PTSD (Post-Traumatic Stress Disorder)

What is PTSD?

Post-traumatic stress disorder (PTSD) is a syndrome that often develops after exposure to a traumatic experience. Trauma may affect combat veterans (it used to be called “shell shock” and “combat fatigue”). But it can also affect people who have experienced physical or sexual assault, abuse, natural disasters, accidents, or other serious events. A trauma is defined as a disturbing event that is frightening and sometimes life-threatening.

People with PTSD often feel uncontrollably angry, irritable, and on high alert. They have nightmares and intrusive memories about the traumatic event. This leads to issues with sleep, concentration, and affects many other aspects of their life. They tend to feel disconnected from people who haven't experienced trauma, or feel numb. These experiences can completely disrupt their life.

People with PTSD often drink, use drugs, or find other ways to self-medicate the very intense and disruptive symptoms. They could be at higher risk of depression, anxiety, suicide, and substance use disorders. Therapy and medications can help you recover.

What does PTSD look like?

There are many symptoms of PTSD, but people typically feel intense anger, irritability, and anxiety. You have PTSD if you have symptoms for more than one month after the traumatic incident. (If one month or less, it is called “acute stress disorder.”)

Symptoms of PTSD are very intense and disrupt your daily tasks and relationships. Symptoms can vary from person-to-person and change over time.

Main symptoms

There are 4 categories of symptoms.

Intrusion symptoms

• Repeated unwanted thoughts and nightmares about the traumatic event.
• Flashbacks—you feel like you are re-experiencing the event.
• Intense emotional or physical distress at cues that remind you of the event.

Avoidance

• Trying to avoid thoughts or feelings related to the event or any reminders that cause distressing thoughts, feelings, or memories of the event.
• Avoiding people, places, activities, objects, or situations.
• Using different unhealthy coping mechanisms such as substance use or sex addiction.

Negative changes in mood and thoughts

• Exaggerated negative beliefs about yourself or the world (like “I am broken,” “the world is completely dangerous”).
• Blaming yourself for what happened.
• Persistent (ongoing) negative emotional state (like fear, anger, guilt, shame).
• Feeling detached from other people.
• Feeling emotionally numb.
• Inability to experience positive feelings (like happiness, love).
• Inability to remember important moments from the event.

Hyperarousal

• Feeling constantly on edge.
• Angry outbursts.
• Easily startled.
• Trouble paying attention.
• Difficulty sleeping.

Other symptoms you may have

• Depersonalization—which is feeling detached from your own mind or body. People will talk about floating over themselves, and watching their life, as if they are an observer rather than in their body living their life.
• Derealization—which is when your life seems colorless, far away, unrelated to you, or blurry. It is a defense mechanism which helps people separate from the intense pain of their life.
• Intense physical symptoms, including dizziness, fatigue, headaches, nausea, rapid heart rate, teeth grinding, twitching, and bodywide weakness.

What causes PTSD?

PTSD can be thought of as a normal response to an abnormal event. Your body protects you from a stressor by preparing to fight, flee, or freeze.

People who have developed PTSD have experienced something horrifying and often life-threatening. So their body continually remembers this event as a protective measure, telling them that they are in danger even when they are not.

What makes you more likely to have PTSD?

Something that is traumatic to one person might not be to another. Mental health experts think of the range of trauma as “Big T's” and “Little T's.”

Big T's are things like war, sex abuse, and life-threatening events. Little T's might be loss of a friendship, not getting a job, or an embarrassing moment. How people experience these Big and Little T’s varies.

You could also have PTSD from indirect trauma, such as by hearing about the violent death of a close friend or family member. People in certain occupations are at higher risk because they are repeatedly exposed to details of trauma (like people in law enforcement and social workers).

Your risk of PTSD may be increased if you have poor social support, a prior trauma, feelings of helplessness, and other mental health problems.

Typically, good social support, feeling empowered, and having otherwise good health are certain factors that can reduce the risk.

PTSD in children and adolescents

Children and adolescents may react to trauma differently. In children, symptoms of PTSD may include:

• Bed wetting
• Difficulty speaking
• Increased clinginess to parents or other adults
• Repetitive play that re-enacts traumatic event
• Disruptive behavior
• Feeling guilty

PTSD treatment

Most people who have PTSD require treatment. Some people try to push through the symptoms, but it is easier to overcome with treatments. PTSD may get better with time, but generally, symptoms do not improve on their own.

A combination approach is the best way to treat PTSD. Therapy, medication, social support, and good health behaviors can dramatically improve the symptoms. Connecting with others who have PTSD is a great way to both learn skills and understand that you are not alone. If you have developed an alcohol or substance use disorder, that needs to be treated as well.

Psychotherapy

Therapy can include learning about trauma and its effects or practicing relaxation and anger-reduction skills. Therapy could help you improve daily routines (like sleep, diet, and exercise). It can also address feelings of guilt, shame, or anger related to the event—and support you in changing how you react to reminders of the trauma. A variety of therapies are recommended for PTSD:

• Exposure therapy: You will be exposed to symptom triggers in a gradual and repeated way. This will be in a safe and controlled environment, to help you gain control and learn to cope with distress.
• Cognitive processing therapy: Focuses on altering negative emotions (like guilt, anger) and thoughts (“the world is dangerous”).
• Group therapy with survivors of similar events.
• Eye movement desensitization and reprocessing (EMDR): A form of exposure therapy. You are asked to follow a moving object (like the therapist’s finger) while imagining the trauma again. The goal is to distract your brain while recalling a traumatic memory to help head off the PTSD response.
• Family therapy: PTSD can affect your partner and children. Understanding the impact of trauma on you and your family is a very important part of treatment. Family or marital therapy can be helpful.

Medications

Prescription medications can help relieve symptoms of PTSD. For some people, it also helps them participate better in psychotherapy.

• Antidepressants: People usually try selective serotonin reuptake inhibitors (SSRIs) first, such as sertraline (Zoloft). Antidepressants can help reduce flashbacks, intrusive thoughts, irritability, difficulty with concentration, hyperarousal, anxiety, and depressed mood. But it may take a few months before you start feeling better.
• Prazosin (Minipress): This medication blocks the adrenaline receptor, and can be effective in reducing nightmares and insomnia in PTSD.

Next steps

If you are experiencing any of these symptoms and worry that you have PTSD, consult with your doctor or a mental health specialist (found through your insurance company or on Psychology Today).

If you or someone you know is having thoughts about ending their life or is unable to take care of themselves at home due to PTSD, call 911 or go to the nearest ER right away.

Prevention

While there is no way to prevent a reaction to a traumatic event, there are things you can do to help you cope better if you experience one:

• Seek support from friends, family, or other caring individuals after a traumatic event.
• Participate in support groups after traumatic events.
• Use positive coping strategies (therapy, exercise, healthy sleeping, and eating habits), and reduce reliance on more negative ones like alcohol or drugs.