The cause of post-traumatic stress disorder
Dear Dr. Bob: What causes post-traumatic stress disorder, and what are the best methods to help people open up about their traumatic experiences and overcome them?
If a traumatic experience is very severe, an individual can try to avoid the unpleasant memories by shutting down or putting a lid on them. Suppressing the vividly fearsome and horrible images enables the individual to escape temporarily from the feelings of horror, anxiety, and depression associated with the experience. Without being able to suppress the shocking imagery of the event, a person may develop an acute traumatic disorder that sticks with the person even when the terrifying event has ended.
Depending on the severity of the trauma and also on the personality traits of the individual, flashbacks to the sounds and images of the terrible experience may occur that involuntarily push the lid off the memories. Post-traumatic stress disorder (PTSD) can emerge decades after the initial trauma was experienced, often triggered by some event that brings the memories back.
PTSD can continue for a long time and is accompanied by anxiety, depression, irritability and anger, problems in family relationships and at work, alcohol and drug abuse, and bad dreams. Startle reactions and frightening flashbacks may occur when a noise or situation occurs that is reminiscent of the traumatic event. Veterans of war, for example, may be startled and experience a momentary flashback to a battle scene if they hear a car backfire, a helicopter fly overhead, or see a bloody and realistic war movie.
While some medications—usually antidepressants—can reduce the symptoms of PTSD, the best way to treat this illness is to expose sufferers in their imaginations to the very traumatic experiences that they have been trying to shut down. Re-experiencing the traumatic event—called exposure through mental imagery—often reduces and even eliminates the symptoms of PTSD. But the treatment must be done gradually and with individualized attention to the needs of each patient. Only an experienced and trained expert should offer exposure treatment.
Dear Dr. Bob: Can you explain the difference between Bipolar I and Bipolar II disorder?
Bipolar disorder refers to episodes when an individual experiences mania alternating with depression. Bipolar I is much more extreme than Bipolar II, but both can be disabling. Many famous and successful people have Bipolar II disorder without ever knowing it because it enables them to be so productive and fun during their “hypomanic” periods.
Hypomania is not as extreme as full blown mania. Mania refers to euphoria and excessive energy levels that are not anchored to any realistic explanation, as well as elevated or irritable mood, abnormal “highs,” and inflated self-esteem or grandiose ideas. During the manic period in Bipolar I disorder, the individual has racing thoughts and is more talkative than usual with a pressured speech that is sometimes hard to follow. Other signs of mania—which lasts at least one week—include hyperactivity, distractibility, less need for sleep, unrestrained spending sprees, sexual indiscretions, or foolish business dealings.
In Bipolar II disorder, the episodes of expansiveness and elevated mood are often not significantly above what passes as normal. Almost always, periods of depression follow the manic or hypomanic phase, hence the alternative term “manic depression.” The depressive phase lasts much longer than the mania or hypomania and is the primary cause of disturbances in the social and occupational functioning of afflicted individuals.
| Article Author: |
Robert Liberman, MD |
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