your action plan for defeating PTSD.
The Warning icon alerts you to be careful about a possible hazard or to seek professional help in handling a particular problem.
This icon lets you know that a piece of information is interesting but not necessary to read if you’re pressed for time and want to zero in on the facts you need to jump-start your healing from PTSD.
This icon points you to inspiring, enlightening, or just plain interesting stories about real patients — mine and other doctors’ — and the insights these survivors have to offer. Where I include stories about patients of mine, know that these people are real. However, I’ve changed their names and other identifying details to make sure I protect their privacy.
Where to Go from Here
Depending on who you are — a person with PTSD, friend, or family member — some parts of this book will be more important to you than others. That’s why you don’t need to start on page 1 and read straight through. Instead, you can use the Table of Contents or index to find the topics that interest you the most. For example, if the facts and figures about PTSD don’t interest you, feel free to cut to the chase and start with Part II, where you can find info on effective treatments.
As you read this book, feel free to skip from section to section and read it in any order. I do recommend reading Chapters 2 and 3 if you’re seeking a basic understanding of what PTSD is. And I suggest reading Part II for information on treatments if you’re saying, “I’m ready to get better — how do I start?” If you’re helping a child who has PTSD, or pitching in to aid a PTSD-affected friend in need, Part V is an excellent place to dive in.
Wherever you start, you’re making an excellent move — because the advice and strategies in this book can help you take back control of your life (or effectively support someone you love in doing so) and make your future a better and brighter one. I wish you the very best of luck in achieving that goal!
Part I
The Basics of PTSD
In this part . . .
H aving some basic facts under your belt can be a big help if you’re tackling PTSD. In this section, I look at the history of this disorder, the number of people it affects, and the big reasons getting help for PTSD is so important. Next, I talk about what doctors mean by stress and trauma and why some people are more vulnerable than others to PTSD. After that, I go through the signs and symptoms of PTSD, talk about other disorders that often are part of the package, and discuss why PTSD in kids and teens is different from the adult version. Finally, I talk about preventive treatments for PTSD and explain their benefits and limitations — and why you may still have PTSD even if you received one of those treatments.
Chapter 1
The Invisible Epidemic of PTSD
In This Chapter
Diagnosing PTSD
Tracing the history of PTSD
Counting the number of people PTSD affects
Recognizing the most common causes of PTSD
Adding up PTSD’s cost to society
You jump out of your skin if you hear a police siren or a car backfiring. You wake up screaming after terrible nightmares. You feel cut off from your life and the people around you, and you’re angry or sad all the time. Worst of all, you experience moments of sheer terror when your mind pulls you out of the present and drags you into a horrifying time in your past.
If you suffer from symptoms like these, you probably feel very much alone — but in reality, you aren’t. Instead, you’re likely one of millions of people around the world who suffer from a disorder called post-traumatic stress disorder (PTSD).
If so, you’re facing a problem as old as humankind. The difference between the past and now, as you discover in this book, is that for today’s PTSD sufferers, effective help for this pain is available. In the chapters that follow, I talk about the many ways to treat PTSD and explain why you can be very optimistic about your future.
As you begin your journey into a better tomorrow, it’s a good idea to gain a little knowledge about the adversary you’re facing. In this chapter, I take a quick look at what PTSD is, as well as why treating this disorder is crucial. I also offer an overview of the history of PTSD as a diagnosis and explain how people’s understanding of this disorder has evolved over time. Next, I talk about the numbers of people (both adults and children) affected by PTSD, as well as the many types of traumatic experiences that can set PTSD in motion. In addition, I look at the toll PTSD takes not just on each individual sufferer but also on society as a whole.
The Diagnosis of PTSD: A Serious Matter That Requires Serious Intervention
PTSD is a major, life-altering disorder that strikes many people who survive traumatic experiences. I use the phrase invisible epidemic to describe this disorder because it affects millions of people of every age and in every walk of life, and many of them suffer alone and in silence. They feel scared, anxious, and isolated from the rest of the world — and they feel like no one can understand what they’re going through.
To a casual observer, these people often seem to be doing just fine. But in reality, they’re battling devastating symptoms that, if left untreated, make it difficult or impossible for them to hold down jobs, have meaningful relationships, or achieve their goals and dreams.
PTSD short-circuits people’s lives by causing disabling symptoms that include a hyper-alert nervous system, numbness and detachment, and intrusive thoughts or flashbacks about the trauma (see Chapter 3 for an in-depth discussion of these problems). Living with these symptoms is a huge challenge, made even bigger by the fact that other problems such as depression or substance abuse often come along for the ride (another topic I cover in Chapter 3). People with complex PTSD, which stems from multiple traumas, may develop an even wider range of severe problems, including dangerous and self-destructive behaviors (see Chapter 2).
Getting treatment if you have PTSD is crucial because this disorder doesn’t simply go away on its own. Unlike the normal, temporary stress symptoms that often occur after a life crisis, PTSD involves profound biochemical and psychological changes that cause the toxic memories of a trauma to remain strong instead of fading. (See Chapter 2 for more on the differences between normal stress responses and PTSD.) As a result, people with PTSD become trapped in their trauma, unable to process what happened and move on with their lives. In addition, untreated PTSD often leads to secondary wounding (a topic I cover in Chapter 8) because the problems caused by PTSD can lead to broken relationships, lost jobs, and other new traumas.
The good news — and it’s very good news indeed — is that PTSD is highly treatable, and the vast majority of people with this disorder gain freedom from the disabling symptoms and get control of their lives again. In Chapters 8 through 10, I describe the wide range of treatments doctors and therapists now have to help adults with this disorder, and in Chapter 13, I look at interventions that can benefit children and teens. In addition, as I explain in Chapter 12, you can combine therapy with self-help steps that boost your healing power. So take heart: If you’re in the depths of PTSD right now, the solutions are within your reach.
A Little Background on PTSD
PTSD is an age-old problem, but in a sense, it’s also a new disorder because professionals are still learning about its causes, symptoms, and treatment.
As I explain in Chapter 2, PTSD can stem from any type of traumatic experience. However, much of the current knowledge about PTSD comes from one particular source — the military — for an obvious reason: War causes trauma on a massive scale. Throughout history, each successive war led to new names for the condition and new theories about its causes:
During the American Civil War, doctors called combat-related trauma soldier’s heart. (The name wasn’t far off the mark because — as I discuss in Chapter 3 — PTSD can affect your heart as well as your thoughts, emotions, and behavior.)
World War I doctors called it shell shock, thinking that it stemmed from changes in air pressure when artillery shells exploded.
During World War II, doctors renamed combat trauma battle fatigue and made the terrible error (also made by many earlier generals) of blaming it on weakness or cowardice.
By the beginning of the Korean War, psychiatrists began to recognize PTSD — then dubbed gross stress reaction — as a real disorder crying out for study.
PTSD made its way into the medical world as a legitimate disorder by finding a place in the Diagnostic and Statistical Manual of Mental Disorders, or DSM (the bible of modern American psychiatry) in 1980, following the Vietnam War. By this point, doctors recognized that civilians as well as soldiers could develop PTSD after a trauma. Even so, people who developed PTSD still found little sympathy, and the cruel myth that PTSD was a sign of weakness persisted. That myth finally died out (although not totally, as I explain in Chapter 17) toward the end of the 1900s, largely because soldiers from the Vietnam era and the first Gulf War fought hard to get the military — and the rest of the world — to take PTSD seriously.
Everyone dealing with PTSD, on either a personal or a professional basis, owes a big debt of gratitude to those wounded warriors who refused to sweep PTSD under the rug. Their persistence gave PTSD research a huge boost, and that research in turn opened doctors’ eyes to the fact that millions of people — not just soldiers but also people who survived sexual assaults, natural disasters, illnesses, and other traumatic events — have a real medical problem and need real medical help.
As a result, people who suffer from PTSD today are likely to get an accurate diagnosis and effective treatment instead of a cold shoulder and a brusque recommendation to “just get over it.” (To increase your odds of success in diagnosis and treatment, see my advice in Chapters 5 and 6 on finding good professional help.) Better yet, treatments for PTSD grow more effective with each passing year. In fact, current research (see Chapter 4) hints that someday, doctors may be able to stop many cases of PTSD before they start.
Professionals still have far to go in fully understanding PTSD, but they’re light years ahead of where they were just a few decades ago — thanks largely to generations of vets who finally won their battle against ignorance and stigma.
The story behind PTSD: A problem as old as humanity
As I explain in Chapter 2, PTSD has a lot to do with biochemistry — that is, the chemicals that make your body tick. Because your ancestors had almost exactly the same biochemistry as you, it’s no surprise that PTSD made its first appearance around the dawn of human history. In fact, the first person to describe it was an Egyptian doctor in 1900 BCE. But doctors didn’t immediately figure out what causes PTSD. In fact, they came up with some pretty bizarre theories about it.
The oddest of these theories arose in the 1800s, when doctors studied people hurt in train wrecks (common events in those days). In addition to their physical injuries, many of these people reported having insomnia, nightmares, memory loss, and extreme fear of train travel — no doubt symptoms of PTSD stemming from the terrifying experiences they survived. The cause of these symptoms, the doctors said, was the incredibly fast speed of the newfangled trains of the era — which went about 30 miles an hour!
By the late 1800s, leading lights in psychiatry, including Sigmund Freud, began spotting the link between trauma and PTSD-like symptoms. Unfortunately, Freud set progress back again by changing his mind and deciding that these symptoms stemmed, at least in women, from sexual fantasies rather than real traumas. (For a genius, he could be pretty dim sometimes.) It took two World Wars, and several smaller ones, for experts to gain a true understanding of how PTSD affects people traumatized by war or other catastrophic events.
Stats on PTSD: The Numbers Game
It’s easy to tell whether the man next to you in the checkout line has a head cold (all too easy, in fact!) or whether the neighbor you pass on the street has a broken leg. But PTSD is a silent problem whose sufferers usually hide in plain sight. Millions of people with PTSD don’t even know that they have the disorder, and millions more keep their pain to themselves because they’re afraid (for reasons I explain in Chapter 5) to seek help.
As a result, knowing the true scope of this tragedy is impossible. However, even the numbers that experts do know reveal a huge cost in human pain. According to the U.S. government’s National Technical Information Service (www.ntis.gov), PTSD is “one of the most prevalent of all mental disorders, surpassed only by substance use disorders and depression as major public and mental health issues.” Here’s a quick look at the numbers of adults and children this disorder affects.
PTSD in adults
Once upon a time, experts thought that PTSD affected only soldiers. Now, however, it’s clear that anyone — librarians, cab drivers, teachers, dentists — can fall prey to this life-altering disorder. All it takes to trigger PTSD is a trauma, and unfortunately, there are plenty of those to go around.
In fact, more than 70 percent of Americans suffer a traumatic event at some time in their lives. Of these trauma survivors, up to 20 percent develop PTSD. Put another way, approximately 13 million Americans — 5 percent of the population — suffers from PTSD at any given time.
Women develop PTSD at twice the rate of men, for reasons I talk about in Chapter 2. Studies suggest that rates of PTSD also are higher for people who are Hispanic or African American, possibly because people in these groups have a higher exposure to violence. For similar reasons, rates of PTSD are sky-high in refugees from countries torn by violence. For example, according to a 2005 study by Grant Marshall and colleagues in the Journal of the American Medical Association, more than 60 percent of a group of Cambodian refugees who resettled in the United States two decades ago exhibited PTSD symptoms.
PTSD in children and teens
No matter how hard they try, parents can’t always shield their kids from trauma. Fires and earthquakes shatter the worlds of children as well as grownups, and so do car accidents, disease, and acts of terrorism. As a result, millions of kids and teens have a PTSD diagnosis, and millions more have undiagnosed PTSD symptoms. (See Chapter 3 for more on kids and PTSD.) Here are some statistics on the toll PTSD takes on youngsters:
Of all children, 14 to 43 percent experience at least one traumatic event.
Of these children, 3 to 15 percent of girls and 1 to 6 percent of boys exhibit PTSD.
Of children who witness a school shooting, 75 percent develop PTSD.
Among sexually abused kids, 60 percent develop PTSD, and so do more than 40 percent of physically abused kids.
Those numbers are hefty but don’t tell the whole story because many children show few or no signs of PTSD after a trauma until years later, when they reach adulthood and grownup pressures cause symptoms to kick in. (For more on this condition, called delayed PTSD, see Chapter 2.)
Trauma Triggers: The Most Common Causes of PTSD
PTSD, as I explain in Chapter 2, stems from an experience that horrifies and overwhelms you. That experience can be anything from a hurricane to a terrorist attack to the very private moment of hearing a doctor say that you have a life-threatening disease. PTSD can begin after a tour of duty in a war zone, or it can strike after a freeway accident or sexual assault. What’s more, the same event can cause PTSD in one person and leave another unscathed, for reasons I talk about in Chapter 2.
Although many types of catastrophes can cause PTSD, some life crises are far riskier than others. Figure 1-1 shows statistics on the events most likely to trigger PTSD. Several of these events score high on the PTSD scale in part because of their sheer magnitude. Others, although smaller in scale, make the list because of the depth of the pain they cause.
Figure 1-1: The risk of developing PTSD after different types of trauma.
Graph courtesy of the PTSD Alliance
In this section, I look at several types of these trauma-provoking events and how they differ in their power to cause harm.
The ill winds (and fires, floods, tremors, and disease) that can lead to PTSD
For most of your life, Mother Nature is a kind friend. The sun smiles on you, the grass grows underfoot, and the river flows gently through your town. But Mother Nature has teeth and claws, and she can turn quickly from a kindly friend to a vicious foe. When that happens, your life can turn upside down in an instant.
Anyone who’s watched a natural disaster unfold on TV — or worse, had to live through one of these calamities — can understand why these events leave a swath of PTSD in their wake. The biggest offenders, which can affect thousands of lives in a single day, include
Hurricanes, tornadoes, and tsunamis
Fires
Earthquakes
Floods
Natural disasters often trigger PTSD because they rain so many blows on their victims — lost homes, lost jobs, lost lives. Hurricane Katrina is a good example. Even after the winds and floodwaters subsided, many people remained without shelter, food, water, money, or medical aid for days. Thousands lost their jobs, and many lost loved ones. As a result, a single event turned into a series of traumas, and survivors suffered sky-high rates of PTSD. (One study by Lisa Mills, reported at the 2007 annual meeting of the Society for Academic Emergency Medicine, found that more than a third of Katrina survivors seen at a New Orleans emergency department had PTSD — a far higher toll than for most disasters.) Natural disasters also leave their scars on the rescue teams who lend a helping hand after catastrophe strikes, and many of these people experience secondary trauma (see Chapter 2) as a result of witnessing the suffering around them.
Mother Nature doesn’t always strike with wind, water, fire, or earthquakes, however; often, she terrorizes people in quieter ways. One powerful risk for PTSD, often overlooked by doctors until recent years, is a serious illness such as cancer or AIDS.
People battling life-threatening illnesses (or watching a family member go through this experience) have very high rates of PTSD. In the Journal of Clinical Oncology, a 2005 study by Anne Kazak and colleagues found that nearly 100 percent of parents of children being treated for cancer develop some degree of PTSD and that more than half of the fathers and three- quarters of the mothers of these children develop moderate-to-severe PTSD. PTSD often affects people for years or decades after a serious illness, even if the initial threat to the person’s health passes.
The horrific scale of abuse in America
How big of a toll do domestic violence and other acts of partner abuse take on society? Here are some shocking numbers offered by the National Center for Posttraumatic Stress Disorder (www.ncptsd.va.gov):
At least once in their lifetimes, 20 to 30 percent of American women are physically abused by a partner.
Each year, 1.3 million women and more than 800,000 men are physically assaulted by an intimate partner.
More than 200,000 women are raped by an intimate partner each year.
Of those in same-sex relationships, 11 percent of women and 23 percent of men are raped, otherwise physically assaulted, and/or stalked by an intimate partner.
More than 500,000 women and 185,000 men are stalked by an intimate partner each year.
Of all women’s emergency-room visits, 30 to 40 percent are for injuries due to domestic violence.
Fifty percent of men who assault their female partners also assault their children.
Each year, 3.3 million children witness acts of domestic violence.
The human acts that can cause PTSD
On September 11, 2001, the United States witnessed an act of human cruelty on a scale that shook the entire world. Other countries, too, have been rocked by episodes of genocide caused by wars or terrorism. Such dark moments in history are mercifully rare, but every single day, individual acts of violence — armed robberies, sexual assaults, and other violent attacks — derail the lives of thousands of people around the globe.
These acts, whether they affect thousands of people or a single life, put people at extreme risk for PTSD. As I explain in Chapter 2, intentional acts of violence or betrayal cut much deeper than traumas caused by the random acts of nature — especially when these acts happen in childhood or occur over and over.
The human-caused traumas that carry the highest risk for PTSD include
Childhood sexual or physical abuse
Rape and other forms of sexual assault
Domestic violence
Armed robberies and other nonsexual physical attacks
Violent acts resulting in deaths that cause trauma in surviving relatives and loved ones
Torture or acts of terror committed during war
Overall, according to the National Center for Posttraumatic Stress Disorder, the traumatic events most often associated with PTSD include the following:
For women: Rape, sexual molestation, physical attack, being threatened with a weapon, or being abused as a child
For men: Rape, combat experiences, or neglect or physical abuse in childhood
Violence also takes a huge toll on the courageous folks who put their lives on the line every day in the course of their jobs. As we count on police officers and soldiers to protect us from harm, we put these heroes directly in PTSD’s line of fire. Police officers, for example, have rates of PTSD that may be four to six times higher than those of people in the general population, and for soldiers, the numbers are astronomical (see Chapter 2).
But although exposure to violence or abuse is a key cause of trauma, not all human-caused traumas involve violence, and not all of them are intentional. In fact, motor-vehicle accidents are the leading cause of PTSD in the general population. More than6 million road accidents occur in the U.S. each year, causing around 3 million injuries and 40,000 deaths. Nearly one in ten people involved in a serious accident develops PTSD, and for kids, the rate of PTSD may be even higher. A 2000 study by Herb Schreier and colleagues, reported at the International Conference on Pediatric Trauma, evaluated kids injured in car crashes and other types of accidents; they found that 60 percent of the children reported PTSD symptoms a month after their traumas, and 40 percent still had symptoms six months afterward.
Other stressful events that occasionally cause PTSD
In the preceding two sections, I describe the catastrophes that frequently cause trauma. But as professionals discover more about PTSD, they’re finding that many of life’s events that people simply think of as tough breaks — the too-bad-but-you’ll-get-over-it kinds of events — may lead to PTSD as well. Here are some recent findings:
People who live through events most experts consider to be upsetting but not traumatic have a high risk of PTSD. In 2005, Saskia Mol and colleagues surveyed nearly 3,000 people to find out what stressful events they’d experienced and how many PTSD symptoms they had. The results surprised these scientists. They expected people who’d survived floods, hurricanes, wars, and near-death experiences to have an elevated rate of PTSD, which is just what they found; but they also reported in their article, which appeared in the British Journal of Psychiatry, that people who lived through events most experts consider as upsetting but not traumatic — for instance, a job loss or divorce — also had a high risk of PTSD.
A study of people chronically bullied on the job by bosses or co-workers found that many had PTSD symptoms. Stig Berge Matthiesen and Ståle Einarsen, reporting in 2004 in the British Journal of Guidance & Counselling, said this finding isn’t really surprising because “a traumatized person experiencing bullying at work may have a strong shattered experience of the world as not being a just place, with a strong anticipation of future misfortune to come.” The same may be true for bullied children, a topic researchers are now studying.
One lesson of these studies is that it doesn’t take a hurricane, a war, or a near-death experience to trigger PTSD. The other lesson is that you shouldn’t hesitate to seek help for PTSD symptoms, even if you don’t think your life crises were major enough to affect you. Trauma is in the eye of the beholder, and a life problem that may look like no big deal to an outsider may actually be very damaging, depending on your life circumstances.
Tolls of war
As professionals learn more about PTSD, trauma-scarred soldiers are finally starting to get the help and the respect they need. This change is a welcome one from past generations, when veterans often suffered in silence.
Because of that silence, many people think of war-related PTSD as a disease that appeared out of the blue during the Vietnam War. The truth, of course, is that combat-related PTSD occurs in every war. Here are some facts and figures about the toll of PTSD in past conflicts:
A 2005 study of Korean War veterans in Australia reported that up to 33 percent of those soldiers met criteria for PTSD.
During World War II, half a million soldiers developed battle fatigue (another name for PTSD). In 2004, as many as 25,000 World War II veterans still received disability compensation for symptoms related to PTSD.
Britain recently issued pardons (a little late in the game) for about 300 soldiers executed during World War I on charges of cowardice. A review of these soldiers’ records indicated that many of them actually had PTSD.
Adding It Up: The Costs of Untreated PTSD
Turn on the TV, and you hear public-service announcements about the perils of untreated diabetes, heart disease, or high blood pressure. You never see a commercial about the dangers of untreated PTSD, but you should. PTSD is a major public health crisis, affecting more people than diabetes or asthma. What’s more, the cost of PTSD in dollars is staggering.
As experts begin to understand just how widespread PTSD is, they’re also starting to realize the high price of this disorder — not just for each individual sufferer but also for society as a whole. Here are just a few of the ways that PTSD affects us all:
Lost lives: Every year, society loses many of its best and brightest to the pain of untreated PTSD because the disorder significantly increases the risk of suicidal thoughts or behavior. The risk of suicide is especially high for people who develop both PTSD and depression, unless they receive effective treatment. (See Chapter 3 for info on the link between these two conditions.)
High medical costs: People who don’t get treatment for the fallout from trauma have higher rates of disability, more physical symptoms, more mental disorders, more medical diagnoses from doctors, and more risky health behaviors than other people. (See Chapter 3 for info on the health problems that PTSD causes.) The costs of untreated trauma-related alcohol and drug abuse alone are estimated to be $160 billion per year in the U.S. (Chapter 7 explains the substance abuse/PTSD link.)
Legal woes: The out-of-control veteran on a shooting spree is a destructive Hollywood stereotype (see Chapter 17), but PTSD frequently does play a role in criminal behavior. PTSD can impair judgment, self-esteem, the ability to plan for the future, and the ability to control anger, putting people at increased risk for impulsive or destructive behavior. More than 60 percent of Vietnam combat vets with PTSD, for example, have a history of at least one arrest after returning from the war. Studies show that PTSD is a strong risk factor for both adult crime and juvenile delinquency and that it plays a powerful role in steering people into prostitution, drug dealing, and pathological gambling.
Poor work performance and, in turn, lost jobs: PTSD can impair a person’s concentration and productivity, create problems in getting along with co-workers, and trigger emotional outbursts on the job. All these factors, as well as the health problems associated with PTSD (see Chapter 3), can make it hard for people with PTSD to get and keep jobs, resulting in higher-than-normal rates of unemployment. In addition, people with PTSD often have difficulty making upward career moves and frequently stay stuck in a low-salary rut because of their symptoms. Experts estimate that the United States loses $3 billion each year due to work problems caused by PTSD.
Family troubles: PTSD makes it hard to control emotions, empathize with other people, cope with financial matters, and handle the day-to-day pressures of relationships. It also ups the risk for substance abuse and other self-destructive behaviors. Because of this, the divorce rate for people with untreated PTSD is sky-high. In addition, children in families dealing with untreated PTSD have more learning and emotional problems than their peers. Rates of physical and verbal abuse are also high in families with a member suffering from PTSD. (For ways to cope if you’re a family member of someone battling PTSD, see Chapter 13.)
That list is scary, but as you read it, don’t be discouraged. Instead, focus on the word untreated, because that’s the key. If you have PTSD and you get effective treatment, your risk for all these problems drops like a rock. (See Part III for info on medical treatments and Chapter 12 for self-help steps.)
Untreated PTSD almost always gets worse, putting you at ever-increasing risk for medical problems, broken relationships, and loss of quality of life. Conversely, treated PTSD almost always gets better (see Chapters 14 and 18 for some of the big and little changes you can expect). Recovery takes time and a lot of hard work (Chapter 11 details the therapy process), but it’s well worth the effort. Just ask the millions of happy, healthy, creative, productive, joy-filled people who’ve left PTSD in their past.
If you’re the friend or loved one of a person with PTSD, you can also take hope from another fact: Along with treatment, strong social support can play a powerful role in reducing the risks of the problems I outline in this section. (For details, see Chapters 13 and 16.) You can’t shoulder the burden of aiding a person with PTSD all on your own — in fact, calling in the pros is essential — but your love and support can help give a trauma survivor the courage to break free from the chains of PTSD.
Chapter 2
Aftershocks: When the Past Won’t Stay in the Past
In This Chapter
Understanding what a trauma is
Noting the difference between trauma and stress and types of PTSD
Understanding PTSD risk factors
Considering the role of triggers in PTSD
“We’ll always have Paris,” says Humphrey Bogart as he parts from Ingrid Bergman in Casablanca. It’s a great movie line, and it says a lot about the amazing gift called memory. Like Bogey, you can keep your favorite places and people with you simply by pulling up your happy memories of them — even if they’re miles away or long-gone. Without flipping open a scrapbook or putting in a CD, you can conjure up your newborn’s first smile or first word, the ecstasy (or agony) of prom night, or even the aroma of Mom’s freshly baked bread.
But memories have a dark side, too: They can make you feel devastated, furious, or humiliated (many of you just thought about prom night again, didn’t you?), even decades after something bad happens. What’s more, bad memories seem to stick more than happy ones — and that’s especially true for terrible memories like the ones that can trigger PTSD. Minor crises such as a missed plane flight or a tiff with a friend may make you cringe when you recall them, but these memories don’t change your life. Experience a terrible trauma, however, and the memories can torment you for months — or much longer — if you develop PTSD.
To understand why a single moment in time can change your life so dramatically, it helps to know just what a trauma is and how it can impact you both instantly and over the long run. In this chapter, I define what the term trauma means, explain why trauma is very different from stress, and describe how a trauma can turn a helpful tool — memory — into a destructive force. In addition, I look at the different forms of PTSD that can occur when a bad memory just won’t let go, and I explain how triggers can set off the bad feelings in a snap.
Looking Closely at Trauma
Every case of PTSD starts in the same way: with a trauma. The word trauma comes from the Greek word for wound,
