PTSD (Posttraumatic Stress Disorder)

Estimates suggest that up to 70 percent of American adults have experienced at least one significant trauma during their lifetimes. Many of those people may subsequently have suffered from an emotional reaction known as posttraumatic stress disorder or PTSD. Further estimates suggest that 5 percent of the population currently lives with PTSD.

What Is PTSD?

Posttraumatic stress disorder occurs in some cases when people are exposed to a very stressful event, which is known as an extreme stress trigger. To be diagnosed with PTSD, they must continue to experience symptoms of PTSD for at least one month after exposure to this trigger.

Who Experiences PTSD?

Although women are twice as likely as men to develop PTSD, anyone who experiences an extremely traumatic event may develop posttraumatic stress disorder. Examples of extreme stress triggers include:

• Criminal assault or rape
• Natural disasters
• Serious accidents
• Combat exposure
• Child physical or sexual abuse or severe neglect
• Witnessing traumatic events
• Imprisonment/hostage/displacement as refugees
• Torture
• The sudden unexpected death of loved ones

Although other types of stress may be severe and can be quite upsetting, they typically do not result in PTSD. Such events might include the death of an elderly parent, divorce, or job loss.

What Are the Symptoms of PTSD?

People with PTSD typically experience three main types of symptoms. First, they may reexperience the traumatic event that led to developing PTSD. This can include:

• Flashbacks in which they feel that the triggering event is recurring even while they are awake
• Distressing recollections of the traumatic event
• Nightmares of the event
• Exaggerated physical and emotional reactions to triggers that remind them of the event

The second type of symptom involves emotional numbing or even avoidance. It may include the following symptoms or behaviors:

• Avoidance of places, thoughts, activities, conversations, and feelings related to the event or trauma
• Feelings of detachment
• Loss of interest
• Restricted emotions

The third symptom type relates to increased arousal related to the event and may be indicated by:

• Outbursts of anger
• Irritability
• Difficulty sleeping
• Hypervigilance
• Difficulty concentrating
• Exaggerated startle responses

Related Conditions and Problems

In addition to the symptoms listed above, people with PTSD may face an array of other symptoms. With successful treatment, many of these symptoms will improve. The person with PTSD may require extra treatment to address the full scope of conditions related to PTSD.

Panic Attacks

People who have experienced a significant trauma may have panic attacks when they are exposed to a trigger that reminds them of the inciting trauma. For instance, someone who develops PTSD as a result of combat exposure may have a panic attack upon hearing a loud noise that reminds them of an explosion. During a panic attack, the person will commonly experience intense discomfort or fear. This may be accompanied by psychological or physical symptoms, which might include:

• Sweating
• Racing or pounding heart
• Sortness of breath
• Shaking or trembling
• Dizziness
• Nausea
• Chest pain
• Numbness
• Hot flushes
• Tingling

People may experience a sense of detachment or may even feel as though they are dying, going crazy, or having heart attacks.

Severe Avoidance Behavior

One of the most common symptoms of PTSD is avoidance of anything that reminds the person of the original event. Avoidance can sometimes extend to everyday situations. In some cases, this type of avoidance becomes so severe that the individual is unable to leave his or her home.

Depression

Many people suffering from PTSD also experience depression. They may be unable to take pleasure or interest in activities they once enjoyed. Unjustified feelings of self-blame or guilt are common.

Suicidal Thoughts

In some instances, depression may become so severe that the person with PTSD experiences thoughts of suicide because of feelings that life is simply not worth continuing.

Substance Abuse

People with PTSD may also use drugs or alcohol in an effort to numb the pain they are experiencing. They may misuse over-the-counter drugs or prescription drugs. This substance abuse can magnify the symptoms of PTSD.

Treatments for PTSD

There are two primary types of treatment available for PTSD: psychotherapy and medication. Some people are able to fully recover from posttraumatic stress disorder using psychotherapy alone, but others need a combination of both treatments to achieve full recovery.

Psychotherapy alone is often best for people who experience mild symptoms, those who should not take medication due to pregnancy or because they are breastfeeding, and people who prefer not to take medication.

Medication may be a good option for individuals with severe symptoms or those who have lived with their symptoms for a long time. People who have additional psychiatric problems such as anxiety or depression may also require medication.

Psychotherapy

Professionals may use three types of psychotherapy when treating PTSD: cognitive therapy, anxiety management, and exposure therapy. If they are treating children with PTSD, they may also use play therapy. During anxiety management, patients learn how to better cope with their symptoms through relaxation training, breathing retraining, and positive thinking and self-talk. Therapists may teach patients how to control their anxiety and fear by relaxing the major muscle groups in their bodies, one at a time. In order to deal with hyperventilation, therapists teach patients how to use slow breathing techniques to combat tingling, dizziness, and palpitations. During positive thinking and self-talk, therapists help people to replace negative thoughts with positive thoughts when they are faced with reminders of the original trauma. Therapists may also use assertiveness training to teach patients how to express their emotions without pushing others away.

Medication

Several types of medication are available to treat posttraumatic stress disorder. These include antidepressants, mood stabilizers, and antianxiety medications.

People with acute PTSD who have had symptoms for fewer than three months may require medication for between six and 12 months. Individuals with chronic PTSD who have had symptoms for longer than three months may need medication for a minimum of one year. In some instances, people may relapse and begin to experience symptoms after they have ceased therapy and stopped taking medication. This can happen even years after the end of the treatment. If this happens, they may need to resume psychotherapy and medication.

For more on the topic of PTSD, we’ve included the following expert consensus documents as reference materials:

• Full reprint in PDF: Treatment of Posttraumatic Stress Disorder
• Guide for Patients and Families in PDF

View Resources

• MiTalk – more information about PTSD
• VetAffairs – treatment of PTSD
• MentalHealth – PTSD overview
• PTSD Nebraska – PTSD services in nebraska
• PubMedHealth – general information about PTSD