Post Traumatic Stress Disorder ...

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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
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
© Humana Press, a part of Springer Science + Business Media, LLC 2009
All rights reserved. This work may not be translated or copied in whole or in part without the written
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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).
v
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