Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a serious mental illness triggered by traumatic experiences. It causes emotional mood swings, fear, anxiety, avoidance, and terrifying flashbacks and nightmares. Having untreated PTSD can negatively impact several areas of a person’s life, making it difficult or impossible to function at work, at home, or in relationships. Complications of PTSD can be serious and include suicide and substance abuse, but dedicated treatment is effective and can help individuals overcome trauma and its aftermath.
What is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder, or PTSD, is a mental illness characterized by a difficult reaction to a traumatic event that persists for months or even years. While troubling symptoms after a frightening, threatening, or dangerous experience are normal, severe symptoms that don’t go away or get any better with time are not—they can be a sign of PTSD.
PTSD is characterized by extreme fear and anxiety, frightening memories and flashbacks, nightmares, and obsessive thoughts about the traumatizing event. This condition can be debilitating, causing a person to be unable to work or go to school, have normal relationships with other people, or in some cases even leave the house at all.
The symptoms of PTSD often set in soon after a trauma, but in some cases they may not appear until years later. Treatment can help a person get relief and learn to accept and cope with a terrible experience.
Types of Post-Traumatic Stress Disorder
Most people who are diagnosed with PTSD fall under the main category of symptoms and classifications. However, there are two subtypes of this condition that may be diagnosed in special cases. One is the preschool subtype. This is PTSD that occurs in a child younger than six years old. In such young children, signs of PTSD can be complicated with developmental behaviors, so special criteria have been designed to make this diagnosis.
The other subtype of PTSD is called dissociative PTSD. This causes the typical symptoms of PTSD but also dissociative symptoms. These can include a feeling of being detached from the world or from other people, of being detached from one’s own body, or feeling generally unreal or as if the world is unreal or distorted.
Facts and Statistics
PTSD is a mental health condition that is caused by trauma, and while not everyone who experiences trauma will develop it, PTSD is not uncommon. Certain groups of people, like military veterans, are more susceptible than others.
- About 7.7 million adults in the U.S. are affected by PTSD.
- There are no age restrictions, and anyone can be diagnosed with PTSD.
- Women are more likely than men to be diagnosed with PTSD.
- Estimates for the rates of PTSD in military veterans are 30 percent for those who served in Vietnam, 12 percent for those who served in the Gulf War, and between 11 and 20 percent for those who served in Iraq and Afghanistan.
- In the general population the rate of PTSD is seven to eight percent, about four percent in men and 10 percent in women.
Symptoms and Diagnosis of Post-Traumatic Stress Disorder
PTSD causes symptoms that can range from mild to severe and include flashbacks, troubling memories, jumpiness, anxiety, and other difficult symptoms that cause impairment in everyday functioning. The diagnostic criteria include four groups of symptoms. To be diagnosed, an individual must experience one or two from each group, the symptoms must last for more than a month, and they must cause significant distress or impairment. The four clusters are categorized as re-experience, avoidance, negative mood or thoughts, and arousal.
Re-experience symptoms include:
- Intrusive memories that recur and are unwanted
- Having flashbacks that force a person to relive the traumatic experience
- Nightmares about the event
- A severe emotional or physical reaction to reminders of the event
Avoidance symptoms include:
- Avoiding thinking about or talking about trauma
- Avoiding places, people, or anything else that act as reminders of the traumatic experience
Negative mood and thought symptoms include:
- Feelings of hopelessness about the future
- Negative feelings about oneself or the world in general
- Withdrawal from friends and family
- Emotional numbness
- Difficulty feeling pleasure or enjoying activities
- Difficulty remembering aspects of the traumatic event
- Difficulty keeping up with relationships
Arousal symptoms include:
- Being aggressive or irritable, having angry outbursts
- Being startled easily
- Having trouble concentrating
- Difficulty sleeping
- Being hypervigilant about surroundings
- Engaging in self-destructive behaviors
The diagnostic criteria also include the requirement that a person was actually exposed to some type of trauma. The trauma must be either a direct exposure to harm or threat, a witnessing of harm or threat to someone else, learning that a loved one was harmed or threatened, or being exposed indirectly to the details of a traumatic event.
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Causes and Risk Factors
This is one of few mental illnesses that has a known cause: trauma. Although the cause can be pinpointed in those who suffer PTSD, what cannot be explained exactly is why some people who go through a traumatic experience develop the condition while others do not. There are some known risk factors that make someone more susceptible to have this reaction to a traumatic experience, including:
- More intense, long-lasting, or repeated trauma
- Traumatic experiences that occur earlier in life
- Having a job that increases the risk of being exposed to trauma
- Experiencing other mental health issues, or being diagnosed with another mental illness
- Not having good support from friends or family in general, but specifically after a traumatic experience
- Drinking or using drugs
- Having a family history of PTSD or other mental illnesses
PTSD often occurs alongside other mental and behavioral conditions. In some cases these other conditions may increase the risk of having PTSD after trauma, but having PTSD can also trigger other mental illnesses. Examples of common co-occurring disorders with PTSD are depression, anxiety disorders, eating disorders, and substance use disorders. Suicidal behaviors may also occur with PTSD.
Substance use is particularly common and problematic with PTSD. This is likely because someone with PTSD, especially untreated, may turn to drugs or alcohol as a way to cope with the fear, anxiety, memories, flashbacks, and other symptoms. It is an unhealthy and destructive habit that can increase the avoidance of facing trauma and also lead to a significant substance use disorder. Anyone who has been diagnosed with PTSD should be screened for substance use disorders and treated for both at the same time.
Among military veterans who served in Iraq and Afghanistan, a physical injury called traumatic brain injury (TBI) often co-occurs with PTSD. TBI is caused by the blast waves from explosions, which shake the brain inside the skull. These injuries and their consequences are not fully understood, but there may be some link between the damage they cause to the brain and PTSD.
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Treatment and Prognosis of Post-Traumatic Stress Disorder
Because PTSD can be such a debilitating mental illness it is often recommended that individuals get treatment in a residential setting. This allows them to have access to a variety of treatments and professionals, and also gives them the space and time to focus on treatment and not have to worry about home, work, and other responsibilities.
Treatment for PTSD revolves around therapy. Trauma-focused therapies are most useful, but each patient responds differently. In a treatment setting, the right combination of therapies can be found to help each patient recover most effectively. Types of therapies commonly used to treat PTSD include:
- Exposure therapy. This type of therapy forces a patient to face the trauma that is causing symptoms but in a way that is safe. Once those memories are faced head on, a therapist can guide a patient through learning how to process and cope with them. Technology is aiding this kind of therapy with the use of virtual reality in some settings.
- Eye movement desensitization and reprocessing (EMDR). Exposure therapy is combined with a series of eye movements in EMDR to help patients process and change reactions to frightening memories.
- Trauma-focused cognitive behavioral therapy (CBT). CBT is often the gold-standard in therapy for all types of mental illnesses, but it can also be modified for trauma patients. Therapists work with traumatized patients to help them recognize and change their behaviors that are negative and not productive.
- Writing therapy. Writing about traumatic experiences and emotions is helpful for patients trying to process and come to terms with their memories. It is done with a therapist in a guided session.
Treatment for PTSD may also involve medications, usually anti-depressants, if appropriate for the individual. These medications help relieve depression and anxiety symptoms, which often occur with PTSD. By minimizing some troubling symptoms, a patient may be in a better position to benefit from therapy.
Additional approaches to treatment in a residential setting include supplemental therapies, such as animal, art, music, or movement therapies. Patients can also benefit from group therapy and support or sessions that involve family. They can learn relaxation techniques and healthier coping mechanisms that can be used once out of treatment.
The prognosis for PTSD is very good when a patient receives treatment. Untreated, this condition can negatively affect all areas of a person’s life and be nearly impossible to overcome. But with dedicated and intense treatment and with support from loved ones, it is possible to process trauma and move past it.