San Francisco Center for Integrative Anxiety Solutions

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Posttraumatic Stress Disorder (PTSD)

Posttraumatic stess disorder (PTSD) is a condition that sometimes develops following the experience or witnessing of a trauma, such as a life-threatening event like combat warfare, a car accident, violent attack, or natural disaster.  Individuals with PTSD experience symptoms that can be classified into four categories:  intrustions (such as intrusive thoughts or memories of the event), effortful avoidance (avoiding places, people, or situations that remind the individual of the trauma), negative alterations in cognitions and mood (extreme sadness, fear or anxiety; distorted thoughts about onself and the world), and alterations in arousal and reactivity (exaggerated startle response, difficulty sleeping, intense anger/irritability, and hypervigilance). [1]    PTSD can develop at any age, including childhood, and tends to be a chronic and impairing condition.  Women are more likely than men to develop the disorder, and susceptibility to its development may run in families.  [2]

Biological Characteristics

There are many biological factors that contribute to development of the disorder, including certain genetic factors [3], epigenetic factors (changes in the way in which genes are transcribed) [4], and alterations in the body's biological stress-response system (known as the hypothalamic-pituitary-adrenal axis, or HPA axis) [5].  The body's chemical stress response system has two aspects:  a fast aspect which functions to ready the body for fight-or-flight (mediated by chemicals like adrenaline), and a slow aspect which functions to promote stress recovery and adaptation (mediated by a chemical known as cortisol).  Individuals with PTSD generally show abnormalities in cortisol levels and cortisol responses to stress [6].  Abnormalities in brain function are also commonly noted in PTSD, with hyperactive responses in regions of the brain responsible for threat detection, fear, and anxiety and reduced responsiveness of brain regions responsible for emotion regulation [7].  Some of these brain characteristics may exist prior to the development of the disorder and may serve to increase likelihood of its development, while others emerge as a consequence of its expression [8].

Psychological Characteristics

Individuals with a personality type characterized by experiencing high levels of negative emotionality are thought to be at greater risk of developing PTSD following the experience of a traumatic event [9], though this is a non-specific risk factor for a whole range of different disorders.  Another psychological risk factor for development of PTSD is early life stress or experiencing childhood maltreatment, abuse, or neglect.  These early experiences seem to prime individuals to be more likely to deveop PTSD following a later trauma, as well as numerous other mental disorders [10].    Following development of PTSD, individuals generally experience a thought style characterized by excessive and exaggerated negative thoughts, particularly regarding the world being a dangerous place, feeling unable to trust or connect with others, blaming themselves or others for things that are beyond their control, and thinking that their situation is hopeless and they will never be able to change [11]. A good portion of therapeutic work involves correcting these maladaptive beliefs and adopting a more balanced thinking style.  In addition to changing the content and tone of thoughts, PTSD often results in prominent cognitive difficulties, such as difficulty concentrating and deficits in memory and other cognitive functions [12].      

PTSD Treatment

Although PTSD is a chronic condition that doesn't tend to go away on its own, there are a number of effective psychotherapies that have been developed to treat the disorder.  As a specialist in PTSD treatment, I have experience and training with several of these techniques, including cognitive processing therapy (CPT), prolonged exposure therapy (PE), and eye movement desensitization and reprocessing (EMDR).  All of these treatment options have several factors in common, including education on PTSD, its symptoms, and causes;  a controlled process of exposure to the traumatic memory and real-life situations that serve to trigger symptoms; examination of thought patterns, beliefs, and viewpoints that have been impacted by the experience of the trauma and development of the disorder; and practice of skills outside of session.  Research has found all of these treatments to be about equally effective [13]