Behind the Facade, Post-Traumatic Stress - New York Times

Behind the Facade, Post-Traumatic Stress

By Karen Barrow
November 2, 2010

A soldier returns from war unable to get the images of battle out of his head. An earthquake survivor rides out long, anxiety-filled nights. A young woman in a pretty floral dress walks her dog along the streets of Manhattan.

All three may be suffering from post-traumatic stress disorder.

The woman walking her dog is Robin Hutchins, 25. She looks confident and self-assured, and few would guess that a year ago she discovered that she had the stress disorder.

“When I tell people I have P.T.S.D., it’s like I have to convince them it’s a real issue,” she said.

The disorder — in which a traumatic experience leaves the patient suffering from severe anxiety for months or years after the event — is often associated with battlefield combat and natural disasters. But as Dr. Frank Ochberg, a clinical professor of psychiatry at Michigan State University, noted in an interview, the typical trigger is more mundane — most commonly, a traffic accident.

In Ms. Hutchins’s case, it was sexual violence. During her first year in college, on a weekend home to tend to a broken leg, she was raped by a young man she knew. She returned to college without telling her parents about it. “I just really wanted to be a freshman in college,” she said.

Ms. Hutchins spoke to a counselor there and resumed her routine — attending class, hanging out with friends and trying to put the trauma behind her. “Nobody ever said, ‘You need to stop your life and deal with this — you can’t just walk through it,’ ” she said.

The following year she was briefly pinned to a wall by a drunken male student. Seemingly a minor incident, but it sent Ms. Hutchins into a tailspin. Anxiety and panic began to strike her without warning. The prospect of leaving her dorm terrified her. She stopped going to class.

Her reaction was not to get help, but to leave college. She traveled to Mongolia in hopes of clearing her head, but a car accident during her trip only made things worse.

Friends didn’t understand why she never wanted to go out. They would play down her anxiety and say, “Oh, you’re just going to laugh at this in a couple days.” It took years of sleepless nights and paralyzing anxiety over tasks as simple as grocery shopping before she began to look for help.

She sought out psychologists, but some dismissed her. “They’d say, ‘What does a pretty girl like you have to worry about?’ ” she said. Others were simply too expensive. Finally, during an initial consultation, a psychologist heard her full story and said the simple phrase that changed everything: “You have P.T.S.D.”

Dr. Ochberg, the Michigan State professor, who has never met Ms. Hutchins, estimated that as many as 80 percent of rapes may lead to symptoms of post-traumatic stress. But the stigma of rape, along with a general misunderstanding of the disorder and how it can affect anyone who has suffered trauma, often gets in the way of a proper diagnosis.

For Ms. Hutchins, the diagnosis came as good news. “When you can’t control your emotions at work, at home, with friends, you stop trusting yourself,” she said. “Knowing that my panic attacks came from P.T.S.D. was such a relief.” Understanding the cause of her emotional outbursts gave her tools to change them.

Dr. Ochberg explained that the disorder causes violent memories to surface despite a person’s best efforts to tame them.

Worse, the memory often feels more recent than it should. “There’s no sense of place in time,” Dr. Ochberg said.

Studies suggest that the disorder may be associated with structural changes in the brain — in particular, a shrinking of the hippocampus, a region associated with memory.

For most young professionals, a night out at a bar is routine; for Ms. Hutchins, the strange faces and crowds put her on high alert. Crossing the street calls up a swarm of terrifying possibilities: Will the bus hit me? Is that guy following me? Should I run? Should I fight back? If I do, will I put others at risk?

Weekly therapy sessions helped her work through some of those irrational fears, and anxiety medications helped prevent some of the panic attacks. Still, she remained unnaturally vigilant.

Then she met Dexter.

After reading that “emotional support” dogs can be trained to comfort people with post-traumatic symptoms — staying by their side in overwhelming situations, for example — Ms. Hutchins adopted a small Lhasa apso from a shelter. Now, she and Dexter are training each other.

Dexter keeps Ms. Hutchins calm on airplanes and forces her to go outside for long walks. People who see Dexter in his little blue service jacket smile at him — and at her, calming her further.

She is still working on gaining control of her emotions, and she knows that the post-traumatic symptoms may linger. But there is less anxiety, fewer panic attacks. About Dexter she said, “He’s given me a partner in all of this.”