POST-TRAUMATIC STRESS DISORDER (PTSD) (2023)


POST-TRAUMATIC STRESS DISORDER (PTSD)

By: Veronica Rose, Chief Analyst

POST-TRAUMATIC STRESS DISORDER (PTSD) (2)
QUESTION
What is PTSD? What are the symptoms, diagnoses, and treatment for PTSD?

SUMMARY

The definition of PTSD has been revised several times over the years. But the Diagnostic Statistical Manual (DSM), which provides standard criteria for the classification and diagnosis of mental disorders by mental health professionals in the United States, classifies it under trauma- and stress-related disorders in its most recent edition, DSM-5, 2013.

PTSD stems from exposure to a traumatic event, such as combat, violent crime, torture, sexual violence, or a natural or man-made disaster, that caused or threatened to cause death or serious injury. It can affect those who (1) personally experience or witness the event; (2) learn that the event happened to a close relative or friend; or (3) experience repeated or extreme exposure to unpleasant or gruesome details of the traumatic event, such as first responders collecting human remains in the aftermath of a disaster (DSM-5, 2013 p. 271).

The typical symptoms associated with PTSD vary, but they include (1) recurring recollections of the traumatic event (“flashbacks”); (2) intense psychological or physiological reaction to cues symbolizing aspects of the event; (3) persistent display of negative emotions (such as fear, anger, guilt, or shame); (4) persistent inability to experience positive emotions (such as happiness, satisfaction, or love); (5) markedly diminished interest in participating in significant activities; (6) angry, reckless, and self-destructive behavior; and (7) avoidance of thoughts or situations reminiscent of the trauma. The symptoms may start soon after the triggering event or may be delayed for months or years after exposure to the event (delayed expression). To be characterized as PTSD, the symptoms must last for more than one month and cause significant impairment in a person's ability to function. And they cannot be attributable to the physiological effects of a medical condition or substance, such as alcohol. (Separate diagnostic criteria included in DSM for children under age six are not discussed in this report.)

Not everyone who experiences trauma suffers from PTSD. Some research suggests that temperament and genetic makeup have some bearing on the chances of developing PTSD, and it is more likely to affect people with certain predisposing conditions such as depression. But it has also been diagnosed in people with no predisposing conditions. And it can affect people of any age. Research indicates that PTSD rates are higher among veterans and others whose work increases the risk of traumatic exposure (such as police, firefighters, and emergency medical personnel.) Highest rates (ranging from one-third to more than one-half of those exposed) are found among survivors of rape, military combat, and captivity and ethnically or politically motivated internment and genocide. Higher PTSD rates have also been reported among U.S. Latinos, African Americans, and American Indians than Caucasians, and lower rates among Asian Americans, after adjusting for traumatic exposure and demographic variables (DSM-5, p. 276). Events most commonly associated with PTSD in women are rape and sexual violence. In men, the event is combat exposure.

According to the literature, the main types of treatment for PTSD are psychotherapy (counseling), medication, or a combination of both.

The diagnosis of PTSD has its critics. One 2007 study, for example, describes it as a “faddish postulate” that “has redefined and overextended the reach of a long-recognized natural human reaction of fear, anxiety, and conditioned emotional reactions to shocks and traumas.” The study authors conclude that “the concept of PTSD has moved the mental health field away from, rather than towards, a better understanding of the natural psychological responses to trauma” (McHugh, P.R. and Treisman G., PTSD: a problematic diagnostic category, Journal of Anxiety Disorders 21(2): 211-22). The authors of a 2008 study concluded that the disorder's “core assumptions and hypothesized mechanisms lack compelling or consistent empirical support” (Rosen G. M. and Lilienfeld S. O., Posttraumatic stress disorder: An empirical evaluation of core assumptions, Clinical Psychology Review 28:837-68).

WHAT IS PTSD?

The definition of PTSD has been revised several times over the years. Historically linked to combat veterans, and once labelled as “combat fatigue,” “battle fatigue,” or “shell shock,” PTSD is increasingly being diagnosed in civilians.

DSM is the standard classification of mental disorders used by mental health professionals in the United States. It contains a list of standard diagnostic criteria for the classification of psychiatric disorders. DSM-IV classified PTSD as an anxiety disorder. DSM-5, the current edition, classifies it with trauma and stress-related disorders. The change in classification from an anxiety- to a stress-related disorder means PTSD is no longer treated as an anxiety related to mental illness but a disorder connected to an external event.

PTSD is a mental disorder that follows exposure to an extremely traumatic or life-threatening event. These include:

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1. exposure to war as a combatant or civilian;

2. incarceration as a prisoner of war;

3. torture;

4. threatened or actual sexual violence, including rape or sexual abuse;

5. threatened or actual physical assault, such as robbery, childhood physical abuse, or the Sandy Hook Elementary School shooting;

6. man-made disasters, such as a factory explosion, and natural disasters, such as the recent Washington mudslide;

7. severe motor vehicle accidents; and

8. certain medical incidents, such as waking during surgery, or a medical catastrophe involving one's child (although a life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event).

Regardless of its trigger, PTSD causes clinically significant impairment in an individual's social interactions, capacity to work, and other important areas of functioning, which is not caused by another medical condition, medication, drugs, or alcohol.

HOW IS PTSD DIAGNOSED?

DSM-5 identifies eight criteria for mental health professionals to use in diagnosing PTSD in anyone over age six: (1) exposure to a traumatic event, (2) four clusters of symptoms (Criteria B through E), (3) duration of the symptoms, (4) how the symptoms impact one's ability to function, and (5) whether the symptoms are caused by substance abuse or another medical condition. To be characterized as PTSD, the symptoms must have started or been significantly exacerbated after exposure to the traumatic event. (The diagnostic criteria for children under age six are not discussed in this report.)

Exposure to Traumatic Event

The exposure to trauma may result from an individual:

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1. directly experiencing or personally witnessing the traumatic event;

2. learning that the event involved a close family member or close friend and, in the case of actual or threatened death, was either violent or accidental; or

3. experiencing first-hand repeated or extreme exposure to distasteful or gruesome details of the traumatic event, such as first responders collecting body parts, or professionals repeatedly exposed to details of child abuse. (Indirect non-professional exposure through the electronic media or television such as televised images of the 9/11 attacks, photographs, or movies, unless work-related, do not qualify.)

Symptoms

The essential feature of PTSD is the development of characteristic symptoms following exposure to a traumatic event (id. at p. 274). These symptoms usually start within three months after exposure, but may be delayed for months or years before criteria for the diagnosis are met. They also may come and go over time.

DSM-5 classifies PTSD symptoms into four clusters: intrusion, avoidance, negative alterations in thoughts and mood, and arousal.

Intrusive Recollections. The traumatic event is relived in one of several ways:

1. recurring, involuntary, and intrusive distressing memories of the traumatic event;

2. nightmares related to the event;

3. “flashbacks” (feeling or behaving like the event is happening again), which can be triggered by images, sounds, smells, or feelings; and

4. intense or prolonged psychological distress, or marked physiological reactions when exposed to cues that symbolize or resemble some aspect of the event (such as hearing firecrackers or gun shots).

Avoidance of Reminders. Stimuli associated with the event are persistently avoided, including situations, people, memories, thoughts, conversations, places, or activities that trigger memories of the traumatic event.

Negative Thoughts and Feelings. Negative changes in thought and mood associated with the event begin or worsen after the event. These negative changes can take various forms including:

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1. an inability to recall key aspects of the event (amnesia) unrelated to head injury or other external source;

2. persistent and exaggerated negative beliefs about or expectations of self, others, or the world;

3. persistent, distorted ideas about what caused the event or its consequences, causing the person to blame him or herself or others;

4. a persistent negative emotional state (such as fear, horror, guilt, or shame);

5. a markedly diminished interest or participation in significant activities;

6. feelings of detachment or estrangement from others; or

7. persistent inability to experience positive emotions, such as happiness, satisfaction, or love.

Arousal. PTSD is also characterized by marked changes in arousal and responsiveness associated with, and beginning with or worsening after, the traumatic event, as evidenced by two of the following:

1. irritability and unprovoked anger, typically expressed as aggressive behavior toward people or objects (for example, yelling at people or getting into fights);

2. reckless or self-destructive behavior, such as dangerous driving, suicidal behavior, unsafe sex, and excessive drug or alcohol use;

3. being constantly tense and on guard (“hypervigilance”);

4. being easily startled (“exaggerated startle response”);

5. difficulty concentrating; or

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6. difficulty falling or staying asleep.

In addition to the above symptoms, some PTSD sufferers may also experience feelings of detachment from mind, body, or both (“depersonalization”); recurring feelings that their surroundings are unreal or dreamlike (“derealization”); or both.

The clinical presentation of PTSD varies, depending on such factors as age of onset, type and intensity of the trauma, duration and frequency of exposure, and proximity in time and place to the trauma, among other things. For example, in some individuals, emotional and behavioral symptoms may be dominant, while in others negative arousal or negative behaviors may be most prominent (id. at p. 274). Also, symptoms may recur and worsen in response to new trauma or reminders of the original trauma.

Individuals with PTSD are 80% more likely to have symptoms that meet diagnostic criteria for at least one other mental disorder such as depression, anxiety, or substance abuse (id. at p. 280).

Other Criteria

The remaining three criteria for a PTSD diagnosis are: the symptoms (1) last for more than one month; (2) cause clinically significant distress or impairment of social, occupational, or other important areas of functioning; and (3) are not attributable to the physiological effects of a substance, such as medication or alcohol, or to another medical condition.

PREVALENCE RATES

Approximately 8.7% of people in the United States will likely develop PTSD in their lifetime, with the lifetime occurrence (prevalence) in combat veterans ranging from 10% to 30%. Somewhat higher rates of this disorder have been found to occur in U.S. African Americans, Hispanics, and Native Americans compared to Caucasians.

Anyone can develop PTSD at any age, including childhood. But women, perhaps because of greater likelihood of exposure to traumatic events such as rape and interpersonal violence, are more likely than men to develop PTSD, and women in the general population experience PTSD for a longer time than men. About 10% of women develop PTSD sometime in their lives compared to 5% of men (National Center for PTSD–http://ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp)

PTSD rates are higher among veterans and others whose work increases the risk of traumatic exposure (such as police, firefighters, and emergency medical personnel.) Highest rates (ranging from one-third to more than one-half of those exposed) are found among survivors of rape, military combat and captivity and ethnically or politically motivated internment and genocide (DSM-5 at p. 276).

TREATMENT AND RECOVERY

According to the literature, the main types of treatment for PTSD are psychotherapy (counseling), medication, or a combination of both.

According to DSM-5, duration of PTSD symptoms varies, with complete recovery occurring in approximately 50% of adults diagnosed with PTSD within three months of the traumatic event, but some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years (id. at p. 277).

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FAQs

Can a person with PTSD live a normal life? ›

Yes, living a healthy life with PTSD is possible. A person struggling with PTSD should seek out a treatment plan that will work for them to get them on track to managing their PTSD.

What coping strategies work best for PTSD? ›

Five ways to cope with PTSD
  • Mindfulness meditation. Increasingly, meditation and mindfulness-based relaxation techniques have been shown to help manage a range of disorders. ...
  • Regain focus through physical activity. ...
  • Aromatherapy. ...
  • Art therapy. ...
  • Pets for PTSD.
20 Oct 2017

How do you calm a trigger after PTSD? ›

Try grounding techniques.
  1. Get to know your triggers add. You might find that certain experiences, situations or people seem to trigger flashbacks or other symptoms. ...
  2. Confide in someone add. ...
  3. Give yourself time add. ...
  4. Try peer support add. ...
  5. Find specialist support add. ...
  6. Look after your physical health add.

How does a person with PTSD Act? ›

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people.

Does PTSD ever go away fully? ›

So, does PTSD ever go away? No, but with effective evidence-based treatment, symptoms can be managed well and can remain dormant for years, even decades. But because the trauma that evokes the symptoms will never go away, there is a possibility for those symptoms to be “triggered” again in the future.

What does PTSD do to your life? ›

Post-traumatic stress disorder can disrupt your whole life ― your job, your relationships, your health and your enjoyment of everyday activities. Having PTSD may also increase your risk of other mental health problems, such as: Depression and anxiety. Issues with drugs or alcohol use.

Do people with PTSD shut you out? ›

Emotional numbing is a term used to describe a state of mind in which people with PTSD try to cope. Specifically, they emotionally shut down.

Can I heal from PTSD alone? ›

Many people get better on their own. But it often takes time. Sometimes professional help is needed. People who feel they can't get control of their lives because of their responses to the trauma may have posttraumatic stress disorder (PTSD).

What are PTSD triggers? ›

Triggers can include sights, sounds, smells, or thoughts that remind you of the traumatic event in some way. Some PTSD triggers are obvious, such as seeing a news report of an assault. Others are less clear. For example, if you were attacked on a sunny day, seeing a bright blue sky might make you upset.

What type of therapist is best for PTSD? ›

Who Is Licensed to Provide Psychotherapy for PTSD?
  • Psychologists. Licensed clinical psychologists focus on mental health assessment and treatment. ...
  • Clinical social workers. ...
  • Licensed professional mental health counselors. ...
  • Psychiatrists. ...
  • Psychiatric nurses or nurse practitioners.

What is the most successful form of treatment for PTSD? ›

Cognitive Behavior Therapy (CBT):

CBT is a type of psychotherapy that has consistently been found to be the most effective treatment of PTSD both in the short term and the long term. CBT for PTSD is trauma-focused, meaning the trauma event(s) are the center of the treatment.

What do PTSD episodes look like? ›

intrusive thoughts or images. nightmares. intense distress at real or symbolic reminders of the trauma. physical sensations such as pain, sweating, nausea or trembling.

What are three unhealthy coping skills for PTSD? ›

Ginger Mercer: How Treatment Helps Me
  • Substance abuse. Taking a lot of drugs or alcohol to feel better is called substance abuse. ...
  • Avoiding others. ...
  • Staying always on guard. ...
  • Avoiding reminders of the trauma. ...
  • Anger and violent behavior. ...
  • Dangerous behavior. ...
  • Working too much.

What happens after a PTSD episode? ›

Flashbacks of the event or emotional/psychological dissociation when triggered. Avoidance of thoughts, feelings, people, places, or any reminders of what happened. Difficulty remembering details of the event. Changes in mood, memory, or thinking patterns.

What are 2 things that can happen to you if you have PTSD? ›

Many people with PTSD also have a number of other problems, including: other mental health problems, such as depression, anxiety or phobias. self-harming or destructive behaviour, such as drug misuse or alcohol misuse. other physical symptoms, such as headaches, dizziness, chest pains and stomach aches.

What do PTSD patients avoid? ›

Avoidance is a core symptom of PTSD, with at least one avoidance symptom required for a diagnosis. People often try to cope with the trauma by avoiding distressing memories, thoughts, or feelings associated with the event.

What is it like living with someone with PTSD? ›

PTSD isn't easy to live with and it can take a heavy toll on relationships and family life. You may be hurt by your loved one's distance and moodiness or struggling to understand their behavior—why they are less affectionate and more volatile. You may feel like you're walking on eggshells or living with a stranger.

Does PTSD count as a disability? ›

The Social Security Administration (SSA) considers post-traumatic stress disorder a disability. It falls under the category of trauma and stressor-related disorders. According to the SSA, these disorders occur after witnessing or experiencing a stressful or traumatic event.

Does PTSD cause brain damage? ›

According to recent studies, Emotional Trauma and PTSD do cause both brain and physical damage. Neuropathologists have seen overlapping effects of physical and emotional trauma upon the brain.

What are the 5 stages of PTSD? ›

What are the five stages of PTSD?
  • Impact or Emergency Stage. ...
  • Denial/ Numbing Stage. ...
  • Rescue Stage (including Intrusive or Repetitive stage) ...
  • Short-term Recovery or Intermediate Stage. ...
  • Long-term reconstruction or recovery stage.

How does PTSD affect memory? ›

Studies of individuals with PTSD have found that PTSD damages the hippocampus, reducing it in volume by an average of eight percent. Not only does PTSD lead to flashbacks, anxiety and disjointed memories of traumatic events, PTSD also damages the brain's ability to convert short-term memories into long-term memories.

Does PTSD cause lack of empathy? ›

Abstract. Trauma survivors with PTSD show social interaction and relationship impairments. It is hypothesized that traumatic experiences lead to known PTSD symptoms, empathic ability impairment, and difficulties in sharing affective, emotional, or cognitive states.

Can a person with PTSD love? ›

In time, most are able to resume their prior level of closeness in relationships. Yet the 5% to 10% of survivors who develop PTSD may have lasting relationship problems. Survivors with PTSD may feel distant from others and feel numb. They may have less interest in social or sexual activities.

Why do people with PTSD push others away? ›

Emotional avoidance is a common reaction to trauma. In fact, emotional avoidance is part of the avoidance cluster of post-traumatic stress disorder (PTSD) symptoms, serving as a way for people with PTSD to escape painful or difficult emotions.

How long does PTSD usually last? ›

PTSD symptoms usually appear soon after trauma. For most people, these symptoms go away on their own within the first few weeks and months after the trauma. For some, the symptoms can last for many years, especially if they go untreated. PTSD symptoms can stay at a fairly constant level of severity.

How does God heal PTSD? ›

God Brings Healing to Many Aspects of PTSD

Soothing – calming our mind, emotions, negative thoughts and their impact on the whole person. Peace – knowing the event and all related to it is in God's hands and He loves and cares for you, wanting the best for you so He will take care of you in the best way.

What is the fastest way to cure PTSD? ›

What Are the Treatments for PTSD?
  1. Therapy.
  2. Cognitive Processing Therapy.
  3. Prolonged Exposure Therapy.
  4. Eye Movement Desensitization and Reprocessing.
  5. Stress Inoculation Training.
  6. Medications.
21 Jan 2022

How do doctors test for PTSD? ›

For physical health problems, this could include labs (like bloodwork), tests (like an x-ray, scan or biopsy) or a physical exam. For PTSD, an assessment includes answering questions about your thoughts, feelings and behaviors. PTSD is most often diagnosed, or confirmed, by a mental health provider.

What foods help with PTSD? ›

Shift towards more anti-inflammatory foods, such as omega 3-rich fish three times a week, flax seeds, sour cherries and berries, apples, pears, and pomegranate. Choose a plant-based diet. Eat mostly whole grains, nuts, seeds, fruits, and vegetables. Balance your meals with protein and fat.

What are PTSD flashbacks like? ›

In a PTSD flashback, you may feel like you're reliving a past traumatic incident as if it is happening right now. PTSD flashbacks can be triggered by anything that reminds you of past trauma you have experienced. Self-care techniques can help you cope with flashbacks, and you may also need professional support.

How many therapy sessions are needed for PTSD? ›

As conducted in research studies, treatment consists of 16 individual sessions, each lasting between 45 minutes and one hour. Sessions are typically scheduled once per week. Each of the 16 sessions has a specific objective. This intervention is intended for individuals who have experienced a single traumatic event.

How long does it take to recover from PTSD? ›

The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic. A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

How long does therapy take for PTSD? ›

Conditions such as post-traumatic stress disorder typically take around 15-20 sessions for 50% of patients to feel improvement. It's been found that those treated with Cognitive Behavioral Therapy report feeling better after around 10-20 sessions.

Can people with PTSD work? ›

Your ability to work when you have PTSD can depend on the severity of your condition and the effect that treatments have on you. However, work can also have a positive effect on your mental health because it offers you: Structure and routine. A sense of purpose and accomplishment.

What is the gold standard for treating PTSD? ›

Trauma-focused cognitive behavior therapy

behavior therapy, or TF-CBT, is considered the gold standard treatment for children and adolescents with PTSD.

What is the best mood stabilizer for PTSD? ›

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), might be used to help reduce symptoms of depression or anxiety in people with PTSD.
...
Other medications used for PTSD
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

What does PTSD feel like physically? ›

People with PTSD may also experience physical symptoms, such as increased blood pressure and heart rate, fatigue, muscle tension, nausea, joint pain, headaches, back pain or other types of pain. The person in pain may not realize the connection between their pain and a traumatic event.

How can you tell if someone has PTSD? ›

They might have upsetting images or memories of the most upsetting parts of the trauma, even though they spend a lot of time trying to avoid anything that might remind them of what happened. The events feel too overwhelming to think or talk about.

Can you feel a PTSD episode coming? ›

These memories are often accompanied by sensory experiences; visions, sounds, and even smells from the incident may return, as if they are happening in the present moment. Perceiving imminent danger, your brain will go into a state of alarm: your heart races, you sweat profusely, and your breath speeds up.

What is the most common trauma associated with PTSD? ›

Post-Traumatic Stress Disorder (sometimes called PTSD) is a form of anxiety disorder. Some people develop this condition after they have experienced a traumatic event. This event might be a serious accident, physical or sexual assault, war or torture, or a natural disaster such as a bushfire or a flood.

Can you have a PTSD relapse? ›

PTSD symptoms can come and go over many years. A relapse is the return of enough symptoms to meet the criteria for diagnosis with PTSD. Though you might not have a full relapse, you may find yourself slipping into old patterns of thought or behavior.

How hard is it to recover from PTSD? ›

Recovery from PTSD is a gradual, ongoing process. Healing doesn't happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many steps you can take to cope with the residual symptoms and reduce your anxiety and fear.

How does PTSD affect normal life? ›

Post-traumatic stress disorder can disrupt your whole life ― your job, your relationships, your health and your enjoyment of everyday activities. Having PTSD may also increase your risk of other mental health problems, such as: Depression and anxiety. Issues with drugs or alcohol use.

Is PTSD a permanent disorder? ›

How long do the symptoms persist? Symptoms generally last for at least one month. Symptoms may recur or intensify in response to reminders of the traumatic event, ongoing life stressors, or newly experienced traumatic events. 7 Without treatment, a person can have PTSD for years or the rest of his or her life.

What does PTSD prevent you from doing? ›

Changes in mood and cognitive function

This fear, mistrust, and negative self-image can wreak havoc on how you handle everyday situations and relationships. On the cognitive side, not only can PTSD affect your memory, but your ability to concentrate and focus, which leaves you less able to handle school or work.

How does PTSD damage the brain? ›

Your brain is equipped with an alarm system that normally helps ensure your survival. With PTSD, this system becomes overly sensitive and triggers easily. In turn, the parts of your brain responsible for thinking and memory stop functioning properly.

How does PTSD affect communication? ›

Communication can be more difficult when PTSD is involved. Just as trauma survivors are often afraid to address what happened to them, family members are sometimes fearful of facing how their loved one's PTSD impacts their lives. Family members may want to avoid talking about the issues.

What does PTSD look like in relationships? ›

Intimacy in relationships can be affected when you live with certain symptoms of PTSD, such as: lack of interest in enjoyable activities. negative self-image. feelings detached from others, or an inability to emotionally connect.

How does PTSD affect you socially? ›

Trauma survivors with PTSD may have trouble with their close family relationships or friendships. The symptoms of PTSD can cause problems with trust, closeness, communication, and problem solving which, in turn, may impact the way a loved one responds to the trauma survivor.

Can you get 100% PTSD disability? ›

PTSD disability ratings can be 10%, 30%, 50%, 70%, or 100%.

When does PTSD become a disability? ›

PTSD can be considered a disability by the SSA if the criteria for Listings 12.15 or 112.15 Trauma- and stressor-related disorders are met by the applicant. If your symptoms of PTSD are so severe that you are unable to work, the SSA will consider you disabled and you will be able to get disability with PTSD.

What makes PTSD chronic? ›

If symptoms last at least three months, the disorder is referred to as chronic PTSD. If symptoms manifest at least six months following a traumatic event, the disorder is classified delayed-onset PTSD, according to the National Institute of Health (NIH).

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