Defining and Treating Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

PTSD is one of the most common reasons patients come to see me. From combat stress to the aftereffects of child abuse, trauma is endemic in our society and has seemingly endless permutations. The profound and enduring effects of trauma have been with us for millenia. Indeed, researchers studying PTSD have turned to Homer’s Iliad for insight into the effects of trauma on combat veterans. In recent decades we have uncovered definitive evidence that trauma inflicted during childhood, so-called “adverse childhood experiences,” leads to severe mental and physical problems in adulthood. From the time of the PTSD diagnosis’s inception, it was mostly seen as afflicting combat veterans, however, largely because of our greater understanding of the prevalence and impact of traumatic childhoods, a related diagnosis of “complex PTSD,” or PTSD-C has arisen to give a more specific descriptor to survivors of this kind of abuse and neglect. Not everyone who experiences trauma is afflicted by the full slate of potential post-traumatic stress reactions, but for those who are it can be a truly crippling disorder leading to substance abuse, social isolation, and even suicide.

Prazosin

Prazosin (Minipress) is a relatively mild drug originally designed to treat hypertension (high blood pressure). People with PTSD commonly suffer from hypervigilance, where they feel unusually aware to the presence of potential “threats” in their environment. Hypervigilance is also common in people with anxiety disorders. Patients with PTSD are also frequently plagued by extremely distressing, chronic nightmares. Prazosin has been shown to help treat both of these problems. Unlike the benzodiazepines, it is not habit-forming. Moreover, because of its mechanism of action, we are able to adjust the dose very precisely to treat your individual symptom levels.

Other treatments

There is a long history of using psychotherapy to treat PTSD with complicated results. Dr. Bessel van der Kolk, who is largely responsible for the creation of the PTSD diagnosis and a tireless advocate for people who suffer from the aftereffects of trauma, has written about the possibility that traditional psychodynamic psychotherapy may in fact be counterproductive for some patients. This is largely related to the fact that this kind of psychotherapy (essentially the modern incarnation of Freudian psychoanalysis) is necessarily “archaeological,” that is, it focuses on returning to the past in order to sift, layer by layer, through the foundational material of our unconscious. But for many people with PTSD, returning to their trauma in such depth, rather than providing greater insight, could in fact inadvertently retraumatize them. People with PTSD are often exceptionally fragile. This is not meant dismissively. On the contrary, surviving trauma requires immense bravery and resilience, but being plagued by awful memories or simply exhausted by hypervigilance can take an immense toll on a person. While my approach to each patient is to understand their individual situation and personalize their care accordingly, this is especially necessary with people suffering from post-traumatic stress disorder. The only truly universal thing I can offer a prospective patient with PTSD is my promise that you will be taken seriously, and that your needs and your life experience will be absolutely valid and real to me.