PTSD or Post-Traumatic Stress Disorder is one of the important Stress and Trauma-related Disorders. It is a mental disorder that occurs as a result of exposure of individuals to stressful or traumatic events. These may include sexual assault, losing a loved one, a serious injury, etc.
Now, many people are either witness to or personally experience such stressful and traumatic events. It’s typical to feel sad, have issues sleeping, or feel on the edge post such events. However, this feeling of sadness and grief eventually reduces with time. The pain that they experience as a result of such events lessens and they return to normal life.
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But, if one is facing such challenges even after a few months and continues to show such symptoms, he may be experiencing PTSD. As per research, 1.9% to 8.8% of people may have PTSD during their lifetime.
Further, people with PTSD have a high risk of having poor physical health. This may include higher odds of having cardiorespiratory, immunological, gastrointestinal, and musculoskeletal disorders.
Therefore, proper PTSD diagnosis and treatment are necessary to prevent such effects of PTSD.
In this article, we will talk about what is PTSD, symptoms of PTSD, PTSD causes, types of PTSD, PTSD tests, PTSD recovery.
What is PTSD?
The DSM-5 defines PTSD as having four groups of symtoms. These include:
- intrusive and recurrent memories of trauma
- avoiding trauma-related stimuli
- numbing and negative changes in mood or cognitions related to trauma
- changes in reactivity and arousal
Trauma consists of events that cause a crucial threat to one’s emotional, physical, and psychological safety and wellbeing. People who experience such traumatic events are bound to encounter a host of posttraumatic physiological and psychological reactions. These may include grief, repeated memories of the event, mood fluctuations, sadness, etc. However, such reactions remain for a few days and fade away quickly a few days after the traumatic event. But, factors like age, the support available, the severity of events, etc decide how quickly such reactions fade away with time.
And if such reactions last for long, they may meet the diagnostic criteria for PTSD. In addition to this, PTSD can range from being mild to completely devastating. It is also found to expose the individual to revictimization and retraumatization.
Symptoms of PTSD
PTSD diagnosis is undertaken by clinicians who check if individuals meet the DSM-5 PTSD diagnostic criteria. Individuals meeting this criterion are known to show signs of PTSD.
The following section talks about the DSM-5 PTSD criteria in the case of adults, adolescents, and children above 6 years, and children below 6 years.
I. Symptoms of PTSD in Case of Adults, Adolescents, and Children Above 6 Years
The following diagnostic criteria for PTSD apply to adults, adolescents, and children above 6 years.
1. Exposure to the Traumatic Event
An individual becomes vulnerable to actual or threatened death, sexual assault, or serious injury. Such an exposure takes place in any one or more of the following ways:
- experiencing traumatic events directly
- being an in-person witness, to the event as it happened to others
- getting to know that the traumatic event took place with a close family member or a close friend. Further, the events were accidental or violent where there are cases of actual or threatened death of a loved one.
- repeatedly experiencing or being exposed to the unpleasant details of the traumatic event. However, this does not include one’s exposure to the unpleasant details of the event via media, television, social media, etc. This is till the time such exposure is not related to work.
2. Existing of Interfering Symptoms
There exist one or more of the following interfering symptoms that are related to the traumatic event. Such symptoms start occurring after the happening of the traumatic event.
- repeated, involuntary, and intrusive memories of the traumatic event. However, in the case of children above 6 years, these symptoms occur as repeated play in which themes or parts of the traumatic events are conveyed.
- repeated sad dreams where the content of the dream or its effects are associated with the traumatic event. However, children may experience dreadful dreams without any identifiable content.
- dissociative reactions like flashbacks. In this, the individual acts as if the traumatic event is taking place again. However, in the case of children, trauma-related reenactment may take place in the play.
- experiencing intense sadness or distress for a long period. This is each time the individual is exposed to internal or external stimuli that resemble various aspects of the traumatic event.
- noticeable physiological reactions to internal or external stimuli that look like some aspect of the traumatic event.
3. Continuous Avoidance of Triggers Related to The Traumatic Event
This involves continuous avoiding of the stimuli that are related to the traumatic event. Such an avoidance begins after the happening of the traumatic event. The following points represent the type of avoidance taht takes place.
- avoiding or attempting to avoid sad or distressing memories, feelings, or thoughts closely related to the event.
- avoiding or attempting to avoid external triggers like places, conversations, people, that bring back sad memories about the event.
4. Negative Changes in Mood
This involves negative changes in understanding and moods related to traumatic events. These either improve or worsen post the happening of the traumatic event. Further, such changes are proved by two or more of the following.
- not being able to remember a critical part of the traumatic event. This is because of dissociative amnesia and not other factors like alcohol, drugs, head injury, etc.
- continuous and overstated negative beliefs or expectations about oneself or others
- continuous, twisted understanding of the cause or the effect of the traumatic event. This may result in the person blaming oneself or others
- being in a continuous negative emotional state. This may include being angry, fearful, horrified, guilty, or feeling shameful
- noticeable lack of interest or participation in critical activities
- feeling detached or estranged from others
- continuous lack of ability to feel positive emotions. This may include the inability to feel happy, satisfied, feelings of love.
5. Noticeable Changes In Arousal
This relates to noticeable changes in the triggering or reactivation related to the traumatic event. Such triggers become worse after the happening of the event. Moreover, these are evidenced by two or more of the following.
- irritable behavior and angry out lashing with no significant trigger. This is usually expressed in the form of physical or verbal aggression towards other people.
- irresponsible or self-destructive behavior
- issues with concentrating
- excessive startling response
- issues with sleeping which include finding it difficult to fall asleep or restless sleep
6. Duration of Disturbance
The above-mentioned disturbances like interfering symptoms, avoiding trauma-related triggers, negative changes in mood, and marked changes in arousal last for more than a month.
Further, the above diagnostic symptoms result in clinically important distress or hampering of social, occupational, and other aspects of life. In addition to this, such disturbances are not due to the physical effects of substance abuse or any mental condition.
Apart from meeting the above diagnostic criteria, one must also check for the following.
1. Dissociative symptoms
In addition to meeting the above criteria, the individual also experiences any of the following.
This is a condition in which one feels repeatedly detached from one’s several thoughts and body. This may include feeling as if one were living in a dream. Further, it may also include having a sense of unreality about self.
This is having a repeated sense of unreality of one’s surroundings. For instance, one may feel that the world around him is unreal.
2. Delayed expression
One also needs to see if the above-mentioned complete criteria are not met at least six months post the event.
II. Symptoms of PTSD in Case of Children Below 6 Years
1. Exposure to a Traumatic Event
Children who are 6 years and younger must be exposed to a traumatic event such as a severe injury, death threats, or sexual violence in any of the following ways.
- experiencing the event directly
- physically witnessing the traumatic events as they happen to others. This specifically includes the primary caregivers. This does not include the events witnessed in media, movies, etc.
- getting to know about the traumatic event that happened to a parent or caregiver.
2. Presence of Intrusion Symptoms
The following one or more of the intrusion symptoms linked to the traumatic event must be present. This is after the traumatic event has occurred.
- repeated involuntary, intrusive, and sad memories associated with the traumatic event
- repeated sad dreams in which the content or the effect of such a dream is linked to the traumatic event
- dissociative reactions. These include flashbacks in which the child feels as if the traumatic event has occurred. Such a reenactment may reflect in play.
- intense or continuous psychological stress on being exposed to internal or external triggers that look like the traumatic event.
- noticeable physical reactions to things that remind of the traumatic event.
3. Avoiding Triggers or Negative Changes in Mood
One or more of the following symptoms must be present. These relate to either avoiding the triggers linked to the traumatic event. Or negative changes in one’s understanding and mood linked to the traumatic event. These must be present after the traumatic event has occurred.
I. Continuously Avoiding the Stimulus
- avoiding or making effort to avoid triggers that remind of the traumatic events
- Avoiding or making efforts to avoid conversations, people, etc that remind of the traumatic events.
II. Negative Changes in Cognitions
- Significantly increased recurrence of negative emotional states. These include feeling guilty, fearful, ashamed, confused, etc.
- a noticeable decrease in interest or participation in important events. For instance, reducing play.
- socially retiring behavior
- a continuous decline in expressing positive emotions
4. Changes in Reactivation Linked to Traumatic Event
There are changes seen in the arousal or reactivation linked to the traumatic event. This may initiate or get worse after the happening of the traumatic event by two or more of the following ways.
- overstated startling response
- irritable behavior and angry out lashing behavior with little or no trigger. This is usually expressed in the form of verbal or physical aggression towards people, objects, etc.
- finding difficulty in concentrating
- sleep issues like insomnia, hypersomnia, or restless sleep
5. Duration of Disturbance
Such disturbances continue for more than 1 month.
6. Disturbance Causing Pathological Distress
Such disturbances result in clinically important distress. Further, they also result in hampering relationships with peers, siblings, parents, etc.
Effects of PTSD
Post-traumatic stress is linked to extreme levels of physical, occupational, and social disability. In addition to this, it calls for a good amount of cost as well as the use of medical facilities. Further, people with PTSD experience impaired functioning in various aspects of life. These include occupational, social, educational, physical, developmental, and interpersonal avenues.
Finally, PTSD in society is linked to absenteeism from work, lower income, less professional and educational success, and poor social and family relations.
There exist a number of risk factors that can result in post-traumatic stress disorder. These are grouped into three heads such as pre-traumatic, peritraumatic, and post-traumatic factors.
I. Pretraumatic Factors
These include a number of factors. For instance:
- lower education
- lower socioeconomic status
- childhood difficulties like parental separation or death, financial crisis, etc.
- vulnerability to any prior trauma
- lower intelligence
- being a member of a minority group, etc
These include being a female and being exposed to trauma at a young age. However, certain gene types are at a higher risk of having PTSD after being exposed to a traumatic event.
Temperamental factors consist of childhood emotional issues faced by the age of 6 years. For instance, any previous exposure to a traumatic event, anxiety issues, etc. This may also include having any previous mental health disorders like PTSD, panic disorder, OCD, etc.
II. Peritraumatic Factors
These factors include the degree of severity of the trauma. Higher the degree, the higher the odds of having PTSD. In addition to this, personal injury, interpersonal violence, being a perpetrator or the one killing enemies, or facing challenges as military personnel.
III. Posttraumatic Factors
These factors consist of being repeatedly vulnerable to distressing reminders, adverse life episodes, and financial or trauma-related losses.
These factors include having acute stress disorder, negative appraisals, and unsuitable coping strategies.
Why Seek PTSD Help?
One must go for PTSD treatment because treatment helps in PTSD recovery. There are a host of PTSD treatment options to choose from. Various talk therapies and medications have proved effective to cure PTSD.
In many cases, people can do away with PTSD symptoms completely. Whereas in others, people feel that they have fewer symptoms or have lesser intense symptoms post PTSD treatment.
Now, many people think that PTSD symptoms may reduce eventually with time without any treatment. However, such a thing is quite unlikely. This is specifically the case where individuals experience PTSD symtoms for more than a year. Thus, even if they feel that they can deal with the symptoms, the condition may worsen with time.
Therefore, it is important to take PTSD treatment. This helps you to prevent issues in your relationships, your education, and your career and helps you live a normal life.
Best Treatment for PTSD
Typically, trauma-focused psychotherapies and medication are used for PTSD treatment.
1. Trauma-focused Psychotherapies
The clinical advice claims trauma-focused psychotherapies to be effective for PTSD treatment. Here, trauma-focused relates to the memory linked to the traumatic episode. The three most effective psychotherapies include CBT, EMDR, and Exposure therapy. In each of these therapies, individuals meet their therapists and try to achieve specific objectives, and cover various issues during the sessions.
a. Cognitive Behavioral Therapy (CBT)
CBT is an effective therapy for PTSD. It is typical to have negative thoughts after experiencing a traumatic event. This may include self-blaming and doubting, considering the world to be a dangerous place, etc. This is where CBT helps. It enables individuals to identify and change their misleading thought patterns, beliefs, and behavior. These include working on issues with shame and guilt.
In addition to this, CBT also helps such individuals to alter which resulted in overstating the threat.
b. Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is another therapy for PTSD that enables individuals to process the trauma which helps in to heal. EMDR consists of the individual focussing on the back-and-forth movement or sound as he/she remembers the distressing memory. This happens until shifts in ta manner that the individual experiences that he/she is processing more information from the past.
c. Prolonged Exposure Therapy (PE)
PE is psychotherapy that educates the individual to slowly face trauma-related memories, feelings, thoughts, and events that he/she has been avoiding since the trauma happened. Thus, one can eventually reduce PTSD symptoms by facing such trauma-related issues.
After trauma-focused therapy, the second-best treatment for PTSD is medication. This is suggested by both WHO and The National Institute for Health and Care Excellence. The one experiencing PTSD may not have the optimal amount of specific brain chemicals that help in dealing with stress. The two medications that are typically given to treat PTSD include SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors). These increase the specific brain chemicals that help one feel better.
Commonly given SSRIs for PTSD treatment include fluoxetine, paroxetine, and sertraline. Likewise, venlafaxine is the SNRI that is commonly given to treat PTSD.
In addition to this, many medical professionals even prescribe benzodiazepines, one of the anxiety medications. However, they are not good enough to cure PTSD. This is because they are addictive in nature and may result in other mental health issues.
Types of PTSD
There are different types of PTSD based on the various symptoms faced by individuals. One must remember that different people respond to traumatic episodes in different ways. Hence, they show a variety of symptoms that are individual to each person.
Further, it is not mandatory that each individual facing a traumatic situation will necessarily have PTSD.
Typically, PTSD initiates as a stress response to a given traumatic situation and eventually develops into PTSD. The following are the various types of PTSD.
1. Dissociative PTSD
One of the critical features of dissociative PTSD includes one experiencing dissociative symptoms and emotional detachment. The dissociate symptoms include depersonalization and derealization.
In addition to this, a person with dissociative PTSD may have:
- chronic PTSD symptoms
- an important history of trauma during early years of life
- increased co-occurrence with other mental health conditions
- dissociative flashbacks and dissociative amnesia
2. Complex PTSD
Several symptoms faced by people with PTSD match with people who go through long periods of abuse, flashbacks, insomnia, and fear. Still, PTSD is different from complex PTSD. Complex PTSD or complex post-traumatic stress disorder happens when multiple traumas happen repeatedly to an individual over a long period of time.
This is different from PTSD where trauma happens once and is all over. For instance, an accident, sexual assault, etc.
Further, severe trauma linked to complex PTSD symptoms can take place during childhood or adulthood. Also, such severe symptoms can result in behavior alterations and issues with relationships.
In addition to this, a person experiencing complex PTSD can show physical symptoms like severe pain and fatigue.
3. Uncomplicated PTSD
People experiencing uncomplicated PTSD show symptoms that resemble PTSD. These include avoiding the situation, people, or places associated with trauma. Or repeatedly reliving the trauma.
However, what differentiated this from others is that uncomplicated PTSD does not simultaneously occur with other mental health conditions like depression.
In addition to this, this is one of the most common types of PTSD.
4. Natural Stress Response
Stress comes naturally as a response to threatening or traumatic episodes. A natural stress response releases hormones like cortisol and puts an individual in a fight or flight mode as a result of the release of adrenaline.
Such a response results in both physical and physiological changes. Further, it also impacts the immune and the endocrine system. But once the stressful situation or event is no more, the individual turns backs to his pre-stress state.
A small amount of stress is completely normal. However, chronic stress or some stress for longer periods turns pathological and severely impacts an individual’s health.
One of the common ways to deal with stress is psychotherapy.
5. Acute Stress Disorder
Acute stress disorder is much like PTSD that happens after the occurrence of a traumatic event.
It includes almost similar symptoms. For instance:
- experiencing the trauma directly
- being a witness to the trauma happening to others
- getting to know that a loved one has faced a trauma
- being repeatedly exposed to situations or details of the traumatic event
However, the only thing that distinguishes Acute Stress Disorder from PTSD is the duration. The symptom pattern in acute stress disorder is limited to a period of 3 days to 1 month. This is after being exposed to the traumatic event.
6. Co-morbid PTSD
People experiencing PTSD have an 80% higher chance of having any other mental disorder simultaneously. For instance, along with PTSD, they may have bipolar, anxiety, or substance use disorder.
A medical professional undertake such assessments and gives a customized plan to individuals fot PTSD treatment.
Apart from conducting such tests, the medical professionals may conduct interviews, one-on-one sessions to collect more information about the patients.
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Military people encounter warfares, bloodshed, and are sent on missions. They are vulnerable to dreadful situations and horrifying experiences day in and day out. Such situations can result in PTSD.
According to the U.S. Department of Veterans Affairs, veteran PTSD varies across service areas.
For instance, 12% of the gulf war veterans have PTSD in a given year. Likewise, 30% of the Vietnam War veterans had PTSD in their lifetime.
Apart from this, there are a host of other factors that add more stress to an already stressful situation. They may include activities you undertake in the war, war politics, etc.
Signs of PTSD in Women
As said earlier, PTSD is more prevalent among women than men over a lifetime. Also, women experience PTSD for longer durations relative to men. Now, these higher odds of PTSD in women are due to their vulnerability to traumatic events like rape or other forms of interpersonal violence.
In addition to this, they suffer symptoms of PTSD in a different way relative to men. Some of the common signs of PTSD in women are as follows.
- avoiding people, situations, events, etc linked to the trauma
- re-experiencing the trauma repeatedly
- too much anxiety, hypervigilance, irritability, issues with focusing, getting startled excessively, etc
- experiencing emotional numbness
PTSD develops after experiencing a traumatic event. As discussed earlier, PTSD can become complicated as it may result in the development of other disorders. These include depression, substance abuse, etc. These issues may interfere with the routine functioning of individuals. Therefore, PTSD diagnosis and PTSD treatment must be done at the right time.
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1. What are the 5 Signs of PTSD?
The 5 major signs of PTSD include experiencing a traumatic event, showing intrusive symptoms like repeated trauma memories, flashbacks, psychological distress, etc, avoiding triggers, negative changes in mood and thought, and changes in reaction associated with the traumatic event.
2. What are the 5 Stages of PTSD?
There are five stages of PTSD. These include:
- Impact Stage
This is the first stage that follows immediately after the individual experiences trauma. At this stage, the individual is trying hard to deal with what he has been through.
- Denial Stage
Not everyone goes through this stage. But, there are people suffering from PTSD who use denial to avoid experiencing PTSD symptoms. By avoiding complex emotions, one tries to protect himself from experiencing pain. It tries to do away with the stress linked to trauma. This is where a mental health professional can help them to deal with pain in place of avoiding it.
- Rescue Stage
In this stage, the individual begins to accept the traumatic event he has been through. Thus, the person may visit or visit places that were part of the traumatic event. This stage makes the person go through feelings of confusion, denial, sadness, etc.
- Intermediate Stage
Also called the short-term recovery stage, the person begins to return back to normal. This takes place after the person has met his survival needs. They begin to understand how PTSD has impacted them. This understanding further paves the way for things they can do to deal with PTSD symptoms.
- Recovery Stage
This is a stage when the person initiates working out and executing the recovery plan. One learns how to cope with PTSD symptoms and utilizes these newly learned skills in routine life.
This stage may stretch for a longer period as many people go back when they encounter triggers. Thus, it is very important for the p[erson to execute the coping strategies and skills learned. This is because it will help him deal with PTSD and deal with life.
3. What are 3 treatments for PTSD?
As stated earlier, there are a host of psychotherapies and medications used for treating PTSD symptoms. Some people are treated using only psychotherapies like CBT, EMDR, etc. While others are given medications like SSRIs and SNRIs. However, a mix of psychotherapy and medication is used in many cases to treat PTSD symptoms.