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PTSD

L. David Willison IV, MD, PhD

Psychiatrist located in Westwood, Los Angeles, CA

Post-traumatic stress disorder (PTSD) affects approximately 10% of adults. I have extensive experience treating PTSD in both my private practice, and as an Attending Psychiatrist the West Los Angeles Veterans Affairs Medical Center where I personally treat veterans with PTSD and teach psychiatry residents how to effectively treat PTSD (with psychotherapy and medications).

PTSD Q & A

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop after people experience situations where they think they themselves, or their loved ones, are at imminent risk of dying or being killed. In the past, only soldiers with direct war and/or combat experience were thought to have an increased risk of developing PTSD.  We now know that this is incorrect. People who witness or experience a terrifying threat such as the violent death of loved ones, actual or threatened serious injury to themselves or others (including physical, sexual and emotional violence) can cause PTSD. Other examples include:

  • Natural disasters.
  • Actual, or threatened, serious illnesses/diseases.
  • Serious accidents.
  • The loss of, or separation from, a parent/parents (especially during childhood).
  • Burglaries or attempted burglaries even if you or your family were not home
  • Childhood bullying (emotional, verbal, physical, sexual, or even passive - such as through exclusion or shunning).

 

It’s natural to feel fear and anxiety during and after one of these situations. However, most people recover from these symptoms on their own within a few weeks. PTSD causes you to experience continued stress and fear for months or years after the traumatic event.

What are the symptoms of post-traumatic stress disorder?

PTSD symptoms are grouped into the following categories. The symptoms must persist for more than 1 month after the traumatic experience. It's important to know that you do not need to have every symptom listed.

Re-experiencing symptoms

  • Unwanted, intrusive, memories of the trauma.
  • Flashbacks where you unexpectedly relive the trauma - the fear, the sights, sounds, smells or other aspects of the trauma.
  • Nightmares about the trauma, or simply distressing dreams that can be related to the trauma, or unrelated.
  • Emotions, places, people, situations, or objects that remind you of the trauma bring back the fear and/or the physiologic symptoms of fear such as a racing heart, sweating, tremor, or difficulty breathing.

 

Avoidance symptoms

    • Avoidance of places or objects that remind you of the traumatic experience.
    • Avoidance of the memory of the traumatic event including the emotions and physiologic sensations associated with the traumatic event.
    • Physiologic symptoms include a racing heart, sweating, shaking, or difficulty breathing.

Arousal and reactivity symptoms

    • Irritability (chronic).
    • Aggression (impulsive and sudden, but chronic over months and years)
    • Heightened startle response (being "jumpy", tense, or on guard).
    • Outbursts of anger, and general mood instability.
    • Impulsivity such as engaging in destructive or risky behaviors.
    • Difficulty sleeping.
    • Difficulty concentrating.
  • These symptoms tend to persist even if nightmares and flashbacks slowly diminish over the months and years after the initial trauma.

Cognitive and mood symptoms

    • Inability to recall key aspects of the trauma.
    • Persistent negative thoughts or assumptions about the yourself, other and/or the world.
    • People with PTSD often blame themselves for the trauma inflicted on them or their loved ones. Guilt and shame about the tauma are extremely common. 
    • Depression, persistent sadness.
    • Inability to derive pleasure in the world, from your own achievements, and from others.
    • Persistent feelings of being detached and unable to connect to other people.
    • Believing that your life is foreshortened and that you will die younger than you should (this is sometimes though to be an avoidance symptom).
    • Insomnia, even if you do not remember experiencing distressing dreams or nightmares .
    • Difficulty concentrating.

What is the procedure for treating post-traumatic stress disorder?

There are a handful of evidence-based treatments that are backed decades of clinical trials. These include Cognitive Behavioral Therapy with Exposure Response Prevention (CBT-ERP).  CBT-ERP is by far the most evidenced-based treatment for PTSD (as well as for all the other anxiety disorders). But, in order for the "CBT" portion to be effective, the "ERP" must also happen - in fact study after study has shown that, by far, the most effective intervention for anxiety is ERP. Unfortunately, most providers omit the ERP. 
Prolonged Exposure therapy (PE) and Cognitive Processing Therapy (CPT) are the other well studied psychotherapeutic treatments for PTSD.

I offer CBT and ERP, PE, CPT, along with medication management if appropriate to all of my PTSD patients. I treat PTSD patients from the age of about 8 years old through adulthood.

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