PTSD, Trauma & Stress Disorders

The mental health implications of disasters on individuals and communities are enormous. Psychiatrists play a key role in helping to mitigate and lessen the traumatic burden and in fostering resiliency efforts.

The characteristics that bring people into the caring professions are, ironically, the very factors that make them vulnerable to vicarious trauma and job burnout. It is our responsibility to ensure that these adverse outcomes are minimized among those who have chosen such a career.

There are feasible and replicable ways for caring adults to help heal themselves as well as the next generation through mass application of reflection and altruistic caring for the remaining offspring, whether in Sichuan, Gaza, New Orleans, or Haiti.

The recent disaster that trapped 33 Chilean miners for the past 2 months piqued my curiosity as a psychiatric researcher: how will these hearty survivors cope with the aftermath of being buried alive?

Results from a study published in the Journal of Psychopharmacology suggest that MDMA combined with psychotherapy may be a safe and effective treatment for symptoms of post-traumatic stress disorder.

Any effort to develop a diagnostic manual for world-wide use must grapple with the question of cross-cultural applicability. The description and diagnostic criteria for schizophrenia must work as well in East Timor as in the US or France. In this piece I choose PTSD to show the complexity of the cultural issue for DSM-5.

The latest information released by the US Army reveals that last year American soldiers attempted suicide at the rate of about 5 /day. There were 160 successful suicides last year and during June the rate was 1/day. Military research has reported that one in 10 Iraq veterans may develop a severe case of PTSD.

In continuing efforts to help the overwhelming number of soldiers returning from Iraq and Afghanistan with PTSD, the US Army is using therapy dogs.

By teaching those with PTSD to manage the stress and pain associated with the disorder's recurring horrors and disturbances, Edna Foa , MD has earned a spot on Time Magazine’s top 100 list of the most influential people in the world.

Positive results from a new study on the drug 3,4-methylenedioxymethamphetamine (MDMA)--also known as ecstasy--may give new hope to returning war troops with posttraumatic stress disorder (PTSD).

Neuroscientists are exploring ways to erase bad memories in patients who have experienced traumatic events. This possibility raises ethical concerns: Is it ethical to erase a memory or flashback and the feelings associated with that moment to alleviate suffering, or should clinicians focus on therapies such as CBT and EMDR (Eye Movement Desensitization and Reprocessing) to help patients cope with a trauma?

When a soldier is killed while in the military service the President writes a condolence letter to the family. However, if a soldier is psychologically injured and then commits suicide, there is no Presidential letter of condolence.

Virtual reality (VR)-facilitated exposure therapy for posttraumatic stress disorder (PTSD), recently evaluated under combat conditions in Iraq, appears to be safe and effective, according to LCDR Robert McLay, research director for mental health with the US Naval Medical Center San Diego (NMCSD). Speaking at the 17th Annual Medicine Meets Virtual Reality (MMVR-17) Conference in Long Beach, Calif, McLay said that military providers need to make PTSD treatments available in such military theaters as Iraq and Afghanistan, as well as stateside. (McLay was speaking as an individual, not as a US Navy or Department of Defense representative.)

A 24-year-old veteran of Operation Iraqi Freedom (OIF) presents to the ED mid-morning on a weekday. While the veteran is waiting to be triaged, other patients alert staff that he appears to be talking to himself and pacing around the waiting room. A nurse tries to escort the veteran to an ED examination room. Multiple attempts by the ED staff and hospital police-several of whom are themselves OIF veterans-are unsuccessful in calming the patient or persuading him to enter a room.

PTSD filled a nosological gap by providing a way to characterize the long-lasting effects of trauma exposure.1 This led to a plethora of previously lacking scientific observations. Now the existence of PTSD is being called into question because some of the original assumptions that helped make the case for it have proved to be incorrect.2-4 However, it is possible to update some of the flawed assumptions of PTSD without rescinding the diagnosis. There is no reason to throw the baby out with the bathwater.

Currently the Veterans Administration (VA) is the world’s largest recipient of per patient funding for PTSD. The VA treats 200,000 veterans with this diagnosis annually at a cost of $4 billion. But research calls into question the very existence of the “PTSD” syndrome, and its diagnostic formulation remains invalid. We do not minimize the suffering of those who experience trauma or the need for comfort and restitution. We seek only to reexamine research evidence, to clarify the impact of culture on diagnosis, to reevaluate the consequences of trauma, and to ensure optimal allocation of resources.

Psychological symptoms develop in some women who are victims of physical, sexual, and psychological abuse, making it difficult for them to regain control.

Chronic posttraumatic stress disorder (PTSD) may occur secondary to combat, terrorism, civilian assaults including physical and sexual abuse, or other traumatic experiences.

Our returning military veterans remind us dramatically of the importance to consider traumatic brain injury (TBI) as a potential comorbid illness in cases of posttraumatic stress disorder (PTSD). The common causes of comorbid TBI and PTSD are assault and battery to the head, head trauma (personal or work-related injuries), civilian or military explosions, inflicted head trauma in children, motor vehicle accidents, and suicide attempts by jumping. Prevalence figures for comorbid TBI and PTSD historically have been lacking

The National Comorbidity Survey estimates that approximately 50% of the population in the United States is exposed to traumatic events and that the lifetime prevalence of posttraumatic stress disorder (PTSD) is approximately 7.8%.

Reports of 1 in 5 military service members returning from Iraq or Afghanistan with posttraumatic stress disorder (PTSD) and/or depression and rising suicide rates have led researchers and military leaders to warn civilian psychiatric care providers of a “gathering storm”1 headed their way.

Despite an abundance of studies linking both traumatic experiences and anxiety disorders with eating disorders, relatively little has been reported on the prevalence of associated posttraumatic stress disorder (PTSD) or partial PTSD in patients with eating disorders.

In recent years, we have learned a great deal about posttraumatic stress disorder (PTSD) and its public health implications. From 9/11 to Katrina and the present Iraq war, PTSD has been in the forefront of health concerns and public policy.

This is the last installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). In Part 1, I described some basic clinical observations of PTSD and the challenges these observations pose to researchers attempting to understand underlying biological substrates.1 Part 2 examined progress on addressing these challenges at the level of the tissue and cell.2 In Part 3, I will discuss efforts to understand PTSD at the level of DNA, including potential genetic underpinnings and heritable risk factors.

This is the second installment in a 3-part series discussing the behavioral, cellular, and molecular characteristics of posttraumatic stress disorder (PTSD). The first installment described clinical aspects of PTSD and how these characteristics make understanding the underlying biological substrates so challenging. In this installment, I discuss progress addressing these challenges at the tissue and cell level. In the final installment, I will review potential genetic underpinnings of PTSD, with emphasis on potentially heritable risk factors.