What is PTSD?

Post-Traumatic Stress Disorder (PTSD) can bring much distress and significantly interferes with a person’s daily life. It can be associated with several comorbid disorders. There are several treatments for PTSD.

What is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a disorder that can develop in people who have experienced a traumatic event. You can develop PTSD at any age. Some common traumatic events that can cause PTSD include way, terrorist attacks, abuse, assault, accidents, natural disasters, and medical crises. You don’t have to have experienced a traumatic event yourself to develop PTSD. You can develop PTSD from witnessing traumatic events, learning a close friend or family experienced trauma, or being chronically exposed to graphic material in your employment. PTSD can affect your mental, physical, social, and/or spiritual well-being.

People with PTSD have intense, disturbing thoughts and emotions related to their traumatic experiences. They may relive or reexperience the event through flashbacks, nightmares, associated emotions or body sensations. They may avoid people, places, or situations that remind them of their trauma. People with PTSD may be triggered by ordinary things like loud noises, touch, smells, or other things connected with their trauma.

Risk Factors for PTSD

You may be more likely to develop PTSD after a traumatic experience if one or more of the following apply to you:

• Have previous traumatic experiences, particularly during childhood
• Getting hurt yourself or witnessing people getting hurt or killed
• Feeling horror, helplessness, or extreme fear
• Having little or no social support after the event
• Dealing with extra stress after the event, such as the loss of a loved one, pain and injury, frustrations with insurance companies, or loss of a job or home.
• Having a personal or family history of mental illness or substance use

Resilience Factors for PTSD

You may be less likely to develop PTSD if one or more of the following apply to you:

• Seek out support
• Come to terms with your actions in response to a traumatic event
• Have a coping strategy for your reactions to and learning from the traumatic event.
• Are prepared and can respond to traumatic events as they occur despite fear and other emotions.

History of PTSD

The history of PTSD started in early literature. It progressed to where it is now, with multiple names associated with it over the years before it was referred to as PTSD.

• Tales within early works, such as the Bible, works by Hippocrates, and the Epic of Gilgamesh, include descriptions of how witnessing traumatic events such as death and war results in chronic psychological symptoms.
• “Nostalgia” was used by Swiss physician Dr. Johannes Hofer in the late 17th century to characterize soldiers who suffered from post-war symptoms.
• “Railway spine” was used by physicians confused by psychological symptoms displayed by survivors of major railway disasters, who believed that microscopic lesions on the spine or brain caused the signs.
• “Soldier’s heart” was used by Dr. Jacob Mendes Da Costa after the Civil War after mistaking post-combat psychological symptoms for a cardiac condition.
• “War neurosis” was used to describe the effects of trauma on soldiers of World War I (WWI) because the source of these disorders was believed to be wartime experiences. It was the initial basis for the clinical PTSD diagnosis.
• “Shell shock” was introduced by psychologist Charles Myers in 1915 to describe PTSD symptoms observed during WWI.
• “Traumatic neurosis” was identified by Abram Kardiner as having both physical and psychological symptoms and that it needed treatment to prevent it from becoming chronic.
• “Combat stress reaction,” “combat stress,” “battle fatigue,” and “exhaustion” were some of the terms used during World War II to describe traumatic stress responses to combat.
• Post-Vietnam syndrome studies eventually led to the inclusion of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

What are the Symptoms of PTSD?

Acute Stress Disorder (ASD)

Since you need to have PTSD symptoms for one month to meet the criteria for PTSD. Acute Stress Disorder (ASD) is what you would be diagnosed with if you have had more symptoms for less than that. 80% of people with ASD develop PTSD, but you can still develop PTSD if you do not develop ASD (4-13%).

Post-Traumatic Stress Disorder (PTSD)

To be diagnosed with PTSD, an adult must have all of the following for at least one month, and the symptoms must be severe enough to interfere with aspects of daily life but not associated with medication, substance use, or other illnesses. They also need to meet the following criteria

At least one reexperiencing symptom:

• Experiencing flashbacks—reliving or reexperiencing the traumatic event, including physical symptoms or emotional reactions
• Having recurring nightmares, memories or dreams related to the event
• Having distressing thoughts associated with the event
• Experiencing physical signs of stress
• Reexperiencing symptoms can be triggered by thoughts, feelings, words, objects, smells, or situations that are reminders of the event.

At least one avoidance symptom:

• Avoiding places, objects, or situations that remind you of the traumatic experience
• Avoiding thoughts or feelings associated with the traumatic event
• Changing your routine to avoid specific actions or activities.

At least two arousal and reactivity symptoms:

• Being easily startled
• Feeling tense, on guard, or on edge (hypervigilance)
• Having difficulty focusing or concentrating
• Having sleep issues, especially difficulty falling asleep or staying asleep
• Finding yourself easily irritated and having angry or aggressive outbursts
• Engaging in risky, reckless, or destructive behaviour

Arousal symptoms are usually constant. They can be stressful and may interfere with parts of daily life.

At least two cognition and mood symptoms:

• Having trouble remembering critical features of the traumatic event
• Having negative thoughts about oneself or the world
• Having exaggerated feelings of blame directed toward oneself or others
• Having ongoing negative emotions, such as fear, anger, guilt, or shame
• Losing interest in enjoyable activities
• Having feelings of social isolation
• Having difficulty feeling positive emotions, such as happiness, joy or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event. You may find yourself feeling detached from friends or family members.

The Course of PTSD

Symptoms of PTSD usually begin within three months of the traumatic event, but they sometimes emerge later. The course of PTSD varies. You may recover within six months or have symptoms lasting one year or longer. Some people may have symptoms that continue or worsen to the point that they prevent the person from going about their life as expected. It is common to have co-occurring conditions with PTSD, such as depression, substance use, chronic pain, or anxiety disorders.

How is PTSD Treated?

The main treatments for PTSD are psychotherapy, medications, or a combination of psychotherapy and medications. Psychotherapy treatment for PTSD can take place one-on-one or in a group and usually lasts at least 6 to 12 weeks.

Cognitive Processing Therapy (CPT)

Cognitive processing therapy (CPT) helps people understand how trauma alters the ways they think and feel and develop new ways to think about the experience. It is a specific type of Cognitive Behaviour Therapy (CBT) designed to treat PTSD and comorbid symptoms. It focuses on changing painful negative emotions and beliefs due to the trauma by resolving stuck points.

Prolonged Exposure Therapy (PET)

Prolonged exposure therapy (PET) reduces PTSD distress and symptoms by gradually repeated exposures to the trauma in a safe and controlled way to help you face and gain control of the fear and distress and learn to cope. This can be done with real or imagined stimuli, including virtual reality.

Trauma-Focused Cognitive Behaviour Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy is an evidence-based treatment model for children and adolescents that incorporates trauma-sensitive interventions with cognitive behavioural, family, and humanistic principles and techniques.

Eye Movement Desensitization and Reprocessing (EMDR) Therapy

Eye movement desensitization and reprocessing (EMDR) helps a person reprocess the memory of the trauma so that it is experienced differently. EMDR uses bilateral stimulation on a target memory to process the distress and maladaptive beliefs associated with the trauma. It can integrate the fragments of trauma memories with associated memories so they don’t cause as much distress or as many disturbing symptoms.

Flash Technique

Flash Technique was developed for use with EMDR who find the recall of a traumatic memory to be too disturbing or overwhelming. It can be effective for people who dissociate when they get overwhelmed. As opposed to other trauma techniques that focus on recalling the details of trauma memories, Flash only uses very brief exposure to the target. Flash was found to reduce avoidance during recall of traumatic memories, disturbance or emotionality of traumatic memories, PTSD symptoms, symptoms of depression, and symptoms of dissociation.

Medications

The only medications that are approved for PTSD are antidepressants: sertraline (Zoloft) and paroxetine (Paxil). Fluoxetine (Prozac) and Venlafaxine (Effexor) have also been used for PTSD. They are conditionally recommended treatment for PTSD. Medications for PTSD are symptom reducers rather than an option to resolve the disorder like some of the psychotherapeutic options can.

Conclusion

Although PTSD can cause a lot of suffering and distress, there is hope in multiple treatments available to reduce your symptoms and the effect they have on your life.