Post Traumatic Stress Disorder: Signs, Symptoms & Solutions
What Is Post-Traumatic Stress Disorder (PTSD)?
PTSD is a condition that develops in some people after they have witnessed or experienced a shocking, tragic, scary, abusive or dangerous event. For some people, PTSD may develop after repeated exposure to details of disturbing events in the course of their professional duties, or after being told a loved one has suffered a violent or accidental death.
PTSD can happen to anyone. The more disturbing the experience, the more likely someone is to develop PTSD. It may occur immediately following the event, months or even years afterward. While it is natural to feel stressed or afraid during or soon after a traumatic event, these feelings persist in people with PTSD, sometimes for the rest of their life.
Why Do Some People Develop PTSD And Not Others
When we witness or experience a traumatic or dangerous event, our body instinctively reacts. This acute stress response (also known as "fight or flight") is our body's way of increasing our chance of survival. Our sympathetic nervous system instructs our adrenal glands (located on the top of each kidney) to release epinephrine and norepinephrine into the blood stream. At the same time, our hypothalamus triggers the release of adrenocorticotropic hormone (ACTH) from our pituitary gland which in turn triggers the release of more than 30 other hormones. All these "stress hormones" prepare our body to fight or flee. Our heart rate and blood pressure increase, our pupils dilate, and the veins in our skin constrict in order to direct blood to our muscles and heart. In addition, smooth muscle inside our lungs relaxes allowing better oxygen flow; glucose is released from stored glycogen in our liver; and non-essential functions, such as our digestive and immune system, shut down.
If we successfully fight or flight, then our stress hormones naturally dissipate allowing our bodies to return to a normal level of functioning. If the threat is so extreme that it causes us to freeze, or so persistent that our stress hormones remain elevated for extended periods of time, we become at risk of PTSD.
PTSD is common, affecting about 1 in 10 men and 2 in 10 women. Prevalence increases depending on occupation, or in the case of the military, service era with PTSD reported in 11-20% of veterans involved in Operations Iraqi and Enduring Freedom; 12% of veterans who experienced the Gulf War, and over 30% of those who served in Vietnam.
What Events Are More Likely To Cause PTSD
PTSD can happen to anybody who experiences a life-threatening or disturbing event or witnesses it. Sometimes it can happen to people who have just heard about the event, particularly if it involves somebody close to them. Examples of events that may cause PTSD include:
- Military combat or a stressful or terrifying experience in a war zone
- Sexual or physical assault as an adult or a child
- Serious motor vehicle or workplace accidents
- Earthquakes, fires, floods, hurricanes, tornados, tsunamis or other natural disasters
- Terrorist attacks.
PTSD is also more likely to affect people who have little or no support following a traumatic event; with a history of childhood trauma, mental illness or substance abuse; without adequate coping strategies; who have witnessed a death or seen a dead body; or who feel troubled by their own actions during the event.
Symptoms Of Post Traumatic Stress Disorder
Actual symptoms and the length of time somebody has PTSD varies, but to be diagnosed with PTSD, all the following must be present:
- One or more re-experiencing symptoms - for example, flashbacks (reliving the trauma repeatedly), nightmares, frightening thoughts
- One or more avoidance symptoms - avoiding thoughts or feelings, places, activities, or objects that remind you of the event
- Two or more arousal and reactivity symptoms - feeling on edge, sleeping difficulties, angry outbursts
- Two or more cognition and mood symptoms - trouble remembering key details of the event, feeling guilt or blame, pessimistic thoughts, loss of interest in previously enjoyable things.
A diagnosis of PTSD can only be given if the symptoms last more than a month following the event, and are not due to any substance misuse, medical illness, or injury. People who experience similar symptoms that go away after a few weeks are usually diagnosed with acute stress disorder (ASD). ASD can develop into PTSD.
Children May React Differently
Symptoms of PTSD in children may be different to those in adults. Children less than six may become more clingy, wet the bed at night despite previously having learned how to use the toilet, constantly act out the scary event, refuse or be unable to talk.
Older children may develop destructive or disruptive behaviors and be disrespectful. Revenge may be high on their agenda. Guilt or self-blame is also common.
Screening Tool For PTSD
If you have experienced or witnessed some kind of traumatic event and are still struggling to come to terms with it, read the following questions and see how many times you answer "yes".
In the past month, have you:
- Had nightmares or thought about the event when you didn't want to?
- Tried not to think about the event or have gone out of your way to avoid situations that remind you of the event?
- Been easily startled or felt constantly on guard or watchful?
- Blamed yourself or others or felt guilty about the event or the problems it may have caused?
If you returned at least three "yes" answers then you should talk to a mental health care provider about PTSD. Even if you scored less than three, but your symptoms are affecting your quality of life, talk to your doctor because certain treatments may help even if you don't have PTSD.
Treatments for PTSD: Psychotherapy And Medications
PTSD can be treated in a number of different ways; however, one type of therapy may suit one person but not another and several may need to be tried or used in combination before you feel better. It is never too late to seek help for your PTSD, and many cases have been successfully helped years after the actual event. PTSD hardly ever gets better by itself, and in some instances, it can get worse if not treated.
Treatment for PTSD usually comes in the form of psychotherapy (also called Talk Therapy) and medications. Many people have a complete resolution of symptoms following treatment, whereas others may have some residual symptoms remaining; however, these are usually less intense. Almost everybody confirms their quality of life improves after treatment.
Psychotherapy: Talking Can Actually Help
Sometimes, people with PTSD are initially reluctant to engage in psychotherapy, believing they don't really need it. However, one session is usually all it takes to change their mind.
Several guidelines including the VA/DoD Clinical Practice Guidelines recommend cognitive behavioral therapy (a type of talk therapy) as the most effective treatment for PTSD. Most guidelines also recommend Eye Movement Desensitization and Reprocessing (EMDR) as well.
Cognitive Behavioral Therapy: Changing Your Perception Of The Event
Cognitive behavioral treatments (CBTs) are based on the theory that it is our thoughts that cause our feelings and behaviors, not external factors such as people, situations, or events. There are several types of CBTs used for PTSD, but exposure-based treatments and cognitive restructuring techniques have the most evidence of a benefit in PTSD.
Prolonged exposure therapy exposes the person with PTSD to the thoughts, feelings and situations they have been avoiding. While this may seem quite frightening to some and counterproductive to others, it has been very effective, as research has found avoiding these situations in the long-term presents a barrier to recovering from PTSD. Facing situations you have been scared of in a safe way helps you realize that your fear comes from within, and you don't need to avoid these situations for the rest of your life.
Prolonged exposure therapy is a gradual process, usually carried out over several months, allowing you to build up your confidence slowly. As one veteran said, it makes you look at the situation from all angles, not just the one perception that you have been holding onto.
Cognitive Processing Therapy: Another Form of CBT
Cognitive Processing Therapy (CPT) challenges and modifies your thoughts and behaviors related to the trauma. Conducted over 12 weekly sessions of 60 to 90 minutes, your therapist will teach you more helpful ways to think about your trauma, and may ask you to write about it as well. You will not be asked to go into a great deal of detail straight away, but will gradually work up to the point where you feel comfortable challenging your perception of the event.
CPT gives you tools to cope with your emotions, specifically any feelings of anger, sadness, or guilt. After a couple of months, you will be better able to understand how these emotions affect other areas of your life such as relationships and intimacy, your sense of trust, safety and control, and your self-esteem.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) therapy has eight phases of treatment, usually conducted over a period of up to twelve weeks. EMDR teaches strategies to use for past, current, and future incidents that elicit distress.
Once your therapist thinks you are ready to identify and process negative beliefs using EMDR techniques (phase three to six of treatment), he/she will help you to select a thought to target, and specific sounds (like a beeping tone) will be played, or a movement will be performed (such as your therapist waving a finger back and forth across your eyes) while you think about that particular thought. This helps your brain to work through those negative memories and later on a positive thought can be added once the memory becomes less upsetting. Studies have indicated EMDR can be very effective and results can often be seen in as little as three weeks.
Stress Inoculation Training: Vaccinating Against Stress
Stress Inoculation Training (SIT) helps to teach you skills in order to solve problems and deal with stress in your life. Therapy sessions aim to teach you about what causes stress and how our bodies respond, and how this can lead to negative outcomes. At the end of treatment, you should be able to anticipate any pitfalls that may occur during an event and plan and prepare your response in order to avoid those pitfalls.
Since people with PTSD are often under a lot of stress, SIT is often used in addition to other forms of psychotherapy, and sometimes in addition to medication.
Medications For PTSD: SSRIs and SNRIs
Medication can also help symptoms of PTSD; however, it does not resolve the underlying cause of your symptoms - only psychotherapy can do this. This means that medication will only work if you continue to take it. Sometimes medication is prescribed in addition to therapy.
Selective serotonin reuptake inhibitors (SSRIs) and are thought to help restore levels of certain neurotransmitters in your brain such as serotonin that help regulate mood and other bodily functions that become compromised during stress. These medications are also commonly used for other conditions associated with PTSD such as depression and anxiety. SSRIs that are FDA-approved to treat PTSD include sertraline (Zoloft) and paroxetine (Paxil); however many other agents such as fluoxetine (Prozac) and the selective norepinephrine reuptake inhibitor (SNRI), venlafaxine (Effexor), are also used.
Experts generally recommend SSRIs be tried first when medication is considered necessary for the management of PTSD. If SSRIs are not tolerated or effective, venlafaxine may be tried.
Other Antidepressants And Mood Stabilizers For PTSD
SSRIs and SNRIs don't suit everybody, and sometimes other antidepressants may need to be tried. Other antidepressants that may be suitable for PTSD include mirtazapine (Remeron) and nefazodone (Serzone). Tricyclic antidepressants (such as imipramine) and monoamine oxidase inhibitors (such as phenelzine) may also help.
Mood stabilizers are another option. These drugs balance out the effects of the excitatory neurotransmitter glutamate and the inhibitory neurotransmitter GABA and are also used for the treatment of epilepsy. Many require monitoring (such as blood cell counts, liver function, for the appearance of a rash) and most cause tiredness or fatigue. The most commonly used mood stabilizers in PTSD are:
Atypical Antipsychotics: Not For PTSD Unless Psychotic Symptoms Present
Unfortunately, large-scale trials failed to replicate positive effects of smaller trials and as a class, atypical antipsychotics are not recommended as monotherapy for PTSD, unless psychotic symptoms or mood disorders are also present. Risperidone is contraindicated for use as an add-on agent, as its potential harms outweigh any benefits.
Benzodiazepines (such as lorazepam and clonazepam), are not generally recommended in PTSD because trials have not shown them to be helpful at reducing PTSD symptoms (in fact they may worsen them). They are also highly addictive, can cause loss of inhibition, an increased risk of falls, and mental clouding, particularly in the elderly.
Where To Go For Help
Veterans are able to access specific PTSD programmes nationwide. All others with suspected PTSD should contact their local Mental Health Care provider. Finding a professional who is a good fit for you is very important. Don't be afraid to look for a different therapist if the first one doesn't suit you or offer the type of treatments you want.
Support groups are a good way to connect with others in a similar situation about your day-to-day problems. They are a good addition to PTSD treatment, although they won't treat PTSD. The Department of Veterans Affairs also has good information on helping family members who have PTSD.
Finished: Post Traumatic Stress Disorder - Signs, Symptoms and Solutions
- How Common Is PTSD? U.S. Department of Veterans Affairs. http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp
- Post-Traumatic Stress Disorder. Feb 2016. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
- Post-traumatic Stress Disorder. Royal College of Pyschiatrists. http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/posttraumaticstressdisorder.aspx
- Institute of Medicine (IOM) 2008. Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington DC. The National Academies Press.
- What is EMDR? EMDR Institute.com https://www.emdr.com/what-is-emdr/
- What is the actual EMDR session like? EMDRIA http://www.emdria.org/?120
- Cognitive Processing Therapy for PTSD US Department of Veterans Affairs. http://www.ptsd.va.gov/public/treatment/therapy-med/cognitive_processing_therapy.asp
- Understanding PTSD and PTSD Treatment. National Center for PTSD. http://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf
- Alexander W. Pharmacotherapy for Post-traumatic Stress Disorder In Combat Veterans: Focus on Antidepressants and Atypical Antipsychotic Agents. Pharmacy and Therapeutics. 2012;37(1):32-38.
- Connell R, Zeier K, Thomas CJ. A review of atypical antipsychotics and their utility in post-traumatic stress disorder. Mental Health Clinician 2013 2:7, 187-194