Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

We all experience traumatic events in our lives. These events trigger our fight or flight response - a state of heightened reactivity in which our heart pounds, breathing is rapid, and stress hormones cause muscles to tense for quick action.^[2]

For most of us, though, these physiological changes occur in passing. Once the threat of danger is gone, so is the stress response. However, other people continue experiencing stress response symptoms long after the event. In some cases, the severity of symptoms reaches the level of a PTSD diagnosis.

PTSD goes well beyond a typical stress response and involves debilitating symptoms.^[3] People with PTSD might experience flashbacks to the event, difficulty sleeping, and feelings of being constantly on edge. Likewise, PTSD might include disproportionate feelings of self-blame, avoidance of specific locations or events, and angry outbursts.

Types of PTSD

The DSM-V doesn’t specify different types of post-traumatic stress disorder. However, categorizing PTSD according to specific sets of common symptoms and experiences is helpful for understanding how it might affect other people. Each of these levels of PTSD features different symptoms:

Acute stress disorder

Acute stress disorder shares many symptoms with PTSD. However, acute stress disorder is not a long-term condition like PTSD. Instead, it lasts a few days, weeks, or up to one month and might affect anyone that has directly or indirectly experienced trauma

Symptoms might include flashbacks, an inability to experience positive emotions, and an inability to sleep. Angry outbursts, difficulty concentrating, and heightened reactivity to loud noises might also occur. Treatments for acute stress disorder include individual or group therapy and medication.^[4][5]

Uncomplicated PTSD

Uncomplicated PTSD occurs after a single, specific traumatic event, such as the death of a loved one. Symptoms include mood changes, flashbacks or nightmares, and avoidance of people, places, and events that remind the person of the trauma. Anyone can experience uncomplicated PTSD, but psychiatric therapy or medication can help manage it.^[4]

Complex PTSD

Complex PTSD occurs after multiple traumatic events, such as repeated instances of abuse or violence. The symptoms are essentially the same as uncomplicated PTSD, though substance abuse, impulsivity, and aggression can also occur.

Furthermore, some people with complex PTSD have comorbid conditions, such as dissociative disorder, borderline personality disorder, or antisocial personality disorder.^[4] Common treatments for complex PTSD include eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavioral therapy (CBT).^[6]

Comorbid PTSD

Comorbid PTSD refers to a situation in which PTSD presents with at least one other mental health concern, commonly a substance use disorder, anxiety disorder, or mood disorder.^[4] Comorbid PTSD includes typical symptoms related to hyper-alertness, irritability, and flashbacks. These symptoms present alongside the signs of the comorbid condition.

For example, someone with PTSD and a depressive disorder might have feelings of worthlessness, a loss of interest in enjoyable activities, and suicidal ideation. Cognitive behavioral therapy and medication are the most common treatments and are most effective when used together.^[7]

Symptoms of post-traumatic stress disorder

PTSD is a common psychological disorder with symptoms within three months after a traumatic event. However, everyone experiences trauma differently, so some won’t present PTSD symptoms until much later, perhaps years after the initial trauma.^[3]

PTSD symptoms occur in four clusters: intrusion, avoidance, cognition and mood, and arousal and reactivity. The outline below lists common symptoms within each:^[8]

Intrusion PTSD symptoms:

• Intrusive memories that are recurrent, involuntary, and distressing
• Distressing dreams related to the traumatic event
• Dissociative reactions during which the individual experiences flashbacks and feels as though the traumatic event is occurring all over again
• Psychological distress that’s prolonged, intense, and in reaction to cues that resemble aspects of the initial trauma
• Psychological reactions to cues that symbolize aspects of the initial trauma

Avoidance PTSD symptoms:

• Avoidance of memories, thoughts, or feelings about the initial trauma and anything closely associated with it
• Avoidance of external reminders of the trauma, which might include locations, people, objects, and situations related to the trauma

Cognition and mood PTSD symptoms:

• Inability to remember aspects of the trauma, which is often due to dissociative amnesia; memory problems cannot be better explained by other factors, like drug or alcohol use or a head injury
• Negative beliefs about oneself, others, or the world in general that are persistent and exaggerated (e.g., “I can’t trust anyone”)
• Distorted cognitions about the trauma that is persistent and lead to self-blame
• Persistent negative emotional state that manifests as anger, shame, guilt, fear, and the like
• Drastically reduced interest in activities that used to bring joy
• Feelings of detachment from others
• Persistent inability to experience positive emotions such as love, happiness, or satisfaction

Arousal and reactivity PTSD symptoms:

• Alterations in behavior, including angry outbursts, physical aggression, or verbal aggression
• Reckless behavior, including self-destructive behavior
• Hypervigilance and an exaggerated startle response
• Difficulty concentrating
• Difficulty sleeping

Children under six years of age might experience different PTSD symptoms than older children and adults. Clinicians often look for the following as signs of childhood PTSD:

• Frequently acting out the traumatic event during play
• Unusual clinginess to parents or other caregivers
• Wetting the bed, even if potty trained
• Losing the ability to talk

Symptoms of PTSD can persist for several months or years, depending on the person. In some cases, PTSD becomes a chronic, lifelong disorder.

Symptoms can also worsen without effective treatment, causing even more significant impairment in daily functioning. Fortunately, PTSD is highly treatable with therapy, medication, or a combination.

Causes of post-traumatic stress disorder

PTSD can develop as a result of virtually any traumatic situation. What’s more, what one person finds traumatic, another person might not, so the threshold for “traumatic” is different for each of us.

Common traumatic events that might lead to PTSD include:^[6]

• Experience in military combat, including active duty in a war zone
• Violence upon a person, such as physical assault, sexual assault, or robbery
• Significant health problems, such as terminal cancer
• Serious accidents in which injuries or death occur
• Natural disasters, like tornadoes and hurricanes

There are risk factors associated with the development of PTSD as well, meaning someone with one or more of the following is more likely to develop PTSD:^[3]

• Childhood trauma, including physical, mental, emotional, or sexual abuse
• Family history of substance abuse or mental illness
• Frequent exposure to traumatic events, including dangerous situations (e.g., drug use in the home)
• Experiencing physical injuries, seeing others injured, or witnessing others being killed
• Lack of social support, particularly after a traumatic event

Likewise, people that experience stressful events after the traumatic event (e.g., a death in the family after living through a hurricane) are more likely to develop PTSD symptoms.

Though researchers have identified these risk factors as increasing the likelihood of developing PTSD, the precise cause is as yet unclear. Genetics and neurobiology are two potential causes of interest to psychological researchers.^[9]

Diagnosing PTSD

The first steps in diagnosing post-traumatic stress disorder include a physical examination and a psychological evaluation. A physical exam is necessary to determine if symptoms result from a bodily injury, such as head trauma. A psychological evaluation helps develop a clearer picture of the presenting condition and how the symptoms might be classified.

A DSM diagnosis requires that the person exhibits symptoms from each of the four symptom clusters (as outlined in the PTSD symptom section above) for one month or more.^[8] This includes:

• At least one intrusive PTSD symptom, such as distressing dreams. Intrusive symptoms might manifest from a person’s feelings or thoughts or result from reminders of the traumatic event, such as driving by the location of a severe car accident.
• At least one avoidance PTSD symptom, such as actively avoiding talking about the trauma. Using the car accident example from above, an avoidance symptom might be altering one’s commute to work to avoid seeing the location of the accident.
• At least two cognition and mood PTSD symptoms, such as self-blame and a lack of interest in enjoyable activities. For example, a person with PTSD might blame themselves for a car accident, even if it wasn’t their fault.
• At least two arousal and reactivity PTSD symptoms, such as hypervigilance and extreme reactions to loud noises. In our car accident example, someone with PTSD might be so on edge behind the wheel that they find it difficult to drive again.

Additionally, the expression of these symptoms must cause clinically significant distress, such as difficulty in social situations, daily functioning, or work settings. For example, a person’s inability to sleep might cause their performance at work to deteriorate to the point of being fired.

Another condition must not better explain the symptoms. For example, some medical conditions, substance abuse, and medications can cause symptoms similar to PTSD.

Prevention of PTSD

No matter who you are, you will experience trauma at some point in your life. When these events occur, it’s common to experience PTSD-like symptoms for a short time. The goal is to prevent these normal post-trauma feelings from developing into something more serious and long-lasting.

The list below summarizes approaches you can take to stave off PTSD. Keep in mind that these techniques are not guaranteed to prevent PTSD. Instead, literature reviews support the efficacy of these approaches in preventing PTSD in most people:^[10]

• Get support early and often. PTSD is more common in people that avoid processing their feelings about the trauma.
• Identify as a survivor of the trauma. Putting yourself in a survivor rather than a victim mindset can help minimize self-blame.
• Try to find positive meaning in the trauma. This can be very difficult to do. However, with the support of loved ones, other trauma survivors, and a mental health provider, you can find a silver lining that helps you reframe the experience in a more positive light.
• Help other trauma survivors. Though your specific traumatic experience might differ from someone else’s, sharing those experiences and supporting one another will help you both process your emotions and take positive steps toward recovery.

You must start early if you use one or more of these approaches or work on your recovery through other means. The sooner you begin processing your feelings and emotions, the less likely you will develop PTSD.

Treatment for PTSD

PTSD treatment usually falls into two categories: therapy and medication.

Like many diagnosable mental health conditions, the best course of action is often a combination of therapy and medication. The list below describes some of the most common approaches to treating PTSD:

Medications for PTSD include:^[11]

• SSRIs, or selective serotonin reuptake inhibitors, are often the most effective medications for PTSD. These antidepressant medications (e.g., Zoloft, Paxil, Prozac) treat the core symptoms of PTSD by increasing serotonin levels in the brain. This helps reduce intrusive thoughts, avoidant behavior, and changes in cognition and mood, among other PTSD symptoms.
• SNRIs, or serotonin-norepinephrine reuptake inhibitors, are also highly effective for PTSD treatment. These antidepressant medications (e.g., Effexor) prevent serotonin and norepinephrine from being absorbed, effectively increasing the levels of both neurotransmitters in the brain. The effect is similar to SSRIs in that core PTSD symptoms are reduced.
• SRIs, or serotonin reuptake inhibitors (e.g., Serzone), aren’t as effective as SSRIs and SNRIs. However, mental health professionals might give a prescription if the desired effect isn’t achieved by one of the medications listed above. SRIs help balance serotonin levels in the brain, which can help reduce PTSD symptoms.
• TCAs, or tricyclic antidepressants (e.g., Tofranil), might be used if SSRIs or SNRIs don’t have the desired effect. TCAs work similarly to the other medications listed above in that they help balance and restore levels of neurotransmitters which can improve mood.
• MAOIs, or monoamine oxidase inhibitors (e.g., Nardil), prevent enzymes in the brain from breaking down dopamine, serotonin, and norepinephrine. By doing so, MAOIs increase the levels of these neurotransmitters in the brain and improve mood.

Therapies include:^[1]

• Cognitive behavioral therapy (CBT) focuses on changing patterns in thinking. For PTSD treatment, several CBT techniques are effective:
  • Stress inoculation therapy helps build effective coping strategies to defend against triggers related to the trauma.
  • Cognitive processing therapy focuses on confronting and processing negative emotions like shame and guilt.
  • Prolonged exposure therapy involves re-experiencing the trauma in a controlled, supportive environment so the person can gain control of the trauma and learn how to cope positively.
• Psychodynamic therapy is traditional talk therapy and focuses on the emotional components of PTSD. It can be effective for working through the trauma, identifying triggers, and building skills for coping.
• Group therapy provides social support among trauma survivors and is a safe place to share and experience feelings and emotions related to the trauma.

Self-care for PTSD

If you’re experiencing PTSD symptoms, the best self-care approach you can implement is to seek help. As noted above, avoiding the trauma and your feelings you more likely to develop PTSD. In addition, getting support from friends, family, and a mental health provider dramatically increases your chances of feeling better sooner.

Other self-care strategies you can implement include:^[12]

• Avoiding the use of alcohol or drugs, which can exacerbate PTSD symptoms.
• Eating right, exercising, and getting plenty of rest.
• Setting realistic goals (e.g., understanding that recovery is a process and that improvement won’t happen immediately).
• Following the treatment plan you’ve devised with your mental health provider, including attending therapy and/or taking medications as prescribed.
• Researching PTSD to better understand your condition and how it affects you.
• Practicing mindfulness, which focuses on being in the present moment, which can help you cope with triggers as they arise.
• Get an emotional support animal to assist in your treatment and recovery.

Helping someone with PTSD

If you know someone with PTSD, one of the most important things you can do to help is be supportive. People with PTSD might not ask you for help (and might actively resist it), but your support can be an integral component of their recovery.

Consider helping someone with PTSD by doing the following:^[3]

• Encourage your loved one to seek appropriate treatment. This might be something as simple as providing them with the phone number of a mental health provider.
• Offer to attend treatment with your loved one. The support of a trusted friend or relative will help build a solid foundation upon which recovery can take place.
• Recognize positive growth while being patient and understanding that recovery is a long road.
• Provide positive outlets for your loved ones, such as taking a walk, enjoying a sunset, playing with a dog, and other innocuous activities.
• Be available. Making yourself available to your loved one for emotional and social support is crucial for their treatment progress.

Frequently asked questions about PTSD

How does PTSD impact daily life?

PTSD can significantly impact one’s ability to function in daily life, including changes in personal and work relationships, ability to regulate mood, and seeking relief from symptoms by using drugs or alcohol as coping mechanisms. In addition, feelings of powerlessness, fear, and anxiety can lead to isolation and avoidance, disturbed sleep, and loss of appetite.

How common is PTSD?

Approximately one in 11 people are diagnosed with PTSD in their lifetime.^[1] Roughly 12 million American adults have PTSD each year,^[13] and approximately 3.6 percent of the world’s population experiences PTSD in a given year.^[14]

PTSD vs. PTS – What is the difference?

Where PTSD is a diagnosable mental health disorder often requiring treatment, PTS is a normal, situation-specific response to trauma or danger. PTS might be best described as the fight-or-flight response, which prepares us to act in the face of threats but subsides when the situation no longer poses a danger.