Post-Traumatic Stress Disorder (PTSD)

In prior posts, we’ve examined how the demands of practicing render physicians and dentists uniquely susceptible to anxiety and depression.  In this post, we are going to examine Post-Traumatic Stress Disorder (PTSD), another serious condition that often affects doctors—particularly doctors who work in high stress environments and who are repeatedly exposed to trauma on a daily basis.

What is PTSD?

PTSD is a mental health disorder caused by exposure to a shocking or dangerous event.  Although most people who experience a traumatic event experience an immediate emotional response when they are experiencing the event, those who develop PTSD continue to experience the symptoms of exposure to trauma after the event, and feel stressed or panicked even when there is no danger.  While some of the symptoms are similar to other anxiety disorders, PTSD is categorized as a particular type of anxiety that is caused by a specific external catalyst.  The onset of PTSD can occur within months after a traumatic event; however, in some cases symptoms may not appear until years later.

Prevalence

PTSD is associated with those who have been exposed to a traumatic event, such as combat, violence, serious accidents, or natural disasters.   Approximately seven to eight percent of the U.S. population will have PTSD at some point in their lives, with about eight million adults suffering from PTSD in any given year.[1]

PTSD can be caused by one event, or by prolonged exposure to trauma over time.  This exposure can be experienced directly, and through indirect exposure (i.e. witnessing the event).[2]

Many physicians, depending on their specialty, interact on a daily basis with traumatic situations from early on in their careers, and sometimes encounter events where patients die or are seriously harmed in a way that is very distressing to a practitioner.  Significantly, research has shown that 13 percent of medical residents meet the diagnostic criteria for PTSD.[3]  Emergency physicians, physicians practicing in remote or under-served areas, and physicians in training (i.e. residents) are particularly prone to developing PTSD.[4]

The prevalence of PTSD is also substantially elevated in individuals who are also suffering from chronic pain.  While only 3.5 % of the general population has a current PTSD diagnosis, one study found that 35% of a sample of chronic pain patients had PTSD.  Another study of patients with chronic back pain showed that 51% experienced significant PTSD symptoms.  In instances where the chronic pain is caused by the traumatic event (e.g. someone involved in a motorcycle accident or someone injured during the course of a violent crime), the pain can serve as a reminder of the event and worsen the PTSD.[5]

Symptoms

Physicians who suffer from PTSD may lose this ability to confidently react, which can impair their ability to safely practice.  Untreated, PTSD can also lead to a marked decline in quality of life, and potentially other mental health disorders or medical issues.  Some common symptoms of PTSD include:

Re-experiencing symptoms:

  • Flashbacks
  • Nightmares
  • Frightening thoughts
  • Physical reactions or emotional distress after exposure to reminders
  • Intrusive thoughts

Avoidance symptoms:

  • Staying away from places, events, or objects that are reminders to the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Arousal and reactivity symptoms:

  • Being easily startled
  • Feeling tense and “on edge”
  • Having difficulty sleeping
  • Being irritable or aggressive
  • Heightened startle reaction

Cognition and mood symptoms:

  • Trouble remembering key events of the traumatic event
  • Negative thoughts about the world, and oneself
  • Distorted feelings of guilt or blame
  • Loss of interest in previously enjoyed activities
  • Negative affect

Diagnosis

PTSD is typically diagnosed by a clinical psychiatrist or psychologist.  A diagnosis is made when an individual meets the criteria for exposure, and has at least one re-experiencing symptom, one avoidance symptom, two arousal and reactivity symptoms, and two cognition and mood symptoms.

Treatments

Some of treatments that are used, either alone or in conjunction, to treat PTSD include;

  • Cognitive Behavioral Therapy
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Prolonged Exposure Therapy
  • Antidepressants
  • Anti-anxiety medication
  • Medication for insomnia

The intensity and duration of PTSD symptoms varies.  Individuals who recognize any of the above-referenced symptoms in themselves should talk to a treatment provider right away.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

 

References:

Medscape, http://emedicine.medscape.com

National Institute of Mental Health, https://www.nimh.nih.gov

WebMD, http://www/webmd.com/

[1] U.S. Department of Veterans Affairs, PTSD: National Center for PTSD, How Common Is PTSD?, https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp

[2] U.S. Department of Veterans Affairs, PTSD: National Center for PTSD, PTSD and DSM-5, https://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp

[3] Myers, Michael, MD, PTSD in Physicians, Psych Congress Network, Sept. 16, 2015, https://www.psychcongress.com/blog/ptsd-physicians

[4] Lazarus, A., Traumatized by practice: PTSD in physicians, J Med. Pract. Manage., 2014 Sept-Oct; 30(2): 131-4.

[5] DeCarvalho, Lorie T., PhD, U.S. Department of Veterans Affairs, PTSD: National Center for PTSD, The Experience of Chronic Pain and PTSD: A Guide for Health Care Providers,  https://www.ptsd.va.gov/professional/co-occurring/chronic-pain-ptsd-providers.asp