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Understanding and Treating PTSD

Brought on by experiencing or witnessing a traumatic event, PTSD impacts approximately nearly 8 percent of Americans each year. Learn what it is and how it’s treated.

Inability to sleep. Depression. Anger. These are a few of the symptoms of Post-Traumatic Stress Disorder, or PTSD. Anne Menahemy, MD, is a psychiatrist at Kaiser Permanente Richmond Medical Center whose interest in the condition dates to her residency under noted PTSD researcher Bessel van der Kolk, MD, and experience working in his trauma clinic at Massachusetts General Hospital. She explains the condition, and what can be done to help patients.

Anne Menahemy, MD

What is PTSD?

According to clinical handbooks, PTSD is caused by the threat of death, or actual or real injury or sexual violence. But PTSD symptoms can result from any experience that overwhelms a person’s capacity to cope. It can be caused by witnessing even the peaceful death of a loved one, or learning about the death of a loved one, or a traumatic event, such as losing a home to natural disaster. It may begin within 3 months of the event, but sometimes begins years later.

How does PTSD present in people?

How it manifests can depend upon the vulnerability of the individual and the nature of the trauma, as well as how long ago the event took place. A core symptom is sensory recollection of traumatic events such as flashbacks or nightmares. People may have trouble going or staying asleep, feel on edge, exist in a state of hyper-arousal, or be prone to irritability.

Sometimes they blame themselves for what happened. They can experience mood shifts, and have a more somber view of life. For those who experience chronic or repetitive traumatic stress in childhood, there is also a strong connection to the development and prevalence of a wide range of health problems.

My patients are referred by their therapist or general practitioners and may arrive saying that they are feeling anxious or even terrified. In some cases, they are not able to link something terrible that happened when they were a child to their current state. Then I take their history and when we put the pieces together it all makes sense. They have PTSD.

How common is PTSD?

Most people who experience a traumatic event do not develop PTSD. Though they may have symptoms in the days or weeks after the event, they are able to integrate their experience and move on. For the roughly 13 percent of people suffering from trauma who do develop PTSD, factors such as a childhood history of trauma, history of depression or anxiety, and a low level of social support may have made them more vulnerable. Generally, interpersonal trauma — something deliberately done to you or someone you care about — is more likely to result in PTSD than random events.

Rape is a trauma often resulting in PTSD. One study that examined PTSD symptoms among women who were raped found that about one-third of the women reported symptoms 9 months after the trauma.

How is PTSD treated?

Psychotherapy helps the individual to modulate or tolerate the emotional and physical arousal associated with traumatic memories while working on integrating what has happened to them. (Integration is the process of mixing disparate groups and incorporating previously disconnected entities into one larger entity. Over time the patient is able to identify the disturbing thoughts and beliefs that have perpetuated his or her emotional distress and made the trauma difficult to integrate.) This awareness allows the patient to begin to modify those beliefs, accept that the trauma has happened, and find a way forward. There are several therapeutic techniques that have been shown to facilitate resolution of PTSD. These include Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Cognitive Processing Therapy (CPT).

What are suggestions for self-care, in addition to therapy?

At Kaiser Permanente, we always recommend exercise, mindfulness practices, a healthy diet, and social connections. There are also many online educational resources, including the National Center for PTSD and the The National Child Traumatic Stress Network.