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PTSD: An Interview with Dr. Joe Verga

What are some of the symptoms of PTSD?

Diagnostically, PTSD is grouped with anxiety disorders but differs from most anxiety disorders in its cause, main symptoms and its severity.  Research has shown that psychological trauma actually results in changes in the brain.

PTSD is caused by some type of severe trauma i.e. being in a life threatening situation, experiencing or witnessing severe injury or death, a severe personal injury, or being severely abused or violated.  In such a situation, the person has no way to process that experience consciously with reasoning and cognition which would be the usual way.  Instead, it is processed in a more primitive way in order to protect the individual from the overwhelming nature of what has happened.  This enables the person to survive at the time but leaves the person vulnerable to later problems.

In your work with veterans, what type of situations may cause PTSD?  How might their lives be impacted when they return home?

Combat is full of life-threatening situations-- being under fire, the threat of capture, seeing comrades wounded or killed. The conflict in Iraq has included a lot of urban warfare with IEDs resulting in maiming and mutilation.  Exposure to this type of trauma puts returning veterans at particular risk for developing PTSD.

When there is trauma, shock is instant, PTSD is not.  Not everyone who is traumatized will develop PTSD. Other factors which may contribute to its development include early life experiences, individual makeup and certain cultural norms relating to how emotions are handled which may make a person more or less vulnerable.

Symptoms of PTSD may include: 
     --emotional distress
     --hyper arousal, over reaction
     --hyper vigilance, always on guard
     --exaggerated startle response
     --dissociation

Another symptom with which people may be familiar is flashback.  This can be triggered by a sight, sound or smell.  A loud noise, such as a car backfire, can trigger memories of gunfire.  I have worked with Vietnam veterans who went into tunnels after the enemy, and as a result the smell of hay or urine has become an intense trigger.  The availability of 24/7 news coverage and continual rerunning of news stories may be a visual trigger.

Most often we hear about PTSD as it relates to veterans.  What type of situations may cause PTSD for others?  How might it affect their day-to-day lives?

Any life threatening situation has the potential to cause PTSD. It could be a robbery, being held at gunpoint, a sexual assault or witnessing or being involved in an accident with severe injury.  Mental health professionals who are specially trained in crisis debriefing go over what has happened in a way that helps relieve the stress and potential long-term effects of a situation.  They can provide an individual with a venue for facing and normalizing feelings, to provide a way to name them, know what to expect, and how to help avert PTSD.

PTSD is not as readily recognized in the average person as it is in veterans.  They may suffer from panic attacks, sleep disturbances, or have generally decreased functioning.  They may be hypersensitive in relationships, almost brittle, and may feel threatened or fearful.  All of this may lead to a diagnosis of depression or an anxiety disorder rather than PTSD.  The result will be treatment of symptoms rather that a correct diagnosis and attention to the underlying cause.

What should a spouse, family member or friend look for if they suspect someone may have PTSD?

In life in general, moods may cycle for a few days or even a few weeks.  With PTSD the recurrence of symptoms goes on for a very long time.  If you are aware of any exposure to trauma within the past 6 months, a professional evaluation should be considered.

If the trauma took place in early childhood, they may have been misdiagnosed several times with the focus on anxiety, depression or behavioral issues.  Palliative care, treating only the symptoms rather than the underlying causes, will not bring healing. 

What help is available or successful in treating PTSD?

There are many resources available in the mental health community and through the Department of Veterans Affairs which can be brought to bear.  The first step is always a correct evaluation and diagnosis.  Treatment may combine medication for symptom relief and therapy to relieve and work through the source of the trauma.

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