What is PTSD?

In a recent issue of The Johns Hopkins Depression and Anxiety Bulletin, Dr. O. J. Bienvenu, associate professor of psychiatry at Johns Hopkins, talked about post-traumatic stress disorder or PTSD – an increasingly common condition.

Q. What is the difference between a normal reaction to a traumatic event and PTSD?

A. Individuals can experience a wide array of reactions to a traumatic event, ranging from relatively mild to severe emotional responses that create major disruptions in a person's life. It is important to remember that most emotional and behavioral responses are normal reactions to an abnormal event. It is very common for people to experience anxiety, fear, shock, and grief, as well as emotional numbness and personal or social disconnection for several weeks.

For most people, the emotional and behavioral responses to a trauma gradually diminish over time. It is often helpful to speak with family and loved ones about what happened, express one's feelings about the event, and get support from trusted friends and colleagues and perhaps a mental health professional. For some people exposed to trauma, disturbing symptoms can persist or even worsen, developing into the syndrome known as PTSD. A syndrome is a constellation of symptoms that consistently occur together and thereby define a condition.

The symptoms that define PTSD must last at least one month for a diagnosis of PTSD and may include:

• Recurrent, intrusive, distressing dreams and memories of the trauma
• A sudden sense that the event is recurring; experiencing flashbacks
• Extreme distress when confronted with events that symbolize or resemble the trauma
• Attempting to avoid thoughts, feelings, and activities associated with the event
• Inability to remember important aspects of the trauma
• Markedly diminished interest in important activities
• Feelings of detachment and estrangement from loved ones
• A sense of a foreshortened future
• Insomnia
• Extreme irritability
• Inability to concentrate
• Hyper vigilance or an exaggerated startle response

Q. How do you define "trauma"?

A. The Diagnostic and Statistical Manual of Mental Disorders DSM-IV (Fourth ed.) -- the primary guidebook in the U.S. for classifying and diagnosing mental disorders --defines a traumatic experience as one that involves a threat of death or serious injury and inspires intense fear, helplessness, or horror. The victim may experience the trauma directly, witness it first hand, or be confronted with it in some other way.

The phrase "confronted with it in some other way" is somewhat controversial. It allows many kinds of events to "qualify" as traumatic; i.e., merely hearing about a traumatic event could be considered "being confronted with it."

Not all traumas are alike, and people's reactions to trauma vary greatly. The most common traumatic events that trigger PTSD include violent personal assaults such as rape or mugging, military combat, accidents, and human-caused or natural disasters (e.g., the attacks of 9/11 and Hurricane Katrina).