Post Traumatic Stress Disorder PTSD.pdf

POST-TRAUMATIC STRESS

DISORDER

POST-TRAUMATIC

STRESS DISORDER

BASIC SCIENCE AND

CLINICAL PRACTICE

Edited by

PRIYATTAM J. SHIROMANI

Harvard Medical School, Department of Neurology, VA Boston

Healthcare System, West Roxbury, MA

TERENCE M. KEANE

National Center for Post-Traumatic Stress Disorder,

VA Boston Healthcare System, Boston MA

JOSEPH E. LEDOUX

New York University, Center for Neural Science, New York, NY

Editors

Priyattam J. Shiromani

Terence M. Keane

Harvard Medical School

National Center for Post-Traumatic

Department of Neurology

Stress Disorder

VA Boston Healthcare System

West Roxbury, MA

Boston MA

Joseph E. LeDoux

New York University,

Center for Neural Science,

New York, NY

ISBN 978-1-60327-328-2

e-ISBN 978-1-60327-329-9

DOI: 10.1007/978-1-60327-329-9

Library of Congress Control Number: 2008942054

permission of the publisher (Humana Press, c/o Springer Science + Business Media, LLC, 233 Spring

Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly

analysis. Use in connection with any form of information storage and retrieval, electronic adaptation,

computer software, or by similar or dissimilar methodology now known or hereafter developed is

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The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are

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While the advice and information in this book are believed to be true and accurate at the date of going

to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any

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to the material contained herein.

Printed on acid-free paper

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Preface

Post-traumatic stress disorder or PTSD is a psychiatric condition that can

occur in anyone who has experienced a life-threatening or violent event. The

trauma can be due to war, terrorism, torture, natural disasters, accidents, vio-

lence, or rape. PTSD was once associated exclusively with military service and

characterized by the terms “shell shock” and “battle fatigue.” However, now

it is recognized that PTSD can occur in any traumatic situation and can afflict

children as well as adults. Studies across cultures, languages, and races suggest

that PTSD is a universal response to exposure to traumatic events.

In the U.S. population, the prevalence rate of PTSD is approximately 8%,

with the rate for women more than twice that for men ( 1 ) . In the aftermath

of Hurricane Katrina, the prevalence of PTSD in the New Orleans metro area

(hardest hit by the hurricane) was 30.3% compared to 12.5% in the remainder

of the hurricane area ( 2 ) . Among U.S. military personnel, a study ( 3 ) found

that during the 1991 Gulf War symptoms of PTSD were evident in 6.2% of

the deployed troops versus 1.1% of the nondeployed peers. Importantly, 10

years later the rate of PTSD among deployed veterans (Operation Enduring

Freedom-Operation Iraqi Freedom; OEF-OIF) was three times higher than in

the nondeployed peers. In the Iraq War, a U.S. Army study found that 12.9%

of the soldiers suffered from PTSD ( 4 ) . Not all individuals exposed to a life-

threatening event develop PTSD, indicating significant individual differences in

coping with the stressful event. However, prior history of trauma may increase

the risk for PTSD ( 5 ) , suggesting an additive effect of stress.

The brain’s response to trauma and stress, also termed the “fight-or-flight”

response, was first described by Walter Cannon in 1915 ( 6 ) . Its purpose is to

mobilize the body to action and protect us from danger. The cascade of chemicals

unleashed during a fight-or-flight response acts on specific brain regions, in

particular the hippocampus and amygdala, which are parts of the limbic system

related to emotion, memory, and cognition. The amygdala is especially vulner-

able because it is here that a fearful association of the event is processed and

stored.

Individuals with PTSD have memories of the event that they relive again

and again (i.e., flashbacks, nightmares, preoccupation with thoughts or images

of the events of war); they avoid people and places associated with the trauma,

becoming distressed at cues or reminders of the experience (e.g., the anniversary

of the event); and they are hyperaroused (difficulty sleeping, trouble concentrating,

hypervigilant).

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