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Invisible wounds: understanding PTSD

Image of a service member appearing distressed with hand on head. Click to open a larger version of the image. Click to open a larger version of the image. Post-traumatic stress disorder develops in some people after exposure to a traumatic event. It affects approximately 8 million Americans and can interfere with a person’s daily life and impact personal relationships. (U.S. Air Force photo by Senior Airman Christian Clausen/Released)

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In the United States, 60% of men and half of all women experience at least one traumatic event in their lives, according to the Department of Veterans Affairs' National Center for PTSD. Roughly 8 million adults live with post-traumatic stress disorder.

Trauma exposure itself doesn’t mean everyone will experience PTSD. “We know that a number of variables put people at risk: prior trauma history, lack of social support, suffering an injury as a result of the trauma, and preexisting mental health issues,” said Holly O’Reilly, a clinical psychologist. The effects of trauma also accrue over time, she added, “So repeated trauma exposure will increase the likelihood of developing post-traumatic symptoms.”

PTSD is a mental health condition that some people develop following exposure to a traumatic event, said O’Reilly, who works at the Psychological Health Center of Excellence, a division of the Defense Health Agency Research and Development Directorate. Although anxiety and depression can overlap with PTSD symptoms, the conditions are different. Anxiety is a pattern of worrying or being fearful of something that could happen while depression refers to a depressed mood for two weeks or more, explained O’Reilly. “Individuals with symptoms of PTSD continue to be anxious as a result of a prior trauma experience or exposure,” she said.

An official diagnosis of PTSD requires exposure to a traumatic event and symptoms from four different categories. They include reliving trauma through intrusive memories; avoidance of any reminders of trauma; persistent negative thoughts and emotions associated with the trauma; and hyperarousal, which is consistently feeling “on edge,” particularly in response to reminders of the trauma. People may be easily startled, feel irritable, or have difficulty falling asleep.

PTSD can interfere with a person’s daily life and impact personal relationships. “Individuals who have symptoms of PTSD may demonstrate difficulty completing everyday tasks, experience persistent anxiety, or have upsetting reminders of previous traumatic events,” said O’Reilly.

As people practice social distancing, social isolation may contribute to PTSD symptoms, she cautioned. If a person used social activity to avoid intense emotions, the loss of social activity could lead to thinking about past trauma and a worsening of symptoms.

“Research has shown that PTSD can be treated successfully via evidence-based psychotherapy,” she said. “The best way for individuals to fully recover is to fully participate in evidence-based psychotherapy, allowing them to process their response to the trauma and learn skills to move forward.”

A common misconception is that a diagnosis of PTSD will negatively impact a person’s career, but without treatment, symptoms will persist and may even worsen. PTSD treatments work and people can fully recover, said O’Reilly. Even years after the initial trauma, people can still benefit from treatment, but the sooner a person seeks therapy, the better. Many types of evidence-based PTSD treatment usually take two to three months to complete and occur in weekly individual sessions. O’Reilly encourages practicing new therapy skills outside of the sessions.

PTSD can result in changes to changes in the brain, but it may not be permanent, said Dr. Robert Ursano, director of the Uniformed Services University of the Health Sciences’ Center for the Study of Traumatic Stress, who spoke recently at a PTSD roundtable. “We know specifically three primary and several other areas in the brain but principally the prefrontal cortex, the hippocampus and the medulla show alterations in those with PTSD versus that those who don't,” he said. “We also have data that showed that after treatment the brain can change back again.” PTSD is a highly treatable disorder with effective medications and psychotherapies, he added.

“If you or someone you care about has symptoms of PTSD and they cause distress or interfere with daily activities, you should seek help from your local behavioral health clinic,” said O’Reilly, adding all military hospitals and clinics have PTSD experts available. “You may also connect through Military One Source, or the inTransition program,” she added. Resources on PTSD treatment are available on the Psychological Health Center of Excellence website.

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