This Issue

Post-traumatic stress disorder

For the young, overcoming trauma requires a safe place

Anxiety: When you need to worry

Q & A

Signs and Symptoms


Generally, the symptoms of post-traumatic stress disorder are
subdivided into three main categories.

Re-experiencing the traumatic event

• Flashbacks or repeated reliving of the event
• Intrusive, upsetting memories of the trauma
• Repeated nightmares or bad dreams
• Intense physical reactions to reminders of the event
(e.g. pounding heart, sweating)

Avoidance and numbing

• Avoiding activities, places, thoughts or feelings that remind you of the trauma
• Inability to remember important aspects of the trauma
• Loss of interest in general activities
• Feeling detached from others and emotionally numb
• Hopelessness about the future

Increased anxiety and emotional arousal

• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance – on constant alert
• Feeling jumpy and easily startled


Diagnosis

According to the National Mental Health Institute, to be diagnosed with PTSD a person demonstrates symptoms in all three categories for at least one month:

• At least one symptom in the
re-experiencing category
• At least three avoidance symptoms
• At least two symptoms of increased arousal
• Additional symptoms that interfere with normal activities
of daily living

A mental health professional should confirm the diagnosis

Signs and Symptoms

Risk Factors

Do you think you have PTSD?

Ask yourself a few questions

In your life, have you ever had any experience that was so frightening, horrible or upsetting that, in the past month, you:

1. Have had nightmares about it or thought about it when you did not
want to?

YES
NO

2. Tried hard not to think about it or went out of your way to avoid
situations that reminded you of it?

YES
NO

3. Were constantly on guard, watchful or easily startled?

YES
NO

4. Felt numb or detached from others, activities or your surroundings?

YES
NO

Current research suggests that if you answered “yes” to any three questions, you might have PTSD. If so, it may be helpful to talk to a mental health professional. PTSD is highly treatable with psychotherapy (talk therapy), drug therapy or a combination of both.

Source: Prins et alia, (2004). The primary care PTSD screen (PC–PTSD): Corrigendum. Primary Care Psychiatry, 9, 151

When the stress is too much
to handle alone ask for help


If PTSD is not diagnosed and treated it can lead to other mental health disorders, such as depression and alcohol or drug abuse. In some cases the person suffering from trauma has thoughts of suicide. If you are having thoughts of harming yourself or ending your life, or if you know someone who is having these thoughts, seek help right away. Call your doctor, 911 or the National Suicide Prevention Lifeline at 800-273-TALK.

Need more information?

• National Center for
Trauma-Informed Care
866-254-4819
nctic@nasmhpd.org

• National Institute of
Mental Health
866-615-6464
nimhinfo@nih.gov

• Anxiety Disorders Association of America
240-485-1001
www.adaa.org

• National Mental Health Association
800-969-NMHA
www.nmha.org

• Mental Health America
800-969-6642
www.nmha.org

For more information on suicide

Do you think you have PTSD?

When the stress is too much to handle alone ask for help

DANA-FARBER/HARVARD CANCER CENTER
Initiative to Eliminate Cancer Disparities
2011 National Minority Cancer Awareness


April 17 - April 23

Boston Public Library Cancer
Awareness Display


• Codman Square Branch Library
690 Washington Street

• Mattapan Branch Library
1350 Blue Hill Avenue

• Brighton Branch Library
40 Academy Hill Road

April 28: 12 - 1 p.m.

Secondhand Smoke Exposure
Harvard Street Neighborhood
Health Center
632 Blue Hill Avenue


May 16: 11 a.m. - 1 p.m.
Skin Cancer Prevention
Roxbury YMCA
285 Martin Luther King Boulevard


April 21:
9 a.m. – 4 p.m.

Reducing Cancer Disparities & Promoting Health Equity Among Socioeconomically Disadvantaged Populations
Beth Israel Deaconess Medical Center
Riesman Lecture Hall, 330 Brookline Avenue

Registration is required: http://sesrcdbostonapril2011.eventbrite.com

All events are open to the public
For any additional information contact
Athene Wilson Glover at 617-632-4860

Another good reason to visit the dentist


“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance


The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.


Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon
617-638-8260

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
617-636-1664
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
617-573-3340
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.
781-326-4600

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
617-726-0218
Remember to call ahead to confirm
time and date
of screenings.

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Risk Factors

It’s not possible to predict who will get PTSD; it occurs in people of all ages and races. Some factors, however, may increase its risk:

• Gender – more common in females

• Intensity and length of trauma

• A previous trauma earlier in life

• Existence of other mental health problems, such as anxiety or depression

• Family history of depression or PTSD

• Abuse or neglect as a child

• Lack of a good support system of family and friends

• Lack of coping skills


Anxiety: When you need to worry


Everyone experiences anxiety. It’s impossible to skate through life without it. Anxiety and fear are natural reactions when you’re faced with a threat to your well-being. In fact, a jolt of anxiety can drive you to study for a test, polish a presentation or hop out of the way of danger.

“A little anxiety is motivating,” says Dr. Ken Duckworth, a psychiatrist and associate medical director for behavioral health at Blue Cross Blue Shield of Massachusetts. “But large amounts of anxiety are debilitating.”

How we react to anxiety


Anxiety stamps its mark on us physically and psychologically. Physical symptoms may include a pounding heart, sweating, trembling, feeling hot or icy, blushing, agitation, being hyper-alert, faintness, dizziness, chest pain, nausea or a sensation of smothering. Psychological symptoms may include worry, dread, unease, uncertainty, fear, nervousness, panic, outbursts of anger, an out-of-body sensation or even the conviction that you’re about to die.

When persistent anxiety interferes with your daily tasks, activities, or enjoyment of life, it’s best to seek professional help (see “Getting Help”). At this point, your coping behaviors may be hurting you, too. Perhaps you can’t leave home because you’re afraid you’ll have a panic attack in public. Maybe you’re driven to perform certain rituals — washing hands, for example, or repeatedly touching, checking on or counting things — to relieve distress. Perhaps you’re isolating yourself because any social occasion makes you unbearably nervous, or abusing alcohol or drugs to help calm anxiety.

A common thread

Anxiety disorders are very common, affecting roughly 40 million Americans 18 or older each year. Some often start in childhood or teenage years, such as obsessive-compulsive disorder (OCD) and social phobia. For anxiety to cross into the realm of a disorder, it must affect daily functioning.

Common anxiety disorders are:

Generalized anxiety disorder: Excessive worries, tension and varied concerns about money, work, relationships and health with little rational reason. Affects 6.8 million American adults. Continual spikes in worry and tension, skipping from one anticipated disaster to the next are a few symptoms.

Obsessive-compulsive disorder (OCD): Persistent, upsetting thoughts (obsessions) and rituals (compulsions) that relieve the anxiety sparked only temporarily. Fear of germs that prompts repeated hand washing is one example. Affects about 2.2 million American adults. Repeated rituals and behaviors — counting, hoarding, arranging items symmetrically — are a few symptoms.

Panic disorder: Sudden attacks of terror, usually peaking within 10 minutes and often accompanied by a sense of unreality, impending doom, or fear of losing control. Inability to predict when the next attack may occur causes great anxiety. Affects about 6 million American adults. Pounding heart, sweating and faintness are a few symptoms.

Post-traumatic stress disorder (PTSD): Witnessing or being the victim of violence, natural disasters or combat may lead to PTSD, which affects about 7.7 million American adults. Not everyone in these circumstances develops PTSD, however. Nightmares, intrusive thoughts, startling easily are a few symptoms.

Social phobia (or social anxiety disorder): Feeling extremely anxious, excessively self-conscious and watched and judged in everyday social situations. Affects about 15 million American adults. Trembling, blushing, feeling that all eyes are watching are a few symptoms.

Specific phobia: Intense, irrational fear of something — dogs, small spaces, flying — that poses relatively little or no danger. Affects about 19.2 American adults. Severe anxiety, pounding heart, sweating are a few symptoms.

Very often, anxiety disorders co-exist with depression. Or they are compounded by substance abuse, a self-medication strategy likely to hamper improvement and cause additional problems. If necessary, seek professional help for these issues, too.

Getting help

First, talk to your doctor, who can consider whether a health problem or medication could be prompting anxiety. For example, an overactive thyroid or stimulant drugs taken for attention-deficit disorder or another health issue could make you feel very anxious. After ruling out these issues, your doctor can refer you to a mental health professional. Depending on how much anxiety affects you, you may want to try coping skills, such as exercise and relaxation techniques, first to see if this helps you sufficiently before seeing a mental health professional.

Treatments for anxiety

Generally, mental health professionals treat anxiety with a combination of coping strategies plus exposure therapy and cognitive behavioral therapy described below. When necessary, medications are added.

Cognitive-behavioral therapy (CBT): CBT helps change unhelpful thought and behavior patterns. Someone with OCD who fears germs might be encouraged to get his hands dirty, then wait before washing for increasing amounts of time. A woman who has panic attacks might first need to learn she’s not having a heart attack, then be taught strategies to help her tolerate symptoms.

Exposure therapy: A therapist helps you face your anxiety through a series of gradual steps. The goal is to learn to tolerate anxiety for increasing lengths of time. Exposure therapy is not typically used for PTSD, but works well for phobias like fear of snakes or flying and most other anxiety disorders.

Medications: Depending on the disorder, a doctor may prescribe anti-anxiety drugs, which can block physical symptoms of anxiety, or other medications.

Other emerging treatments, such as eye-movement desensitization and reprocessing (EMDR) for PTSD are being studied to see if they are effective.

Anxiety is a very common, treatable problem. You don’t need to entirely erase anxiety, but you’ll be able to manage it better if you understand what level of anxiety you face and attend to it accordingly.

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