Q: My husband was mugged in an poorly-lit parking garage a few months ago. Although he sustained very minor physical injuries, his whole personality seems to have changed, and he's become isolated, irritable, unsociable, and jumpy. He can't concentrate and is making mistakes on his job. He denies it, but I hear him talking in his sleep like he's having bad dreams a few nights a week. And he's used up all his sick days at work. Sometimes he tells me he thinks he thinks he's going crazy. Is he?
A: Probably not crazy, but suffering from a psychological syndrome related to his frightening experience, called posttraumatic stress disorder, or PTSD. Diagnostically, this is defined as "a syndrome of emotional and behavioral disturbance that often follows exposure to a traumatic stressor that injures or threatens self or significant others, and that involves the experience of intense fear, helplessness, or horror." PTSD manifests itself through a characteristic set of symptoms, which may include most or all of the following.
Anxiety. Patients describe a continual state of free-floating anxiety, and maintain an intense hypervigilance, scanning the environment for impending threats of danger.
Physiological Arousal. The patient's nervous system is on continual alert, producing increased bodily tension in the form of muscle tightness, tremors, restlessness, heightened startle response, fatigue, heart palpitations, breathing difficulties, dizziness, headaches, or other physical symptoms.
Avoidance/Denial. Patients try to blot out the event from their minds. They avoid thinking about or talking about the traumatic event, as well as news items, conversations, or TV shows that remind them of the incident.
Intrusion. Despite patients' best efforts to keep the traumatic event out of their minds, the disturbing incident pushes its way into their consciousness, typically in the form of intrusive flashbacks by day and/or frightening dreams at night.
Repetitive Nightmares. Sometimes the patient's nightmares replay the actual traumatic event; more commonly, the dreams echo the general theme of the trauma, but partially disguise it with different content. Sleep disorders may lead to daytime fatigue, with associated impairment of daily activities.
Irritability. There is a pervasive edginess, impatience, loss of humor, and quick anger over seemingly trivial matters. The person is no joy to live with.
Withdrawal and Isolation. The patient shuns friends, schoolmates, and family members, having no tolerance for the petty, trivial concerns of everyday life. This may spur resentment and counteravoidance, leading to a vicious cycle of mutual rejection and eventual social ostracism of the patient.
Although traditionally associated with wartime trauma - where it has been variously referred to as "shell shock" or "battle fatigue" - PTSD is also commonly seen in civilian casualties, such as traffic accidents, medical crises, criminal assault, and most recently, terroristic trauma. It can also be seen among "first responders," such as police officers, firefighters, and paramedics, who develop what is called critical incident stress following particularly horrific emergency calls, such as terrorist bombings, child murders, or plane crashes.
It is important to realize that PTSD is not just a "made up" syndrome. In a clinical setting, changes can be measured in the patient's psychological and neurophysiological functioning. However, in the legal context, there may be some skepticism about PTSD, since many of the symptoms are subjective - similar to the situation with postconcussion syndrome and chronic pain (see those columns).
The good news is that the vast majority of PTSD sufferers largely recover in about 6 to 12 months. Many of those with persisting symptoms can be treated effectively. In a small minority of patients, PTSD constitutes a long-term disabling psychological injury, and efforts continue to learn how best to help these individuals reclaim their shattered lives.
Laurence Miller, PhD is a clinical, forensic, and consulting psychologist in Boca Raton, Florida. This information is for educational purposes only, and is not intended to make a clinical diagnosis or render a legal opinion. Dr. Miller can be reached at 561-392-8881, or at email@example.com.
© 2005, Laurence Miller, PhD. All rights reserved. This article may not be reproduced in whole or in part without the express written consent of Dr. Miller.