Medical Questions » Stress Questions » Question No. 963
| Question: | After being involved in a car accident in which the driver of the car I was in was killed, I have been diagnosed with post-traumatic stress. Please tell me more about this problem as I keep seeing my dead friend as he was after the accident, in constant nightmares. |
| Answer: | Post-traumatic stress disorder (PTSD) occurs after experiencing a situation that causes extreme stress and a feeling of helplessness (eg. armed holdup, serious accident, war violence, being assaulted or raped, observing atrocities etc.). Most symptoms start between two weeks and three months of the triggering catastrophe, but may start as late as six months.
To make the diagnosis, doctots must observe in patients at least one symptom from each of the following four categories:
General category
— Symptom duration more than one month, with significant distress or
inability to function normally in society.
Re-experiencing phenomena
—Experience intrusive recollections, nightmares, flashbacks as if the event was recurring, psychological distress on exposure to cues that may trigger memories, or physiological effects (eg. rapid pulse, rapid breathing) on exposure to cues. Avoidance behaviour
—Avoiding thoughts, feelings or conversations about the incident; avoiding places, people or activities connected with the incident; selective amnesia about the traumatic event; reduced interest in everyday activities or detachment from others; unable to look forward to future events with pleasure; or abnormal personality compared to before the incident. Excessive arousal
— Insomnia, irritability, anger, poor concentration, increased vigilance or
increased startle response to frights.
Treatment involves psychological counselling and debriefing immediately after the event, and a trained counsellor should follow up the victim for at least six months. Normal work and activities should be resumed as soon as possible. Referral to a psychiatrist is necessary if the patient does not appear to recover within six months, or deteriorates sooner, when medication may be necessary. PTSD may also lead to recurrent minor illnesses, poor physical health, and in extreme cases, suicide.
In most patients, the problem usually settles within 3 to 6 months, but in some it may become chronic.
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