Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a well-known mental health disorder that creates many life difficulties. It causes intense anxiety and is disturbing in its unpredictability, with flashbacks likely to be experienced at any moment. Without intervention, the trauma that caused the disorder is likely to remain unresolved. The good news is that PTSD is highly amenable to treatment, and those who are dedicated to overcoming it can put the past behind them and move on to a brighter future.
What Is Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is one of the more well-known mental health disorders. But even though most people have heard the label, they may not be sure what PTSD actually is.
When people are exposed to shocking and traumatizing events, it will take them some time to process what happened, and to adjust emotionally and psychologically to their experiences. This is normal and part of the recovery process.
But for some people, even a significant passage of time is not enough to take the edge off of their traumatic memories. These memories and their associated emotions endure, causing chronic and debilitating anxiety that can be especially acute if provoked by occurrences or exposures that somehow relate (or seem to relate) to the past trauma.
This is PTSD, and it is an unwelcome and unwanted companion that plagues the lives of millions of people in the United States alone. Without mental health assistance people with PTSD may struggle to hold down jobs, maintain relationships, or manage their daily affairs.
Types of Post-Traumatic Stress Disorder
In addition to normal PTSD, there is a subtype of the condition called complex PTSD , which is more severe and problematic than its root disorder.
While PTSD is associated with single or limited-duration trauma, complex PTSD is a more grievous disorder that can develop in those who’ve been exposed to long-term or repeated abuse or trauma. Being subjected to years of child abuse, domestic violence, warfare, or captivity and torture are examples of experiences that can lead to complex PTSD, which produces symptoms that are generally more pervasive and disabling than those associated with conventional PTSD.
Facts and Statistics
Post-traumatic stress disorder is a common mental health disorder, as various studies reveal:
- At some point in their lives, six in 10 men and five in 10 women will experience a trauma severe enough to potentially cause PTSD.
- Between 25 and 30 percent of those who experience severe trauma will eventually develop PTSD (or complex PTSD).
- The lifetime incidence of PTSD in the United States is 6.8 percent (3.6 percent among men and 9.7 percent among women).
- In the United States, about 3.5 percent of the general adult population will have PTSD in any given year (1.8 percent of men and 5.2 percent of women).
- Among adolescents aged 12-17, rates of PTSD are even higher: in one comprehensive study, the six-month prevalence was 3.7 percent for boys and 6.3 percent for girls.
- No occupation or set of experiences predicts the onset of PTSD better than military service: the rates of current PTSD among veterans who served in Vietnam, the Gulf War, and more recent conflicts in Iraq and Afghanistan has been estimated to range from 11 to 20 percent. Lifetime rates are known to be higher, and up to 30 percent of Vietnam veterans have experienced the symptoms of PTSD at some time in their lives.
Almost 50 percent of people in outpatient treatment for mental health disorders suffer from PTSD. Nevertheless, only about half of those who need treatment for this disorder will ever receive it.
Symptoms and Diagnosis of PTSD
The initial symptoms of PTSD may occur very soon after the precipitating event. But some people will seem to have recovered from their trauma, only to develop PTSD months or even years later.
Regardless of when it develops post-traumatic stress disorder is a life-altering condition, and its effects can impact virtually every area of a person’s life.
The core symptoms of PTSD include:
- Lucid memories. Despite efforts to forget the trauma, memories remain graphic and fresh, regardless of how much time has passed.
- Flashbacks. The most notorious and well-known symptom of PTSD, these flashbacks seem less like memories and more like an actual reliving of the traumatic events. Flashbacks can be triggered by a wide variety of events or circumstances.
- Nightmares. These vivid dreams can be literal remembrances, or they may be surreal or exaggerated recreations of the traumatic events.
- Panic attacks. Physical symptoms of extreme anxiety are often experienced during flashbacks, or when memories are especially vivid. Included in the list of such symptoms are temporary feelings of dissociation, which are common among those who have PTSD.
- Emotional volatility. People with PTSD tend to be highly reactive in their emotional responses. In comparison to others, or to the way they were before the trauma, they are quicker to anger, get frustrated, become discouraged, feel fear, or anticipate worst-case outcomes.
- Mood swings. Depression frequently accompanies PTSD, as do feelings like shame, guilt, inferiority, helplessness, and other negative emotions. People with PTSD can escape from their memories for a while, but these respites never seem to last for long.
- Avoidant behavior. Men and women with PTSD will go to great lengths to avoid situations they fear might trigger unpleasant memories, or troubling physical or emotional responses.
People with severe PTSD may also suffer some psychotic symptoms, including hallucinations and delusions, although this is far from universal.
In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), PTSD was recategorized as a “Trauma and Stressor-related Disorder,” in recognition of its unique relationship to certain types of life experiences.
The diagnostic criteria for PTSD include:
- Direct exposure (or indirect exposure through the experiences of loved ones) to one or more stressors (traumatic events)
- Intrusive thoughts or memories (including flashbacks and nightmares)
- Obsessive avoidance of possible PTSD triggers
- Negative changes in mood and cognition (selective amnesia about the trauma, feelings of self-blame or guilt, inability to experience joy or happiness, etc.)
- Changes in arousal patterns and level of emotional reactivity (hypervigilance, difficulty concentrating or sleeping, irritability, etc.)
- Symptoms of PTSD must be experienced for at least one month
- Symptoms of PTSD create emotional disquiet or functional impairment
- Symptoms of PTSD cannot be traced to other mental or physical health problems
In addition to these criteria, two other specifications must be met: the person must experience some level of dissociation (feelings of unreality or disconnection from self or the world) when PTSD triggers are encountered, and at least six months must have passed since the traumatic event occurred.
Post-Traumatic Stress Disorder Causes and Risk Factors
Anyone could be at risk for PTSD, if they’ve experienced (or witnessed) domestic violence, child abuse, natural disaster, sexual violation, abandonment by caretakers, warfare, extreme illness or serious injury. However, there are certain risk factors that can increase a person’s chances of developing PTSD after they’ve been exposed to trauma, such as:
- Previous history of psychiatric disorders
- A lack of social support after the traumatic event
- Higher levels of neuroticism (being prone to feelings of anxiety, depression, shame, guilt, fear, envy, jealousy, insecurity, frustration, etc.)
- Lower economic status
- Lack of education
- Exposure to severe forms of abuse
- A history of physical, emotional, or sexual victimization during childhood
- Traumatic brain injuries
Even though men and women are about equally likely to be exposed to trauma, women develop PTSD more than twice as often as men. Research suggests this is related to the strong association between PTSD and sexual assault, which is far more likely to be experienced by women or girls than by men or boys.
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This is accounted for largely by shared risk factors—exposure to trauma, abuse, and neglect makes a person vulnerable to most types of mental health conditions, and for substance abuse problems as well.
The list of co-occurring conditions most frequently experienced by people with PTSD include:
- Substance use disorders. In the 2010 National Epidemiologic Survey on Alcohol and Related Conditions, 46.4 percent of participants with PTSD also met the criteria for a drug or alcohol use disorder.
- Depression. Approximately 50 percent of men and women with PTSD will be diagnosed with depression.
- Anxiety disorders. Because of the pervasive nature of each condition, generalized anxiety disorder (GAD) overlaps significantly with PTSD. In one study, 40 percent of those who met the criteria for PTSD also had GAD.
- Psychotic disorders. Rates of PTSD in people with schizophrenia have been measured at above 50 percent in some studies. Besides the symptomatic overlaps, both conditions are frequently connected to abuse at young ages.
- Borderline personality disorder. In the 2004 (Wave 2) version of the National Epidemiologic Survey on Alcohol and Related Conditions, it was revealed that 24.2 percent of men and women with PTSD also had borderline personality disorder, confirming the strong connection between these conditions.
Treatment and Prognosis for PTSD
People with post-traumatic stress disorder tend to enter treatment with a high level of motivation. Their suffering is often acute and the consequences for their lives profound, and they are usually relieved to have a diagnosis that helps explain what they’ve been going through.
Three options exist for people with PTSD seeking mental health treatment: inpatient programs, outpatient programs, and dual diagnosis programs (when co-occurring addiction has been diagnosed). The choice will depend on individual circumstances, and the nature and depth of the condition or conditions experienced.
Regardless of the program chosen, patients will be immersed in an environment where the focus is on healing and personal growth. Individual counseling sessions will introduce practically-oriented therapies like CBT (cognitive behavioral therapy), exposure therapy, and EMDR (eye movement desensitization and reprocessing), all of which can help traumatized men and women change their patterns of thinking and reacting. Group and family therapy will supplement the recovery regimen, offering compassion, understanding, and moral support as the patient continues to work through the terrifying memories that have kept them trapped in misery for so long.
In addition to therapy, antidepressant and anti-anxiety medications may be prescribed, in carefully controlled doses, to help patients cope with their most disabling symptoms of anxiety and depression. Specialized life skills classes can teach specific strategies for avoiding triggers, and evidence-based holistic healing methods for stress management and anxiety reduction will likely be included in the recovery regimen as well.
Once formal treatment concludes, patients will transition into aftercare, where their participation in therapy sessions and peer group meetings will help reinforce their newfound perspectives on the past, present, and future. Aftercare services will remain available for as long as they are needed, to make sure the symptoms of PTSD are kept under control.
Post-traumatic stress disorder is a condition that can create significant emotional turmoil, and when its symptoms are severe it may seem impossible to overcome. But with expert assistance and a deep dedication to their recovery programs, men and women with PTSD can experience dramatic improvements in their ability to manage their symptoms, giving them a chance to reclaim their freedom and restore their peace of mind.