Coping with CATASTROPHE
Once thought to strike only soldiers, PTSD diagnoses are increasingly common
In the post-World War I era, it was called “shell shock.” By the end of World War II, it was dubbed “combat fatigue.” In our more modern times, it’s post-traumatic stress disorder, or PTSD, a moniker that took hold as soldiers returned from Vietnam.
It first appeared in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 1980. In general, experts say, it arises from exposure to a life-threatening event – anything from a natural disaster to an episode of domestic abuse or assault – in short, an event that changes the body’s response to stress. In Bergen County, “we saw a spike after 9/11 and again after Hurricane Sandy,” says Michael J. Tozzoli, MSW, LCSW, chief executive officer of West Bergen Mental Healthcare and a practicing therapist.
Though experts sometimes disagree on whether a person can have PTSD and be unaware of it, most agree that delayed onset PTSD is a reality, with symptoms materializing at least six months after the life-threatening event. Even in textbook cases of PTSD, the disorder is not diagnosed until at least 30 days after the traumatic event.
Dr. Gabriel Kaplan, medical director for Behavioral Health Services at Bergen Regional Medical Center in Paramus, says PTSD is defined as one of several anxiety disorders with one very important characteristic.
“It develops when you are exposed to a very stressful stimulus,” Kaplan says. “It has to be a major traumatic event, such as a car accident, war and terror, for which symptoms then cause significant disruption to your life. Women who were abused as children and children who have been abused, particularly when the abuse is sexual or physical and is unknown to the rest of the world, can have delayed onset PTSD.”
“Any range of events can cause symptoms of PTSD,” Tozzoli says. “Generally, the event is a psychologically significant event that causes ongoing anxiety, depression and other feelings. This can
include losing a baby, physically abusing relationships and, of course, a period of time away from one’s family in a war zone.”
According to the American Psychiatric Association, symptoms of PTSD can include vivid flashbacks or nightmares in which they relive the experience, as well as feelings of detachment, often avoiding close relationships or situations that might trigger painful memories. Those who suffer from PTSD are often highly irritable and hyperaroused.
“PTSD symptoms generally come on slowly but can escalate rapidly,” Tozzoli says. “It can be a matter of months, or it can take even longer than that. Symptoms can range from depression and significant anxiety to avoidant behaviors. Often these symptoms are co-mingled with coping mechanisms that can be maladaptive, like alcohol or drug use.”
One of the most vexing questions about PTSD is why some people get it and others don’t.
“There is some research,” Tozzoli says, “that suggests there is a genetic component to all anxiety disorders, including PTSD. However, the levels of PTSD that are experienced in a war zone far outweigh any genetic predisposition.”
“We don’t know with certainty what the risk factors are,” Kaplan says. “But it’s generally believed that the healthier you are emotionally, the less likely you are to develop it, and conversely, if you have had previous stresses in your life, you are more likely to develop PTSD.”
Kaplan notes that the severity of the trauma is also a factor.
“The theory now is that there is a connection between a person’s genetic vulnerability to it and their exposure,” he says.
A former Veterans Affairs physician with considerable experience treating veterans with PTSD, Kaplan says, “Mental health diagnoses are never
“We no longer believe that the will to get better makes you get better. But the will to get better makes you more motivated to receive care, and if that’s the case, you will probably have a better outcome.”
DR. GABRIEL KAPLAN MEDICAL DIRECTOR FOR BEHAVIORAL HEALTH SERVICES, BERGEN REGIONAL MEDICAL CENTER, PARAMUS
“Any range of events can cause symptoms of PTSD. Generally, the event is a psychologically significant event that causes ongoing anxiety, depression and other feelings." MICHAEL J. TOZZOLI,
CHIEF EXECUTIVE OFFICER, WEST BERGEN
easy to make. But for experts familiar with PTSD, it can be relatively easy to recognize.”
Treating PTSD is a process. In most cases, Kaplan uses a two-pronged approach to treatment.
“Psychotherapy [cognitive behavioral therapy] helps patients reframe their thoughts,” he says. “It’s a very pragmatic therapy, but it’s not always effective.
In addition, Kaplan uses medication to address specific symptoms, including anxiety and depression. “There is no one medicine for PTSD,” he says. “The specific protocol,” Tozzoli says, “uses cognitive behavioral therapy, a structured process that involves, in the broadest sense, changing negative thoughts to neutral ones. In addition, medication is often useful as an additional modality but is often not the main focus of treatment.”
The odds of beating PTSD are good. “We no longer believe that the will to get better makes you get better,” Kaplan says. “But the will to get better makes you more motivated to receive care, and if that’s the case, you will probably have a better outcome.”
In addition, Kaplan notes that though there no real breakthroughs in treatment, medical research at VA hospitals is ongoing.
“Because returning combatants have a high frequency of PTSD,” he says, “the VA is at the forefront of research.” The brightest spot on the horizon? “Many people with PTSD will get well,” says Kaplan, who recommends sufferers adopt a lowstress lifestyle, as studies reveal a risk associated with a repeat episode. “According to various research, 30 to 50 percent of PTSD patients will resolve their symptoms.”
Tozzoli says the duration of treatment depends of the level of symptoms.
“Some level of treatment may be needed for a number of years,” he says, “but the intensity of the cognitive behavioral therapy can last 12 to 18 months. As with all emotional illnesses, we encourage people to seek treatment sooner rather than later. Small fires are easier to put out than big fires.”