Relieving the Trauma

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For sufferers of post-traumatic stress disorder, prompt and proper treatment can be lifesaving.

The faces of post-traumatic stress disorder are as diverse as they are disconcerting.

There are the faces we expect to see&emdash;the Vietnam veteran still haunted by flashbacks, the soldier just back from Iraq who sees a clump of dirt in the road and swerves instinctively to avoid a bomb.

There are the police officers, firefighters and paramedics whose daily dance with death is the very definition of traumatic stress.

And then there are the everyday people afflicted by PTSD&emdash;a group less visible but equally in need of help.

People think first of soldiers, but the more common causes of PTSD are significant auto accidents, physical and sexual assaults, and other situations that put a threat to your personal existence, such as the recent fires in Tahoe, says Peter Yellowlees, M.D., a professor of psychiatry at UC Davis. An estimated 5.2 million American adults have PTSD in any given year, according to the National Center for Posttraumatic Stress Disorder.

What causes post-traumatic stress disorder?

Exposure to a traumatic event that causes or threatens serious harm or death to you or to others is the precipitating factor for PTSD. Whether single or repetitive in nature, the event is typically characterized by a flavor of being horrific, extreme, catastrophic and out of the blue, so there’s no ability to cope or prepare, says psychiatrist Richard Bowdle, M.D., medical director for Sutter Mental Health in Sacramento.

Flashbacks, nightmares, emotional numbness, anger, irritability, hyper-vigilance and avoidance behavior are some of the hallmarks of PTSD. Related physical complaints are common, including gastrointestinal distress, headaches, muscle cramps and aches, lower back pain and gynecological problems. Symptoms may start soon after the event or be delayed for months or years, and then wax and wane. While anyone with acute symptoms lasting longer than four weeks is likely to have PTSD, a formal diagnosis can be made at six months, according to Yellowlees.

Not everyone who experiences trauma will develop PTSD. Yet, curiously, the disorder can manifest in those who are one step removed. You can witness the event or be told about the event and get PTSD, notes Bowdle, who sees PTSD patients every day. Yes, there are a lot of soldiers who develop PTSD. But there are also a lot of family members watching coverage of the war on TV who can be equally affected.

Science is still looking at the question of why some traumatized individuals develop the condition while others don’t. Some theorize that genes and brain chemicals may play a part, including gastrin-releasing peptide, which in mice appears to help control the fear response. Head injury, a history of mental illness, a tendency to view challenges negatively and a lack of social support are other factors that may adversely affect an individual’s response to trauma.

Intensity, duration and frequency of trauma also can increase one’s vulnerability to the disorder, says Melinda Keenan, Ph.D., a psychologist and coordinator of the PTSD program at the Sacramento VA Medical Center. A lot of people think that people who get PTSD are psychologically weak or that something’s wrong with them, says Keenan, who has treated veterans from World War II forward. Anybody can get PTSD if exposed to a stressor that is intense enough.

Combat and PTSD

Keenan says about 17 percent of vets returning from Iraq and Afghanistan are currently showing symptoms of PTSD. But the final tally is expected to be unprecedented, say experts, pointing to such added stressors as repeated deployments and an absence of safe zones. Soldiers serving multiple war-zone rotations are significantly more likely than those with one tour to develop acute combat stress, increasing their risk of PTSD, according to a recent Army study.

Alex Maxwell, who served on the front lines of the Iraq invasion in 2003, returned home to Sacramento after less than a year in combat, a victim of PTSD. I started having nightmares and noticed something was different about myself, recalls the 26-year-old former Marine. But no one told us about PTSD, so I didn’t know what it was. As he tried to readjust to civilian life he found himself in a daze, running red lights (stopping in Iraq meant possible ambush) and swerving to avoid trash in the road, still on alert for bombs. I felt like I was going mad. My anxiety level was through the roof. I would see their (Iraqi) faces in my dreams and wake up, sweating, thinking I was still in Iraq. Counseling through the VA has been helpful, Maxwell says, but he’s still struggling. I’m learning a lot about myself, and I’m better equipped to handle myself in everyday life. I’m having fewer nightmares. But the internal struggle is still there.

The struggle also continues for Andy O’Hara, a 60-year-old retired California Highway Patrol sergeant whose battle with PTSD resulted in a near-suicide attempt. My 24-year career ended with me sitting on the bedroom floor with my service revolver loaded, trying to decide whether to shoot myself in the side of the mouth or in the head, says O’Hara, who was stopped by his wife and immediately entered hospital treatment. Though he witnessed murders and dodged bullets in the line of duty, O’Hara’s disorder was not prompted by a single catastrophic event, but came on cumulatively&emdash;the end result of a life of police work.

People don’t realize that sometimes cops feel very helpless, but yet they’re trained to remain in control, to not talk about being scared or about mistakes they’ve made, he says. A lifetime of such suppression can take its toll, and the dirty little secrets of an officer’s life, as O’Hara calls them, ultimately come home to roost, often in the form of PTSD.

Treatment Options

Early intervention and proper treatment is important for any health disorder. But for those with PTSD, which has an alarmingly high suicide rate of 20 percent, it literally can be lifesaving. There’s a significant level of suicide attempt and completion, says UC Davis’ Yellowlees. I’ve seen several servicemen who’ve tried to kill themselves while on a break from military combat because they were due to go back to Iraq. Depression and substance abuse, both commonly associated with PTSD, increase the likelihood of harming oneself and also complicate treatment.

Diagnosed and treated early, the disorder can be nipped in the bud before full-blown PTSD develops, according to Sutter’s Bowdle. In about half the cases, early treatment with psychological and sociological interventions can prevent the full-fledged disorder, he says. Like anything else, the longer it lasts in the system, the harder it is to treat.

While psychiatrists typically combine antidepressants and psychotherapy (talk therapy), a number of other approaches also have been found to be useful in treating PTSD, including cognitive behavioral therapy, which teaches patients different ways of thinking and reacting to events that trigger symptoms. I find it to be very effective with my PTSD patients, says Laurie Wiggen, a licensed clinical psychologist who practices in Roseville. It’s very hands-on, giving them the tools to handle whatever comes their way. Anxiety reduction techniques also are an important part of therapy, says Wiggen, because with anxiety disorders such as PTSD, there is often anxiety with the anxiety&emdash;becoming fearful of having a panic attack or feeling anxious about when they’re going to have the next flashback.

Alternative, shorter-term treatments also offer hope. Roger Vuilleumier, a marriage and family therapist for Mercy Medical Group, reports an astonishing success rate of virtually 100 percent with hypnotherapy, which he’s been using with PTSD patients for nearly 15 years. In just two sessions, he says, the PTSD-specific symptoms disappear&emdash;the nightmares, the flashbacks, the hyper-arousal. But hypnosis won’t erase such concurring symptoms as depression, he notes. Another short-term therapy gaining ground in PTSD treatment is Eye Movement Desensitization and Reprocessing, or EMDR, which has been shown in numerous studies to be effective.

All of which leads to the $6 million question: Can PTSD, with its chronic and recurrent nature, ever be cured?

O’Hara, the CHP sergeant who is still haunted by ghosts of the past after 14 years of the best of care, has his doubts.

Faces in a store take me back to horrible events, he says. I have to avoid movies or television shows that have screams in them. Stresses that were once routine can now be overpowering. The damage, he suspects, is never completely undone.

Trauma breaks your heart, says the VA’s Keenan. You can’t go back to being perfect or the way you were before. But with proper treatment, she says, symptoms can be significantly reduced and quality of life improved.

Moving Forward, With Hope

One bright light at the end of the tunnel may exist in the form of drug therapy. Early studies are promising for the beta-blocker propranolol (Inderal), which has been shown to reduce or seemingly prevent PTSD in small numbers of trauma victims. Already widely prescribed to treat high blood pressure, propranolol inhibits the release of certain stress hormones, which, in PTSD, may help to stop unwanted memories from being reinforced in the hard drive of the brain.

Time will tell whether such medications will give a new lease on life to PTSD sufferers. Meanwhile, suggests Yellowlees, it’s important to see the glass as half full, because treatment can help.

Most of these people do get better over time, so you’ve got to have a positive approach, he says. It may take one to three years. But the great majority do gradually get better.

Data shows that about half of those who receive treatment for PTSD do get better with time. About one out of three will always have some symptoms.

Removing the stigma

While recovery can’t happen without help, men in particular are unlikely to step forward. Males, on the whole, tend to be more likely to be stoic and not admit they’ve got a problem, says Yellowlees. One thing that can move them in that direction, he says, is connecting with others in the same boat. Group support is clearly very helpful.

Seconding that notion is Keenan. I wholeheartedly believe group therapy is the most effective for PTSD because it’s so isolating&emdash;makes you feel like a pariah. Most PTSD patients at the VA are treated in a group, not individually, she says.

Support is needed&emdash;and with that should come the destigmatization of mental illness, adds Robert Ruxin, M.D., chief of outpatient psychiatry at Kaiser Permanente in South Sacramento.

It’s like everything else in mental health: You have to get past the stigma and get people treated and get treated early, he says. If someone gets PTSD, it’s not something you can blame them for. It’s not their fault.   

Symptom clusters of post-traumatic stress disorder

The four main symptom clusters are:

• Reliving the event (also called re-experiencing symptoms)

• Avoiding situations that remind you of the event

• Feeling numb

• Feeling keyed up (also called arousal or hyper-arousal)

Source: National Center for Posttraumatic Stress Disorder

PTSD Facts
• Women are twice as likely to develop PTSD as men.

• About 60 percent of men and 50 percent of women experience a traumatic event in their lives. Women are more likely to experience sexual abuse as children and sexual assault. Men are more likely to experience accidents, physical assault, combat, disaster or to witness death or injury.

• Military sexual trauma (sexual harassment and/or assault experienced while in the military) also is a common cause of PTSD. Among veterans using VA health care, approximately 23 percent of women reported they had been victims of MST.

• Most people who experience a traumatic event will not develop PTSD.

Source: National Center for Posttraumatic Stress Disorder