Learn About PTSD
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is an incapacitating psychiatric disorder that affects 7-10% of the U.S. population and imposes an economic burden exceeding $42 billion. It develops in 1 in 5 people that experience or witness a traumatic event, such as warfare, natural disasters, accidents, and abuse.
Symptoms include avoiding reminders of the traumatic event, constant re-experiencing of the event, and increased tendency to be startled. Under normal circumstances, these symptoms are a healthy response that helps a person adapt and cope with the trauma. For instance, avoiding reminders of the traumatic event lessens the probability of encountering the threat or others like it. However, patients with PTSD lose normal daily functioning because these responses become exaggerated and therefore detrimental instead of helpful.
Who gets PTSD?
Anyone can get PTSD at any age. It can result from a variety of traumatic or life-threatening incidents such as sexual assault, child abuse, accidents, bombings, or natural disasters (e.g., hurricanes, earthquakes). Even witnessing a traumatic event can cause PTSD. PTSD can form from an acute, severe trauma (e.g., a natural disaster) and even chronic or repeated traumas/stressors (e.g., repeated child abuse). Not everyone with PTSD has been through a dangerous event. Some people get PTSD after someone close to them—a friend or family member—experiences danger or harm.
PTSD can affect:
- Anyone who was a victim, has witnessed or has been exposed to a life-threatening event
- Survivors of violent acts, such as rape, sexual, physical and/or verbal abuse or domestic violence
- Combat veterans or civilians exposed to war
- Survivors of unexpected dangerous events, such as a car accident, natural disaster, or terrorist attack
- People who have learned of, experienced, or witnessed an unexpected and sudden death of a loved one
- Emergency responders who help victims during traumatic events
- Children who are neglected or physically, sexually or verbally abused
Military vs. Civilian PTSD
The devastating nature of warfare exposes soldiers to the types of severe traumas that cause PTSD. As a result a significant number of veterans suffer from PTSD: for example, up to 20% of those who served in the Iraq and Afghanistan wars and up to 30% of those who served in Vietnam
Even though the media typically associates PTSD with military veterans, PTSD is certainly not only a military condition. In the United States alone, about 8-10% of the total population will have PTSD at some point in their lives. In a given year, approximately 5 million adults are coping with PTSD. Civilian cases of PTSD stem from traumas such as accidents, assaults, abuse, or other similar events.
PTSD in Men vs. Women
While women are slightly less likely to experience a trauma than are men, women are more than twice as likely to develop PTSD than are men (10% for women and 4% for men).
The traumatic experiences most common for women are different than for men. Women are much more likely to experience sexual assault or domestic violence- about 1 in 3 women will experience a sexual assault in their lifetime. Women are also more likely to experience childhood abuse or neglect or abuse in childhood. Women are even more vulnerable to develop PTSD later in life if they have been previously sexually assaulted.
Children and teens can also develop PTSD after a trauma. In young children, these symptoms can include:
- Bedwetting, after having been toilet-trained
- Forgetting how or being unable to talk
- Acting out the scary event during playtime
- Being unusually clingy with a parent or other adult
The DSM-V introduced a preschool subtype of PTSD for children ages six years and younger. Diagnosis is sometimes difficult if children are too young to verbalize their reactions and no adults were present at the time of the trauma.
Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, destructive, or disrespectful behaviors.
Not everyone who lives through a traumatic event gets PTSD. In fact, most will not get the disorder. Approximately 20% or 1 in 5 people who experience a trauma will go on to develop PTSD.
Many factors play a part in whether a person will get PTSD. Risk factors for PTSD include:
- Having a history of mental illness
- Actually having a physical injury from the event (e.g., burn victims)
- Seeing people hurt or killed
- Feeling horror, helplessness or no control over the situation
- Having little or no social support after the event
- Having a history of experiencing previous traumatic events
Resilience factors that may reduce the risk of PTSD include:
- Having a support system, such as friends and family or even a support group
- Having positive feelings about or semblance of control over one’s own actions in the face of the trauma
- Having a coping strategy, or a way of getting through the bad event and learning from it
- Being able to act and respond effectively despite feeling fear
- Researchers are studying the importance of various risk and resilience factors
Does PTSD mean I am weak?
NO! After a trauma, there are physical changes in the brain that are linked to the ability to manage stress. Just because these changes are not visible like a broken arm does not mean they don’t exist. Strep Throat is a good analogy—for Strep, a bacterial infection causes the symptoms. For PTSD, a change in brain chemistry causes the symptoms. It is an actual change in the body and not just “being weak.”
Signs & Symptoms
Currently PTSD is diagnosed by symptom checklists based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)
In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the DSM’s fifth edition (DSM-V). PTSD is included in a new category, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.
The first criterion focuses on the type of trauma experienced:
Criterion A: The person was exposed to one of the following types of trauma:
- Actual or threatened death
- Actual or threatened serious injury
- Actual or threatened sexual violence
The trauma must be experienced in at least one of the following ways:
- Direct exposure to the trauma
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders or medics)
The next 4 criteria describe the types of symptoms one with PTSD can experience:
Criterion B: Reliving or re-experiencing the event in at least one of the following ways:
- Intrusive thoughts about the trauma
- Nightmares about the trauma
- Flashbacks, where one feels as though he/she is experiencing the trauma again
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criterion C: Avoiding trauma-related stimuli in at least one of the following ways:
- Trauma-related cues or reminders (e.g., avoiding driving after a serious car accident)
- Trauma-related thoughts or feelings
Criterion D: Experiencing negative thoughts or feelings that began or worsened after the trauma, in at least two of the following ways:
- Inability to recall key features of the trauma (i.e., trauma-related amnesia)
- Excessive blame of self or others for causing the trauma
- Overly negative thoughts and assumptions about oneself or the world (i.e., distrust)
- Negative emotions
- Decreased interest in activities
- Feeling isolated and abstaining from relationships
- Difficulty experiencing positive emotions
Criterion E: Experiencing trauma-related arousal and reactivity that began or worsened after the trauma, in at least two of the following ways:
- Irritability or aggression
- Risky or maladaptive behavior
- Heightened startle reaction
- Difficulty sleeping
- Difficulty concentrating
Again, symptoms must:
Last over 1 month (Criterion F)
Cause impairment in social or occupational function (Criterion G)
Not be caused by a medication or substance abuse (Criterion H)
PTSD patients may also have what is referred to as “delayed specification,” where diagnostic criteria are not met until at least 6 months after the trauma, or “dissociative specification,” where in addition to meeting PTSD diagnostic criteria, patients may also have “out of body” experiences or distorted reality.
Are these symptoms normal?
While it is normal and adaptive to have stress and fear reactions after a traumatic event, they generally subside with time.
Typical emotional reactions to a very stressful event include: anger, guilt, sadness, shock & disbelief.
Typical physical reactions to a very stressful event include: increased heart rate, feeling jumpy or shaky, shortness of breath, racing thoughts, & loss of appetite.
These reactions are very similar to the symptoms used to diagnose PTSD. Some big differences between healthy, normal responses to a traumatic event and PTSD are the severity of the responses and length of time they last. If these reactions last over one month, disrupt normal daily function and cause great distress, and are not caused by any other medication, substance use, or other illness, it is important to seek help.
Is there a difference between PTSD and other disorders?
Yes! PTSD is a very different disorder from anxiety and depression, even though they are sometimes combined. While there is some overlap in symptoms (e.g., negative thoughts and feelings can be a symptom of both PTSD and depression), PTSD and other disorders are caused by different things, display different physiological changes, and should be treated by different therapies and medications.
The biggest difference between PTSD and other anxiety disorders is real versus imagined danger; to diagnose PTSD, a trauma must be directly or indirectly experienced, whereas for anxiety disorders, the threat may only be perceived or imagined to be present.
While some therapies, such as cognitive behavioral therapy, may work for PTSD, anxiety, and depression, each disorder may be treated best with different medications. Depression is sometimes treated by selective serotonin reuptake inhibitors (SSRIs) such as Zoloft and Prozac, serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta, and tricyclic antidepressants such as Anafranil. Anxiety disorders are generally treated by benzodiazapines such as Xanax and Valium. Currently, there is no true consensus on how to medically treat PTSD and much research is being done on the subject. Both anti-anxiety and antidepressants are used for PTSD; in fact, the only FDA approved drugs to treat PTSD are Zoloft and Paxil. However, these medications only treat one or a few symptoms.
Current Treatments & Therapies
There is much research being done on PTSD therapies and treatments. Here are the currently accepted and/or proposed therapies:
Psychotherapy for PTSD
Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:
- Cognitive behavioral therapy (CBT): There are different types of CBT, such as cognitive therapy and exposure therapy.
- Cognitive Processing Therapy (CPT): CPT is a therapy in which the patient learns skills to understand how trauma has changed his/her thoughts and feelings and reconceptualizes the trauma in a way that decreases negative emotion toward it.
- Prolonged Exposure (PE): PE is a trauma-focused psychotherapy that involves talking about and revisiting the trauma and trauma-related cues repeatedly until memories are no longer upsetting.
A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements and engaging in side to side eye movements while a patient talks about the trauma. The goal of EMDR is to reduce the long-lasting effects of traumatic memories by engaging the brain’s natural adaptive information processing systems, thereby relieving present symptoms. There is conflicting evidence over whether the concurrent eye movements during therapy are effective.
Medications for PTSD
Currently, only two drugs are FDA-approved to treat PTSD. They are selective serotonin-reuptake inhibitors (SSRIs) generally used as antidepressants, Zoloft and Paxil. These medications help reduce panic and depression symptoms sometimes seen with PTSD. Many people suffering from PTSD do not always respond to antidepressants and they are estimated to be about 50% effective.
The most common alternative to antidepressants are atypical antipsychotics, such as risperidone (Risperdal). Antipsychotic medicines seem to be most useful in PTSD patients who suffer from dissociation, hypervigilance, paranoia, or brief psychotic breaks (i.e., not being in touch with reality). Medicines like beta blockers (e.g., propranolol) help to reduce the physical symptoms of PTSD, such as increased heart rate.
The newest medications currently being researched are:
- Cyclobenzeprine (Tonix)
- FAAH inhibitors (SpringWorks)
- MDMA (“ecstasy”)
- Targeted glutamate receptor inhibitors (Neurovation Labs)