Overview
Post Traumatic Stress Disorder (PTSD) is a mental health disorder that some people develop after they experience or see a traumatic event. The traumatic event may be life-threatening, such as combat, a natural disaster, a car accident, or sexual assault. But sometimes the event is not necessarily a dangerous one. For example, the sudden, unexpected death of a loved one can also cause PTSD. As a result, the person experiences feelings of intense fear, helplessness, or horror.
PTSD can happen to anyone at any age. It occurs as a response to chemical and neuronal changes in the brain after exposure to threatening events.
Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. When the sense of safety and trust is shattered, it’s normal to feel unbalanced, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.
For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder, the symptoms don’t decrease. You don’t feel a little better each day. You may start to feel worse.
Cause
Health care providers do not know why traumatic events cause PTSD in some people, but not in others. Your genes, emotions, and family setting may all play roles. Past emotional trauma may increase your risk of PTSD after a recent traumatic event.
With PTSD, the body’s response to a stressful event is changed. Normally, after the event, the body recovers. The stress hormones and chemicals the body releases due to the stress go back to normal levels. For some reason in a person with PTSD, the body keeps releasing the stress hormones and chemicals.
PTSD can occur at any age. It can occur after events such as:
• Assault
• Car accidents
• Domestic abuse
• Natural disasters
• Prison stay
• Sexual assault
• Terrorism
• War
Symptoms
While everyone experiences PTSD differently, there are four main types of symptoms.
1. Re-experiencing the traumatic event through intrusive memories, flashbacks, nightmares, or intense mental or physical reactions when reminded of the trauma.
2. Avoidance and numbing, such as avoiding anything that reminds you of the trauma, being unable to remember aspects of the ordeal, a loss of interest in activities and life in general, feeling emotionally numb and detached from others and a sense of a limited future.
3. Hyperarousal, including sleep problems, irritability, hypervigilance (on constant “red alert”), feeling jumpy or easily startled, angry outbursts, and aggressive, self-destructive, or reckless behavior.
4. Negative thoughts and mood changes like feeling alienated and alone, difficulty concentrating or remembering, depression and hopelessness, feeling distrust and betrayal, and feeling guilt, shame, or self-blame.
PTSD symptoms in children
In children – especially very young children – the symptoms of PTSD can differ from those of adults and may include:
● Fear of being separated from their parent
● Losing previously acquired skills (such as toilet training)
● Sleep problems and nightmares
● Somber, compulsive play in which themes or aspects of the trauma are repeated
● New phobias and anxieties that seem unrelated to the trauma (such as fear of monsters)
● Acting out the trauma through play, stories, or drawings
● Aches and pains with no apparent cause
● Irritability and aggression
Treatment
The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and PTSD affects people differently, so a treatment that works for one person may not work for another. Anyone with PTSD needs to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD may need to try different treatments to find what works for their symptoms.
If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicide.
Psychotherapy
Cognitive Behavior Therapy (CBT):
CBT is a type of psychotherapy that has consistently been found to be the most effective treatment of PTSD both in the short term and the long term. CBT for PTSD is trauma-focused, meaning the trauma event(s) are the center of the treatment. It focuses on identifying, understanding, and changing thinking and behavior patterns. CBT is an active treatment that involved the patient to engage in and outside of weekly appointments and learn skills to be applied to their symptoms. The skills learned during therapy sessions are practiced repeatedly and help support symptom improvement. CBT treatments traditionally occur over 12 to 16 weeks.
Main Components of CBT:
While different CBTs have different amounts of both exposure and cognitive interventions, they are the main components of the larger category of CBTs that have been repeatedly found to result in symptom reduction.
● Exposure therapy. This type of intervention helps people face and control their fears by exposing them to the trauma memory they experience in the context of a safe environment. Exposure can use mental imagery, writing, or visits to places or people that remind them of their trauma. Virtual reality (creating a virtual environment to resemble the traumatic event) can also be used to expose the person to the environment that contains the feared situation. Virtual reality, like other exposure techniques, can assist in exposures for treatment for PTSD when the technology is available. Regardless of the method of exposure, a person is often gradually exposed to the trauma to help them become less sensitive over time.
● Cognitive Restructuring. This type of intervention helps people make sense of bad memories. Oftentimes people remember their trauma differently than how it happened (e.g., not remembering certain parts of the trauma, remembering it is a disjointed way). It is common for people to feel guilt or shame about aspects of their trauma that were not their fault. Cognitive restructuring helps people look at what happened with facts to get a realistic perspective on the trauma.
Other PTSD Treatments:
There are other types of PTSD interventions that are not considered CBTs.
● Eye Movement Desensitization and Reprocessing (EMDR) is a form of psychotherapy that involves processing upsetting trauma-related memories, thoughts, and feelings. EMDR asks people to pay attention to either a sound or a back and forth movement while thinking about the trauma memory. This treatment is effective for treating PTSD, but some research has shown that the back and forth movement is not the active treatment component but rather the exposure alone is.
● Present Centered Therapy (PCT) is a type of non-trauma-focused treatment that centers around current issues rather than directly processing the trauma. PCT provides psychoeducation about the impact of trauma on one’s life as well as teaching problem-solving strategies to deal with current life stressors.
Medications:
Medications are sometimes used as an adjunct to one of the therapies described above. One of the more common types of medications used is antidepressants as depressed mood can be part of PTSD.
Other
Exams and Tests
Your provider may ask how long you have had symptoms. PTSD is diagnosed when you have had symptoms for at least 30 days.
Your provider may also do a mental health exam, physical exam, and blood tests. These are done to look for other illnesses that are similar to PTSD.
