What is Post-traumatic stress disorder (PTSD)?
Post-traumatic Stress Disorder (PTSD) frequently occurs after the experience of traumatic events such as wars,1 disasters,2-5 acute medical events,6 traumatic loss,7 severe psychiatric illness,8,9 and sexual and physical assault. Symptoms of PTSD are wide-ranging and can affect trauma-exposed people in a number of different ways.
Key symptoms of PTSD include re-experiencing of the traumatic event (including intrusive thoughts, nightmares and flashbacks), avoidance of thoughts of the traumatic event and people, places, or other stimuli that evokes the trauma, hypervigilance, hyperarousal (including irritability, concentration difficulties, and disrupted sleep), and increases in troubling thoughts and negative feelings. PTSD is commonly associated with functional impairment (when normal function is at less than full ability),10 psychiatric comorbidity (having more than one psychological condition),11 suicidal ideation, and increased utilization of medical care.12
PTSD in Veterans
Military personnel are at higher risk for experiencing traumatic events, including exposure to combat, injury, loss, captivity, and sexual abuse.13 Consequently, PTSD is a relatively common syndrome among veterans, and is frequently associated with functional impairment. Veterans with PTSD often suffer from a wide range of additional psychiatric symptoms including depression and substance and alcohol abuse.
PTSD in Civilians
A wide range of traumatic events may lead to PTSD in civilians. Some of the most common events include childhood sexual and physical abuse, rape, and domestic violence. These are just some of the “man-made” traumas that have been shown to have a strong influence on the development of PTSD. Other events that may lead to PTSD include natural disasters and long-term exposure to highly graphic or violent information (such as with police or first responders). A number of research studies have linked indirect exposure to trauma to PTSD, including exposure to media coverage of disasters14 and working with clients exposed to trauma.15
Treatment for PTSD
Treatment may help individuals understand more about trauma and its impact, identify emotions related to the trauma, and work to resolve and/or alleviate PTSD symptoms. A number of therapeutic approaches have been supported in clinical trials, such as Prolonged Exposure (PE) Therapy. PE is a type of cognitive behavioral therapy that uses in vivo exposure – safely exposing the individual to real world situations that are related to the trauma or its triggers. It also employs imaginal exposure by talking through the trauma with the therapist, so that the individual can gain control of thoughts and feelings. The therapy educates patients about their symptoms and teaches patients to use breathing techniques to help individuals relax to help manage their distress. Recently, interpersonal treatment (IPT) was found to have comparable efficacy to PE among PTSD patients.16 In addition to psychotherapy, different medications such as selective serotonin reuptake inhibitors (SSRIs) can be prescribed to aid in the reduction of symptoms of anxiety and depression. A recent study has shown better rates of symptom alleviation when SSRIs are used in conjunction with therapy, as opposed to just therapy alone. Our team is continuing to investigate new and innovative approaches, such as Attention-Bias Modification Treatment, which is offered as part of our ongoing research. Evidence-based, effective treatment for PTSD and other problems are offered to all with current or past US military service and their families.17
Addressing Gaps in the Research of PTSD
Despite extensive efforts to develop and test new treatments for PTSD, available treatments have shown only limited efficacy. The cause of limited treatment efficacy may lie not only in the treatments themselves but also in the heterogeneity within the diagnosis of PTSD. PTSD is frequently comorbid with other disorders; it lacks clear biological margins as it shares its biological underpinnings with other disorders. In addition to our treatment program, our lab has been focusing on addressing these problems. Informed by extensive cross-species research of fear and reward processes our research projects aim to characterize the aberrant circuitries in PTSD in order to expand knowledge about the pathophysiology of PTSD, and identify treatment targets that would potentially drive the development of novel PTSD treatments, for which measurable, replicable targets hardly exist
- Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13-22.
- Neria Y, Nandi A, Galea S. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2007:1-14.
- Shultz JM, Marcelin LH, Madanes SB, Espinel Z, Neria Y. The "Trauma Signature:" understanding the psychological consequences of the 2010 Haiti earthquake. Prehosp Disaster Med. 2011;26(5):353-366.
- Neria Y, Wickramaratne P, Olfson M, et al. Mental and physical health consequences of the September 11, 2001 (9/11) attacks in primary care: a longitudinal study. Journal of traumatic stress. 2013;26(1):45-55.
- Gross R, Neria Y, Tao XG, et al. Posttraumatic stress disorder and other psychological sequelae among world trade center clean up and recovery workers. Ann N Y Acad Sci. 2006;1071:495-499.
- Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y. Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLoS One. 2012;7(6):e38915.
- Neria Y, Gross, R., Litz, B., Maguen, S., Insel, B., Seirmarco, G., Rosenfeld, J., Suh, E.J., Kishon, R., Cook, J., & Marshall, R.D. . Prevalence and psychological correlates of traumatic grief among bereaved adults 2.5-3.5 years after September 11th attacks. Journal of traumatic stress. 2007;20:251-262.
- Neria Y, Olfson M, Gameroff MJ, et al. Trauma exposure and posttraumatic stress disorder among primary care patients with bipolar spectrum disorder. Bipolar Disord. 2008;10(4):503-510.
- Neria Y, Bromet EJ, Sievers S, Lavelle J, Fochtmann LJ. Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. J Consult Clin Psychol. 2002;70(1):246-251.
- Westphal M, Olfson M, Gameroff MJ, et al. Functional impairment in adults with past posttraumatic stress disorder: findings from primary care. Depression and anxiety. 2011;28(8):686-695.
- Ghafoori B, Neria Y, Gameroff MJ, et al. Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: a study in primary care. Journal of traumatic stress. 2009;22(3):218-226.
- Neria Y, Gross, R., Olfson, M., Gameroff, M.J., Wichramaratne, P., Das, A., Pilowsky,D., Feder, A., Blanco, C., Marshall, R.D., Lantigua, R., Shea, S., & Weissman, M.M. Posttraumatic stress disorder in primary care one year after the 9/11 attacks. General Hospital Psychiatry. 2006;19(47):22.
- Neria Y, Solomon Z, Ginzburg K, Dekel R, Enoch D, Ohry A. Posttraumatic residues of captivity: a follow-up of Israeli ex-prisoners of war. J Clin Psychiatry. 2000;61(1):39-46.
- Neria Y, Sullivan GM. Understanding the mental health effects of indirect exposure to mass trauma through the media. Jama. 2011;306(12):1374-1375.
- Levin A, Besser A, Albert L, Smith D, Neria Y. The effect of attorneys' work with trauma-exposed clients on PTSD symptoms, depression, and functional impairment: a cross-lagged longitudinal study. Law Hum Behav. 2012;36(6):538-547.
- Markowitz JC, Petkova E, Neria Y, et al. Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD. Am J Psychiatry. 2015:appiajp201414070908.
- Schneier FR, Neria Y, Pavlicova M, et al. Combined prolonged exposure therapy and paroxetine for PTSD related to the World Trade Center attack: a randomized controlled trial. Am J Psychiatry. 2012;169(1):80-88.