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


Questions & Answers



Orlando B. Lightfoot, M.D.
Chief of Psychiatry
Codman Square Health Center
1. Why do some people get post-traumatic stress disorder (PTSD) and others do not?

Everyone is at risk of being exposed to traumatic events, but there is no certainty as to why some individuals are more susceptible or prone to developing signs and symptoms of PTSD. Research is underway to determine if specific biological and genetic differences play a role. Clinicians do know that people with supportive family and community relationships who readily seek help when needed and have solid methods of problem solving and coping with difficult situations may be more successful in avoiding PTSD.

2. Does the disorder differ between men and women?

Both men and women are at risk for PTSD. Surveys have shown, however, that in non-combat community situations, women are impacted more — 20 percent versus 8 percent in men. A reason for the disparity is the type of trauma. Females are more subject to childhood sexual abuse, rape, domestic violence and family conflict.

3. Is alcohol or substance abuse associated with PTSD?

Alcohol or substance abuse does not cause PTSD, but an individual suffering from the disorder is more likely to use alcohol or drugs as a way of escaping the feelings associated with the trauma. In most circumstances, alcohol and drugs can offer only temporary relief and escape, but can confound the long term management and recovery. Frequently alcohol or substance dependence is an accompanying diagnosis of PTSD.

4. Can people develop PTSD months or years after the trauma?

The timing of PTSD can differ. Many people experience signs and symptoms soon after a traumatic event, but can bring their response under reasonable control within a few months. Some, however, do not identify the difficulties they experience in life, such as feeling isolated, feeling fearful in crowds, problems keeping a job or excess use of alcohol or drugs, as possibly related to prior traumatic events or experiences. The awareness that this could be PTSD can be delayed for many years. Still other individuals do well over many years until a life change “triggers” the past trauma. Generally, a detailed and complete history can uncover material that strongly points to a diagnosis of PTSD.

5. Is the disorder curable?

Some individuals respond after a traumatic experience with minimal impairment and require minimal intervention. Others involved in the same event suffer tremendously. The signs and symptoms of PTSD are treatable; improvement can and does occur consistently. Clinicians use a wide array of tools — support, guidance and medication — to help in the recovery process. Many individuals have demonstrated an ability to get better when they have access to and take advantage of these interventions.

6. What differentiates “normal” bad dreams and nightmares from symptoms of PTSD?

One function of dreams is to allow an individual to “work through” the events of the day. Yet, disturbing dreams can occur in all individuals. Dreams associated with PTSD allow some revisiting of the traumatic event, and can offer a chance to revenge the hurt or shape a different outcome of an actual experience, making it more palatable. When PTSD dreams are frequent and disturbing they require an intervention by a mental health professional to help modify the intensity of the experience and assist with improved sleep.

7. Do children react differently from adults?

Several traumatic experiences can result in PTSD in children: desertion and abandonment, improper and inadequate feeding, physical and psychological abuse and sexual abuse, to name a few. While some children are more resilient, others may respond by withdrawing, not eating or overeating, crying excessively, agitation or other dramatic change in behavior. Fortunately, children do respond positively to treatment including changes in the environment, loving attention and reassurance.

8. Are certain physical ailments, such as headaches or stomach aches, associated with PTSD?

The relationship of physical ailments and PTSD has long been recognized. Studies have found that pain is one of the most regularly reported physical problems reported by people with PTSD regardless of the type of trauma. In many cases the pain is caused by physical trauma, such as automobile accidents. A special problem of the management and use of pain medication for legitimate chronic pain is an ongoing concern of medical practitioners. In some cases, however, pain, such as headaches, stomachaches or back pain that cannot be substantiated by diagnostic tests may be more closely linked to anxiety rather than a medical problem.