Emotional trauma doesn't discriminate: it can touch anyone. Trauma includes natural disaster, sexual assault, motor vehicle accidents, death of a loved one, diagnosis of a life-threatening disease, or even learning about harm to someone you love. Although feelings of stress and anxiety are very natural after trauma, women are more likely than men to suffer from long-term effects. It's important to understand how you're feeling, and know when to seek help.

The Basics of Post-Traumatic Symptoms
After a traumatic event, people experience a wide range of feelings. Most people experience some symptoms, including: interrupted sleep, thinking about the event frequently, "shaky" feelings. These symptoms typically fall into the normal range of reactions.

However, if you find yourself having difficulty functioning at work, with friends or at home with your family, then you need to consider the possibility of disorders like acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). Also, if you find yourself experiencing symptoms from previously treated problems that you thought had been resolved, these disorders (like depression or substance use) may be the reason.

The primary difference between ASD and PTSD is that in ASD the symptoms and functional impairment last less than one month; in PTSD the symptoms and dysfunction persist longer than one month. Not everyone who experiences trauma develops PTSD. In fact, only about 10 to 30 percent of people exposed to the same traumatic event are reported to develop it.

When the traumatic event is a natural or man-made disaster affecting an entire community, acute stress and anxiety may take longer than a month to fade. PTSD may not be diagnosed until as many as six months or in some cases, even a few years have passed after the disaster.

With support, most women can draw on their own reserves of strength and resilience to cope with post-traumatic stress. For women who develop PTSD, help is available.

Symptoms of PTSD
Women with PTSD experience the following types of symptoms:

• Re-experiencing the traumatic event, through:
  
  • unwanted, intrusive memories
    
  • dreams or nightmares
    
  • flashbacks

• Increased arousal, in the form of:
  
  • Anxiety
    
  • Difficulty sleeping
    
  • Irritability
    
  • Difficulty concentrating
    
  • Being easily startled or angered
    
  • Increased heart rate and breathing
    
  • Nausea, diarrhea
    
  • Intense anxiety after experiencing sights, sounds, smells or events that serve as reminders of the trauma, or on anniversaries of the trauma

• Avoidance of feeling or reminders, in the form of:
  
  • Sadness, depression, feelings of numbness
    
  • Avoiding everyday things that remind you of what happened
    
  • Guilt, self-doubt, feelings of helplessness or hopelessness
    
  • Loss of interest in activities
    
  • Emotional detachment from others

Who is at Risk?
About 7.7 million American adults have PTSD, but it can also occur in childhood. Women are more likely than men to develop PTSD after a traumatic event. Over a lifetime, about 10 percent of women will develop PTSD. However, most people with PTSD (an estimated 60 percent) never seek help and for this reason are never treated for PTSD.

For women, the traumatic event most likely to lead to PTSD is rape or sexual molestation. However, PTSD is more frequently due to the sudden death of a loved one, since losing a loved one is more common experience overall.

Women with PTSD are vulnerable to behavior leading to other problems such as drug abuse, excess drinking, or eating disorders.

Diagnosing PTSD
See your health care professional and ask for help or for a referral for therapy if:

• Your stress and anxiety doesn't lift at all, but is still just as painful about four weeks after the traumatic event (or 6 months after a community-wide disaster)
  
• You find that your feelings or reactions interfere with your functioning at work (or your ability to look for work), your interactions with friends (or your ability to maintain relationships with friends or community members), or your family life at home.
  
• You feel that you must have professional help to cope.
  
• You have trouble taking care of yourself.
  
• You need to talk to a counselor about your grief.
  
• Your grief is still just as painful and hard to cope with about a year afterward.
  
• You need alcohol or drugs to get through the days or nights.

Your doctor may refer you to a mental health professional, such as a psychiatrist (a medical doctor with a specialty in psychiatry, who can prescribe medication), a psychologist (a licensed therapist with a background in psychology and either a doctorate or master's degree), or a counselor (a licensed or certified individual with supervised training in psychology).

Treating PTSD

Medical Approaches

Medications that raise serotonin levels are typically used to treat the symptoms of PTSD. Serotonin is a chemical naturally produced by the body and brain that takes part in many physical functions, including nerve transmission. Not everyone may receive the same medications for PTSD. This is because medications for PTSD are tailored to the individual's symptoms and co-existing disorders if present.

Psychological Therapy

Therapists can offer a range of psychosocial techniques for women with PTSD. Supportive psychotherapy allows women to talk about the trauma and its effects. Cognitive behavior therapy (CBT) teaches women how to identify and put aside negative thoughts that trigger anxiety, and how to change their behavioral responses to reminders of the traumatic event. Exposure therapy helps women with PTSD gradually confront a situation or object that causes anxiety.

Lifestyle Approaches

The following steps may help you relieve and begin to overcome the symptoms of PTSD:

• Eliminate substances that may affect your mood, such as nicotine or caffeine
• Exercise regularly
• Take care of yourself, with healthy meals and adequate sleep
• Restore your normal household and daily routine as much as possible. Choose a routine that is positive, constructive and gives you a sense of personal control.
• Know that painful feelings happen even to people who are resilient enough to recover from trauma
• Use optimism and believe in yourself. Have faith in your ability to cope, and view the future with hope.
• Maintain or build good relationships with supportive family members or friends. Accepting help graciously and providing help to others through your church or community groups are two good ways.

Remember:

• Intense feelings of anxiety, anger, fear and grief soon after a life-altering traumatic event are normal reactions to a very abnormal situation.
• The way you're feeling is natural, unless it doesn't get better after one to six months.
• If you have problems with anxiety or PTSD, reaching out to the help you have available is positive and healthy.
• You can use help from others and your own courage to restore your sense of well-being and start your life again.

Questions to Ask Your Health Care Professional about PTSD:

1. Do I have PTSD? How do you know? Do you see a connection between how I feel and PTSD?
2. Is PTSD treatable? Can I recover from it?
3. What treatment do you recommend for me?
4. If you are recommending medication, what is the proper dosage and how do I take it?
5. For medication, what are the expected effects and side effects?
6. For medication, how long should I expect to be taking it?
7. If you are recommending psychotherapy, what type of therapy?
8. For psychotherapy, how long is it expected to take?
9. For psychotherapy, what should I do to cooperate with my therapy?
10. Until my treatment starts working, how can I manage my anxiety and stress to help prevent it from becoming overwhelming?

Resources

Resource list for consumers

References
Elmore KO and Schneider RK. Anxiety disorders in women. Women's Health in Primary Care 2001;4(11):691-8. www.womenshealthpc.com

Reliving Trauma: Post-Traumatic Stress Disorder, 2001. www.nimh.nih.gov

Novac A. Traumatic Stress and Human Behavior. Psychiatric Times. Vol XVIII, Issue 4, 2001. www.psychiatrictimes.com

Fostering resilience in response to terrorism: a fact sheet for psychologists working with adults. American Psychological Association. www.apa.org

After a Disaster: Self-Care Tips for Dealing with Stress. www.mentalhealth.samhsa.gov

Post Traumatic Stress Disorder, NIH publication No. 00-4675, www.nimh.nih.gov

When Terrible Things Happen: What You May Experience. www.ncptsd.va.gov

Reactions to a Major Disaster: A Fact Sheet for Survivors and Their Families. www.ncptsd.va.gov

After a Disaster: A Guide for Parents and Teachers. www.mentalhealth.samhsa.gov

Reactions of Children to Disasters: Normal Reactions to Disaster-Induced Stress. www.mentalhealth.samhsa.gov

Age-specific Interventions at Home for Children in Trauma: From Preschool to Adolescence. www.mentalhealth.samhsa.gov

After a Disaster: What Teens can Do. www.mentalhealth.samhsa.gov

MerckSource (based on Dorland's Medical Dictionary). www.mercksource.com

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