Watching her two daughters happily tumble around the sunny playground, Carolyn could hardly believe that she’d been so traumatized by her elder daughter’s birth that she’d spent the beginning of her second pregnancy haunted by sleepless nights and terrifying flashbacks of her first labor and delivery.

It had been rough -- 16 hours of unremitting pain and fear, as obstetricians and pediatricians conferred about whether or not her baby was in trouble and whether Carolyn would need a cesarean. What Carolyn remembered most vividly was her own terrified thought -- that one, or both, of them would die.

But Carolyn is a doctor. So once she took a close look at her symptoms, it didn’t take her long to realize that she was suffering from post-traumatic stress disorder (PTSD), a biological condition once called shell shock or combat fatigue because it was thought to affect only battlefield veterans.

But a recent study at the Henry Ford Health System in Detroit paints a different portrait of the PTSD sufferer. The research found that 89% of Americans witness or experience the kinds of traumatic events that can trigger the disorder, characterized by irritability, being constantly on the alert for hidden danger, and in many cases, re-experiencing the horror through nightmares and flashbacks of intrusive memories. Not only are they not all veterans, women are two times more likely to have PTSD than are men.

Like other stress disorders, PTSD that goes untreated can become a chronic problem that can be associated with an increased risk of heart disease, high blood pressure, cancer, and premature death. Studies even show that stress can change the structure of the brain.

Fortunately, in part thanks to the experience of combat veterans, there are effective treatments for PTSD, from the standard “talking it out” to a relatively new and innovative therapy involving eye movements that may offer surprisingly quick relief.

No one is really sure why women are so prone to PTSD. “One guess,” says psychiatrist Laura Miller, MD, chief of women’s services at the University of Illinois in Chicago, “is that women had to evolve to be more sensitive to potential dangers in order to protect themselves and their offspring. So they’re more vulnerable to normal anxiety and, possibly, more vulnerable to anxiety disorders such as PTSD in general.”

Another theory involves the biological differences in the way men and women react to danger. When you’re in a life-threatening situation, two major chemical systems in your body respond-whether you’re a man or a woman. One floods your brain with adrenaline -- like chemicals that jump -- start the body’s defensive response, characterized by increased heart rate, pumped-up blood pressure, and depression of the immune system. The other floods the brain with cortisol, a substance that sends a blast of grab-your-gun chemicals throughout the body.

With men experiencing PTSD, once the immediate threat has passed, the adrenaline-like system continues to flood the brain as if it’s still in danger. But with women, both systems continue to respond.

“What difference that makes isn’t known,” adds Dr. Miller. But both the cortisol and adrenaline are chronically activated in women with PTSD.

“Cortisol produces a toxic effect on the brain over time,” says brain researcher Richard J. Davidson, PhD, the Vilas professor of psychology and psychiatry at the University of Wisconsin at Madison. Brain cells are actually killed, and animal studies reveal that excessive cortisol causes the hippocampus -- a key part of your brain involved in processing memory -- to shrink.

Until recently, the events that trigger PTSD were thought to be relatively rare-combat; a natural disaster such as a tornado, hurricane, or earthquake; a serious accident; or being kidnapped or tortured. You’re also at risk if you were physically or sexually abused or neglected as a child, have been physically attacked, robbed, or raped, or witnessed any of these traumatic events.

In the Henry Ford Center study, the events that were most likely to trigger the disorder were the unexpected death of a close friend or relative, being assaulted, or being raped-experiences that happen to an astonishing number of Americans. The Detroit study found that 60% are likely to have a friend or relative die unexpectedly. And more than 37% are likely to be assaulted-which means that one out of every three women is at risk.

Less common but no less devastating triggers of PTSD are auto accidents, a cancer diagnosis, miscarriage, and traumatic childbirth, says Dr. Miller. A study at Stanford University School of Medicine recently found, for example, that up to half of those diagnosed with metastatic breast cancer experienced the symptoms of PTSD. And a British study of 264 women who experienced “normal” childbirth recently discovered that an amazing three of the new mothers experienced PTSD-while an additional 24% had at least one of the symptoms.

While insomnia, fear, and flashbacks are the most obvious symptoms of PTSD, others are far more subtle, including nightmares that don’t seem to have any meaning, jumping out of your skin when someone enters a room, and avoiding things-people, places, smells, clothes-that remind you of the traumatic event.

But “the most insidious kind of avoidance is when you avoid intimacy, and you really don’t know why,” says Dr. Miller. “You may not even know you’re doing it. You simply cannot get close to anyone. Sometimes the avoidance is sexual, sometimes just a general numbing. You don’t have strong feelings; you don’t have strong, intense, intimate relationships of any kind. You just keep a wall between yourself and the world.”

PTSD symptoms will sometimes resolve on their own, says Constance Dancu, PhD, a researcher at the University of Pennsylvania who is founder of the Center for Cognitive and Behavior Therapy in Wilmington, DE. But if symptoms are still present 1 month after the event, chances are that they’ll become chronic and begin to ripple through all areas of your life.

Here’s how to deal with them: Start talking. The best thing you can do after a traumatic event is talk about it, says Dr. Dancu. It gives you an opportunity to digest the experience, process it, and regain control of your life.

Find yourself a pro. Don’t just tell your story to those near and dear. Tell it to a therapist who specializes in PTSD, says Dr. Miller.

People react to a traumatic event in many ways, she explains, but the most common reactions that pose problems are either stuffing the memory in the back of the mind and repressing it, or thinking about nothing else. Neither way is healthy. Repression causes memories of the event to periodically break free and hijack your consciousness with a flashback. Obsessing about the traumatic event can make you feel terrorized all the time.

Fortunately, a therapist can teach you how to balance yourself between these two extremes, says Dr. Miller. “You can look at your memories in the light of day and put them in perspective. And that stops the whole problem.”

One type of therapy that’s sometimes used with PTSD sufferers is exposure therapy, a process that strips the event of its emotional impact. In some cases, you may face your fear in real life-for example, by driving a car after you’ve recovered from a terrible accident or by revisiting the place where you were assaulted. Repeated exposures can help you realize that the situation is no longer dangerous.

Some therapists will help you confront your fears and emotions by asking you to recount the event over and over until it doesn’t trigger your fear. You may even be asked to tape your retelling of the event that triggered PTSD, then replay it at home over and over again. “Do it,” urges Dr. Dancu. “The more you play it, the faster you will heal.”

Question everything. Once you’ve been able to share the incident with your therapist, start asking yourself questions about what you believe to be true about the incident, says Dr. Dancu. See if your beliefs are supported by the evidence. For example, trauma victims often feel guilty about the trauma-believing that if they’d just “done something differently,” it might not have ever happened. A therapist -- particularly one who practices cognitive therapy-can help you change your unrealistic beliefs and assumptions as well as short -- circuit the automatic thoughts that cause you so much distress.

Be careful about using medication. “Given the managed-care environment we live in today, there’s a great deal of pressure to medicate everything,” says Dr. Miller. “There are many medications that have been tried for PTSD, but there’s no single, well-researched study indicating that any of them are terribly effective.”

The most helpful role that medication plays in PTSD, she says, is to treat related symptoms, such as depression.

Speed healing. “One of the most interesting new kinds of treatment is a supplement to psychotherapy called EMDR, which stands for Eye Movement Desensitization and Reprocessing,” says Dr. Miller. It allows you to reprocess the traumatic event in a way that you recall it without the anguish and emotional charge that it carried before. “One of the things that your therapist will ask you to do is to recount the traumatic event while your eyes rhythmically follow the back-and-forth movement of her hand,” explains Madeline Muecke, LCSW, an assistant professor in social work at the University of Illinois in Chicago, who uses EMDR.

Just how EMDR works isn’t known, adds Dr. Miller. Scientists suspect that moving your eyes may compete with accessing your memories for passenger space on the same neurological circuit to consciousness. As movement and memory fight it out, your memories of the traumatic event are processed without you being overcome by remembered terror.

EMDR also helps you handle situations that may trigger a memory of that past trauma. Just one to three sessions as part of the psychotherapy process can bring relief if the disorder has been triggered by a single traumatic event.

Expect some anxiety. Therapy isn’t easy, says Dr. Dancu. You will be reliving the trauma that caused your symptoms, and those feelings may make the event seem very immediate and real. You can take a class in relaxation training or work with your therapist on techniques such as “positive self-talk” in which you replace negative thoughts (“I’m going to lose control”) with more positive ones (“I can handle this”). One of the simplest ways to relieve your anxiety is to use a breathing technique. The minute you notice you’re getting upset, inhale normally, then exhale to the count of four as you slowly say the word “calm.” Count to four, inhale, then exhale as you speak once again.

Exercise. Another way to release the tension that working through PTSD generates is exercise, says Beverley Donovan, PhD, the staff psychologist in charge of the PTSD program at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Brecksville, OH, which serves half a million men and women. “Try exercising three times a week for 45 minutes,” says Dr. Donovan. The natural release of endorphins can counteract your anxiety. Try brisk walking, biking, or even skating-anything that increases your heart rate and lets you work up a sweat.

Don’t get sidetracked. Other issues always come up in therapy, says Dr. Dancu-how your parents treated you as a child, why your brother never calls, the situation at work. Postpone talking about them until another time, suggests the therapist. Stay focused on PTSD.

Journalize. When memories of a traumatic event start to overwhelm you outside a therapy session, jot down their essence in a journal specifically for that purpose, says Dr. Miller. “Then close the book, and say to yourself, ‘Listen, this is not for now, this is for therapy.’ Then distract yourself. Get up and take a walk, call a friend, clean your closet. Decide in advance what you’re going to do, then do it. And take that journal to therapy.”

Use imagery. Imagery is a powerful way to help process traumatic events, says Dr. Donovan. One imagery exercise she finds particularly effective in dealing with PTSD was developed by Akron, OH, therapist Belleruth Naparstek, MSW, specifically for those who are experiencing PTSD.

The exercise is now available on cassette tapes and CDs, which are being used at rape and domestic violence centers and hospitals around the US. To order a copy, contact Image Paths, Inc., 891 Moe Drive, Suite C, Akron, OH 44310, or call (800) 800-8661.

Get help even if you don’t have a serious case. “Keep in mind that you don’t need to be a textbook case of PTSD to get some help,” says Dr. Dancu. An hour’s worth of counseling after a car crash, miscarriage, or cancer diagnosis isn’t a big deal. Especially if it can keep you off a treadmill of terror.

If you suspect that you have PTSD, call your health insurance company, and ask them for the name of a therapist near you who specializes in PTSD. You can also call the department of psychiatry at a nearby medical school or hospital and ask for a recommendation.

For information on support groups or a list of professionals in your area who treat PTSD, contact: