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


Post-traumatic stress disorder
In U.S., nearly 8 million suffer from condition —
and not all are combat vets


Tina Chéry (in cap and gown) received an honorary Doctor of Law degree from Mt. Ida College. Shown (from left to right) are her mother, Zoila Wedborn, Rev. LeSette Wright, her daughter, Alexandra Chery and co-workers Milton Jones and Rachel Razzino.
Tina founded the Louis B. Brown Peace Institute following the murder of her 15-year-old son. (Photo courtesy of Louis D. Brown Peace Institute)


Nearly 20 years have passed and Tina Chéry still remembers the shock of hearing the news that her son had been murdered. Louis was 15 years old at the time when he was caught in crossfire near Field’s Corner. Ironically, he was on his way to a Teens Against Gang Violence meeting.

For Chéry, dreams of what Louis might have become — he often told his mother that he would be the first black president — turned into a debilitating mix of nightmares, anger and guilt. She blamed herself for allowing her son to walk the dangerous streets. She often lashed out and started having headaches. She avoided the spot where he died.

Most of all, she was just plain numb, unable to concentrate or focus on anything. “I didn’t know what it was,” she said. “But I was a walking basket case.”

What Chéry did not know at the time was that she was probably suffering from post-traumatic stress disorder (PTSD), an anxiety disorder that results from a major trauma that involves the threat of injury or death. It has many sources — natural disasters, plane or car accidents, physical or sexual abuse, assaults, even the sudden violent death of a loved one.

Though most people are able to bounce back from such episodes — and continue on relatively unscathed — many are not. According to the National Institute of Mental Health (NIMH), 7.7 million adults in this country suffer from PTSD.

PTSD can be quite varied. Its impact can change from person to person. Symptoms can develop within hours or days of the trauma. For some it takes weeks to months to appear. It’s not necessary to actually experience the traumatic episode. Merely witnessing the traumatic incident or involvement in the aftermath is all it takes. And the more severe the trauma or the more traumas experienced, the more significant the PTSD. People living in crime-ridden neighborhoods may suffer continuous trauma, thereby increasing its risk.

Marie Pierre-Victor, LICSW, clinical manager of the behavioral health department at Codman Square Health Center, has seen her share of PTSD. Not everyone who experiences horrible trauma will get the disorder. Two people may experience the same trauma with completely different outcomes. “People process things differently,” Pierre-Victor explained. “Some people get frozen in time. Their thoughts put them back at the place of trauma.”

Such was the case for many responders of the September 11 attack on the World Trade Center. A study of roughly 29,000 persons who performed rescue and recovery work there found that they had an increased risk of PTSD for up to three years later, especially if they lost co-workers as a result of the attack.

Anxiety in itself is not a bad thing. It’s natural to be fearful when in danger. The “fight or flight” response kicks in to protect a person from harm. But people with PTSD often still feel stressed or frightened when the danger has passed. It is not uncommon for people to suffer anxiety after a horrible trauma, but if the symptoms persist several months later, a person might be experiencing PTSD.

The cause of PTSD is not well understood and is the subject of several studies. Researchers from Emory University found that women, but not men, with higher blood levels of a particular stress hormone displayed more symptoms of PTSD. A recent study published in Biological Psychiatry suggests that the size of the region of the brain (hippocampus) that controls memory may have an impact.

The symptoms of the disorder are varied and tend to fall into three main categories — reliving the event, avoiding the event or hyperarousal.

People with PTSD most often experience flashbacks and relive the trauma over and over. The backfire of a car — a sound very similar to a gunshot — can set the symptoms in motion. Sleep does not always provide a respite. Replays of the event can occur in bad dreams.


Marie Pierre-Victor, M.S.W., L.I.C.S.W.
Clinical Manager, Behavioral Health Department
Codman Square Health Center
Avoidance causes afflicted people to stay away from locations or activities — such as driving a car — that bring back the memories. These people often lose interest in activities and feel detached from others.

Those with hyperarousal symptoms startle easily, feel “on edge,” or have difficulty sleeping or concentrating. According to the NIMH, symptoms of hyperarousal are typically constant feelings of stress and anger.

The disorder does not always exist in a vacuum. Depression or physical aches and pains can result if PTSD goes undiagnosed or untreated. PTSD sufferers might attempt to self-medicate with alcohol and drugs.

Research by Boston University Schools of Public Health and Medicine bore that out. In the PRISM study, the schools determined the prevalence, predictors and associations of PTSD in a predominantly minority urban primary care practice. The researchers found that mental health disorders — most typically heavy drinking, substance dependence and major depression — were closely linked to PTSD.

Roughly 25 percent of those studied engaged in heavy drinking or substance dependence; more than 30 percent suffered major depression and more than 40 percent had anxiety disorders.

It wasn’t only mental health disorders that were disproportionately high in this group. A noticeable percentage suffered chronic pain and various illnesses, such as irritable bowel syndrome. Those with PTSD were hospitalized more often with longer lengths of stay and utilized mental health services more than the group without PTSD.

The perception of the disorder has changed over the years. At one time it was considered a psychological condition suffered by combat veterans and went by names such as “shell shock” or “battle fatigue.” In 1980 it was recognized as a disorder with specific symptoms that can affect survivors of other trauma and was added to the American Psychiatric Association’s manual of mental disorders.

Children and teenagers are severely affected and may respond differently to trauma than adults. For instance, young children may wet the bed or act out the event during play or cling to an adult. Teens often develop disruptive behavior, feel guilt or have thoughts of revenge.

Fortunately, PTSD responds to several types of treatment including medications, talk therapy and cognitive behavior therapy. “People do get better,” Pierre-Victor said.

The key is recognizing and facing the trauma. Failure to do so begins to impact a person’s ability to function. Unrecognized and untreated PTSD can also take a toll on a person’s physical well being. Back pains and stomach pains, for example, can result.

Chéry admits she never considered receiving mental health services from a trained specialist because of the stigma, a sentiment too often shared by many victims, according to Pierre-Victor. Instead she relied on a network of friends, some of whom are mental health specialists. “No one ever used those words [PTSD] with me, but I think they were trying to be gentle,” she said.

Chéry credits her priest for her survival. “He was a safe place for me,” she explained. “He allowed me to talk and go through grief at my own pace. He did not let me get stuck. Sometimes it’s easier to get stuck. It’s easier to not have to deal with things.”

Chéry readily admits she is a very different person from the one before her trauma. She says her life has changed, and surprisingly for the better. She established the Louis D. Brown Peace Institute whose purpose is to “transform pain and anger into power and action.”

More important, her healing journey allowed her to be a better mother to her two remaining children.

About five years ago, Chéry said she turned another corner. “I learned what joy feels like and not feeling guilty that I can laugh again.”

And she did something else she had not done in years. She danced.

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