What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder is defined by American Psychiatric Association as “a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.” However, the majority of people exposed to life-threatening or traumatic events do not experience lasting negative effects. But, people with PTSD have intense, disturbing thoughts and feelings related to the traumatic event long after it has ended. Flashbacks or nightmares may make them relive the event. Feelings of sadness, fear or anger can occur. Feelings of detachment or estrangement from other people can be present. They may avoid people or situations that remind them of the traumatic event. They may react negatively to something as ordinary as an accidental touch or a loud noise (American Psychiatric Association, 2017).
Known previously as “shell shock” during World War I and “combat fatigue” after World War II, it affects around 3.5% of adults in the U.S., and one in 11 people will be diagnosed with PTSD in their lifetime. It can occur in all people, in people of any ethnicity, nationality or culture, and any age (American Psychiatric Association, 2017).
Symptoms of PTSD
They will experience the following symptoms in PTSD (National Institute of Mental Health, 2019) (Mayo Clinic Staff, 2018):
- Flashbacks—Reliving the traumatic event as if it were happening again accompanied by racing heart or sweating
- Bad dreams—Upsetting dreams or nightmares about the traumatic event
- Frightening thoughts—Recurrent, unwanted distressing memories of the traumatic event
- Physical reactions or severe emotional distress to anything that reminds you of the traumatic event, such as words, objects, or situations
- Avoiding places, activities or people that are reminders of the traumatic event
- Avoiding thoughts, feelings, or talk related to the traumatic experience
Anything that reminds a person suffering from PTSD of the traumatic experience can trigger these symptoms. For example, after a car accident, one may avoid riding in or driving a car.
Arousal and Reactivity Symptoms
These are symptoms of changes in emotional and physical reactions, which can include:
- Being easily startled or frightened
- Feeling tense or being on guard for danger
- Difficulty sleeping
- Self-destructive behavior, such as driving too fast or drinking too much
- Given to angry outbursts or aggression
- Trouble concentrating
- Excessive shame or guilt
Arousal symptoms are more persistent, being present even without reminders of the traumatic event.
Cognition and Mood Symptoms
- Memory problems, including trouble recalling key features of the traumatic event
- Negative thoughts about oneself, other people or the world
- Hopelessness about the future
- Feeling detached from family and friends
- Inability to have close relationships
- Excessive guilt or blame
- Feeling emotionally numb
- Loss of interest in activities once found enjoyable
Some recover within 6 months, while it lasts much longer in others, and in some people, it can be chronic lasting years. PTSD is often accompanied by depression, substance abuse, or other anxiety disorders.
Diagnosis of PTSD
The above symptoms are natural after a traumatic event. If these symptoms go away after a few weeks, it is labeled acute stress disorder. When the symptoms last more than a month and are not due to anything else except the event itself, it might be PTSD. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. To be diagnosed with PTSD, an adult must have all of the following for at least 1 month (National Institute of Mental Health, 2019):
- At least one re-experiencing symptom
- At least one avoidance symptom
- At least two arousal and reactivity symptoms
- At least two cognition and mood symptoms
This is the Clinician-Administered PTSD Scale (CAPS), which was developed in 1990 to operationalize the DSM-III-R diagnosis of PTSD, modified to obtain a diagnosis by DSM-5 criteria. The interview includes 17 items required to make the diagnosis, covering all four criteria: (1) the event itself, (2) re-experiencing of the event, (3) avoidance, and (4) increased arousal. For each of the 17 items, the interviewer rates both the frequency and the intensity on a five-point scale ranging from 0 to 4. Typically, an item is counted if the frequency is at least 1 and intensity is at least 2. The CAPS must be administered by a trained clinician and requires 45 to 60 minutes to complete, with follow-up examinations somewhat briefer (Sadock, et al., 2017).
Treatment of PTSD
Not everyone with PTSD requires treatment because some get better over time as their symptoms subside, or some may get better with the help of family, friends, or priests. PTSD is treatable. The earlier a person gets treatment, the better the likely outcome.
Both medications and psychotherapy, especially cognitive-behavioral therapy, or their combination, are effective in treating the symptoms of PTSD. Complementary and alternative therapies are also being used to help people with PTSD. Examples include acupuncture and animal-assisted therapy.
Some antidepressants such as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors) are commonly used to treat the core symptoms of PTSD. Other medications may be used to lower anxiety and physical agitation, or treat the nightmares and sleep problems commonly present in PTSD (American Psychiatric Association, 2017).
Psychotherapy emphasizes education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. The most effective psychotherapy in PTSD is cognitive-behavioral therapy (CBT). The types of CBT used to treat PTSD are (American Psychiatric Association, 2017) (National Institute of Mental Health, 2019):
- Cognitive restructuring. This helps people modify bad memories. The therapist helps people with PTSD take a realistic look at what happened. Sometimes people remember the event differently than how it happened. They may feel guilt or shame even though they are not at fault because erroneously they may believe so. The therapist can correct this by drawing their attention to it. That is, he restructures their cognition or thinking process.
- Exposure therapy. This helps people face and control their fear. It gradually exposes them to symptom “triggers” in a safe, controlled way to help a person face and gain control of fear and distress and learn to cope. It could involve imagining, writing, or visiting the place where the event happened. For example, war veterans with PTSD can be exposed to virtual reality programs to re-experience the battlefield in a controlled, therapeutic way.
Other psychotherapies such as interpersonal, family, group, supportive and psychodynamic therapies focus on the emotional and interpersonal aspects of PTSD. These may be helpful when people do not want to be reminded of their traumas.
American Psychiatric Association, 2017. What Is Posttraumatic Stress Disorder?. [Online]
Available at: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
[Accessed 16 Oct 2019].
Mayo Clinic Staff, 2018. Post-traumatic stress disorder (PTSD). [Online]
Available at: https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
[Accessed 16 Oct 2019].
National Institute of Mental Health, 2019. Post-Traumatic Stress Disorder. [Online]
Available at: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
[Accessed 16 Oct 2019].
Sadock, B. J., Sadock, V. A. & Ruiz, P., 2017. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 10th ed. Philadelphia: Wolters Kluwer.