Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health disorder that begins after a traumatic event. That event may involve a real or perceived threat of injury or death.

This can include:

  • a natural disaster like an earthquake or tornado
  • military combat
  • physical or sexual assault or abuse
  • an accident

People with PTSD feel a heightened sense of danger. Their natural fight-or-flight response is altered, causing them to feel stressed or fearful, even when they’re safe.

PTSD used to be called “shell shock” or “battle fatigue” because it often affects war veterans. According to the National Center for PTSD, it’s estimated that about 15 percent of Vietnam War veterans and 12 percent of Gulf War veterans have PTSD.

But PTSD can happen to anyone at any age. It occurs as a response to chemical and neuronal changes in the brain after exposure to threatening events. Having PTSD doesn’t mean you’re flawed or weak.

PTSD symptoms

PTSD can disrupt your normal activities and your ability to function. Words, sounds, or situations that remind you of trauma can trigger your symptoms.

Symptoms of PTSD fall into four groups:

Intrusion

  • flashbacks where you feel like you relive the event over and over
  • vivid, unpleasant memories of the event
  • frequent nightmares about the event
  • intense mental or physical distress when you think about the event

Avoidance

Avoidance, as the name implies, means avoiding people, places, or situations that remind you of the traumatic event.

Arousal and reactivity

  • trouble concentrating
  • startling easily and having an exaggerated response when you’re startled
  • a constant feeling of being on edge
  • irritability
  • bouts of anger

Cognition and mood

  • negative thoughts about yourself
  • distorted feelings of guilt, worry, or blame
  • trouble remembering important parts of the event
  • reduced interest in activities you once loved

In addition, people with PTSD may experience depression and panic attacks.

Panic attacks can cause symptoms like:

  • agitation
  • excitability
  • dizziness
  • lightheadedness
  • fainting
  • a racing or pounding heart
  • headaches

PTSD symptoms in women

According to the American Psychiatric Association (APA), women are twice as likely as men to get PTSD, and the symptoms manifest slightly differently.

Women may feel more:

  • anxious and depressed
  • numb, with no emotions
  • easily startled
  • sensitive to reminders of the trauma

Women’s symptoms last longer than those of men.

PTSD symptoms in men

Men usually have the typical PTSD symptoms of re-experiencing, avoidance, cognitive and mood issues, and arousal concerns. These symptoms often start within the first month after the traumatic event, but it can take months or years for signs to appear.

Everyone with PTSD is different. The specific symptoms are unique to each man based on his biology and the trauma he experienced.

PTSD treatment

If you’re diagnosed with PTSD, your healthcare provider will likely prescribe therapy, medication, or a combination of the two treatments.

Cognitive behavioral therapy (CBT) or “talk therapy” encourages you to process the traumatic event and change the negative thinking patterns linked to it.

In exposure therapy, you re-experience elements of the trauma in a safe environment. This can help desensitize you to the event and reduce your symptoms.

Antidepressants, anti-anxiety drugs, and sleep aids may help relieve symptoms of depression and anxiety.

PTSD causes

PTSD starts in people who’ve been through or witnessed a traumatic event like a natural disaster, military combat, or assault. Most people who experience one of these events have no problems afterward, but a small percentage develop PTSD.

Trauma may cause actual changes to the brain.

However, it’s unknown whether they had a smaller hippocampal volume before the trauma or if the trauma resulted in a decrease in hippocampal volume.

More research is needed in this area. People with PTSD may also have abnormal levels of stress hormones, which may set off an overreactive fight or flight response.

Some people are able to better manage stress than others.

Medical PTSD

A life-threatening medical emergency can be just as traumatic as a natural disaster or violence.

ResearchTrusted Source shows that about 1 in 8 people who have a heart attack develop PTSD afterward. People who develop PTSD after a medical event are less likely to stay on the treatment regimen that they need to get better.

You don’t need to have a serious condition to develop PTSD. Even a minor illness or surgery can be traumatic if it really upsets you.

You may have PTSD if you keep thinking about and reliving the medical event, and you feel like you’re still in danger after the problem has passed. If you’re still upset more than a week afterward, your healthcare provider should screen you for PTSD.

Postpartum PTSD

Childbirth is normally a happy time, but for some new moms it can be a challenging experience.

According to a 2018 study, up to 4 percentTrusted Source of women experience PTSD after the birth of their child. Women who have pregnancy complications or who give birth too early are more likely to get PTSD.

You’re at higher risk for postpartum PTSD if you:

  • have depression
  • are afraid of childbirth
  • had a bad experience with a past pregnancy
  • don’t have a support network

Having PTSD can make it harder for you to care for your new baby. If you have symptoms of PTSD after the birth of your child, see a healthcare provider for an evaluation.

PTSD diagnosis

There’s no specific test to diagnose PTSD. It can be difficult to diagnose because people with the disorder may be hesitant to recall or discuss the trauma, or their symptoms.

A mental health specialist, such as a psychiatrist, psychologist, or psychiatric nurse practitioner, is best qualified to diagnose PTSD.

To be diagnosed with PTSD, you must experience all of the following symptoms for 1 month or longer:

  • at least one re-experience symptom
  • at least one avoidance symptom
  • at least two arousal and reactivity symptoms
  • at least two cognition and mood symptoms

Symptoms must be serious enough to interfere with your daily activities, which can include going to work or school, or being around friends and family members.

Types of PTSD

PTSD is one condition, but some experts break it down into subtypes depending on a person’s symptoms, also known as condition “specifiers,” to make it easier to diagnose and treat.

  • Acute stress disorder (ASD) isn’t PTSD. It’s a cluster of symptoms like anxiety and avoidance that develop within a month after a traumatic event. Many people with ASD go on to develop PTSD.
  • Dissociative PTSD is when you detach yourself from the trauma. You feel separated from the event, or like you’re outside of your own body.
  • Uncomplicated PTSD is when you have PTSD symptoms like re-experiencing the traumatic event and avoiding people and places related to the trauma, but you don’t have any other mental health issues such as depression. People with the uncomplicated subtype often respond well to treatment.
  • Comorbid PTSD involves symptoms of PTSD, along with another mental health disorder like depression, panic disorder, or a substance abuse problem. People with this type get the best results from treating both PTSD and the other mental health issue.

Other specifiers include:

  • “With derealization” means a person feels emotionally and physically detached from people and other experiences. They have trouble understanding the realities of their immediate surroundings.
  • “With delayed expression” means a person doesn’t meet full PTSD criteria until at least 6 months after the event. Some symptoms may occur immediately but not enough for a full PTSD diagnosis to be made.

Complex PTSD

Many of the events that trigger PTSD — like a violent attack or car accident — happen once and are over. Others, like sexual or physical abuse at home, human trafficking, or neglect can continue for many months or years.

Complex PTSDis a separate but related term used to describe the emotional repercussions of continued and long-term trauma, or multiple traumas.

Chronic trauma can cause psychological damage even more severe than that of a single event. It should be noted that considerable debate exists among professionals as to the diagnostic criteria for complex PTSD.

People with the complex type may have other symptoms in addition to the typical PTSD symptoms, such as uncontrollable feelings or negative self-perception.

PTSD in children

Kids are resilient. Most of the time they bounce back from traumatic events. Yet sometimes, they continue to relive the event or have other PTSD symptoms a month or more afterward.

Common PTSD symptoms in children include:

  • nightmares
  • trouble sleeping
  • continued fear and sadness
  • irritability and trouble controlling their anger
  • avoiding people or places linked to the event
  • constant negativity

CBT and medication are helpful for children with PTSD, just as they are for adults. Yet, kids need extra care and support from their parents, teachers, and friends to help them feel safe again.

PTSD and depression

These two conditions often go hand in hand. Having depression increases your risk for PTSD, and vice versa.

Many of the symptoms overlap, which can make it hard to figure out which one you have. Symptoms common to both PTSD and depression include:

  • emotional outbursts
  • loss of interest in activities
  • trouble sleeping

Some of the same treatments can help with both PTSD and depression.

PTSD dreams

When you have PTSD, sleep may no longer be a restful time. Most people who’ve lived through an intense trauma have trouble falling asleep or sleeping through the night.

Even when you do fall asleep, you may have nightmares about the traumatic event. People with PTSD are more likely to have nightmares than those without this condition.

According to the National Center for PTSD, an early study showed 52 percent of Vietnam veterans had frequent nightmares, compared to only 3 percent of civilians.

PTSD-related bad dreams are sometimes called replicative nightmares. They can happen a few times a week, and they may be even more vivid and upsetting than typical bad dreams.

PTSD in teens

The teenage years are already an emotionally challenging time. Processing trauma can be difficult for someone who’s no longer a child, but isn’t quite an adult.

PTSD in teens often manifests as aggressive or irritable behavior. Teens may engage in risky activities like drug or alcohol use to cope. They may also be reluctant to talk about their feelings.

Just as in children and adults, CBT is a helpful treatment for teens with PTSD. Along with therapy, some kids may benefit from antidepressants or other medications.

Coping with PTSD

Psychotherapy is an important tool to help you cope with PTSD symptoms. It can help you identify symptom triggers, manage your symptoms, and face your fears. Support from friends and family is helpful, too.

Learning about PTSD will help you understand your feelings and how to effectively deal with them. Living a healthy lifestyle and taking care of yourself will also help with PTSD.

Try to:

  • eat a balanced diet
  • get enough rest and exercise
  • avoid anything that makes your stress or anxiety worse

Supports groups provide a safe space where you can discuss your feelings with other people who have PTSD. This can help you understand that your symptoms aren’t unusual and that you’re not alone.

PTSD risk factors

Certain traumatic events are more likely to trigger PTSD, including:

  • military combat
  • childhood abuse
  • sexual violence
  • assault
  • accident
  • disasters

Not everyone who lives through a traumatic experience gets PTSD. You’re more likely to develop the disorder if the trauma was severe or it lasted a long time.

Other factors that may also increase your risk for PTSD include:

  • depression and other mental health issues
  • substance abuse
  • a lack of support
  • a job that increases your exposure to traumatic events, such as police officer, military member, or first responder
  • female gender
  • family members with PTSD

Living with someone with PTSD

PTSD doesn’t only affect the person who has it. Its effects can affect those around them.

The anger, fear, or other emotions that people with PTSD are often challenged with can strain even the strongest relationships.

Learning all you can about PTSD can help you be a better advocate and supporter for your loved one. Joining a support group for family members of people living with PTSD can give you access to helpful tips from people who’ve been or are currently in your shoes.

Try to make sure that your loved one is getting proper treatment which can include therapy, medication, or a combination of the two.

Also, try to recognize and accept that living with someone who has PTSD isn’t easy. There are challenges. Reach out for caregiver support if you feel the need to do so. Therapy is available to help you work through your personal challenges like frustration and worry.

How common is PTSD

According to the National Center for PTSD, about half of all women and 60 percent of all men will experience trauma at some point in their lives. Yet, not everyone who lives through a traumatic event will develop PTSD.

According to a 2017 study, there’s at least a 10 percent prevalence of PTSD in women during their lifespan. For men, there’s at least a 5 percent prevalence of PTSD during their lifetime. Simply stated, women are twice as likely as men to develop PTSD.

There’s limited available research on the prevalence of PTSD in children and adolescents.

An early review showed that there’s a 5 percent lifetime prevalence for adolescents ages 13 to 18 years of age.

PTSD prevention

Unfortunately, there’s no way to prevent the traumatic events that lead to PTSD. But if you’ve survived one of these events, there are a few things you can do to protect yourself from flashbacks and other symptoms.

Having a strong support system is one way that may help prevent PTSD. Lean on the people you trust most — your partner, friends, siblings, or a trained therapist. When your experience weighs heavily on your mind, talk about it with those in your support network.

Try to reframe the way you think about a difficult situation. For example, think about and see yourself as a survivor, not a victim.

Helping other people heal from a traumatic life event can help you bring meaning to the trauma you experienced, which can also help you heal.

PTSD complications

PTSD can interfere with every part of your life, including your work and relationships.

It can increase your risk for:

  • depression
  • anxiety
  • suicidal thoughts or actions

Some people with PTSD turn to drugs and alcohol to cope with their symptoms. While these methods may temporarily relieve negative feelings, they don’t treat the underlying cause. They can even worsen some symptoms.

If you’ve been using substances to cope, your therapist may recommend a program to reduce your dependence on drugs or alcohol.

Who gets PTSD

People who develop PTSD have lived through a traumatic event like war, a natural disaster, an accident, or assault. Yet, not everyone who experiences one of these events will develop symptoms.

Your level of support can help determine how you handle the stress of the experience.

The duration and severity of the trauma can influence your chances of getting PTSD. Your likelihood increases with long-term and more severe stress. Having depression or other mental health issues can also increase your risk for PTSD.

Those who do develop PTSD can be of any age, ethnicity, or income level. Women are more likely than men to get this condition.

When to get help for PTSD

If you’re experiencing symptoms of PTSD, understand that you’re not alone. According to the National Center for PTSD, 8 million adults have PTSD in any given year.

If you have frequent upsetting thoughts, are unable to control your actions, or fear that you might hurt yourself or others, seek help right away.

See your healthcare provider or a mental health professional immediately.

PTSD outlook

If you have PTSD, early treatment can help relieve your symptoms. It can also give you effective strategies for coping with intrusive thoughts, memories, and flashbacks.

Through therapy, support groups, and medication, you can get on the road to recovery.

Always keep in mind that you’re not alone.

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