Post-traumatic Stress DisorderA disorder in which an overwhelming traumatic event is reexperienced, causing intense fear, helplessness,
horror, and avoidance of stimuli associated with the trauma.
The stressful event involves serious injury or threatened death to the person or others or actual
death of others; during the event, the person experiences intense fear, helplessness, or horror.
Lifetime prevalence is at least 1%, and in high-risk populations, such as combat veterans or victims
of criminal violence, prevalence is reported to be between 3 and 58%.
Symptoms and Signs
When terrible things happen, some persons are lastingly affected by them. Afterward, the traumatic
event is repeatedly reexperienced, usually through nightmares or flashbacks. The person persistently
avoids stimuli associated with the trauma and has a numbing of general responsiveness as a mechanism
to control symptoms of increased arousal. Symptoms of depression are common. Sometimes the onset
of symptoms is delayed, occurring many months or even years after the traumatic event. If posttraumatic
stress disorder has been present > 3 mo, it is considered chronic. If untreated, chronic posttraumatic stress
disorder often diminishes in severity without disappearing, but some persons remain severely handicapped.
Treatment consists of behavior therapy, pharmacotherapy, and psychotherapy. Behavior therapy
involves exposure to safe situations that the person avoids because they may trigger a reexperience
of the trauma. Repeated exposure in fantasy to the traumatic experience itself usually lessens distress
after some initial increase in discomfort. Preventing certain ritual behaviors, such as excessive washing
to feel clean after a sexual assault, may also help. Antidepressant and anxiolytic drugs appear to have
some benefit but are generally less effective than for other anxiety disorders. Selective serotonin
reuptake inhibitors (eg, fluoxetine, fluvoxamine, paroxetine, sertraline) and monoamine oxidase
inhibitors appear most effective.
Because the anxiety associated with traumatic memories is often extremely intense, supportive
psychotherapy plays an important role. In particular, therapists must be openly empathic and
sympathetic in their recognition of patients' psychologic pain and must validate the reality of the
traumatic experiences. At the same time, therapists must encourage patients to face the memories
as they undergo behavioral desensitization and learn techniques of anxiety control in an attempt to
modulate and integrate the memories into their broader personality organization.
In addition to trauma-specific anxiety, patients may experience guilt because they behaved
aggressively and destructively during armed combat or because they survived a traumatic experience
in which family members or close associates perished--so-called survivor guilt. In such cases, psychodynamic
or insight-oriented psychotherapy aimed at helping patients understand and modify their self-critical and
punitive psychologic attitudes may be helpful.
Please Note: As with all depressive illnesses, it is important that Muslims attempt to get advice from a
Muslim psychologist, psychiatrist, physician, or counselor. For patients that are unable to find a Muslim
physician in their area specializing in psychology, it would still be helpful if they were able to consult with a
Muslim clinician and receive advice or assistant with ensuring that the treatment program outlined is in
accordance with Islamic principles.