Post-traumatic stress

The diagnosis and treatment of post-traumatic stress disorder has come a long way since the 1970s, with research now showing it is both more common and more treatable than once thought.

While early doubters dismissed the condition as a Western phenomenon that arose because researchers pathologized a nonmedical condition, subsequent research identified physiological changes to the brain because of extreme trauma and led to the development of a consistent ability to diagnose the condition, both in Western and other nations.

In fact, while surveys show that 7.8 percent of Americans have experienced post-traumatic stress disorder (PTSD), the numbers are far higher in some other nations, particularly those that have experienced intense violence. In Algeria and Cambodia, for example, which suffered through long civil wars, 37 percent and 28 percent of their populations, respectively, have experienced PTSD, studies say.

Terry Keane, a longtime PTSD researcher, Boston University psychiatry professor, and associate chief of staff for research and development at the Veterans Affairs Boston Healthcare System, described progress in recent decades in understanding PTSD during a talk at the Harvard School of Public Health (HSPH) Tuesday (March 23). Keane delivered his remarks as part of the Barry R. Bloom Public Health Practice Leadership Speaker Series, sponsored by the HSPH Division of Public Health Practice.

Though rates of PTSD are not as high in the United States as in some war-torn nations, Keane said surveys show that PTSD is nonetheless a significant problem. Further, he said, studies show that the numbers and the levels of disability of those suffering from PTSD are higher than those of conditions such as major depression and obsessive-compulsive disorder.

In the United States, women tend to develop PTSD at higher rates than men, something Keane said is not fully understood but that may be related to the personal nature of violence against women. About 60.7 percent of men experience trauma severe enough to potentially trigger PTSD during their lifetimes, with 8.1 percent of them developing PTSD. For women, 51.2 percent experience trauma, with 20.4 percent developing PTSD.

PTSD is caused by an extreme trauma, which Keane described as a “massively disturbing event” that sparks intense alarm, anger, or distress. The condition is marked by apprehension and avoidance behaviors.

PTSD also imposes an economic burden on society, Keane said, with its sufferers missing 3.6 days a month from work, costing an estimated $3 billion in lost productivity annually.

“Can you imagine trying to hold down a job when you miss one day a week?” Keane asked.

The biggest cause of PTSD is the sudden and unexpected death of a loved one, Keane said. In that case, PTSD is different from the normal grieving that such a loss would cause and is triggered by particularly horrific or difficult conditions surrounding the death. Other major causes of the ailment are wartime combat, sexual violence, and community violence.

Those suffering PTSD can feel its effects for decades, Keane said. Progress in treating the condition has resulted in several therapeutic approaches and medicines that can help. Keane said he is very hopeful about the prospects of identifying and treating patients. One of the biggest challenges, though, is education to raise awareness.

“I am so hopeful,” Keane said. “[We can] turn around a devastating condition, a costly condition … if we can just get this [information] out.”