Posttraumatic Stress Disorder: Nightmare After The Ordeal

Michael Rayel

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Sarah is a 28 y/o accountant who had a traumatic past that she kept to herself. At age 15, she was grabbed by a masked man while she was jogging in a park. The man threatened to kill her with a knife and brutally raped her. She screamed but nobody seemed to have heard her.

Since that time, Sarah has developed nightmares about being raped or killed. In most days, she has suffered from flashbacks of her being attacked. Each time she watches TV shows that remind her of the incident, she gets scared, overwhelmed, and becomes agitated. At times, she develops anxiety attacks, palpitations, sweating, and restlessness.

Since the attack, Sarah can hardly trust people. As a result, her relationships have profoundly suffered. More recently, she’s been depressed and feeling hopeless. She hasn’t been sleeping and eating well. Her inattention has negatively impacted her work.

Based on the above symptoms, Sarah is most likely suffering from Posttraumatic Stress Disorder (PTSD). What exactly is PTSD?

PTSD is a psychiatric disorder characterized by avoidance, hypervigilance, emotional difficulties, and recall behavior such as flashbacks and nightmares after a traumatic event such as rape, war, vehicular accident, or natural disasters. Recent researches have shown that after a trauma, biochemical changes develop in the brain that can result in psychological signs as shown above.

If untreated, some individuals develop emotional difficulties such as depression associated with inability to concentrate, sleep, and eat. Occasionally, they also become hopeless to the point that they want to die.

What is the treatment for PTSD?

The combination of individual psychotherapy and medications is known to help. Antidepressants especially SSRIs have been tried with some success. Other medications have been helpful to address the associated symptoms. Anxiety and agitation can be treated with benzodiazepines. The latter should be restricted to short-term use because of their addiction potential. Insomnia can be treated by a small dose of Trazodone.

Psychotherapy or “talk therapy" is an important part of treatment and recovery. The individual should be able to express the fear, the frustration, the guilt, and the blame in a secure and safe setting. Moreover, the therapist should provide ample support and empathy.

Copyright © 2005. Dr. Michael G. Rayel – author (First Aid to Mental Illness–Finalist, Reader’s Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: An Emotional Intelligence or EQ Game. For more information, please visit and


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