Content/Trigger Warning: Please be advised that the below article might mention trauma-related topics that include sexual assault & violence, which could potentially be triggering.
Post-Traumatic Stress Disorder (PTSD) is a complex psychological condition that can develop after an individual experiences a traumatic event or series of events. While psychological trauma impacts many parts of the brain, PTSD can also directly impact a person’s immune system, nervous system, and endocrine system, causing a variety of physical symptoms. Treatment for PTSD, therefore, usually involves addressing the mental, emotional, and physical manifestations of a person’s psychological trauma.
In this article, we will provide a general overview of PTSD, who is more likely to develop PTSD, and how to diagnose and treat the condition.
Before being studied and classified as a stress disorder, PTSD was known as "shell shock" or "combat fatigue" and was thought to only affect war veterans. Over time, researchers and mental health practitioners have come to understand that children and adults of all genders can develop PTSD following a range of traumatic experiences.
The American Psychological Association defines PTSD as “a disorder that may result when an individual lives through or witnesses an event in which he or she believes that there is a threat to life or physical integrity and safety and experiences fear, terror, or helplessness.” Surviving sexual abuse, rape, assault, war, domestic violence, police brutality, or being a witness to or the victim of a violent crime are just a few situations that can lead to developing PTSD.
It's important to note that not everyone who experiences a traumatic event will develop PTSD. After going through a traumatic experience, it's normal to have trouble sleeping, experience intrusive thoughts or flashbacks, and feel anxious, sad, or scared. In most cases, these feelings fade away with time. When these symptoms last no more than four weeks, they are classified as “acute stress disorder.”
For people who develop PTSD, however, these and other symptoms can develop months to years after the traumatic event/s ended and can linger for years, sometimes getting worse over time. In some cases, PTSD may be a lifelong condition.
PTSD begins in the brain. When you feel threatened or go through a scary experience, your brain’s amygdala and hypothalamus respond by cueing the sympathetic nervous system to release the stress hormones adrenaline and cortisol, which prepare you to either fight or flee the threat. In response, your heart rate quickens, your pupils dilate, your sense of hearing sharpens, and your digestive functions pause — all to better prepare you to escape or defend yourself.
Less well-known are the brain’s other two responses to threat: freeze or fawn. Depending on the situation and the individual, the person may react by freezing in the face of danger or, if the threat is human, trying to appease them into changing their threatening behavior. It is important to note that not all threatening situations that lead to PTSD involve physical violence. Psychological abuse, which is often present in situations of intimate partner or domestic violence, can also lead to PTSD.
If the person was able to deflect or defuse the threat in some way, and then re-establish their sense of safety (physical and/or psychological, such as receiving emotional comfort from someone who calms their distress), their brain will likely send signals to the rest of the body that it can return to its normal functions.
However, many traumatic situations may prevent a person from fighting, fleeing, or re-establishing a sense of safety. Sometimes a threat is continuous, such as in cases of domestic violence or war. In other situations, a person may not have the option to call for help or fight to protect themselves. A survivor may also lack a supportive family or community to seek comfort and safety from, forcing them to remain silent about the trauma they experienced.
PTSD symptoms can develop within a few months of a traumatic event or can take as long as several years to manifest. While these symptoms vary from person to person, there are some common symptoms among those diagnosed with PTSD. They can be clustered into three symptom categories: intrusion, avoidance, and arousal.
Intense memories that feel as though the event is re-occurring in real time (often called “flashbacks”)
Nightmares and dreams related to the trauma
Incessant ruminations about the traumatic event
Insomnia or trouble sleeping
Hypervigilance; feeling constantly on guard
Being easily startled
Difficulty remembering events that occurred during the trauma; fragmented memories
Feeling numb or distant; having dissociative experiences
Avoiding places, situations, or topics that remind you of the trauma
Distress when reminded of the trauma (such as when hearing a story related to the trauma)
Feelings of hopelessness or helplessness
Addressing emotional symptoms with self-destructive behaviors (such as drinking excessively)
Irritability and anger
Experiencing feelings of guilt, shame, and/or self-blame
The symptoms of PTSD in children are similar to the symptoms described above. In addition, children may feel cranky, have trouble sleeping, and have difficulty staying focused in school. They may lose interest in the games and activities that previously brought them joy. It is also normal for children to act out what happened to them or create drawings depicting the trauma they experienced.
PTSD symptoms tend to manifest slightly differently in women and men. Women may be more likely to become socially withdrawn, silent, and depressed. Men with PTSD may be more prone to violent outbursts and are more likely to develop a dependency on drugs and alcohol. Anyone with PTSD can be at risk for additional physical effects such as heart problems, anxiety, digestive disorders, and depression.
Who Can Develop PTSD?
Anyone can become a survivor of trauma, and anyone can develop PTSD. The National Center for PTSD estimates that 6% of Americans will have PTSD at some point in their lives. Certain factors can put people at a higher risk for developing PTSD, such as:
The length and type of trauma experienced by the person
A previous history of traumatic events and experiences
A lack of support during and after the traumatic experience
Choice of career: Police officers, military personnel, first responders, firefighters, and other people who face high-risk environments at work have a higher risk of developing PTSD. Veterans who experienced combat or deployed to war zones are more likely to develop PTSD.
Individual personality and manner of handling the traumatic experience
Childhood experiences: Children who grow up in hostile circumstances are more likely to develop childhood PTSD.
Gender: Women are estimated to be twice as likely to develop PTSD than men. This may be because women are more likely to be survivors of sexual assault, rape, and gender violence.
Sexuality: LGBTQ+ people are potentially ten times more likely to experience PTSD than heterosexual, cisgender people due to the prevalence of violent harassment and discrimination against them.
When PTSD is the result of systematic or chronic exposure to traumatic events and experiences over a long period of time as opposed to a single event, it is referred to as Complex Post-Traumatic Stress Disorder (C-PTSD). Some examples of people who may develop complex PTSD include:
Children, adolescent, and adult survivors of domestic abuse
Survivors of human trafficking or child abuse
Prisoners of war or prisoners in concentration camps
People with complex PTSD can experience the general PTSD symptoms as well as other clusters of symptoms related to:
Emotional Control: having a hard time communicating wishes or expressing emotions; experiencing depression, thoughts of mutilation, and suicide.
Disassociation: amnesia, feeling a sense of detachment from the experience, feeling as though it happened to someone else.
Self-Concept: feeling shame, guilt, or self-hatred.
Behavioral Control: explosive anger, demonstrating aggression.
Insecure Attachment: lack of trust in others, social isolation.
If you are thinking about suicide, considering harming yourself or others, feeling that any other person may be in any danger, or if you have any medical emergency, you must immediately call the emergency service number (1-800-273-8255 in the US and 0800-689-5652 in the UK) and notify the relevant authorities. Seek immediate in-person assistance.
People who develop complex PTSD run a higher risk of being harmed repeatedly and may demonstrate significant personality disturbances. Since a traditional PTSD diagnosis does not include these additional symptoms, complex PTSD can be mistaken for other disorders such as Borderline or Masochistic Personality Disorder.
Mental health professionals are encouraged to dig deeper during their assessment to determine whether the patient has PTSD or C-PTSD. Patients, in turn, are encouraged to speak openly and honestly about their difficulties. The treatment for C-PTSD is similar to treating PTSD, with one key distinction: Therapy and counseling for C-PTSD often focus on empowering the survivor and giving them back control of their life.
PTSD is not always recognized immediately. After going through a traumatic event, most people assume it's normal to feel a bit out of sorts. They may wait for their stress symptoms to go away and for life to return to normal. For people whose PTSD symptoms do not manifest for years after the event, it can take further time for them to establish a link between their present symptoms and what happened years ago.
If you believe you are experiencing PTSD symptoms, consider bringing it up with your doctor. They may do a physical evaluation to rule out other causes or medical conditions. Next, they may conduct a psychological evaluation, and a diagnosis can be made based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is also possible to do a self-test by filling out a self-reported questionnaire like the PTSD Symptom Scale. The questionnaire contains 17 items, and a score of 13 or higher means PTSD is likely.
PTSD can be a debilitating condition that can affect many aspects of a person’s life. There is no single cure for PTSD, but it can be managed and treated successfully through a variety of treatment options, including medication, psychotherapy, and complementary therapeutic practices. With treatment, symptoms may go away completely or diminish considerably.
Because PTSD affects both mental and physical health, many people seek holistic treatment for their PTSD symptoms. The following lists common treatments for PTSD.
Psychotherapies with a licensed professional
Cognitive-behavioral therapy (CBT) for PTSD: a therapist will help their patient recognize, understand, and change the thinking and behavior patterns that they have adopted as a result of their trauma. CBT may also include some form of exposure therapy, in which the therapist will gradually help their patient expose themselves in a safe way to their traumatic memories.
Narrative exposure therapy: a therapist will help their patient craft a chronological narrative of their life to help them place their trauma in context and understand traumatic memories.
Eye Movement Desensitization and Reprocessing (EMDR): a therapist will guide their patient through thinking or speaking of a traumatic memory while the patient simultaneously focuses on an external stimulus, such as hand-tapping, a sound, or a moving visual cue. EMDR can help reduce physical arousal and emotional distress triggered by traumatic memories.
Medication as prescribed by a psychiatrist or doctor
Selective serotonin reuptake inhibitors (SSRIs): sertraline and paroxetine are the only two SSRIs currently approved by the FDA for PTSD.
Selective serotonin-norepinephrine reuptake inhibitor (SNRI): venlafaxine is conditionally approved for PTSD.
Complementary therapeutic practices
Yoga and meditation: Both practices can serve to reduce stress and muscle tension, improve your connection with your body (which can help address symptoms of dissociation), and increase an your ability to self-regulate your emotions through conscious breathing.
Dance: In combination with psychotherapy, dance has been shown to help patients reduce their symptoms, in part due to strengthening the connection between their mind and body, as well as allowing them to physically and artistically express their emotions.
Finding meaning and community
Group therapy and support groups can be beneficial, especially for children or teens who are trying to understand what's happening to them. Support groups can help them realize they're not alone in dealing with PTSD.
Traumatic events often feel tragic, bewildering, and random, and can change the course of a person’s life. Survivors of trauma may find a greater sense of agency or closure from finding ways to make meaning out of what they experienced. They may do this through creating artistic works, supporting fellow survivors, or becoming activists and advocates.
Getting Help For PTSD
If you have experienced a traumatic event and have been experiencing some of the symptoms mentioned above, take a look through the PTSD Checklist and make an appointment with your doctor or mental health care professional as soon as you can.
One option for accessing psychotherapy is online therapy, which has been found to be effective in treating a range of mental health conditions, including PTSD. One study confirmed the efficacy of online cognitive behavioral therapy in treating PTSD symptoms, noting that patients were able to establish a therapeutic relationship with their online therapist.
PTSD symptoms can be distressing in and of themselves, but they can also hold people back from getting the help they need. Fear of having a flashback in public, for instance, can prevent some individuals with PTSD from leaving their homes. In these cases, online therapy can be a viable option because it is accessible from home or anywhere you have an internet connection and smart device. Online therapy may also have shorter wait times for starting therapy. The online therapy platform BetterHelp can match you to a therapist who specializes in PTSD within 48 hours of you completing a simple intake questionnaire.
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