An Overview of Post-Traumatic Stress Disorder (PTSD)

People who have lived through a traumatic event can find themselves experiencing emotional challenges long after the event has taken place.

Although it is common for people to experience emotional challenges after trauma, their symptoms can lessen in intensity over time as they continue to heal. However, people who struggle with post-traumatic stress disorder (PTSD) find themselves experiencing symptoms that continue to cause them significant distress.

PTSD symptoms
Illustration by Joshua Seong. © Verywell, 2018.

Definition

The current Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, is a manual that clinical professionals use to diagnose mental health conditions. In previous years, PTSD fell under the category of anxiety related conditions. The current version of the manual has placed post-traumatic stress disorder under the category of trauma- and stressor-related disorders.

Post-traumatic stress disorder can develop after the experience of a traumatic event, either a single isolated event or more chronic and recurring traumatic experiences. A variety of emotional disturbances and symptoms are associated with PTSD that cause clinically significant distress or impairment in the person's social interactions, their ability to work, or other important areas of functioning.

Who Is Affected

It is estimated that there are currently around 8 million people in the United States who are living with PTSD. These numbers vary depending on things like gender, emotional response to trauma, and other factors.

Altogether, it is estimated that 7 to 8 percent of people will experience PTSD at some point during their lifetime.

About 70 percent of adults in the US have reported experiencing a traumatic event at least once in their life. With this in mind, it is important to note that most people who experience a traumatic event will not develop PTSD.

Some factors that can contribute to the likelihood of developing PTSD include things like:

  • Mental or physical health condition
  • Emotional response during the trauma
  • Type of trauma
  • Gender (studies have shown women to be twice as likely to have PTSD)
  • Age
  • Marital status
  • Emotional support system
  • Experience of additional stressors after trauma

Types of PTSD

Within the diagnosis of PTSD there can be certain specifiers identified, which means there are distinct features present that make it different from the more broad diagnosis of PTSD. Some of these specifiers are identified in the DSM-5 including:

  • Dissociative
  • Delayed onset/expression

Preschool

One of the changes made in the most recent update of the diagnostic manual for clinicians is the inclusion of specific PTSD symptoms for children six years or younger. As children witness and live through traumatic events they, too, can experience emotionally distressing symptoms after the event. Just as with adults (and anyone over six years old) there are certain criteria that need to be met in order for a young child to be diagnosed with PTSD.

Dissociative

The dissociative specifier within the PTSD diagnosis refers to the presence of persistent or recurrent depersonalization or derealization symptoms. Depersonalization means that someone is experiencing something as if they are an observer to themselves, observing from outside of their body. Derealization refers to sensing as if things around you are not real, almost as if you are unfamiliar and disconnected from the world around you.

Delayed Onset

The term delayed onset was recently changed to delayed expression in the DSM-5. Although people with this particular specifier do meet the necessary criteria for PTSD, the criteria are not fully met until at least six months after the traumatic event. A person could experience the onset and expression of some of the symptoms more immediately, however, the full symptom criteria for diagnosis would not have been met until after that six month mark.

Complex

Sometimes people can experience isolated, acute instances of trauma such as a horrific car accident or being robbed at gunpoint, for example. These would be considered acute because they are not likely to become recurring experiences. There are other types of traumatic events that can be more recurring, such as domestic violence, sexual abuse, or childhood neglect. The person would experience the event again and again over the course of time. When people have experienced this type of more chronic trauma, it is sometimes referred to as complex PTSD.

Symptoms

Although there are many people who will experience a traumatic event in their lifetime, many will not develop PTSD. There are certain symptoms that someone needs to be experiencing, referred to as diagnostic criteria, in order for them to be accurately diagnosed with post-traumatic stress disorder. PTSD symptoms are divided into four separate clusters including:

1) Re-experiencing:

  • Frequent upsetting thoughts or memories about a traumatic event.
  • Having recurrent nightmares
  • Feeling as though the event were happening again, sometimes called a flashback
  • Strong feelings of distress when reminded of the event
  • Being physically responsive, such as increased heart rate or sweating, when reminded of the event.

2) Avoidance:

  • Making an effort to avoid thoughts, feelings, or conversations about the traumatic event
  • Actively trying to avoid places or people that remind you of the traumatic event
  • Keeping yourself too busy to have time to think about the traumatic event

3) Hyperarousal:

  • Having a difficult time falling or staying asleep
  • Feeling more irritable or having outbursts of anger
  • Having difficulty concentrating
  • Feeling constantly on guard or like danger is lurking around every corner
  • Being jumpy or easily startled

4) Negative Thoughts and Beliefs

  • Having a difficult time remembering important parts of the traumatic event
  • A loss of interest in important, once positive, activities
  • Feeling distant from others
  • Experiencing difficulties having positive feelings, such as happiness or love
  • Feeling as though your life may be cut short

Many of these symptoms are an extreme version of our body's natural response to stress. Understanding our body's natural response to threat and danger, known as the fight or flight response, can help us better understand the symptoms of PTSD.

Diagnosis

To be diagnosed with PTSD, you don't need to have all these symptoms. In fact, rarely does a person with PTSD experience all the symptoms listed above. To receive a diagnosis of PTSD, you only need a certain number of symptoms from each cluster.

Additional requirements for the diagnosis also need to be assessed, such as how you initially responded to the traumatic event, how long you've been experiencing your symptoms and the extent to which those symptoms interfere with your life. For an accurate PTSD diagnosis you would need to review these things with a qualified mental health professional.

Coping

The symptoms of PTSD can be difficult to cope with, and as a result, many people with PTSD can be susceptible to developing unhealthy coping strategies, such as alcohol or drug abuse or deliberate self-harm. Because of these risks, it is important to develop a number of healthy coping skills to manage your PTSD symptoms. Coping strategies you can work on incorporating in your life include:

Treatment Options

A number of psychological treatments have been found to be effective in helping people cope with the symptoms of PTSD. Some of these include:

  • Cognitive-behavioral therapy (CBT) for PTSD focuses on changing the way in which you evaluate and respond to situations, thoughts, and feelings, as well as unhealthy behaviors that stem from your thoughts and feelings.
  • Exposure therapy is a behavioral treatment for PTSD that aims to reduce your fear, anxiety, and avoidance behavior by having you fully confront, or be exposed to, thoughts, feelings, or situations that you fear.
  • Acceptance and commitment therapy is a behavioral treatment that is based on the idea that our suffering comes not from the experience of emotional pain, but from our attempted avoidance of that pain. Its overarching goal is to help you be open to and willing to have your inner experiences while focusing attention not on trying to escape or avoid pain, since that is impossible to do, but instead on living a meaningful life.
  • Eye movement desensitization and reprocessing (EMDR) is another highly effective therapy for treating PTSD that involves thinking about your trauma while paying attention to an outside stimulus, such as a light or a finger moving back and forth. It helps you make new connections between your trauma and more positive thinking.

    In Children

    Children are not immune to the challenges of post-traumatic stress disorder. The National Child Traumatic Stress Institute (NCTSI) states that more than two-thirds of children have reported at least one traumatic experience by the age of 16. Additionally, it is estimated that 19 percent of injured and 12 percent of physically ill youth have PTSD. Examples of potential traumatic experiences could include events such as:

    • Psychological, physical or sexual abuse
    • Community or school violence
    • Witnessing or experiencing domestic violence
    • Natural disasters
    • Terrorism
    • Commercial sexual exploitation
    • Sudden or violent loss of a loved one
    • Life threatening illness or accident

    Because children can have a more difficult time processing their experiences and coping with the lasting emotional impact of trauma, it is important for support people (caregivers, relatives, etc) to allow children the opportunity to talk about their experience. A critical part of a child's recovery and healing is their support system. Having a strong support system and access to trauma-informed care is essential to their healthy coping and overall healing.

    For Loved Ones

    Finding ways to support a loved one with PTSD can be a struggle. One of the most helpful things you can do is learn about the symptoms and the challenges of living with post-traumatic stress disorder. Becoming familiar with what your loved one might be experiencing can help increase compassion and understanding, making it easier to have conversations about their challenges.

    Inviting and encouraging your loved one to seek help from a trained professional is paramount. Since unaddressed symptoms of PTSD can become more severe over time, it is important to try and help your loved one find helpful resources to begin the healing process.

    Do not be afraid to ask your loved one about their experiences and be open to actively listening. You are not expected to "fix" anything, just allow your loved one space to talk openly without fear of judgment or criticism.

    Ask your doctor or mental health professional for a recommendation or referral to someone who specializes in treating PTSD.

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