PTSD and OCD: Prevalence, Etiology, and Treatment

Post-Traumatic Stress Disorder (PTSD) and Trauma

  • Commonality of Trauma

    • Traumatic events are widespread, e.g., motor vehicle accidents, sudden death of a loved one.
    • Approximately half of any given population has experienced a significant trauma.
    • However, many traumas do not lead to PTSD; other stress-related conditions (e.g., acute stress disorder) exist but are not covered in this class.

  • Prevalence of PTSD

    • Epidemiological studies indicate a prevalence of about 3.5\%; some studies suggest it could be as high as 10\%.
    • Affects approximately 5 million people in the United States and about 300 million worldwide.
    • The global prevalence is likely increasing due to ongoing conflicts.

  • Economic Impact of PTSD

    • PTSD is very expensive to manage due to a lack of highly effective treatments.
    • In the United States alone, the annual cost of caring for individuals with PTSD is estimated to be 42 billion dollars.

  • Key Takeaways on Prevalence

    • Prevalence rates vary significantly depending on the study.
    • Not everyone who experiences trauma develops PTSD.
    • PTSD is a substantial national and international health concern and a costly disorder.

  • PTSD in the Military

    • Indicates how common and chronic PTSD is within military populations.
    • Vietnam Veterans: Approximately one-third (33\%) of surviving Vietnam veterans met criteria for PTSD.
    • Iraq and Afghanistan Veterans: About 20\% of veterans returning from these regions (characterized by mountainous terrain and less face-to-face combat) have PTSD. Other numbers may be higher for specific traumatic events.
    • Typical Onset: PTSD usually presents about 3 to 9 months after returning from a military tour (e.g., a veteran returning in August might experience symptoms by March).

  • Commonality of Traumatic Events in Military Service

    • A significant percentage of military personnel experience events that could cause PTSD.
    • Examples of events (y-axis): Seeing dead bodies, being shot at, being attacked/ambushed, experiencing rocket or mortar fire, witnessing individuals killed or wounded in action.
    • Army and Marines (Operation Enduring Freedom - Afghanistan/Iraq): The data shows these events are ubiquitous. For example, reported rates of being ambushed or attacked are as high as 89 out of every 100 people in the Army.
    • Experiencing such events is the rule rather than the exception in combat zones.

  • Chronicity of PTSD

    • Definition of Chronic: Typically, a duration of 3 months or more for neurological or psychological conditions.
    • World War II Prisoners of War (POWs):
      • European Theater POWs: About half (50\%) still met PTSD criteria as older adults.
      • Pacific Theater POWs: Approximately three-quarters (75\%) continued to meet PTSD criteria as older adults, possibly due to more severe mistreatment.
    • Long-term Effects: Individuals can meet PTSD criteria 40 to 60 years later (e.g., from age 20 to 80).
    • A study of a random sampling of older World War II and Korean War veterans (in their 80s and 90s) found that 14\% still met criteria for PTSD, some 50 to 70 years later.
    • Conclusion: PTSD is widespread in military contexts and can be extremely chronic and long-lasting, even with treatment.

  • Treatments for PTSD

    • Limited Efficacy: There are not many highly effective treatments.
    • Eye Movement Desensitization and Reprocessing (EMDR):
      • Developed by Francine Shapiro.
      • Shows some efficacy, though the exact mechanism (e.g., why eye movements help) is unclear.
      • One theory suggests it acts as an attentional distraction, making it difficult to simultaneously experience flashbacks or PTSD symptoms.
    • Cognitive Behavioral Therapy (CBT): While invoked, strong effectiveness data is generally lacking, though it helps some individuals.
    • Exposure Therapy & Systematic Desensitization:
      • Involves gradual exposure to trauma-related stimuli (e.g., hearing gun noises).
      • May offer some effectiveness for certain individuals, but not consistently proven efficacious enough.
    • Pharmacological Treatments:
      • No specific drugs treat the underlying PTSD.
      • Medications are used to manage associated symptoms such as mood problems, substance abuse, and physiological symptoms.
      • EMDR is considered one of the best treatments in terms of available data.

  • Brain Area Associated with Anxiety

    • The amygdala, a deep brain structure, is considered the center for anxiety and fear.
    • An annual party called