Posttraumatic stress disorder(PTSD) is a serious mental condition that some people develop after a shocking, terrifying, or dangerous event. These events are called traumas.
After a trauma, it’s common to struggle with fear, anxiety, and sadness. You may have upsetting memories or find it hard to sleep. Most people get better with time. But if you have PTSD, these thoughts and feelings don’t fade away. They last for months and years, and may even get worse.
PTSD causes problems in your daily life, such as in relationships and at work. It can also take a toll on your physical health. But with treatment, you can live a fulfilling life.
How Does PTSD Happen?During a trauma, your body responds to a threat by going into “flight or fight” mode. It releases stress hormones, like adrenaline and norepinephrine, to give you a burst of energy. Your heart beats faster. Your brain also puts some of its normal tasks, such as filing short-term memories, on pause.
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YOU MIGHT LIKEPTSD causes your brain to get stuck in danger mode. Even after you’re no longer in danger, it stays on high alert. Your body continues to send out stress signals, which lead to PTSD symptoms. Studies show that the part of the brain that handles fear and emotion (the amygdala) is more active in people with PTSD.
Over time, PTSD changes your brain. The area that controls your memory (the hippocampus) becomes smaller. That’s one reason experts recommend that you seek treatment early.
What Are the Effects of PTSD?There are many. They may include disturbing flashbacks, trouble sleeping, emotional numbness, angry outbursts, and feelings of guilt. You might also avoid things that remind you of the event, and lose interest in things that you enjoy.
Symptoms usually start within 3 months of a trauma. But they might not show up until years afterward. They last for at least a month. Without treatment, you can have PTSD for years or even the rest of your life. You can feel better or worse over time. For example, a news report about an assault on television may trigger overwhelming memories of your own assault.
PTSD interferes with your life. It makes it harder for you to trust, communicate, and solve problems. This can lead to problems in your relationships with friends, family, and coworkers. It also affects your physical health. In fact, studies show that it raises your risk of heart diseaseand digestive disorders.
Who Gets It?PTSD was first described in war veterans. It was once called “shell shock” and “combat fatigue.” But PTSD can happen to anyone at any age, including children. In fact, about 8% of Americans will develop the condition at some point in their lives.
Women have double the risk of PTSD. That’s because they’re more likely to experience a sexual assault. They also blame themselves for a traumatic event more than men do.
About 50% of women and 60% of men will experience emotional trauma sometime in the lives. But not everyone develops PTSD. The following factors increase your risk:
It’s important to seek help if you think you have PTSD. Without it, the condition usually doesn’t get better.
WebMD Medical Reference Reviewed by Carol DerSarkissian on February 13, 2017
You may have heard people call someone else a “psychopath” or a “sociopath.” But what do those words really mean?
You won’t find the definitions in mental health’s official handbook, the Diagnostic and Statistical Manual of Mental Disorders. Doctors don’t officially diagnose people as psychopaths or sociopaths. They use a different term instead: antisocial personality disorder.
Most experts believe psychopaths and sociopaths share a similar set of traits. People like this have a poor inner sense of right and wrong. They also can’t seem to understand or share another person’s feelings. But there are some differences, too.
Do They Have a Conscience?A key difference between a psychopath and a sociopath is whether he has a conscience, the little voice inside that lets us know when we’re doing something wrong, says L. Michael Tompkins, EdD. He's a psychologist at the Sacramento County Mental Health Treatment Center.
A psychopath doesn’t have a conscience. If he lies to you so he can steal your money, he won’t feel any moral qualms, though he may pretend to. He may observe others and then act the way they do so he’s not “found out,” Tompkins says.
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YOU MIGHT LIKEA sociopath typically has a conscience, but it’s weak. He may know that taking your money is wrong, and he might feel some guilt or remorse, but that won’t stop his behavior.
Both lack empathy, the ability to stand in someone else’s shoes and understand how they feel. But a psychopath has less regard for others, says Aaron Kipnis, PhD, author of The Midas Complex. Someone with this personality type sees others as objects he can use for his own benefit.
They’re Not Always ViolentIn movies and TV shows, psychopaths and sociopaths are usually the villains who kill or torture innocent people. In real life, some people with antisocial personality disorder can be violent, but most are not. Instead they use manipulation and reckless behavior to get what they want.
“At worst, they’re cold, calculating killers,” Kipnis says. Others, he says, are skilled at climbing their way up the corporate ladder, even if they have to hurt someone to get there.
If you recognize some of these traits in a family member or coworker, you may be tempted to think you’re living or working with a psychopath or sociopath. But just because a person is mean or selfish, it doesn’t necessarily mean he has a disorder.
'Cold-Hearted Psychopath, Hot-Headed Sociopath'It’s not easy to spot a psychopath. They can be intelligent, charming, and good at mimicking emotions. They may pretend to be interested in you, but in reality, they probably don’t care.
“They’re skilled actors whose sole mission is to manipulate people for personal gain,” Tompkins says.
Sociopaths are less able to play along. They make it plain that they’re not interested in anyone but themselves. They often blame others and have excuses for their behavior.
Some experts see sociopaths as “hot-headed.” They act without thinking how others will be affected.
Psychopaths are more “cold-hearted” and calculating. They carefully plot their moves, and use aggression in a planned-out way to get what they want. If they’re after more money or status in the office, for example, they’ll make a plan to take out any barriers that stand in the way, even if it’s another person’s job or reputation.
Brain DifferencesRecent research suggests a psychopath’s brain is not like other people’s. It may have physical differences that make it hard for the person to identify with someone else’s distress.
The differences can even change basic body functions. For example, when most people see blood or violence in a movie, their hearts beat faster, their breathing quickens, and their palms get sweaty.
A psychopath has the opposite reaction. He gets calmer. Kipnis says that quality helps psychopaths be fearless and engage in risky behavior.
“They don’t fear the consequences of their actions,” he says.
WebMD Feature Reviewed by Joseph Goldberg, MD on August 24, 2014
How Does Psychotherapy Help?Psychotherapy helps people with a mental disorder to:
Many studies have found that talk therapy, or psychotherapy, can help treat depression. Talk therapy can help you learn about your depression and help you find ways to manage your symptoms.
“Talk therapy can give you the skills to help handle your depression, so for many people it’s a very empowering experience,” says Larry Christensen, PhD, professor of psychology at the University of South Alabama in Mobile. “This makes it effective over a long period of time.”
If you have mild to moderate depression, talk therapy might be all you need to feel better. But if you have more severe depression, you might benefit from medication in addition to talk therapy. Here are some tips for getting started.
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YOU MIGHT LIKEWhat Type of Talk Therapy Is Best for Depression?There are many different kinds of talk therapy. The two most commonly used for depression are cognitive-behavioral therapy (CBT) and interpersonal therapy. CBT focuses on looking at how negative thought patterns may be affecting your mood. The therapist helps you learn how to make positive changes in your thoughts and behaviors. Interpersonal therapy focuses on how you relate to others and helps you make positive changes in your personal relationships. Both types of therapy can be effective in treating depression.
What Kind of Therapist Should I See for Depression?Various kinds of mental health specialists offer talk therapy:
What to Expect at a Therapy SessionAt your first session, be prepared to tell your therapist about your depression and what led you to seek help. It may be helpful to think about what you’d like to get out of the therapy. For example, are you looking for ways to better deal with personal relationships, or are you hoping to set goals for yourself and make changes? It’s helpful to be as honest as you can with your therapist about your depression and your goals for therapy.
After listening to your situation, the therapist should be able to tell you what type of treatment he recommends and come up with a treatment plan for you. If the therapist thinks you might benefit from medication, he may recommend that you also meet with a psychiatrist or doctor.
When Will I Feel Better From Talk Therapy?You may not feel better right away from talk therapy, but over time, you should start to notice some improvement. You might notice that relationships are getting easier or that your overall mood has improved. Or you might feel better able to understand your feelings or actions.
If you aren’t feeling any better, talk with your therapist. She may be able to try another approach to therapy or refer you for other kinds of treatment. Or you might benefit from seeing someone else. You may need to see more than one therapist to find the type of therapy that’s right for you.
Therapy is not always easy and can sometimes even be painful as you work through difficult problems. But if you stick with it, talk therapy can also be gratifying and rewarding -- and can give you the tools you need to help ease your depression.
WebMD Feature Reviewed by Brunilda Nazario, MD on July 06, 2010
Emails have become a necessary evil in the workplace. I say evil because my inbox right now has 169 unread emails, which makes me quiver with anxiety. But that's nothing compared to some of my friends and colleagues. I've seen inboxes with 3,000+ unread emails!
No surprise, given that by next year, we will send nearly 250 billion emails to each other a day. That's about 33 emails each of us on Earth sends and receives every 24 hours. No wonder we're so burdened and overwhelmed.
With emails accounting for such a big part of our lives, it's incredible there aren't more guidelines on how to use this form of messaging. I've learned tricks and hacks from different people, but a lot of my experience comes from making humiliating mistakes on email. How often did I send personal correspondence on my work emails? A lot. How often did I fire off an emotional email, only to regret it the minute I hit "send?" More times than I'd like to admit.
Email etiquette is very important--it's an integral part of how you communicate and develop relationships with people. I decided one of the first things I'd ask our Radiate Experts for advice on is how they manage emails. Below are some of their--and my own--tips to avoid the most common email mistakes:
A good workout makes you feel better, and regular exercise not only enhances physical health but can lift mood, reduce stress, and heighten self-esteem by improving appearance and physical strength. But how useful is exercise for people with severe depression or anxiety or chronic mental illness? Hundreds of studies now show that it can help — but there are qualifications.
Many reviews and meta-analyses show that regular physical activity is correlated with improvement in clinical depression and anxiety, mild to moderate depressive symptoms, insomnia, and resilience under stress. People who become or remain physically fit or active are less likely to develop clinical depression.
For example, in a study published in 2005, researchers examined the effect of a three-month exercise program on mild to moderate depression. About 80 participants were divided into five groups. Two groups took on a rigorous "public health dose" program, one of them for three days a week and the other for five days a week. Two groups instead participated in lighter "low-dose" exercise three or five days a week. A fifth group, the controls, practiced only stretching for flexibility.
Ratings of depressive symptoms on the standard Hamilton scale fell in all five groups, but the rigorous exercise program caused the biggest drop, an average of 47%. That made it about as effective as antidepressant medications or cognitive behavioral therapy, standard treatments for depression. The low-dose exercisers did no better than the controls, but even patients in these three groups showed some improvement. Any physical activity may have helped.
Exercise has also been found equivalent to cognitive behavioral therapy and antidepressants in direct comparisons. One study compared aerobic exercise with antidepressant drugs or a combination of the two in patients with major depression. After 16 weeks, 60%–70% in all three groups had recovered from the depressive episode, but the exercise effects may have lasted longer. Ten months later, patients in that program had a lower rate of depression than those who took only medication. In other studies, exercise programs have equaled the effect of cognitive behavioral therapy on depression and anxiety.
In a study of more than 2,000 elderly people, daily walking predicted improvement in depressive symptoms over a three-year period. A comparison of aerobic exercise alone, exercise with stress management training, and routine medical care for patients with heart disease found that after 16 weeks, patients in both exercise groups had lower rates of depression. Similar results have been found for anxiety disorders — panic disorder, generalized anxiety, and post-traumatic stress.
Exercise is well known to improve sleep, partly because depression and anxiety are major causes of insomnia. For example, one study found that 16 weeks of moderate exercise helped a group of middle-aged insomniacs to fall asleep an average of 15 minutes sooner and sleep 45 minutes longer.
How it worksIt's obvious that poor physical fitness can lead to ill health, and ill health to depression and anxiety. If physical condition and depressive symptoms are mutually reinforcing, treating one can improve the other. But that is apparently not how exercise works in most cases. In a review of 30 trials, it made little difference how much a person exercised, how intensely, or how long. What mattered was only how long the program lasted — at least two months. Besides, in most studies, improvement in depression and anxiety is not correlated with increased strength or cardiovascular health. And aerobic exercise and strength training are usually found to be equally effective.
Other possible explanations for the mood enhancing effect of exercise include enhanced body image, social support from exercise groups, and distraction from everyday worries. Meeting the challenge of continuing exercise may heighten self-confidence. Physical activity may affect mood by altering the circulation of the neurotransmitters serotonin, norepinephrine, and the endorphins.
Another theory starts with the observation that for most people, not only those who are depressed or anxious, an exercise routine is difficult to start and even more difficult to keep up. It's possible that exercise is a form of controlled, predictable stress that supplies a kind of vaccination against the uncontrolled stress that leads to depression and anxiety.
ProblemsIt's also possible that this effect of exercise is an illusion. According to some surveys and purely observational studies, it could be that depression and anxiety prevent people from exercising rather than the other way around. Or some feature of personality or upbringing might cause both depression and sedentary habits. In some studies, the patients least likely to relapse are those who continue to exercise when they are no longer participating in a formal program. So ability to exercise might be evidence that the depression or anxiety has improved rather than a cause of the improvement.
Even controlled trials often present problems — especially insufficient follow-up, the difficulty of correcting for the effect of expectations, and the fact that people who volunteer for exercise studies are not necessarily typical. Many other factors may be incidentally associated with exercise, too — the chance to master a skill, associate with a group of like-minded people, or just do something interesting and engaging.
These doubts may not matter, be-cause exercise does so little harm (apart from injury, there is the rare risk of exercise addiction, mainly in people suffering from anorexia nervosa). But low motivation is a problem. We are often told to find an activity we enjoy, but depressed people don't enjoy anything much. So it's necessary to begin slowly and remind them that exercise does not have to be strenuous to be helpful. Walking, gardening, or household work will do. Some will want to exercise by themselves; others may prefer to join a friend or group for encouragement and mutual aid.
Exercise will not have the same effect on everyone, and by itself, in most cases, is not an answer to problems of mental illness. But it costs little or nothing, rarely has harmful side effects, and almost always promotes physical health. Although it is no magic remedy, there is little to lose and everything to gain by trying to work off depression and anxiety.
Annesi JJ. "Changes in Depressed Mood Associated with 10 Weeks of Moderate Cardiovascular Exercise in Formerly Sedentary Adults," Psychological Reports (June 2005): Vol. 96, No. 3, Pt. 1, pp. 855–62.
Craft LL, et al. "The Benefits of Exercise for the Clinically Depressed," Primary Care Companion Journal of Clinical Psychiatry (2004): Vol. 6, No. 3, pp. 104–11.
Dunn AL, et al. "Exercise Treatment for Depression: Efficacy and Dose Response," American Journal of Preventive Medicine (January 2005): Vol. 28, No. 1, pp. 1–8.
Hays KF. Working It Out: Using Exercise in Psychotherapy. American Psychological Association, 1999.
Kramer AF, et al. "Enhancing Brain and Cognitive Function of Older Adults through Fitness Training," Journal of Molecular Neuroscience (2003): Vol. 20, No. 3, pp. 213–21.
Lawlor DA, et al. "The Effectiveness of Exercise as an Intervention in the Management of Depression: Systematic Review and Meta-Regression Analysis of Randomised Controlled Trials," BMJ (March 31, 2001): Vol. 322, pp. 763–67.
For more references, please see www.health.harvard.edu/mentalextra.
Harvard Mental Health LetterYoga for anxiety and depressionResearch suggests that this practice modulates the stress response.
Updated: September 18, 2017
Published: April, 2009Since the 1970s, meditation and other stress-reduction techniques have been studied as possible treatments for depression and anxiety. One such practice, yoga, has received less attention in the medical literature, though it has become increasingly popular in recent decades. One national survey estimated, for example, that about 7.5% of U.S. adults had tried yoga at least once, and that nearly 4% practiced yoga in the previous year.
Yoga classes can vary from gentle and accommodating to strenuous and challenging; the choice of style tends to be based on physical ability and personal preference. Hatha yoga, the most common type of yoga practiced in the United States, combines three elements: physical poses, called asanas; controlled breathing practiced in conjunction with asanas; and a short period of deep relaxation or meditation.
Available reviews of a wide range of yoga practices suggest they can reduce the impact of exaggerated stress responses and may be helpful for both anxiety and depression. In this respect, yoga functions like other self-soothing techniques, such as meditation, relaxation, exercise, or even socializing with friends.
By reducing perceived stress and anxiety, yoga appears to modulate stress response systems. This, in turn, decreases physiological arousal — for example, reducing the heart rate, lowering blood pressure, and easing respiration. There is also evidence that yoga practices help increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.
A small but intriguing study done at the University of Utah provided some insight into the effect of yoga on the stress response by looking at the participants' responses to pain. The researchers noted that people who have a poorly regulated response to stress are also more sensitive to pain. Their subjects were 12 experienced yoga practitioners, 14 people with fibromyalgia (a condition many researchers consider a stress-related illness that is characterized by hypersensitivity to pain), and 16 healthy volunteers.
When the three groups were subjected to more or less painful thumbnail pressure, the participants with fibromyalgia — as expected — perceived pain at lower pressure levels compared with the other subjects. Functional MRIs showed they also had the greatest activity in areas of the brain associated with the pain response. In contrast, the yoga practitioners had the highest pain tolerance and lowest pain-related brain activity during the MRI. The study underscores the value of techniques, such as yoga, that can help a person regulate their stress and, therefore, pain responses.
Although many forms of yoga practice are safe, some are strenuous and may not be appropriate for everyone. In particular, elderly patients or those with mobility problems may want to check first with a clinician before choosing yoga as a treatment option.
But for many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.
For more advice about reducing anxiety, visit our online Stress Resource Center at www.health.harvard.edu/stress.