WASHINGTON — Post-traumatic stress disorder (PTSD) often is associated with troops returning from war, but it actually is quite common, not only in the military, but in  civilians who experience natural disasters and other traumatic events.

“PTSD is not uncommon, in fact it may be the “common cold” of psychiatric illnesses,” said Robert Ursano, MD, director of the Uniformed Services University’s Center for the Study of Traumatic Stress (CSTS), Bethesda, MD. “If you have been exposed to a trauma or disaster and for the following months couldn’t sleep a bit, maybe you were in a car accident and so you jump when you hear the brakes behind you. Maybe you decide not to watch the car race on television because you don’t want to be reminded of it and you don’t go in to work for a few days. You actually qualify for a diagnosis of PTSD. The vast majority will recover from that acute response.”

Nor is PTSD rare in the military; experts believe that about 11-20% of veterans of the Iraq and Afghanistan wars are afflicted with the disorder.

Ursano and Valerie Cole, PhD, Disaster Mental Health senior associate at the American Red Cross, spoke at a recent DCoE webinar on PTSD and natural disasters for federal and civilian responders.

Cole said that, while many people are resilient after a disaster, studies have shown that more than 50% of the population was resilient after 9/11, research also shows that on average, 30-40% of direct victims of disaster will experience one or more disorders such as PTSD, depression or anxiety.

“Early intervention can reduce the risk of developing PTSD on a long-term basis,” she said.

Natural Disasters and PTSD

In general, human-made disasters produce more mental-health problems and more persistent mental-health problems than natural disasters, Ursano said, partly because they often result in larger casualty counts and longer-lasting injuries.

 “So as we think of planning and mental-health services, if you are a public health planner or a DoD planner, do I begin to plan for a big problem or a medium-sized problem or a little problem can be a very important decision early on,” he said.

Mental-health responses to disasters and public-health emergencies fall into three categories, Ursano explained. Psychiatric illness responses include PTSD, depression and complex grief. Distress responses include an altered sense of vulnerability, insomnia and irritability.

 “Following 9/11 the most important problem, by the number of times that it presented to emergency rooms, was, in fact, sleep disturbances,” he said. “For many of you who have served in the combat arena, it is not uncommon to find that one is running a sleep clinic much more than a PTSD clinic, as one thinks of the type of presentation that comes in and the tools for dealing with it.”

The third category, health-risk behavior responses, include smoking, alcohol use and “overdedication” in which people forget to rest, eat or drink  because they are working hard to protect themselves, and their friends and loved ones, he said.

Ursano said that even those with no previous psychiatric illness can be at risk for psychiatric illness after trauma, as shown by various studies with war veterans, POWs and after the Oklahoma City terrorist attack.

One question asked during the webinar was whether early intervention could reduce the impact of a traumatic exposure. Intensive targeted cognitive behavioral therapy can be used to do that, Ursano said. “The problem with it is that you can’t deploy it in sufficient intensity and breadth with all those at risk,” he said.

Another way to decrease the likelihood of PTSD, Ursano pointed out, is by preventing injury in the first place.

“Seat belts decrease PTSD in car accidents. Similarly, good training in the military that decreases the probability of injury, decreases the probability of PTSD, because we know that those who are injured have somewhere between a four and six times greater probability of developing PTSD,” he said.

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