Ask Dr. K: PTSD can be caused by many things


DEAR DOCTOR K >> Last year, a truck ran a red light, totaled my car and nearly totaled me. I spent several weeks in the hospital. Since then my body has healed, but I'm not myself. I'm very irritable, easily angered and sleeping poorly. A friend says I have PTSD, but I thought that occurred to people — soldiers, for instance — exposed to repeated threats.

DEAR READER >> Your friend is astute. Post-traumatic stress disorder — PTSD — is a condition in which distressing symptoms occur after a major trauma. While the media often talk about PTSD in soldiers who have seen active combat, you don't have to be in battle to get PTSD. A single horrible event, like a bad auto accident, can surely do it.

In a previous column about PTSD, I mentioned a patient of mine years ago who was in a terrible auto accident as a young man. The accident, which broke many bones and caused him to be hospitalized for many weeks, occurred at a particular intersection not far from his home — a drunk driver ran a red light.

For years afterward, every time he came near the intersection, his heart raced, he broke out in a sweat and he felt like he was going to die. Finally, he stopped driving anywhere near that intersection. But he still had bad dreams. Fortunately, with treatment his PTSD became much less of a problem.

About 10 years ago, though, just after he retired, the bad dreams came back. His explanation: "When I no longer had to worry about work, I was free to worry about other things." An aggressive schedule of church work, book clubs and travel helped beat back the PTSD.

So, a single crisis (such as your serious car accident) or a series of events — as long as they are severe enough — can cause PTSD.

When diagnosing PTSD, doctors often look for three things:

• Hyperarousal: This is an ongoing state of tension that resembles a "fight or flight" response to danger. You may experience insomnia, angry outbursts, an exaggerated startle response and hypervigilance. Headaches, trembling, diarrhea and fatigue are common.

• Avoidance: You may feel detached or numb. You may be unable to talk about the traumatic event or revisit the place where it occurred. PTSD patients often withdraw from people and social events, particularly those even remotely associated with the trauma.

• Re-experiencing: This is the worst symptom. Suddenly, a memory of the traumatic event takes over your brain. It's hard to concentrate or function normally. Recurrent nightmares are also quite typical. In extreme cases, you may mentally relive the traumatic experience.

Talk to your doctor. Whether or not you have PTSD, you clearly need support to recover from your experience.

Dr. Komaroff is a physician and professor at Harvard Medical School.


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