Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a type of anxiety disorder characterized by a variety of stress symptoms associated with reliving a traumatic event. Being diagnosed with or treated for cancer may cause PTSD in some people. Treatment for PTSD often involves various types of counseling and antidepressant medications.

What is posttraumatic stress disorder?

PTSD is the development of certain stress symptoms following a terrifying or traumatic event. Usually, this event involves the threat of death or serious injury, or the actual occurrence of these events. Events that may trigger PTSD include:

• Violent personal assaults
• Natural or human-caused disasters
• Accidents
• Military combat
• Being diagnosed with a life-threatening illness
• Learning that one's child has a life-threatening illness

Initial responses to these stressful events include extreme fear, helplessness, or horror and may trigger PTSD symptoms.

If I experience a traumatic event, will I develop posttraumatic stress disorder?

Not everyone who experiences a traumatic event, such as the examples above, will develop PTSD. For some people, mental, physical, or social factors may make them more likely to develop PTSD. Some factors that may increase the risk of developing PTSD are:

• Previous psychological problems
  • History of trauma
  • High levels of mental distress
  • Ineffective coping skills
• Genetic and other biologic factors
  • Hormone imbalance
• Limited social and/or emotional support

Likewise, most individuals treated for cancer will not develop PTSD. Those who are more likely to develop stress symptoms include patients who experience a recurrence and survivors of childhood cancer who have undergone a very severe, intense, or lengthy treatment.

What are the symptoms of posttraumatic stress disorder?

There are three main symptoms of posttraumatic stress disorder, including:

• Re-experiencing or “reliving” the trauma
  • Nightmares
  • Flashbacks
  • Interfering thoughts
• Continuously avoiding reminders of the trauma
  • Avoiding situations
• Emotional numbing
  • Showing less emotion
  • Responding less to people
  • Detachment from others

Other common responses include:

• Unhappiness
• Guilt over actions taken or not taken
• Overwhelming loss
• Sleeping problems
• Being overly defensive, watchful, or irritable

If you have posttraumatic stress disorder, you may also experience anxiety, depression, alcohol or other substance abuse, or obsessive-compulsive behavior. These are not symptoms of PTSD, but they frequently occur at the same time.

How is posttraumatic stress disorder diagnosed?

PTSD is difficult to diagnose because the symptoms are similar to other mental or emotional problems. You will likely undergo interviews and complete questionnaires as part of the diagnosis process. If you show early symptoms of PTSD without meeting the full diagnosis, it is still important to manage these symptoms because they may indicate that you are at increased risk of developing PTSD later.

How is posttraumatic stress treated?

Various types of psychotherapy and antidepressant and antianxiety medications have shown some benefit in the treatment of PSTD.

Exposure therapy - Studies have shown that therapy in which you gradually and repeatedly relive the frightening experience under controlled conditions may help you to work through the trauma.

Group therapy - Group therapy has also been shown to provide relief from posttraumatic stress.

Counseling - Research also shows that discussing your experience very soon after a traumatic event may reduce some of the symptoms of PTSD. A study of 12,000 school children who lived through a hurricane in Hawaii found that those who got counseling early were doing much better 2 years later than those who did not.

Serotonin reuptake inhibitors - Medications, such as serotonin reuptake inhibitors (Prozac^® [fluoxetine], etc.) and other antidepressants, can help relieve the symptoms of PTSD.

What else can I do?

It is important to ask for help if you are suffering from PTSD. Notify your doctor, nurse, friends, and family if you are having difficulty dealing with the stress of cancer.

Make sure you are getting enough sleep and try to exercise daily. Being well rested will help you cope with your stress. Exercise increases the release of natural chemicals in your body called endorphins, which promote a feeling of well-being. A daily exercise program can be as simple as 20 to 30 minutes of walking.

Also, cancer support groups may help you deal with your stress. Support groups have been shown to improve mood, encourage the development of coping skills, improve quality of life, and improve immune response. Support groups can be found through the American Cancer Society, Cancer Care, or by asking your doctor.

You may wish to try relaxation techniques to help you deal with your stress, such as:

• Meditation
• Yoga
• Deep breathing