• Re-experiencing symptoms (Flashbacks) [2]: Reliving the trauma again and again, including physical symptoms like chest pain, palpitations or sweating. Negative dreams. Scary thoughts.
• Symptoms of neglecting that painful memory [3]: Patient remains away from places, objects and events that remind the patient of the experience. Patient feels emotionally numb. Develops strong guilt, depression, or anxiety. Loses interest in activities that were once enjoyable. Has trouble in remembering the dangerous event.
• Hyperarousal symptoms: Gets easily startled. Feels tense or "on the edge" [4]. The patient has sleeping difficulties or develops frequent anger out-bursts. Hyperarousal symptoms are usually constant unlike other symptoms which are triggered by the things which remind the individual of the traumatic event. They tend to make the person feel pressurized and tensed. These symptoms affect the daily routine like sleeping, eating, or focusing on one’s work and chores. It is natural to have some of these things upset one after a traumatic event. It is called acute stress disorder. But when it persists even after 6 months of the event and lasts for over a month, it is termed as posttraumatic stress disorder.
• Children tend to have different response to traumatic event. Bedwetting, when they use to be dry before the event. The child may forget how to or is unable to talk. The child acts out the scary event during playtime. The child unusually clings [5] to a parent or other adults and avoids being left alone.

Not everyone who faces stressful event develops the disorder. Usually symptoms develop within first three months, sometimes they may develop after many years. Symptoms should last for more than one month to be diagnosed as posttraumatic stress disorder and a person must have all of the following for at least 1 month:

1. At least one re-experiencing symptom [6].
2. At least three symptoms of negligence or avoidance.
3. Minimum of two positive symptoms of increased arousal.

Posttraumatic stress disorder is seen in conjunction with depression and anxiety disorders that must be treated accordingly.

The mainstay for the treatment includes psychotherapy and medications. As every individual is different, treatment needs to be individualized. If someone with is going through continuous trauma, such as being in a stressed and bothersome relationship, then both the problems need to be treated simultaneously. Other ongoing problems can be panic disorder, depression and substance abuse which need attention and the necessary treatment.

Psychotherapy involves talking one’s mind out regarding all the experiences of the traumatic event with a mental health professional in order to treat the mental illness. Psychotherapy can occur either one-on-one or in a group. Psychotherapy usually lasts for 6 to 12 weeks, but can take more time. Few psychotherapies target the negative memories directly. Other therapies focus on accompanying problems relating to the social aspect, family and job. The doctor or therapist may apply more than one therapy depending on individual's needs.

Cognitive behavior therapy (CBT) [7] is widely used and consists of exposure therapy, cognitive reconstruction and stress inoculation therapy. CBT helps people face fear, it helps develop a healthy outlook to the traumatic event and helps people recall their memories in a healthy way.

Selective serotonin reuptake inhibitors (SSRIs) are used primarily in depression, sertraline [8] and paroxetine are used for PTSD. The main side effects include headache which decreases with continued use, nausea, sleeplessness or feeling drowsy, jitteriness and sexual problems. Other group of drugs like benzodiazepines which reduce anxiety and antipsychotics are also used in PTSD.

Treatment after mass trauma

Most people will have PTSD like symptoms in the initial days. Most people can be helped to uplift their confidence with basic support, such as providing a safe shelter, seeing a doctor if injured or diseased, getting basic needs of food and clean water, contacting one's family and friends, learning what is being done to help. As communities try to readjust after a community disaster, people also experience ongoing stress from loss of employment or education, economical stress - trouble paying finances, finding shelter, and getting medical care. This delay in community recovery will cause delay in recovery in patients from PTSD. In the first few weeks after a mass disaster, brief versions of CBT [9] are helpful for some people who face severe distress.

Prognosis is good as most of the memories of the events are erased by repeated cognitive behavioural therapy. Play therapy for children and talking out with mental health professionals removes all the remnant memories of the disturbing event.

Scientists have found genes that contribute to memories of the fear. Stathmin is a protein needed to form fear memories. Gastrin-releasing peptide (GRP) is a signaling chemical in the brain that peaks during such traumatic emotional events. GRP controls the fear response and accounts for healing of the traumatic memories and lack of GRP leads to the development of lasting and grandeur memories of the frightening experience. 5-HTTLPR gene controls levels of serotonin which is a neurotransmitter related to mood and is associated with fear response.

Risk factors for the disorder are experiencing dreadful events, history of mental illness, getting hurt, seeing close relatives being hurt or killed, feeling extremely helpless, or extreme fear and anxiety. Having lack of social support after the event, facing rising levels of stress after the event, such as permanent loss of a loved one, pain due to the event and physical injury of oneself, or loss of work or shelter may also lead to the condition.

Supportive factors that may reduce the risk of developing posttraumatic stress include calling for help from friends and family, finding a support group after the act or the event took place. One should be able to react and respond instead of being afraid.

Women are more commonly affected than men. More than 60% of men and women have one such experience in their life which gives a posttraumatic stress disorder-like effect. Around 80% of people both men and women have comorbid symptoms along with PTSD. Rape in women commonly leads to the condition whereas sexual abuse in men may produce lasting stress.

The amygdala appears to be responsible for acquisition of fear or learning to fear an event (such as coming in contact with a hot object). Storing memories of such events that will again bring on the original fear response leads to posttraumatic stress. This type of fear involves the prefrontal cortex (PFC) area of the brain.

Individual differences in brain areas will still lead to the disorder without actually causing symptoms; this is called as subclinical posttraumatic stress disorder. Other factors like head injury or
history of mental illness or childhood trauma, further increase a person's risk by affecting the development and functioning of the brain.

Personality traits and cognitive factors, such as tendency to look at challenges in a positive or negative way, optimistic or pessimistic attitude and social factors such having a good family support and using a support group, influence an individual's response to traumatic stimuli.

One can prevent such an occurrence by early identification of such patients and early initiation of cognitive behavioural therapy. The condition occurs as the event repeatedly hampers the mind for over a month, but if the victim is given therapy early after the event there will not be any occurrence of the disorder at all.

In patients with posttraumatic stress disorder, the fight or flight reaction to perceived danger is changed or damaged. People with the condition feel afraid even when not in danger. Posttraumatic stress disorder (PTSD) usually develops after a person is exposed to one or more traumatic events, such as sexual abuse, physical injury, warfare or threats of death, death or threat to life of loved ones, that result in feelings of intense fear and horror, or helplessness.

Posttraumatic stress disorder consists of recurrent disturbing flashbacks, avoidance of memories of the event, and increased excitement continuing for more than one month after the occurrence of traumatic event [1]. The disorder was first noticed in war veterans, but later it was found in association with a variety of traumatic events, such as rape, child abuse, torture, being kidnapped, accidents of cars, mugging train derailment, blasts due to bombs, airplane crashes, or natural disasters such as floods or earthquakes.

Posttraumatic stress disorder (PTSD) may develop after a person has experienced one or more traumatic dreadful events, such as sexual assault, warfare, serious physical injury, natural disasters or threats of death that result in feelings of intense fear, horror, and powerlessness.

It is diagnosed when symptoms such as avoidance or non-recalling of memories of the event, recurrent disturbing memories of flashbacks, and hyper-arousal, continue for over a month after the occurrence of traumatic event.

The mainstay in the treatment includes psychotherapy and antidepressant drug therapy. Cognitive behavioral therapy is widely used too which helps the individual fight fear and develop healthy memories of the event.

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