Post-Traumatic Stress Disorder: Risks, Symptoms and Treatment

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.

What causes PTSD?

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:

• Direct experience of trauma: This includes traffic collisions, combat injuries, sexual assault, domestic abuse, life-threatening illness and others. Studies have shown that combat situations and rape are more likely to cause PTSD than other types of trauma, with 50% of all sexual assault victims (both male and female) developing PTSD.
• Witnessing traumatic event(s) occur to others: This is especially common in war zones, natural disasters and other large-scale tragedies.
• Learning of trauma happening to close friend/family member: This involves life-threatening violence or accidents to a loved one but does not include medical conditions (i.e. cancer)
• Repeated or extreme exposure to disturbing elements of trauma: This can occur, for example, in first responders who come into regular contact with human remains. This does not include exposure through television or other electronic media.

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.

• Women are statistically more likely to experience PTSD than men. (10-12% in women versus 5-6% in men)
• Research into genetic risk factors is still ongoing, but it is thought that genes involved in serotonin transportation, the hypothalamic-pituitary-adrenal (HPA) axis, and proteins that protect against oxidative stress may play a part.
• Limited support networks also put one at greater risk of PTSD following a traumatic event. Emotional support and connection can be vital in healing after trauma. Individuals who are isolated or who tend to try and solve problems in isolation are at greater risk of developing PTSD after an incident. While support is essential it may not be enough to stop someone developing the disorder.
• Those who score lower on IQ tests have been shown to be more likely to develop PTSD
• Individuals with higher levels of neuroticism (experience more anxiety, guilt, worry, fear, and sadness) are at greater risk.
• People who have experienced previous traumas are at greater risk of developing PTSD following a subsequent trauma as the effects of trauma have a cumulative effect.
• Having a prior history of mental illness can also make one more vulnerable to PTSD.
• If someone experienced a painful physical injury as part of their traumatic experience, they may be more likely to develop PTSD as the pain reminds them of the event.

Symptoms of PTSD

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:

• Intrusive memories
  • Recurring memories of the traumatic event that are intrusive, involuntary, and distressing.
  • Recurring nightmares related to the event
  • Intense psychological and physiological distress towards internal or external cues associated with the traumatic event
  • Dissociative episodes (flashbacks) where it feels as if the traumatic event is reoccurring. These can be very intense, with vivid sensory stimuli such as sights, sounds, and smells, and can cause a total disconnection from reality.
• Avoidance is when a person begins making persistent efforts to avoid stimuli associated with a traumatic event. They might steer clear of certain areas (combat veterans might avoid driving under overpasses for example) that remind them of their trauma. They might also avoid talking to certain people, interacting with certain objects or watching the news.
• Negative changes in mood and cognition are changes in the way you think and feel after a traumatic event such as:
  • Distorted view of the event, causing you to blame yourself or others
  • Being unable to remember an important part of the event
  • Constant negative feelings (shame, guilt, fear)
  • Severe negative beliefs about yourself or the world (“I’m a bad person”, “Everyone is lying to me”)
  • Little to no interest in activities
  • Feeling detached or estranged from others
  • Being unable to experience positive emotions
• Changes in arousal and reactivity
  • Irritable behaviour, prone to aggressive outbursts with little to no provocation
  • Reckless or self-destructive behaviour (dangerous driving, drug abuse etc.)
  • Hyper-vigilance (constantly scanning for threats or dangers)
  • Exaggerated startle response
  • Difficulty concentrating
  • Problems with sleep (unable to fall asleep, stay asleep or sleep restfully)

Comorbid symptoms

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.

How does PTSD affect the brain?

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.

Managing PTSD

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

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

Therapy is the most common form of treatment for PTSD, it may also be used in conjunction with medication.

Cognitive Behavioural Therapy (CBT)

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 (PET)

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.

• In vivo exposure is when the patient (with a therapist’s assistance) confronts objects or places that they have been avoiding because of PTSD symptoms. As PTSD can cause the brain to associate normally safe places and objects with danger, in vivo exposure works to remove that association. However, in vivo exposure is not always possible (for example, returning to a war zone).
• Imaginal exposure involves the patient imagining situations or images that they are afraid of under the supervision of a therapist.

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

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