Post-Traumatic Stress: Overcoming the Trauma

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Recognizing PTSD

A: Exposure to a traumatic event that involved actual or threatened death and caused a response of intense fear or helplessness.

B: Persistent re-experiencing of the event in the form of nightmares, flashbacks, and painful memories.

C: Avoidance—Numbing of emotions and thoughts, feelings of detachment, inability to recall important aspects of the trauma.

D: Hyperarousal—difficulty sleeping, irritability, outbursts of anger, exaggerated startle response.

E: Criteria B, C, and D persist for at least one month.

F: The symptoms significantly affect social and vocational abilities.

Source: Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV), pub. by the American Psychiatric Association, Washington, D.C., 1994.

by Stuart Overlin, NurseZone contributor

Post-traumatic stress disorder (PTSD) can strike anyone who has survived a horrifying and life-threatening experience such as war, terrorism, natural disaster, violent crime, or rape. Its victims—males and females of all ages, ethnicities and backgrounds—suffer in varying degrees from its effects. Often misunderstood or undiagnosed, PTSD does have some very clear symptoms: recurring "flashbacks" and nightmares, emotional numbness, insomnia and a sense of impending danger long after the actual threat is gone.

The National Mental Health Association (NMHA) reports that at least 3.6 percent of U.S. adults, or 5.2 million Americans, suffer from PTSD each year. Yet another byproduct of traumatic events, secondary PTSD, affects rescue workers, police officers and caregivers, including nurses. Post-traumatic stress therefore demands the special attention of nurses, both in caring for their patients and for their own mental well being.

Basic Facts About PTSD

"Post-traumatic stress disorder" is a recent clinical term for a phenomenon presumably as old as trauma itself. Only in the wake of the Vietnam War, as the veteran population was being studied more closely than ever before, did researchers establish the connection between "combat fatigue" and the disorder among many victims of rape, child abuse, train wrecks, earthquakes, the Holocaust and other severe traumas. The American Psychiatric Association formally defined PTSD in 1980, listing it in the "Diagnostic and Statistical Manual of Mental Disorders—Third Edition" as an anxiety disorder.

According to "The Post-Traumatic Stress Disorder Sourcebook," written by Glenn R. Schiraldi, PTSD is a natural human reaction to an overwhelmingly terrible experience, but not everyone who experiences trauma will suffer from it. PTSD most often surfaces within three months of the trauma. The disorder is labeled as acute if resolved within those three months, and chronic if the problem extends beyond that. Deliberate human traumas—such as murder, terrorism, and rape—can cause particularly devastating cases of PTSD by eroding the victim’s faith in humanity.

Seemingly ordinary sights, sounds or smells can trigger a sudden flashback, in which the person believes he or she is actually reliving the traumatic experience, as explained by the American Psychiatric Association article, "Let’s Talk Facts About Posttraumatic Stress Disorder." Anniversaries and reminders of the event are often especially painful. Many who suffer from PTSD attempt to "self-medicate," abusing alcohol or drugs to ease the pain of their flashbacks, nightmares and unpleasant thoughts. The disorder is closely associated with depression, and a person with chronic PTSD may be at risk for suicide.

The Ripple Effect: Secondary PTSD in Caregivers

Nurses and other caregivers who are frequently exposed to trauma victims are susceptible to what is known as secondary traumatic stress disorder, or "compassion fatigue." Witnessing the effects of traumatic events, when combined with job stress and long hours, can lead to symptoms that resemble those of direct PTSD: intrusive images and thoughts, emotional withdrawal, irritability and anxiety, as explained by the International Society for Traumatic Stress Studies, Indirect Trauma." According to a recent report from the Washington-based Advisory Board Company, which studies healthcare trends, 90 percent of intensive care unit nurses show some symptoms of secondary PTSD.

"What we see most often with nurses is a post-traumatic stress reaction, which is not the same thing as full-blown PTSD," says Penelope Buschman, RN, MSN, CS, director of the Psychiatric Mental Health graduate program at Columbia University. "Nurses, especially in acute care units or burn units, are sometimes traumatized vicariously by what they see. Some of the telltale signs of trouble are fatigue, burnout, absenteeism, alcohol abuse and poor judgment. Even so, it can be difficult for us as nurses to recognize it in ourselves because we’re the ones who are supposed to be ‘OK.’ We’re the ones giving care."

Treatment of PTSD

Fortunately, the potentially debilitating effects of PTSD are very treatable. The basic treatment methods are:

  • Psychiatric care: With cognitive-behavioral therapy and group therapy, the patient repeatedly relives the frightening experience under controlled conditions to help him or her work through the trauma. Mental health professionals also use relaxation techniques such as hypnotherapy.
  • Medication: Antidepressant medications such as Prozac and Zoloft have proven helpful in managing the symptoms of depression and anxiety and promoting sleep.
  • Support groups: Connecting with others who have survived similar experiences can be very important in the healing process. A variety of support groups, many of them based on the Alcoholics Anonymous 12-step model, are available throughout the United States.

Nurses play a vital role in helping people who suffer from PTSD. "By virtue of their communication skills and knowledge base, nurses can help assess PTSD in their patients," says Laura Cox Dzurec, dean and professor at the University of Connecticut School of Nursing. "They can refer patients with post-trauma difficulties to a mental health professional or their local department of mental health for follow-up."

Secondary PTSD: Caring for Yourself

For nurses whose work exposes them to trauma, coping with secondary PTSD begins with candid self-assessment. Dr. Michael Skopek, a practicing psychiatrist in San Diego, California, told NurseZone that nurses should look within while considering a few simple questions: "Do you constantly deal with life-and-death issues or serious trauma issues? How often do you take home fear and a sense of helplessness? Does your work with trauma victims cause recurring thoughts, images or nightmares? Do you experience physiological reactions? Do you attempt to avoid thinking about work or talking about it, and do you feel detached or numb to it?"

If you find yourself answering "yes" to these questions, you may be suffering from secondary PTSD. Most cases can be treated through basic self-care:

  • Eat a nutritious diet: Limit your intake of sugar, caffeine and alcohol.
  • Get enough exercise (a major stress-reducer).
  • Balance work with recreation and rest.
  • Take adequate breaks from working with trauma victims.
  • Ventilate: Talk openly with friends, family and colleagues about what you’re experiencing.

In more severe cases of secondary PTSD, consulting a mental health professional is sometimes necessary. Even then, help is available within the nursing ranks: "Look at a roster of advanced practice psychiatric nurses in your area," suggests Buschman.

"But what’s really important," she added, "is that nurses watch out for each other and interpret the signs whenever there is trauma and high stress."


Anxiety Disorders Association of America

Phone: (301) 231-9350

National Center for Post-Traumatic Stress Disorder

Phone: (802) 296-5132

National Mental Health Association

Phone: (800) 969-NMHA

October 12, 2001© 2001 NurseZone.com. All Rights Reserved.