PTSD: Post-Traumatic Stress Disorder

What is PTSD?

Post-traumatic stress disorder (PTSD) is a psychiatric condition that develops in reaction to a terrifying and traumatic event. Many individuals who experience traumatic events have abbreviated adjustment difficulties but in other instances these difficulties persist and individuals experience chronic problems with intrusive memory, avoidance and numbing, and increased anxiety or emotional arousal (known as hyperarousal).

How often does PTSD occur?

• Wide differences in prevalence rates of PTSD after critical illness have been reported by experts.
• Early studies suggested that PTSD occurred up to half of individuals after critical illness. Recent reports suggest that PTSD may be less common than was previously reported – happening in between 10% to 20% of cases.
• Many individuals have isolated symptoms of PTSD but do not have enough symptoms to be diagnosed with this condition.

Causes of PTSD

Traumatic experiences lead to the development of PTSD. For survivors of critical illness, these experiences vary widely in nature and may include:

• Fear of impending death due to serious illness
• Delusional and hallucinations with themes of a violent or sexual nature
• Intraoperative awareness (recall of events that occur while patient was treated in the ICU)

People most likely to get PTSD

Individuals exposed to similar traumatic stressors often have very different reactions and, in most cases, do not go on to develop PTSD. However, some people are more susceptible than others to developing PTSD after critical illness. Individuals at greatest risk may include those who:

• Have pre-existing mental health problems
• Have a history of exposure to previous traumas of different kinds
• Are young in age
• Are female
• Experience prolonged delirium
• Have vivid memories of delusions and hallucinations during critical illness

Signs of PTSD

Signs of PTSD have been well described, though it remains unclear whether these symptoms might be expressed differently in survivors of critical illness than in others. Common symptoms of PTSD (not a complete list) may include:

• Upsetting and intrusive memories of critical illness which are hard to suppress
• Anxiety – sometimes extreme - when exposed to reminders of critical illness
• Nightmares
• Avoidance of hospitals and healthcare providers and fear of becoming ill
• Disengagement and emotional withdrawal
• A foreboding anticipation of an abbreviated future

Can anything be done for PTSD?

PTSD sometimes develops a chronic character but like many psychiatric illnesses, it is often very treatable. Popular treatments for PTSD include:

• Medications including antipsychotics, antidepressants, and prazosin
• Cognitive therapy, which helps people recognize distorted and maladaptive thinking patterns
• Exposure therapy, which helps people face the thing that they find frightening and upsetting.
• Eye movement desensitization and reprocessing (EMDR). This type of therapy combines exposure therapy with a series of guided eye movements that help you process traumatic memories.

PTSD is typically treated by psychologists and/or psychiatrists – both mental health professionals trained in the management of this condition. If you think you or a loved one has symptoms of PTSD, please consider contacting a mental health professional or ask your primary care provider or medical specialist for a referral.