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"I think I understand a little ...
When things around are calm...
When will daddy tell me ....
About a place called "Nam."



Post-traumatic stress disorder (PTSD) is an extremely debilitating condition
that can occur after exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened. Traumatic events that can trigger
PTSD include violent personal assaults such as rape or mugging, natural or
human-caused disasters, accidents, or military combat.

Military troops who served in Vietnam and the Gulf Wars; rescue workers
involved in the aftermath of the Oklahoma City bombing; survivors of
accidents, rape, physical and sexual abuse, and other crimes; immigrants
fleeing violence in their countries; survivors of the 1994 California
earthquake, the 1997 South Dakota floods, and hurricanes Hugo and Andrew; and
people who witnesses traumatic events are among the people who develop PTSD.
Families of victims can also develop the disorder.

Fortunately, through research supported by the National Institute of Mental
Health (NIMH) and the Department of Veterans Affairs (VA), effective
treatments have been developed to help people with PTSD. Research is also
helping scientists better understand the condition and how it affects the
brain and the rest of the body.

NIMH is conducting a national education program on anxiety disorders, which
include PTSD, panic disorder, obsessive-compulsive disorder, phobias, and
generalized anxiety disorder.

What Are the Symptoms of PTSD?

Many people with PTSD repeatedly re-experience the ordeal in the form of
flashback episodes, memories, nightmares, or frightening thoughts, especially
when they are exposed to events or objects reminiscent of the trauma.
Anniversaries of the event can also trigger symptoms. People with PTSD also
experience emotional numbness and sleep disturbances, depression, anxiety,
and irritability or outbursts of anger. Feelings of intense guilt are also
common. Most people with PTSD try to avoid any reminders or thoughts of the
ordeal. PTSD is diagnosed when symptoms last more than one month.

How Common Is PTSD?

At least 4 percent of U.S. adults (5.7 million people) have PTSD during the
course of a year. About 30 percent of the men and women who have spent time
in war zones experience PTSD. One million war veterans developed PTSD after
serving in Vietnam. PTSD has also been detected among veterans of the Persian
Gulf War, with some estimates running as high as 8 percent.

When Does PTSD First Occur?

PTSD can develop at any age, including in childhood. Symptoms typically begin
within 3 months of a traumatic event, although occasionally they do not begin
until years later. Once PTSD occurs, the severity and duration of the illness
varies. Some people recover within 6 months, while others suffer much longer.

What Treatments Are Available for PTSD?

Research has demonstrated the effectiveness of cognitive-behavioral therapy,
group therapy, and exposure therapy, in which the patient repeatedly relives
the frightening experience under controlled conditions to help him or her
work through the trauma, as well as medications that help ease the symptoms
of depression and anxiety and help promote sleep. Scientists are attempting
to determine which treatments work best for which type of trauma.

Do Other Physical or Emotional Illnesses Tend to Accompany PTSD?

Co-occurring depression, alcohol or other substance abuse, or another anxiety
disorder are not uncommon. The likelihood of treatment success is increased
when these other conditions are appropriately diagnosed and treated as well.

Headaches, gastrointestinal complaints, immune system problems, dizziness,
chest pain, or discomfort in other parts of the body are common. Often,
doctors treat the symptoms without being aware that they stem from PTSD.
NIMH, through its education program, is encouraging primary care providers to
ask patients about experiences with violence, recent losses, and traumatic
events, especially if symptoms keep recurring. When PTSD is diagnosed,
referral to a mental health professional who has had experience treating
people with the disorder is recommended.

Who Is Most Likely to Develop PTSD?

People who have been abused as children or who have had other previous
traumatic experiences are more likely to develop the disorder. Research is
continuing to pinpoint other factors that may lead to PTSD.

What Are Scientists Learning From Research?brain1.gif (1120 bytes)

NIMH and the VA sponsor a wide range of basic, clinical, and genetic studies
of PTSD. In addition, NIMH has a special funding mechanism, called RAPID
Grants, which allows researchers to immediately visit the scenes of
disasters, such as plane crashes or floods and hurricanes, to study the acute
effects of the event and the effectiveness of early intervention.

Research has shown that PTSD clearly alters a number of fundamental brain
mechanisms. Because of this, abnormalities have been detected in brain
chemicals that mediate coping behavior, learning, and memory among people
with the disorder. Recent brain imaging studies have detected altered
metabolism and blood flow as well as anatomical changes in people with PTSD.

The following are also recent research findings:

Some studies show that debriefing people very soon after a catastrophic event
may reduce some of the symptoms of PTSD. A study of 12,000 schoolchildren who
lived through a hurricane in Hawaii found that those who got counseling early
on were doing much better two years later than those who did not.
People with PTSD tend to have abnormal levels of key hormones involved in
response to stress. Cortisol levels are lower than normal and epinephrine and
norepinephrine are higher than normal. Scientists have also found that people
with this condition have alterations in the function of the thyroid and in
neurotransmitter activity involving serotonin and opiates.
When people are in danger, they produce high levels of natural opiates, which
can temporarily mask pain. Scientists have found that people with PTSD
continue to produce those higher levels even after the danger has passed;
this may lead to the blunted emotions associated with the condition.
It used to be believed that people who tend to dissociate themselves from a
trauma were showing a healthy response, but now some researchers suspect that
people who experience dissociation may be more prone to PTSD.
Animal studies show that the hippocampus -- a part of the brain critical to
emotion-laden memories -- appears to be smaller in cases of PTSD. Brain
imaging studies indicate similar findings in humans. Scientists are
investigating whether this is related to short-term memory problems. Changes
in the hippocampus are thought to be responsible for intrusive memories and
flashbacks that occur in people with this disorder.
Research to understand the neurotransmitter system involved in memories of
emotionally charged events may lead to discovery of drugs that, if given
early, could block the development of PTSD symptoms.
Levels of CRF, or corticotropin releasing factor--the ignition switch in the
human stress response--seem to be elevated in people with PTSD, which may
account for the tendency to be easily startled. Because of this finding,
scientists now want to determine whether drugs that reduce CRF activity are
useful in treating the disorder.
Reporters: For more information about post-traumatic stress disorder and
other anxiety disorders, contact: The Anxiety Disorders Education Program,
National Institute of Mental Health at 301/443-4536. The general public can
obtain publications by calling NIMH’s toll-free information service,
1-88-88-ANXIETY; information is also available online from NIMH’s home page: This site is hotlinked to the Web site for
the National Center for Post-Traumatic Stress Disorder of the Department of
Veterans Affairs at



Post-traumatic stress disorder is a disorder that occurs after a person has experienced a traumatic event, such as a natural disaster, participating in combat, or being the victim of a physical assault or rape. Stressors that might trigger PTSD must be outside the range of typical human experience. Typical problems such as grieving the loss of a loved one or marital conflict are not considered severe enough to lead to PTSD. People who have PTSD are people who:

Traumatic events are more likely to lead to PTSD if they are the result of human malice as opposed to an accident or a natural disaster. Prevelence of this disorder is somewhere between 1 and 5% of the American population. Most men who have the disorder have experienced combat and most women have been the victim of a physical assault or rape.


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1. Remove yourself from exposure to further trauma - stabilize your situation

2. Find a therapist who really knows PTSD

3. Find a psychiatrist, with the help of your therapist, to determine if you would benefit from prescription meds

4. Find a medical doctor to examine you for any and all medical problems

5. Stop unhealthy behavior and unhealthy coping

6. Find a support group

7. Learn about PTSD

8. Learn New Healthy Coping Tools to deal with your feelings




PTSD and Families

The symptoms of PTSD not only affect the sufferer, but also may impact severely on other family members. Relationships with partners and children may become strained and difficult. PTSD may cause the sufferer to reject or withdraw from the very people who care most.

PTSD is understood in terms of three groups of symptoms. They can affect individuals and families in the following ways.

Intrusive Symptoms

Traumatic events typically "intrude" into the lives of PTSD sufferers. This can happen in vivid daytime memories or dreams. It can occur suddenly and without obvious cause and is typically accompanied by intense emotions, such as grief, guilt, fear or anger. Sometimes, these intrusions can be so strong or vivid that the individual may believe the trauma is re-occurring.

These symptoms can be frightening not only for the individual experiencing them, but also for other family members. These intrusive symptoms can cause families to feel worried about the PTSD sufferer or perplexed by their behaviour. The individual may make movements or noises when dreaming, which is very disturbing for partners.


Traumatic memories are extremely unpleasant and individuals may try to avoid any situations, people or events which remind them of the incident(s). They may attempt to block out the memories by withdrawing into themselves, cutting themselves off from other people. They may feel unable to respond appropriately to others and to the challenges of everyday life. PTSD sufferers often report being unable to feel emotions, even for those to whom they feel closest. Importantly, this does not mean that they no longer love or care for their family and friends.

This emotional avoidance and numbing inevitably affects relationships. The lack of energy and the tendency to withdraw is difficult for families to understand or tolerate. Family members may feel rebuffed by a PTSD sufferer who is unable to show appropriate involvement, emotion and affection. This can be particularly hard on children. Family members may feel frustrated at having to take on responsibilities the traumatised person can no longer meet.

Arousal Symptoms

Severe trauma can cause individuals to feel vulnerable and frightened. They may be "jumpy" and feel the need to be constantly on guard and watchful. Sleep is often disturbed and restless. They may feel irritable and angry with themselves and others. This may sometimes lead to aggressive and violent behaviour. Memory, concentration, and decision-making are often affected.

The effect of these symptoms on the family can be severe. Anger and irritability can be one of the most difficult symptoms of PTSD for families to endure, especially when the anger is directed at children. Anxiety can cause many difficulties, especially if the sufferer avoids going to shops or crowded places.

Associated Problems

In addition to the core PTSD symptoms, it is common for sufferers to experience feelings of panic or extreme fear, especially when away from home or other "safe" places. Depression, loss of interest in normal activities, and reduced motivation are also common.

PTSD sufferers often engage in potentially harmful habits and behaviours to cope with their symptoms. Thus, they may abuse alcohol or other drugs as a form of "self-medication" in an attempt to blunt memory. Again, this can be very difficult for families to cope with.

Recognising PTSD

If PTSD is not recognised as the cause of the problems, family members may start to blame the affected person or themselves. They may feel rejected or unloved, and powerless to help the sufferer. It may mean that the family will require help with other problems that they had been coping with before.

Unfortunately, PTSD can be a difficult disorder to recognise because there is often:

What To Do If A Member Of Your Family Has Symptoms Of PTSD

Where symptoms are severe, or last for a long time, the person should be seen by an experienced mental health professional. Untreated, PTSD can become a chronic and disabling disorder. Diagnosis and effective treatment should be sought at the earliest opportunity. Family members can play an important role in encouraging the individual to seek treatment and in providing on-going support during the treatment process.

You may wish to talk to your family doctor or community health centre about where to get treatment for your loved one. You could also try your local Vietnam Veterans Counselling Service (VVCS) - they may be able to help even if the person is not a veteran.



Sponsor: Carl T. Hayden Veterans Affairs Medical Center The Post Traumatic Stress Resources Web Page

U.S. Department of Veterans Affairs,
National Center for PTSD, Research and Education on Post-Traumatic Stress Disorder

About Medications For Combat PTSD
This was prepared as educational material for combat veterans, but may be useful to others, such as veterans' spouses

The American Academy of Experts in Traumatic Stress

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