41-3 What is PTSD?

While serving his country in war, one soldier, Jesse, observed the killing “of children and women. It was just horrible for anyone to experience.” After calling in a helicopter strike on one house where he had seen ammunition crates carried in, he heard the screams of children from within. “I didn’t know there were kids there,” he recalled. Back home, he suffered “real bad flashbacks” (Welch, 2005).

Jesse is not alone. In one study of 103,788 veterans returning from Iraq and Afghanistan, 25 percent were diagnosed with a psychological disorder (Seal et al., 2007). Some had traumatic brain injuries (TBI), but the most frequent diagnosis was posttraumatic stress disorder (PTSD). Typical symptoms include recurring haunting memories and nightmares, a numb feeling of social withdrawal, jumpy anxiety, and trouble sleeping (Germain, 2013; Hoge et al., 2004, 2006, 2007; Kessler, 2000). Survivors of accidents, disasters, and violent and sexual assaults (including an estimated two-thirds of prostitutes) have also experienced PTSD symptoms (Brewin et al., 1999; Farley et al., 1998; Taylor et al., 1998). Reliving traumas such as 9/11 or the Boston Marathon bombing—by being glued to television replays, for example—sustains the stress response (Holman et al., 2014).

The greater one’s emotional distress during a trauma, the higher the risk for posttraumatic symptoms (Ozer et al., 2003). Among American military personnel in Afghanistan, 7.6 percent of combatants and 1.4 percent of noncombatants developed PTSD (McNally, 2012). Among New Yorkers who witnessed or responded to the 9/11 terrorist attacks, most did not experience PTSD (Neria et al., 2011). PTSD diagnoses among survivors who had been inside the World Trade Center during the attack were, however, double the rates found among those who were outside (Bonanno et al., 2006).

About half of us will experience at least one traumatic event in our lifetime. Why do some 5 to 10 percent of people develop PTSD after a traumatic event, but others don’t (Bonanno et al., 2011)? Some people may have a more sensitive emotion-processing limbic system that floods their bodies with stress hormones (Kosslyn, 2005; Ozer & Weiss, 2004). The odds of getting this disorder after a traumatic event are higher for women (about 1 in 10) than for men (1 in 20) (Olff et al., 2007; Ozer & Weiss, 2004).

Some psychologists believe that PTSD has been overdiagnosed (Dobbs, 2009; McNally, 2003). Too often, say critics, PTSD gets stretched to include normal stress-related bad memories and dreams. And “debriefing” people, by having them relive a trauma soon after, may actually worsen normal stress reactions (Bonanno et al., 2010; Wakefield & Spitzer, 2002).

Most people, male and female, display an impressive survivor resiliency, or ability to recover after severe stress (Bonanno et al., 2010). Struggling with crises may also lead to posttraumatic growth.

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