Posttraumatic stress disorder

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Posttraumatic stress disorder (PTSD) is a mental disorder that can develop after an organism is exposed to stressful events or threats either real or imagined. Symptoms may include disturbing thoughts, feelings, or dreams related to the incidents, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response.

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  • In recent clinical trials, 61 percent of 107 participants no longer had PTSD symptoms two months after MDMA-assisted psychotherapy. Sixty-eight percent were still PTSD-free a year later. In light of findings like these, the FDA recently deemed MDMA a "breakthrough therapy," putting it on the fast track for approval.
  • I have instructed the Joint Chiefs, and up and down the chain of command, that they have a responsibility to de-stigmatize mental health issues and issues of PTSD, and help to explain to everybody in all of the units under their command that there's nothing weak about asking for help.
  • People with PTSD are afflicted with three primary types of symptoms.
    The first type of symptoms involves all manner of intrusive memories of the event that often come with startling clarity via flashbacks and nightmares. Along with anything else that reminds a person of the trauma, these intrusive memories produce profound psychological distress and physical symptoms, such as a pounding heart.
    The second type of symptoms revolves around avoidance and emotional numbing.
    Bedeviled as they are by unwanted memories, images, nightmares and flashbacks that keep the terrifying reality of their experience emotionally alive for them, people with PTSD often go to heroic lengths to avoid anything in the personal or physical environment that reminds them of the trauma.
    They often also report feeling emotionally deadened, unable to love and disinterested in things others find pleasurable. Often they feel like they will die young or have less of a future than other people.
    The third and final symptom domain of PTSD is known as hyperarousal. Hyperarousal symptoms include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, being hypervigilant and finally, demonstrating an exaggerated startle response.
    These PTSD symptoms usually don't travel alone, unfortunately, but are frequently accompanied by depression and difficulties with drugs and alcohol.
  • There is another symptom of acute trauma that can be easily missed if you are not on the lookout for it that strongly predicts the development of later PTSD. In layman's parlance, we might call it "being spaced out." More technically, we call it dissociation.
    When people dissociate, things come apart in a variety of ways.
    Often they feel separated from themselves, as if they are watching themselves from some outside vantage point. Frequently they feel that there is some type of invisible wall between themselves and the rest of the world. Sometimes they will feel that everything in the world, including themselves, is somehow unreal.
    I've heard patients describe this experience as being like looking at the world through the wrong end of a telescope, so that everything seems smaller and distorted. In extreme instances, people so thoroughly lose track of things that they develop amnesia.
  • For years I have agitated against the diagnostic jargon, Post-Traumatic Stress Disorder (PTSD), because transparently we are dealing with an injury, not an illness, malady, disease, sickness, or disorder. My insistence comes from awareness that within military forces it is entirely honorable to be injured, and that if one is injured and recovers well enough to be fit for duty, there is no real limit to one's accomplishments, even if a prosthesis is employed. Witness the honored career of General Eric Shinseki, who lost a foot in Vietnam, and eventually retired from the U.S. Army as chief of staff. We do not describe him as suffering "Missing Foot Disorder."

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