Post-traumatic stress disorder can occur after single event
DEAR DOCTOR K:
A few months ago I was in a serious car accident. Since then I've been incredibly jumpy and have trouble sleeping. My wife thinks I may have PTSD. Could she be right?
Post-traumatic stress disorder -- PTSD -- is a condition in which distressing symptoms occur after a major trauma. PTSD is often discussed in the context of troops who have served in war zones, but you don't have to see battle to get PTSD.
For example, one of my patients with PTSD, like you, was in a terrible auto accident as a young man. The accident, which broke many bones and caused him to be hospitalized for many weeks, occurred at a particular intersection not far from his home -- a drunk driver ran a red light.
For years afterward, every time he came near the intersection, his heart raced, he broke out in a sweat and he felt like he was going to die. Finally, he stopped driving anywhere near that intersection. But he still had bad dreams. Fortunately, with treatment his PTSD became much less of a problem.
About 10 years ago, though, just after he retired, the bad dreams came back. His explanation: "When I no longer had to worry about work, I was free to worry about other things." An aggressive schedule of church work, book clubs and travel helped beat back the PTSD.
A single crisis (such as a serious car accident) or a series of events -- as long as they are severe enough -- can cause PTSD. You could also have PTSD following:
-- airplane accidents;
-- physical assaults, robberies or kidnappings;
-- heart attacks and other major physical illnesses;
-- natural disasters, such as hurricanes, floods and earthquakes.
It's normal to experience fear, shock, helplessness, stress and extreme sadness soon after a traumatic event. But if you're still experiencing these reactions more than one month after the event, that might indicate a problem. I've put a brief questionnaire on my website, AskDoctorK.com. Your responses to these questions might help you determine if you're suffering from PTSD.
When diagnosing PTSD, doctors often look for three things:
-- Hyperarousal. This is an ongoing state of tension that resembles a "fight or flight" response to danger. You may experience insomnia, angry outbursts, an exaggerated startle response and hypervigilance. Headaches, trembling, diarrhea and fatigue are common.
-- Avoidance. You may feel detached or numb. You may be unable to talk about the traumatic event or revisit the place where it occurred. PTSD patients also often withdraw from people and social events, particularly those even remotely associated with the trauma.
-- Re-experiencing. This is the worst symptom. You may have unwelcome and disruptive thoughts about the event that interfere with normal concentration and function. Recurrent nightmares are also quite typical. In extreme cases, you may mentally relive the traumatic experience.
Talk to your doctor. Whether or not you have PTSD, you clearly need support to recover from your experience. If it is PTSD, psychological support, drug therapy or a combination should help.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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