Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event. This may include a natural disaster, serious accident, terrorist act, war/combat, rape/sexual assault, historical trauma, intimate partner violence, or bullying. PTSD has been known by many names in the past, such as "shell shock" during World War I and "combat fatigue" after World War II, but PTSD does not just happen to combat veterans.

PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime. The condition involves changes in brain function and structure, particularly in areas involved in processing fear and stress. These changes help explain why people with PTSD continue to experience intense, disturbing thoughts and feelings related to their trauma long after the event has ended.

It's important to understand that PTSD is not a sign of weakness. It can happen to anyone, and many factors influence whether someone develops PTSD after trauma, including the nature of the trauma, personal history, and available support systems. The good news is that effective treatments are available, and with proper care, people with PTSD can lead fulfilling lives.

Common Traumatic Events That Can Lead to PTSD

Combat and Military Service

• Direct combat exposure
• Witnessing death or injury
• Military sexual trauma
• Prisoner of war experiences
• Training accidents

Sexual and Physical Assault

• Rape or sexual assault
• Childhood sexual abuse
• Physical abuse or assault
• Domestic violence
• Human trafficking

Accidents and Disasters

• Serious car accidents
• Plane crashes
• Natural disasters (earthquakes, hurricanes, floods)
• Fires
• Industrial accidents

Other Traumatic Events

• Sudden death of a loved one
• Life-threatening medical diagnosis
• Terrorist attacks
• Kidnapping
• Witnessing violence
• First responder repeated exposure

Complex PTSD

Complex PTSD (C-PTSD) can develop from prolonged or repeated trauma, especially in childhood:

• Childhood abuse or neglect
• Concentration camps
• Human trafficking
• Long-term domestic violence
• Being a prisoner of war

PTSD symptoms usually begin within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD.

Additional Symptoms

• Dissociation: Feeling disconnected from yourself or surroundings
• Panic attacks: Sudden episodes of intense fear
• Depression: Persistent sadness or emptiness
• Anxiety: Constant worry or fear
• Guilt or shame: Survivor guilt, self-blame
• Physical symptoms: Headaches, digestive issues, chronic pain

Symptoms in Children

Children may show different symptoms:

• Bedwetting after being toilet trained
• Forgetting how to talk or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with parent or adult
• Regression in development

How PTSD Develops

PTSD develops when the normal stress response to danger becomes altered. During trauma, the body's fight-or-flight response is activated, but in PTSD, this response remains activated even after the danger has passed. Brain imaging shows changes in areas that process fear, emotion, and memory.

Risk Factors

Factors That Increase Risk

• Trauma characteristics: Severity, duration, proximity
• Previous trauma: Especially in childhood
• Mental health history: Anxiety or depression
• Lack of support: After the trauma
• Additional stress: Job loss, divorce
• Gender: Women more likely to develop PTSD
• Genetics: Family history of mental health issues
• Brain structure: Smaller hippocampus

Protective Factors

• Strong social support
• Seeking help early
• Positive coping strategies
• Self-efficacy beliefs
• Finding meaning in the experience
• No prior mental health issues

Who Gets PTSD?

Not everyone who experiences trauma develops PTSD. Factors include:

• About 50-60% of people experience trauma
• Only 6-8% develop PTSD
• Women twice as likely as men
• Can occur at any age
• Different traumas have different rates

Diagnostic Process

• Clinical interview: Detailed discussion of symptoms and trauma
• Symptom assessment: Using standardized questionnaires
• Medical history: Including mental health history
• Physical exam: Rule out medical causes
• Duration check: Symptoms must last >1 month

DSM-5 Diagnostic Criteria

All of the following criteria must be met:

Criterion A: Trauma Exposure

• Direct experiencing
• Witnessing in person
• Learning about violent/accidental trauma to close other
• Repeated exposure to trauma details (first responders)

Criterion B: Intrusion Symptoms (1+ required)

• Recurrent, distressing memories
• Distressing dreams
• Flashbacks
• Psychological distress to cues
• Physical reactions to cues

Criterion C: Avoidance (1+ required)

• Avoiding internal reminders
• Avoiding external reminders

Criterion D: Negative Alterations (2+ required)

• Inability to remember trauma
• Negative beliefs about self/world
• Distorted blame
• Persistent negative emotions
• Diminished interest
• Feeling detached
• Inability to feel positive emotions

Criterion E: Arousal Changes (2+ required)

• Irritable or aggressive behavior
• Reckless behavior
• Hypervigilance
• Exaggerated startle
• Concentration problems
• Sleep disturbance

Assessment Tools

• Clinician-Administered PTSD Scale (CAPS-5)
• PTSD Checklist (PCL-5)
• Impact of Event Scale-Revised
• Child PTSD Symptom Scale

PTSD is treatable, and many people recover with proper treatment. The main treatments are psychotherapy, medications, or both. Everyone is different, and what works for one person may not work for another.

Psychotherapy (Talk Therapy)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

• Addresses trauma-related thoughts and behaviors
• Helps process traumatic memories
• Develops healthy coping skills
• Particularly effective for children

Prolonged Exposure (PE)

• Gradual exposure to trauma-related memories
• Facing avoided situations safely
• Usually 8-15 weekly sessions
• Reduces power of traumatic memories

Cognitive Processing Therapy (CPT)

• Challenges unhelpful beliefs about trauma
• Develops balanced perspective
• Usually 12 sessions
• Can be done individually or in groups

Eye Movement Desensitization and Reprocessing (EMDR)

• Combines trauma memories with eye movements
• Helps brain process traumatic memories
• Reduces emotional distress
• Usually 6-12 sessions

Medications

First-Line Medications

• SSRIs: Sertraline (Zoloft), Paroxetine (Paxil)
• SNRIs: Venlafaxine (Effexor)
• FDA-approved specifically for PTSD
• Help with depression and anxiety symptoms

Other Medications

• Other antidepressants: Fluoxetine, mirtazapine
• Prazosin: For nightmares
• Anti-anxiety medications: Short-term use only
• Sleep aids: For severe insomnia
• Mood stabilizers: For emotional regulation

Complementary Treatments

• Mindfulness meditation: Reduces anxiety and improves awareness
• Yoga: Helps with body awareness and relaxation
• Acupuncture: May help with symptoms
• Service dogs: For veterans and others
• Art/Music therapy: Alternative expression methods
• Equine therapy: Working with horses

Self-Help Strategies

• Join a support group
• Stay connected with supportive people
• Exercise regularly
• Practice relaxation techniques
• Maintain healthy sleep habits
• Avoid alcohol and drugs
• Stick to treatment plan

Daily Management

• Routine: Maintain regular schedule
• Triggers: Identify and manage triggers
• Safety plan: Have strategies for difficult moments
• Medication adherence: Take as prescribed
• Therapy attendance: Keep all appointments
• Self-care: Prioritize physical and mental health

Coping with Symptoms

Managing Flashbacks

• Grounding techniques (5-4-3-2-1 senses)
• Remind yourself you're safe now
• Focus on breathing
• Use comfort objects
• Call someone supportive

Dealing with Nightmares

• Image Rehearsal Therapy
• Create calming bedtime routine
• Keep journal by bed
• Use nightlight if helpful
• Talk to doctor about prazosin

Managing Hypervigilance

• Practice relaxation techniques
• Sit with back to wall in public
• Gradual exposure to safe situations
• Mindfulness exercises
• Regular exercise

Relationships and PTSD

• Communicate openly about needs
• Educate loved ones about PTSD
• Set boundaries
• Couples therapy can help
• Be patient with yourself and others
• Join family support groups

Work and School

• Know your rights under ADA
• Consider workplace accommodations
• Take breaks when needed
• Create calm workspace
• Communicate with HR if comfortable
• Use employee assistance programs

Recovery Process

Recovery from PTSD is a gradual process. There's no set timeline, and everyone's journey is different. Key points about recovery:

• Recovery is possible at any stage
• Symptoms may come and go
• Setbacks are normal
• Progress isn't always linear
• Small improvements matter

Factors Supporting Recovery

• Early treatment intervention
• Strong social support
• Good therapeutic relationship
• Treatment adherence
• Healthy lifestyle choices
• Avoiding substance abuse
• Meaning-making from trauma

Post-Traumatic Growth

Some people experience positive changes after trauma:

• Increased appreciation for life
• Deeper relationships
• Personal strength awareness
• New life priorities
• Spiritual development

Long-Term Outlook

• Many people recover completely
• Others learn to manage symptoms effectively
• Treatment significantly improves quality of life
• Relapse prevention is important
• Ongoing support may be helpful

Veterans and Military

• 11-20% of veterans have PTSD
• Combat exposure major risk factor
• Military sexual trauma
• Multiple deployments increase risk
• VA provides specialized treatment
• Peer support programs available

First Responders

• Repeated trauma exposure
• 10-15% develop PTSD
• Culture may discourage help-seeking
• Specialized treatment programs
• Peer support crucial

Children and Adolescents

• May show different symptoms
• Developmental considerations
• Family involvement important
• Play therapy for younger children
• School-based interventions

Sexual Assault Survivors

• High rates of PTSD (30-50%)
• Complex feelings of shame/guilt
• Specialized trauma therapy
• Safety planning important
• Support groups helpful

Primary Prevention

While we can't always prevent trauma, we can work to reduce risk:

• Violence prevention programs
• Safety education
• Addressing societal factors
• Building resilience
• Community support systems

Early Intervention After Trauma

• Psychological First Aid: Immediate support
• Safety and stabilization: Ensure physical/emotional safety
• Social support: Connect with loved ones
• Normalize reactions: Understanding responses
• Monitor symptoms: Watch for PTSD development
• Early therapy: If symptoms persist

Building Resilience

• Develop coping skills before trauma
• Build strong relationships
• Practice stress management
• Maintain physical health
• Cultivate meaning and purpose
• Learn emotional regulation