Posted On: February 13, 2020
Post-traumatic stress disorder (PTSD) is a condition that has long been associated with combat veterans as it was officially listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) shortly after the end of the Vietnam War as returning soldiers struggled to reconcile the horrors of war with civilian life. Previously the condition had been known as “shell shock” or “combat fatigue.”
Modern understanding, however, has shown that PTSD can occur in anyone who witnesses or experiences a traumatic event. PTSD can be experienced by anyone. Studies show that 70% of adults experience a traumatic episode in their lifetime, and of these, 20% will develop PTSD.
Undergoing trauma can drastically change the way you think. If you thought you were going to die, it can be difficult to feel safe again after the experience. You might begin to feel terrified of things that remind you of your trauma, even if they are safe on their own.
Experiencing Post Traumatic Stress (PTS) following a traumatic event is a normal reaction and, while momentarily intense, the symptoms should abate within a month.
Symptoms of PTSD differ from PTS as they are more intense, debilitating, and long-lasting. PTSD can occur immediately after the event or it may develop weeks, months, or years later.
There are 4 types of exposure to trauma listed in the DSM-5 that qualify someone for PTSD:
While not everyone who experiences trauma in one of these ways will develop post-traumatic stress disorder, there are certain factors that put an individual at greater risk.
PTSD symptoms are characterized by “clinically significant” levels of distress or impairment over a duration of more than 1 month. Symptoms are usually divided into four categories:
Approximately 50% of those suffering from PTSD also suffer from Major Depressive Disorder (MDD). Suffering from PTSD may also lead to abusing drugs and/or alcohol as patients turn to self-medication to cope with their symptoms. Anxiety is also a common comorbid condition with PTSD.
PTSD occurs because of something called the fight or flight response. This is your body’s natural response to dangerous situations. Through a release of hormones, more energy is focused on the muscles and certain parts of the brain. Heart rate and breathing quicken and vision and hearing become more alert while non-essential functions like digestion are halted.
When a traumatic event occurs and the brain goes into fight-or-flight mode the part of the brain that forms emotional memories (the amygdala) becomes overactive, whereas the part of the brain that records details (the hippocampus) is suppressed.
After the event has passed you are left with a powerful, negative emotional memory of the event but no clear picture of the details. Because of this, people with PTSD struggle to remember parts of their trauma and often find themselves thinking too much about the event as their brain struggles to make sense of it.
PTSD treatment usually revolves around types of counselling and therapy such as Cognitive Behavioural Therapy (CBT), Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PET) and others.
Medication is not commonly prescribed for PTSD. When prescribed, medication usually consists of SSRI’s (selective serotonin reuptake inhibitors) such as Paroxetine which are used to treat depression. This is more likely to be prescribed if you are experiencing comorbid depression.
In some cases, older types of antidepressants, known as Tricyclic antidepressants, may be prescribed. However, they are not considered a first-line treatment due to their more severe side effect profile.
In some cases of PTSD involving especially acute anxiety or insomnia, benzodiazepines such as Valium may be prescribed on a short-term basis. However, this class of drugs can incur a variety of unwanted and dangerous side effects in people with PTSD. Due to the disinhibition caused by the drugs, patients are at greater risk of hurting themselves or others while not in control. Furthermore, benzodiazepines are highly addictive and since people with PTSD are at a higher risk of developing substance use disorders this is not a common line of treatment.
Therapy is the most common form of treatment for PTSD, it may also be used in conjunction with medication.
CBT is a treatment that focuses on changing patterns of thought and behaviour. CBT is usually done over a course of up to 12 weeks, with the patient being given exercises or “homework” to do in the time between sessions.
As people with PTSD tend to experience great deals of fear as well as distorted views of themselves and of the incident, CBT can be useful as a way to identify these thoughts in a patient, note when they arise and work on replacing them with more positive thoughts. CBT has been shown to be effective in reducing patient discomfort, with results that continued after the course of sessions was completed.
Prolonged Exposure Therapy focuses on getting the patient to confront and process their trauma, it is most useful in treating avoidance symptoms. There are two kinds of Prolonged Exposure Therapy: imaginal and in vivo.
EMDR therapy is a non-traditional therapy wherein the patient focuses on a traumatic memory and its associated negative feelings while following an object from left to right with their eyes or generating another type of bilateral sensory input such as physical vibrations or finger tapping. The theory behind EMDR is that when your attention is diverted away from the distressing memory you can focus on it without incurring a strong negative response.
Research into EMDR is still ongoing and its efficacy is still a subject of controversy.
Additional Resources & Help
To find help for PTSD near you, click here for a list of available resources if you live in the UK.
For more information on coping with disaster and other information about PTSD, click here to visit the American Psychiatric Association (link directs to article on coping with disaster)
If you are a veteran with PTSD, or are trying to help a veteran with PTSD, click here to visit the U.S Department of Veterans Affairs National Center for PTSD