Post-Traumatic Stress Disorder (PTSD) is trauma and stress-related disorder that may develop after exposure to an event or ordeal in which death or severe physical harm occurred or was threatened. People who suffer from the disorder include military troops, rescue workers, and survivors of shootings, bombings, violence, and rape. Family members of victims can develop the disorder as well through vicarious trauma.
About 6.8 percent of American adults develop PTSD in their lifetime, according to the National Institute of Mental Health. PTSD can occur at any age, including during childhood. Women are more likely to develop the disorder than men, and there is some evidence that it may run in families. PTSD is frequently accompanied by depression, substance use disorder, and anxiety disorders. When other conditions are appropriately diagnosed and treated, the likelihood of successful treatment increases.
When symptoms develop immediately after exposure and persist for up to a month, the condition may be called acute stress disorder. PTSD is diagnosed when the stress symptoms following exposure have persisted for over a month. Delayed expression of PTSD can occur if symptoms arise six months or more following the onset of trauma.
Many people with PTSD tend to re-experience aspects of the traumatic event, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event and similarities in person, place, or circumstance can trigger symptoms. People with PTSD experience intrusive memories or flashbacks, emotional numbness, sleep disturbances, anxiety, intense guilt, sadness, irritability, outbursts of anger, and dissociative experiences. Many people with PTSD may try to avoid situations that remind them of the ordeal. When symptoms last more than one month, a diagnosis of PTSD may be relevant.
- Symptoms associated with reliving the traumatic event:
- Having bad dreams, or distressing memories about the event
- Behaving or feeling as if the event were happening all over again (known as flashbacks)
- Dissociative reactions or loss of awareness of present surroundings
- Experiencing intense emotions when reminded of the event
- Having intense physical sensations when reminded of the event (heart pounds or misses a beat, sweating, difficulty breathing, feeling faint, feeling a loss of control)
- Symptoms related to avoidance of reminders of the traumatic event:
- Symptoms related to negative changes in thought or mood:
- Arousal and reactivity symptoms:
- Sleeping difficulties including trouble falling or staying asleep
- Irritability and outbursts of anger
- Difficulty concentrating
- Feeling easily startled
- Excess awareness (hypervigilance)
The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves. People who have suffered childhood abuse or other previous traumatic experiences are likely to develop the disorder, sometimes months or years after the trauma. Temperamental variables such as externalising behaviours or other anxiety issues may also increase risk. Other environmental risk factors include family dysfunction, childhood adversity, cultural variables, and a family history of psychiatric illness. The greater the magnitude of the trauma, the greater the risk for PTSD from witnessing atrocities, severe personal injury, and perpetrating violence. Inappropriate coping mechanisms, lack of social support, family instability, or financial stress may further worsen the outcome.
Treatment for PTSD typically begins with a detailed evaluation and development of a treatment plan that meets the unique needs of the survivor. The main treatments for people with PTSD are psychotherapy, medications, or both. Due to differences in experience and consequence of the trauma, treatment varies and is tailored to the symptoms and needs of the individual. Treatment by a mental health care provider who is experienced with PTSD allows people to lead more balanced and functional lives. Some people with PTSD may need to try different treatments to see what works for their symptoms.
Medications: The U.S. Food and Drug Administration (FDA) has approved two medications to treat adults with PTSD, sertraline (Zoloft) and paroxetine (Paxil) which are selective serotonin reuptake inhibitors (SSRIs). Both of these medications are antidepressants, which are also used to treat depression. They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb. Using medications jointly with therapy or before starting therapy may make treatment more effective. If an antidepressant is prescribed, it may need to be taken for several days or weeks before providing significant improvement. It is important to not get discouraged and prematurely stop taking medications before they’ve had a chance to work. An adjustment in dosage or a switch to another SSRI may help address these issues. It is important to work collaboratively with your doctor.
Psychotherapy: Therapy is well-regarded in the treatment of PTSD. It involves talking with a mental health professional to work through the experience and its impact on the individual. Psychotherapy can occur one on one or in a group format. Therapy for PTSD usually lasts until the individual has learned to manage and cope with their experience and can be more functional.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
Cognitive behavioural therapy, or CBT, is quite effective in treating PTSD. There are several parts to CBT, including:
Exposure therapy: This therapy helps people be more aware of their experiences. It may expose them to the memory of the trauma they experienced safely. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
Cognitive restructuring: This therapy helps people make sense of their memories and experiences. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened realistically.
Stress inoculation training: This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety when confronting anxiety-provoking situations. Like cognitive restructuring, this treatment helps people look at their experiences healthily.