Hollywood has made millions of dollars portraying the popular notion of post-traumatic stress disorder: A combat veteran seemingly loses his mind while having flashbacks of blood and mayhem on the battlefield years after the war ended. In truth, post-traumatic stress disorder is not confined to veterans. Anyone who has experienced or witnessed any life-threatening or highly traumatic event may be vulnerable to post-traumatic stress disorder, or PTSD. Witnesses or victims of violent crime, such as rape, domestic violence, kidnapping, armed robbery, or assault, and people who lived through fires, earthquakes, hurricanes, plane crashes, major traffic accidents, other disasters, even rescue workers, all are susceptible to PTSD. This is especially true when a loved one died in the disaster. Why some people who suffer traumatic events develop PTSD and others do not is a mystery. Research suggests one possible explanation, that people with PTSD tend to have abnormal levels of key hormones involved in response to stress.

Symptoms

According to DSM-IV, the American Psychiatric Association's diagnostic manual, there are two precipitating components to PTSD:

• The person experienced or witnessed an event that involved real or threatened death or serious injury to themselves or to others
• The experience evoked feelings of intense fear, helplessness, or horror.

Symptoms vary but often involve reliving the ordeal in the form of flashbacks, distressing memories, nightmares, or frightening thoughts, especially when exposed to something reminiscent of the trauma or on the anniversary of their trauma, according to the National Institute of Mental Health (NIMH). Emotional numbness, feeling detached from other people, sleep disturbances, depression, anxiety, guilt, irritability, or angry outbursts are not unusual among PTSD sufferers. Not surprisingly, PTSD often interferes with a person's ability to shoulder responsibilities at work or school. The disorder can also spark conflicts with friends and family members.

Symptoms typically begin within a few hours or days of the traumatic event, and PTSD is diagnosed when symptoms last more than one month. More than 4 percent of the U.S. population, or at least 5.7 million people, experience PTSD each year, according to the NIMH and the Department of Veterans Affairs. A similar but abbreviated form of PTSD, acute stress disorder, is a relatively new diagnosis that is made when symptoms last from two days to four weeks and occur within four weeks of the trauma.

Treatments

Currently, no particular drug has emerged as a definitive treatment for PTSD, although medication is clearly useful for the symptom relief that makes it possible for survivors to participate in psychotherapy. According to the National Center for PTSD, pharmacotherapy (medication) can reduce the anxiety, depression, and insomnia often experienced with PTSD, and in some cases may help relieve the distress and emotional numbness caused by trauma memories. Several kinds of antidepressant drugs have achieved improvement in most (but not all) clinical trials, and some other classes of drugs have shown promise. Research has shown that many PTSD patients have improved markedly with cognitive-behavioral therapy, group therapy, or exposure therapy. Support from family and friends can also aid recovery. One large study of Vietnam veterans found that soldiers who had good social support after they returned home were less likely to develop PTSD, according the NIMH. Other studies show that counseling people as soon as possible after a catastrophic event may reduce some PTSD symptoms. One study of 12,000 schoolchildren who lived through a hurricane in Hawaii found that those who got counseling early were doing much better two years later than those who did not. According to the American Psychiatric Association, early intervention may include taking sleep medication, obtaining professional counseling, and freely venting feelings as soon as possible after the traumatic event.

A new but controversial psychotherapeutic technique, eye movement desensitization and reprocessing, has been shown to benefit people with PTSD and certain other anxiety disorders. During the EMDR therapy session, the patient recalls the traumatic event, including any thoughts, feelings, and memories the event evokes. The therapist then holds his or her fingers about 18 inches from the patient's face and moves them back and forth quickly. The patient tracks the finger movements with his or her eyes while concentrating on the traumatic memory. When the therapy works, the painful feelings associated with the trauma transform into more peaceful emotions. According to the Eye Movement Desensitization and Reprocessing Institute, 14 controlled studies support the effectiveness of EMDR, "making it the most thoroughly researched method ever used in the treatment of trauma." The most recent 5 studies with individuals suffering from PTSD found that 84 to 90 percent of patients no longer had PTSD after three treatment sessions. Critics contend that close scrutiny of the research studies investigating EMDR show that the technique either doesn't work or is no better than existing treatments.