Lifestyle Corner

It is absolutely normal to be affected by the horrific events of September 11, 2001. While all of us are affected, some of us will develop something called Post Traumatic Stress Disorder (PTSD). PTSD reactions start with a terrible event "outside the range of usual human experience and that would be markedly distressing to almost anyone," according to the American Psychiatric Association's Diagnostic and Statistical Manual.

Not surprisingly, this disorder is quite prevalent in our society, and it appears to be more common in women than men. In any given month, slightly more than six percent of women and 1.5 percent of men are estimated to suffer from PTSD symptoms. The disorder is more common than many psychiatric illnesses, including panic disorder and obsessive-compulsive disorder. In a busy primary care practice, at least one to three patients with a significant case of PTSD are seen every week.

Researchers have found that 15 to 30 percent of individuals who experience trauma develop an overt case of PTSD. The traumas most likely to lead to PTSD are different for women than they are for men.

For women, the traumas most likely to trigger PTSD include:

• Fire or natural disaster


• Witnessing injury or violence


• Life-threatening accident


• Sexual molestation


• Rape

Men, by contrast, are more likely to experience PTSD as a result of these traumas:

• Witnessing injury or violence


• Life-threatening accident


• Threat with a weapon


• Fire or natural disaster


• Physical attack

PTSD reactions evolve from sudden situations that bring on intense feelings of fear, helplessness and horror. With more than 5,000 dead in the aftermath of the September 11th terrorist attacks on the U.S., all of us feel for the people who were killed or injured. Moreover, most of us feel less safe in our homes. Americans feel violated, as the violence seen all over the world now appears on our front doorstep.

Repeatedly viewing frightening events on TV can continue to take away a basic sense of security. The continuous display of pain and horror leaves most of us feeling traumatized. When this occurs, the limbic part of the brain kicks in and activates one of three response systems: fight, flight or freeze. Which system we choose depends on many variables. For example, military training conditions soldiers to choose fight, while our culture often trains women to freeze (to take it and endure stressful situations). In nature, flight is often used for survival. Faced with situations we perceive as life threatening, our bodies focus automatically on staying alive and all feelings and physical functions are channeled to accomplish that goal.

Coming to grip with your feelings

PTSD is a complex biological reaction in the human being. The fight or flight instincts are useful at the time of the trauma, but they become harmful if this response system is left on long after the trauma is past. For example, a woman who reacted quickly to a sudden noise used her flight survival skill to get out of the World Trade Center quickly. But months later, she is still hyper-vigilant, constantly scanning her surroundings for physical danger. She stops sleeping soundly (sleep could get her killed if she doesn't hear the plane in time). It is hard for her to concentrate and her sleep is disturbed. What helped her avoid disaster on September 11, 2001 becomes hard to turn off. Especially if the threat of repeat assaults is present.

Another survival skill is "freeze" or numbing and shutting down feelings in order to survive. If medical professionals in the ER last Tuesday sat down on the floor and cried as a response to this tragedy, they would not have saved many lives. Sit down and cry in combat and you will get killed. Numbness is very effective. At some point, when the major part of the crisis is over, it is important to come to grips with the real feelings of the event and let yourself experience them. You cannot keep those feelings of numbness forever, as they, like flight, cannot be kept activated interminably.

When a tragedy of this magnitude occurs, people will often associate the feelings or events they were experiencing at the time of the attack, with sadness or withdrawal. If they were feeling happy when the trauma hit, they may avoid happiness as it makes them remember the event. They may even feel guilty about feeling happy. If they lost people close to them, they may give up closeness and trust. Some lose interest in doing things they once enjoyed. What's the point? Numbness makes it hard for survivors to take care of themselves. Our feelings usually tell us how to do that. If you can't feel, you don't choose healthy behaviors. This is often where binge eating comes into play, since it's so closely tied to depression and feelings of hopelessness.

Symptoms to look for and when to seek help

PTSD is not rare, and it is not a sign of weakness. It is normal to be affected by trauma. Take note of your feelings and reactions right now and try to optimize your ability to cope and adapt, as it appears this national response will be ongoing, with the potential for all out war.

If you feel that you are falling into self-destructive behavior patterns as a result of this terrible national trauma, be aware of this and seek help. Getting better is a slow process. Recovery doesn't erase the trauma, but it can help you deal and move forward. Try not to dismiss your pain.

Here are signs to look for to help you know whether you, a family member or friend is developing PTSD:

• After trauma, many feelings become intense and unpredictable. People with PTS reactions may feel less able to cope with many of life's typical daily stresses.

• You may be irritable, anxious, and your thoughts and behavior patterns may be disrupted.

• Sleeping and eating may be disrupted and become chaotic. Re-experiencing the event through nightmares is common.

• Reoccurring emotional reactions are common, and may be triggered by sounds, sights or watching something on TV.

• Relationships with loved ones may be strained.

• Conflict at work and home is common. Some people begin to isolate themselves and avoid social activities.

• Physical symptoms such as headaches, backaches, and stomach distress, often accompany extreme stress.

Recognizing the need to mourn

There is no one standard reaction to this kind of stress. Some people respond immediately, while others have delayed reactions of months or even years. Some feel increased chronic stress over a long time, while others recover quickly. Variables that affect recovery time include your perception of the intensity of the trauma---how close you were to the event, how much of a threat you perceived it to be as you experienced it. You need to go through the process of mourning. To give you a perspective, that grieving process normally takes about two years if your mother dies of old age, happy at home in her bed and you were expecting it. Give yourself time and don't give up!

Here are some things that can help you cope:

• Give yourself time to heal. Be patient with yourself through this difficult time. Understand that it is normal to feel sadness and to allow yourself time to adjust.

• Ask for emotional support from those who you know will listen and empathize.

• Practice self-care! By taking care of yourself, you can improve your ability to deal with stress. Eat high quality, nutritious food; avoid alcohol; and defend your sleep.

• Establish regular routines for meals and exercise, to lend a sense of security and normalcy to your life. Exercise will make you feel stronger and improve your mood.

• Avoid major decisions (moving, switching jobs, etc.) or doing anything that may add to your stress.

This is a challenging time for all Americans. The uncertainty of the future opens the door for continuing stress. It is imperative that we all cope and adjust our daily lives to learn to live with more uncertainty than that to which we are normally accustomed. This is the time when practicing stress resilient behaviors is of paramount importance. PTSD can be prevented when you understand how to adapt and continue to live each day, optimizing the way you take care of yourself as you care for others in need of support and love.

Pamela M. Peeke MD, MPH, Pew Foundation Scholar in Nutrition and Metabolism, is Medical Advisor to the NWHRC; she also is an Assistant Clinical Professor of Medicine at the University of Maryland, Baltimore, and author of the best selling book Fight Fat After Forty (Viking Press, 2000).

Click www.drpeeke.com, Dr. Peeke's Web site featuring health and wellness issues for women.