Post-Traumatic Stress Disorder PTSD Diagnosis and Treatment - PTSD Diagnosis and Treatment

Written by HealthyPlace.com Staff Writer

>Mucky: Can you talk about delayed onset?

Dr. Fenn: That is a really good question. Some people have PTSD that appears after the trauma, by many months or even up to a year, or eighteen months. However, it's not like it suddenly pops up out of nowhere. In all cases of delayed onset that I have seen studied, the person who later developed PTSD had some symptoms to start with. Just not enough of them to qualify under the official diagnosis.

There also seems to be an important characteristic common in these cases, and that is that delayed onset appears most often in people who dissociate a lot or who try to suppress their reactions, or who are extremely avoidant. It seems that these efforts at avoiding the traumatic memories or reactions are doomed to failure, but that people can keep it up for a good while.

The other important part of this is, that it points out a problem with the diagnostic system itself. There is now a lot of evidence that many people can have what is known as a sub-syndromal form of PTSD. That is they have some symptoms, but not enough to get diagnosed. It is clear that this form of the disorder is extremely debilitating for people. So even if you don't have the full disorder, you may have a problem that needs attention. I expect the diagnostic criteria to be revised on the next cycle of the code.

David: If a person experiences delayed onset of PTSD, is it that another smaller trauma, or stress, comes along to push them over the edge?

Dr. Fenn: It could be that way, but I think that the delayed onset really reflects a breakdown of a coping mechanism that tries to avoid the problem.

Medic229thAHB: What would the differences be in post traumatic stress disorder from a war or a rape case? Would they have the same symptoms?

Dr. Fenn: Yes, they mostly would have the same symptoms. However, there is a difference, but it is probably due to the fact that most war-related cases of PTSD involve multiple and ongoing traumas, where rape is typically a more limited exposure.

David: Here are a few audience comments on what's been said so far tonight, then we'll continue on with the questions:

scarlet47: David, that is what happened to me. At age seventeen I was sexually abused, and at age forty-seven I was stripped by a doctor. That experience brought on flashbacks and PTSD thirty years later!

cbdimyon: But actually it's a collection of responses, that's why syndrome seems a more useful term than disorder.

A_BURDEN: I know all this stuff about PTSD. What I need to know is, how to overcome it. I have tried everything it seems.

Medic229thAHB: I have had PTSD for twenty-seven years. How come it hasn't healed yet?

David: Do some never recover?

Dr. Fenn: PTSD can get very difficult to treat if it has been around for a long time. It is hard to say whether or not there are cases that don't recover, because especially as people adapt to the problems, they entrench their behaviors and attitude. There are multiple issues to treat. So, it is hard to know what all the relevant factors are. I do not know exact statistics, but I recall that all the treatment studies I have seen have a success rate less that 100%.

Now, with that said, I would be very reluctant to say that there might be untreatable cases. It would depend on the nature of the original trauma, the other existing problems, current stressors, and importantly, the skill of the therapist. Most of what I have seen has been very optimistic with regard to treatment success. If people feel like they are not progressing in treatment, they should always consider changing treatments or providers or both. This would be true for any problem.

However, it is also important to note that there are some chemical and structural alterations inside the brain and body. It may be that for some people, there will be some lingering problems, just like when you hurt a knee, for example, it can continue to bother you some, even after it has mostly healed.

David: Here's the link to the HealthyPlace.com Abuse Issues Community. You can click on this link, sign up for the mail list at the top of the page so you can keep up with events like this. The Anxiety Community is here.

JeanneSoCal: Does the "size" of the trauma have anything to do with how long it lasts? For instance, Viet Nam vets seem to deal with this for many years afterward.

Dr. Fenn: The "size" doesn't seem to matter as much as you would think. Some Viet Nam vets have no symptoms. However, with Viet Nam, for many, it was a very prolonged stress. As I said before, whether you think you are going to die seems to be important, so I would also think that this might have been the case for many vets. So for those reasons, PTSD might be worse. However, PTSD can also occur in relatively minor traumas like being in a fender-bender.

NOWAYOUT: Can having PTSD make you hostile?

Dr. Fenn: Yes, absolutely. Anger is one of the seventeen symptoms that constitute the syndrome. It appears to be connected both, to the heightened arousal of the body and to psychological factors.

dekam20: How do you deal with reoccurring systems of PTSD?

Dr. Fenn: Depending on the particular symptom, people can learn specific containment strategies. The overall treatment of PTSD would probably be the same for long-term resolution of the disorder. Although a good therapist will tailor the treatment to your issues.