Mental and Behavioral Conditions
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Post-Traumatic Stress Disorder (PTSD)

Medically reviewed by Anna Kravtsov, D.O., Psychiatrist

Written by Sindy Hoxha

February 26th, 2024

PTSD, or Post-Traumatic Stress Disorder, impacts millions of people worldwide, with global lifetime prevalence estimated to be around 3.9% in the general population (1). The prevalence and impact of PTSD can vary significantly due to factors like conflict, natural disasters, and cultural differences in recognizing and diagnosing mental health conditions. For example, in conflict zones, rates of PTSD can exceed 30% among direct participants and affected civilian populations (2).

In the United States, an estimated 3.6 percent of adults suffer from PTSD annually (3).

What is Post-Traumatic Stress Disorder (PTSD)?

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that may occur following a distressing or traumatic experience (4). Recognized as a diagnosis by the American Psychiatric Association (APA), PTSD may affect individuals who have witnessed or directly experienced such events (5).

Those living with PTSD often experience an intensified “fight or flight” response (6). When they perceive danger, their autonomic nervous system reacts, leading to chemical changes in the brain. These changes might result in a persistent sense of threat and various symptoms, even after the perceived danger has subsided or when no actual threat is present.

Types of Trauma and Stressor-Related Disorders:

PTSD could affect anyone, regardless of age, gender, or background (7). Understanding the different types of stressor-related disorders is crucial for recognizing symptoms and seeking appropriate treatment.

Types of Trauma and Stressor-related disorders:

  • Normal Stress Response: Before PTSD fully manifests, individuals may experience a normal stress response to traumatic events like accidents or surgeries. With support from loved ones and therapy, recovery is often possible within a few weeks (8).
  • Acute Stress Disorder: Acute stress disorder may occur after a life-threatening event, such as a natural disaster or loss of a loved one (9). Acute stress disorder lasts for 3 days up to 1 month. Without proper treatment, it may progress to PTSD. Therapy, medication, and intensive treatments might help manage symptoms.
  • Uncomplicated PTSD: Linked to a single traumatic event, uncomplicated PTSD involves symptoms like avoidance, nightmares, and mood changes lasting longer than 1 month. Treatment typically involves therapy, medication, or a combination of both.
  • Comorbid PTSD: When PTSD coexists with other mental health conditions, such as substance abuse, it can be described as comorbid. Treatment is most effective when both conditions are addressed simultaneously, to help individuals refrain from self-medication and destructive behaviors (10).
  • Complex PTSD: Caused by multiple traumatic events, complex PTSD is common in cases of abuse or repeated exposure to violence. Symptoms may include behavioral issues like impulsivity and emotional difficulties like intense rage. Treatment may involve addressing co-occurring disorders and intensive therapy (11).

Recognizing the type of PTSD one may be experiencing is the first step towards healing. Seeking professional guidance and support is essential for managing symptoms and improving mental well-being. Remember, you’re not alone, and help is available for those who seek it.

Symptoms of PTSD

Post-Traumatic Stress Disorder (PTSD) may significantly affect your daily life. Symptoms usually emerge within the first month following a traumatic event. However, in some cases, symptoms may not manifest until months or even years later. Symptoms may fluctuate, with some experiencing periods of lesser symptoms followed by exacerbations, while others endure constant severe symptoms.

PTSD symptoms vary but generally fall into these categories:

  • Avoidance and Emotional Numbing: Many with PTSD try to avoid reminders of the trauma, including people or places associated with it. They may suppress memories or emotions, leading to emotional numbing, isolation, and withdrawal from activities (12).
  • Re-experiencing: This is a very common symptom of PTSD. Individuals involuntarily relive the trauma through flashbacks, nightmares, or distressing sensations. They may also have persistent negative thoughts about the event, leading to feelings of guilt or shame (13).
  • Hyperarousal: Individuals with PTSD may feel constantly on edge, anxious, and easily startled. This hyperarousal might manifest as irritability, anger, sleep disturbances, and difficulty concentrating (14).

Other problems associated with PTSD include additional mental health issues like depression or anxiety, self-destructive behaviors such as substance abuse, and physical symptoms like headaches or stomach pains. It might also impact work and relationships.

Children may also experience PTSD, exhibiting similar symptoms to adults such as sleep disturbances and nightmares. They may lose interest in activities, display difficult behavior, avoid trauma-related stimuli, or repeatedly re-enact the traumatic event through play (15).

Seek medical advice if symptoms persist after about four weeks post-trauma or if they significantly interfere with daily life. Your GP may evaluate your symptoms and refer you to mental health specialists if necessary.

Causes of PTSD

While the exact reasons behind individual responses to trauma remain unclear, ongoing research sheds light on various factors contributing to the development of PTSD.

Alterations in Brain Function and Structure

PTSD is closely associated with changes in both the functionality and structure of the brain. These alterations play a crucial role in the manifestation and persistence of PTSD symptoms:

  • Hippocampus: The hippocampus, a brain region responsible for regulating motivation, emotion, learning, and memory, tends to decrease in size among individuals with PTSD (16).
  • Medial Prefrontal Cortex (mPFC): The medial prefrontal cortex, which plays a role in modulating the emotional responses generated by the amygdala, appears to be both smaller and less responsive in individuals with PTSD. This dysfunction contributes to difficulties in regulating emotions and processing traumatic memories (17).
  • Amygdala: In individuals with PTSD, the amygdala, responsible for processing emotions and fear responses, often exhibits heightened reactivity. This heightened sensitivity contributes to the intense emotional responses characteristic of PTSD (18).

Neurotransmitter and Hormonal Imbalance

Studies suggest that individuals with PTSD exhibit irregular levels of certain neurotransmitters and hormones, leading to significant physiological changes (19). Notably, cortisol, commonly known as the “stress hormone,” tends to be either normal or low, while levels of corticotropin-releasing factor (CRF) are elevated despite continued stress.

CRF prompts the release of corticotropin, intensifying the body’s sympathetic nervous system response, commonly known as the “fight or flight” reaction (20). This heightened response manifests in increased heart rate, elevated blood pressure, and heightened alertness and startle reactions.

Moreover, research indicates disruptions in other neurotransmitter systems such as Gamma-aminobutyric acid (GABA), Glutamate, and Serotonin among individuals with PTSD, further contributing to the complexity of the disorder (21).

Risk Factors of PTSD

Post-Traumatic Stress Disorder (PTSD) may affect individuals of all ages and certain factors might increase the likelihood of its development following a traumatic event. Here are some key risk factors:

  • Occupation: Certain professions, like military personnel and first responders, inherently involve exposure to traumatic events, increasing the risk of PTSD among individuals in these roles (22).
  • Intensity and Duration of Trauma: Experiencing a particularly intense or prolonged traumatic event may heighten the risk of developing PTSD (23).
  • Previous Trauma: Individuals who have experienced trauma earlier in life, such as childhood abuse, may be more susceptible to developing PTSD after subsequent traumatic experiences (24).
  • Substance Misuse: Problems with substance misuse, such as excessive drinking or drug use, may also increase vulnerability to PTSD. (25, 26)
  • Existing Mental Health Conditions: Pre-existing mental health issues like anxiety or depression may exacerbate the likelihood of developing PTSD following a traumatic event (27).
  • Family History: A family history of mental health problems, including anxiety or depression, may predispose individuals to PTSD (28).
  • Lack of Support System: Having inadequate support from family and friends might make coping with trauma more challenging and may contribute to the development of PTSD (29).

In summary, PTSD arises from a complex interplay of biological, psychological, and environmental factors. Understanding these underlying mechanisms is crucial for developing effective treatment strategies and providing support to individuals affected by this debilitating condition.

Types of Traumatic Events Leading to PTSD

Various traumatic events may trigger the development of PTSD. Some common ones include:

  • Combat Exposure: Military personnel often face intense and prolonged exposure to combat situations, increasing their risk of developing PTSD (30).
  • Childhood Physical Abuse: Trauma experienced during childhood, such as physical abuse, might have lasting psychological effects and increase the likelihood of PTSD later in life (31).
  • Physical Assault: Being a victim of physical assault may lead to significant trauma and increase the risk of developing PTSD (32).
  • Sexual Violence: Survivors of sexual violence are at high risk of developing PTSD due to the severe emotional and psychological impact of such experiences (33).
  • Accidents: Traumatic accidents, such as car crashes or workplace incidents, may also result in PTSD due to the sudden and often life-threatening nature of the event (34).

Additionally, a range of other traumatic events, including natural disasters, muggings, robberies, plane crashes, torture, kidnappings, life-threatening medical diagnoses, and terrorist attacks, may also precipitate PTSD. It’s important to recognize that PTSD might stem from a variety of extreme or life-threatening situations, and seeking support and treatment is essential for recovery.

Diagnosis of PTSD

Diagnosing PTSD doesn’t involve a straightforward test. Instead, your healthcare provider determines the diagnosis by performing an evaluation and discussing various aspects with you including but not limited to:

  • Exposure to traumatic events
  • Symptoms you’ve been experiencing
  • Mental health history
  • Medical history
  • Physical exam and bloodwork
  • Questionnaires and rating scales

Discussing the trauma might be challenging. You might find it helpful to have a supportive loved one accompany you to the appointment. They may offer support and assist in providing details about your symptoms and any changes in your behavior.

Healthcare providers refer to the diagnostic criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DSM-5-TR) to diagnose PTSD (35) (36). For a PTSD diagnosis, you need to have experienced the following symptoms for at least one month:

  • At least one avoidance symptom.
  • At least one intrusion symptom.
  • At least two symptoms related to arousal and reactivity.
  • At least two symptoms related to thoughts and mood.

Additionally, your provider might conduct a physical examination and order specific tests, such as blood tests, to rule out any physical conditions that could be contributing to your symptoms.

Treatment Options for PTSD

It’s worth mentioning that not everyone who goes though a traumatic experience develops PTSD. Depending on the severity and duration of an individual’s symptoms and ability to cope, some people may also not require professional help. Some individuals find relief from symptoms over time, while others find support from family, friends, or spiritual advisors helpful.

However, many individuals struggling with PTSD require professional assistance to navigate through the intense and often disabling psychological distress. It’s crucial to recognize that experiencing trauma may lead to severe distress, but this isn’t the fault of the individual, and it’s important to know that PTSD is treatable. Seeking treatment early enhances the likelihood of successful recovery.

Psychiatrists and mental health professionals utilize various research-proven methods to aid individuals in recovering from PTSD. Talk therapy (psychotherapy) and medication are two primary avenues of effective treatment for PTSD (37).

Cognitive Behavioral Therapy (CBT)

One form of psychotherapy, Cognitive Behavioral Therapy (CBT), has shown significant effectiveness. Cognitive Processing Therapy, Prolonged Exposure Therapy, and Stress Inoculation Therapy are examples of CBT techniques used in PTSD treatment.

  • Cognitive Processing Therapy (CPT): CPT is a cognitive behavioral therapy specifically designed to address PTSD and its associated symptoms. It focuses on reshaping negative emotions and beliefs stemming from the trauma, helping individuals confront distressing memories and emotions with the support of a therapist (38).
  • Prolonged Exposure Therapy (PET): PET involves gradually exposing individuals to traumatic memories or triggers in a controlled setting, allowing them to confront and manage their fear and distress. Virtual reality programs are sometimes employed to recreate traumatic experiences in a therapeutic environment, particularly beneficial for war veterans with PTSD (39).
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): TF-CBT is a treatment model tailored for children and adolescents, integrating trauma-sensitive interventions with cognitive behavioral, family, and humanistic approaches (40).
  • Group and Family Therapy: Group therapy provides a supportive environment for individuals to share their experiences and emotions related to trauma. Family therapy may also be beneficial, as PTSD might impact the entire family dynamic (41).
  • Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a trauma-focused psychotherapy administered over several months. It involves reprocessing traumatic memories to change their emotional impact, often incorporating eye movements similar to those during REM sleep to facilitate this process (42).
  • Other Psychotherapies: Interpersonal, supportive, and psychodynamic therapies focus on the emotional and interpersonal aspects of PTSD, offering alternatives for individuals who prefer not to confront reminders of their trauma directly (43).

Seeking professional help and exploring these various treatment options may significantly aid individuals in overcoming the challenges posed by PTSD. Remember, recovery is possible with the right support and treatment.

Medication

Medication plays a crucial role in controlling PTSD symptoms. Certain antidepressants, such as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors), are frequently prescribed to address the core symptoms of PTSD (44). These medications may be used alone or alongside psychotherapy and other treatments. They work by regulating neurotransmitters in the brain, which might help alleviate symptoms like depression, anxiety, and intrusive thoughts.

Additionally, other medications may target specific symptoms of PTSD, such as reducing anxiety, managing physical agitation, or addressing sleep disturbances and nightmares commonly associated with the condition.

Other Treatments

Apart from medication, various complementary and alternative therapies are gaining recognition for their efficacy in managing PTSD symptoms. These treatments offer alternatives to traditional psychotherapy and may involve less verbal communication, making them suitable for individuals who may find talking about their experiences challenging.

Examples of these therapies include acupuncture, which involves inserting thin needles into specific points on the body to promote relaxation and alleviate stress (45).

Animal-assisted therapy is also gaining popularity, involving interactions with trained animals to provide comfort and emotional support. These animals, such as dogs or horses, might help individuals feel safe and connected, thereby reducing feelings of isolation and distress.

In addition to formal treatments, many individuals with PTSD find solace in peer support groups, where they could share their experiences and feelings with others who have gone through similar challenges. These groups offer a sense of community and understanding, fostering emotional healing and resilience (46).

Prevention of Post-Traumatic Stress Disorder (PTSD)

While it’s not always possible to prevent experiencing a traumatic event, there are certain measures that may reduce the likelihood of developing PTSD afterwards. These measures, known as “protective factors,” include:

  • Seeking support from friends and family following the event, which may provide a sense of security and comfort.
  • Cultivating a positive outlook on one’s actions in the face of danger, focusing on strengths and resilience rather than solely on the negative aspects of the experience.
  • Participating in support groups designed for individuals who have experienced trauma, as this may offer additional avenues for understanding and coping.
  • Developing the ability to act and respond calmly and effectively despite feelings of fear or anxiety, which might help regain a sense of control.
  • Adopting healthy coping strategies to manage stress and process emotions effectively after the traumatic event, such as engaging in physical activity, mindfulness practices, or creative outlets.
  • Assisting others, particularly in situations where multiple individuals have been affected by the trauma, such as natural disasters. This not only fosters a sense of community and connection but also provides opportunities for altruism and empowerment.

By implementing these protective factors, individuals may be better equipped to navigate the aftermath of a traumatic event and reduce the risk of developing PTSD.

Conclusion

Treatment options such as therapy, medication, and support groups are available and may greatly improve quality of life for those living with PTSD. Remember, healing from PTSD is a journey, and it’s important to ask for help. With proper support and treatment, individuals may learn to manage their symptoms and reclaim their lives. Let’s continue to raise awareness and support those affected by PTSD, because everyone deserves the opportunity to heal and thrive!

Sindy Hoxha

Sindy Hoxha is a writer and editor with years of experience in the field. She has worked as a writer for several...Read more

Anna Kravtsov, D.O., Psychiatrist

Anna Kravtsov is a Board-certified general adult psychiatrist with 9+ years of clinical experience. She graduated phi beta kappa from Rutgers University...Read more

Evidence Based

This article is based on scientific evidence, and written, fact-checked & medically reviewed by health experts.

Throughout this article, you’ll find scientific references (highly trusted peer-reviewed scientific papers, links denoted by the numbers in the parentheses (1, 2, 3)).