Imagine, if you will, that you are walking alone at night in an unfamiliar neighborhood. You think you hear footsteps behind you so you walk a little faster. Suddenly someone steps out from behind a bush. You turn around but someone is behind you as well. They are both bigger than you and you are scared to death. Possibly you are mugged or raped. Maybe you escape harm, but you've still had a harrowing experience. You could end up suffering from Posttraumatic Stress Disorder (PTSD) if you have an experience like this or have exposure to any real or a perceived life-threatening trauma where you responded with intense fear.

PTSD is a medically recognized anxiety disorder that occurs in normal individuals under extremely stressful situations. Symptoms may appear immediately and then disappear after several months. At other times symptoms may take up to 6 months to emerge and may never completely go away. Half of those who meet the DSM-IV criteria for PTSD will still suffer from symptoms a year after diagnosis and 1/3 will still have weekly symptoms ten years after the trauma.

CRITERIA FOR PTSD

* Exposure to a traumatic event marked by intense fear, helplessness or horror

* Symptoms from each of the three symptom clusters:

* Intrusive recollections (evoke panic, fear, dread, nightmares, grief, despair, daytime fantasies, etc.)

* Avoidant/numbing symptoms (avoidance of trauma related stimuli, trouble leaving the house, cannot tolerate strong emotions, etc.)

* Hyperarousal symptoms (symptoms resemble panic attacks, generalized anxiety, insomnia, irritability, startle response, hypervigilance that may come across as paranoia)

You may also use the mnemonic "DREAMS"

D = DETACHMENT

R = REEXPERIENCING THE EVENT

E = EVENT HAD EMOTIONAL EFFECTS

A = AVOIDANCE

M = MONTH IN DURATION

S = SYMPATHETIC, HYPERACTIVITY OR HYPERVIGILANCE

STATISTICS

Certain populations are more at risk than others. Here are just a few examples:

* 2% in post-partum women

* 18% in professional fire fighters

* 34% in adolescent survivors of car accidents

* 48% in female rape victims

* 67% in prisoners of war

Up to 80% of patients with PTSD will have a comorbid psychological or psychiatric disorder. The most common diseases that occur with PTSD are:

* major depression

* substance abuse

* dysthymia

* bipolar disorder

* generalized anxiety disorder

* panic disorder

* phobias

* dissociative disorders

TREATMENTS

Medications

Typical first line treatment is with selective serotonin reuptake inhibitors (SSRI's) such as Prozac, Paxil, Zoloft or Lescol. Trazadone and nefazadone (Serzone) are being re-studied since the have SSRI properties and they also reduce or suppress REM sleep, thus reducing or eliminating nightmares. Tricyclic antidepressants and MAOI's have been tried but there is no proven efficacy for these types of medications.

Benzodiazepines were once the first line of treatment but the efficacy has not been proven in controlled studies. They can also cause dependency problems for people who must deal with substance abuse issues. These types of medications also come with a variety of discontinuation problems.

Psychotherapy

Once medications relieve the most distressing symptoms a patient can then concentrate on psychotherapy. A key element to success here is beginning the initial medication treatment within two weeks of the trauma. Then the goal of therapy, breaking the pattern of self-defeat by reexamining the traumatic event and the patient responses to it, can begin. Education about the disease and recognition of cues or situations that trigger symptoms are invaluable. Complete education and healing consists of:

* Exposure

Exposure to the event via imagery allows you to reexperience the event in a safe, controlled environment where your reactions can be monitored.

* Examining

Examining feelings such as anger, shame, guilt, etc. allows you to work on resolving these feelings.

* New Coping Skills

New coping skills teach you how to handle reminders, reactions and feelings without becoming overwhelmed or emotionally numb. This can help foster your relationships with others. Some of the techniques used are:

* Relaxation (i.e. breathing techniques, visualization)

* Biofeedback

* Cognitive restructuring

* Managing Anger

* Preparing for stress reactions

* Addressing urges to use alcohol or drugs

* Communications and relating effectively with people

Group treatment has also proven to be quite helpful for PTSD sufferers. This type of setting allows you to share with others who are more empathetic to your feelings. Being able to share instills more confidence and helps you to trust again. After being allowed to share your trauma you are freer to engage proactively in current relationships.

Eye Movement Desensitization and Reprocessing (EMDR)

This is a relatively new treatment that combines elements of exposure therapy, cognitive behavior therapy and then uses techniques (eye movements, hand taps, sounds, etc.), which creates an alteration of attention back and forth across the person's midline. Fourteen controlled studies have been done on EMDR. The last five done on trauma patients (abuse, rape, accident victims, etc.) have found that 84-90% of the individuals suffered no PTSD after only three sessions. In a study for combat veterans, 77% showed no PTSD symptoms after twelve sessions. Like all therapy the progress rate depends on the individual and the type of trauma. To administer EMDR, therapists must undergo special training.