Ottawa Citizen | November 11, 2013

What is post-traumatic stress disorder

FILE – In this Jan. 15, 2008 file photo, an injured Israeli woman is seen after a rocket fired by Palestinian militants from inside the Gaza Strip hit the southern Israeli town of Sderot. An international human rights group on Thursday, Jan. 28, 2010, disputed the Hamas militant group’s claims that it did not target civilians during last year’s war against Israel. (AP Photo/Ariel Schalit, File) ORG XMIT: JRL106

According to an internationally accepted definition by the American Psychiatric Association, to be diagnosed with post-traumatic stress disorder a person has to have four symptoms and all must have been caused by being involved in or observing a traumatic event or series of traumatic events.

Intrusive memories: These are a re-experiencing of the traumatic event — flashbacks that can last minutes or days. These flashbacks can be so powerful that a sufferer is unable to concentrate on anything else.

Avoidance: PTSD sufferers are often reluctant to leave their homes for fear of being reminded of the traumatic event that caused the injury. Avoidance can take many forms, but PTSD sufferers often withdraw from both their families and society.

Emotional numbing: Often the most debilitating symptom, this can include memory loss, self-blame, estrangement from friends and family and sexual and other relationship difficulties.

Hyper-arousal and anxiety: This commonly includes insomnia, bouts of anger, irritability, depression and startled responses to sounds such as sirens that remind a person of the original traumatic incident.

How PTSD is treated?

Medication: Treatment often begins with anti-depressant and anti-anxiety medications as well as sleep medication, but mental health professionals agree that while drugs can ease or mask some of the most common symptoms, they cannot cure or successfully treat PTSD.

Exposure therapy: The first non-medication phase of treatment is typically the toughest and begins with a PTSD sufferer orally recounting the traumatic event or events and the context in which they took place. The therapist records the account and the client takes the recording home with instructions to repeatedly replay it. This ‘slaying the demon’ treatment is designed to lessen the impact of the traumatic memory to a level the client can at least live with.

The client also lists places he or she avoids — such as supermarkets, crowded events or driving in traffic — and over the course of therapy goes into those situations, typically with the least distressing one first.

Cognitive therapy: This “talk therapy” is aimed at changing ways of thinking. For example, it encourages clients to identify and change negative thoughts and change the emotional responses that stem from the trauma.

Eye movement desensitization and reprocessing (EMDR): Developed and introduced by American psychologist Francine Shapiro in 1989, EMDR is now a commonly used tool in the treatment of PTSD. It combines exposure therapy and controlled eye movement. The therapist asks the client to focus on the trauma in multiple sets of between 15-30 seconds while moving his or her eyes from side to side. The therapist gradually encourages positive images to counter the brief scenes of trauma.

Chris Cobb