Posttraumatic Stress Disorder
Traumatic events—such as an accident, assault, military combat or natural disaster—can have lasting effects on a person’s mental health. While many people will have short term responses to life-threatening events, some will develop longer term symptoms that can lead to a diagnosis of Posttraumatic Stress Disorder (PTSD).
PTSD symptoms often co-exist with other conditions such as substance use disorders, depression and anxiety. A comprehensive medical evaluation resulting in an individualized treatment plan is optimal. PTSD affects 3.6% of the U.S. adult population—about 9 million individuals. About 37% of those diagnosed with PTSD are classified as having severe symptoms. Women are significantly more likely to experience PTSD than men.
A diagnosis of PTSD requires a discussion with a trained professional. Symptoms of PTSD generally fall into these broad categories:
Re-experiencing type symptoms, such as recurring, involuntary and intrusive distressing memories, which can include flashbacks of the trauma, bad dreams and intrusive thoughts.
Avoidance, which can include staying away from certain places or objects that are reminders of the traumatic event. A person might actively avoid a place or person that might activate overwhelming symptoms.
Cognitive and mood symptoms, which can include trouble recalling the event, negative thoughts about one’s self. A person may also feel numb, guilty, worried or depressed and have difficulty remembering the traumatic event. Cognitive symptoms can in some instances extend to include out-of-body experiences or feeling that the world is "not real" (derealization).
Arousal symptoms, such as hypervigilance. Examples might include being intensely startled by stimuli that resembles the trauma, trouble sleeping or outbursts of anger.
Young children can also develop PTSD, and the symptoms are different from those of adults. (This recent recognition by the field is a major step forward and research is ongoing.) Young children lack the ability to convey some aspects of their experience. Behavior (e.g. clinging to parents) is often a better clue than words, and developmental achievements in an impacted child might slip back (e.g. reversion to not being toilet trained in a 4-year-old).
It is essential that a child be assessed by a professional who is skilled in the developmental responses to stressful events. A pediatrician or child mental health clinician can be a good start.
Types of This Disorder
PTSD can occur at any age and is directly associated with exposure to trauma. Adults and children who have PTSD represent a relatively small portion of those who have been exposed to trauma. This difference is not yet well understood but we do know that there are risk factors that can increase a person’s likelihood to develop PTSD. Risk factors can include prior experiences of trauma, and factors that may promote resilience, such as social support. This is also an ongoing area of research.
We do know that for some, our “fight-or-flight” biological instincts, which can be life-saving during a crisis, can leave us with ongoing symptoms. Because the body is busy increasing its heart rate, pumping blood to muscles, preparing the body to fight or flee, all our physical resources and energy are focused on getting out of harm’s way. Therefore, there has been discussion that the posttraumatic stress response may not a disorder per se, but rather a variant of a human response to trauma.
Whether you think of these symptoms as a stress response variant or PTSD, consider them a consequence of our body’s inability to effectively return to “normal” in the months after its extraordinary response to a traumatic event.
Symptoms of PTSD usually begin within three months after experiencing or being exposed to a traumatic event. Occasionally, symptoms may emerge years afterward. For a diagnosis of PTSD, symptoms must last more than one month. Symptoms of depression, anxiety or substance use often accompany PTSD.
When people experience, or are exposed to, trauma, their biological and psychological responses can be intense and painful. Many people will then move on with their lives with few or no symptoms, but for some, the intensity and pain remain. It can be difficult to make the decision to seek help since it's common to feel like we should just "get over" the experience.
There are several well-studied treatment approaches to address the symptoms of PTSD. The best treatment plan should include your preferences while also addressing any other co-existing conditions you may have.
Medications alone are unlikely to heal the psychological wounds of trauma and may also create side effects. Most people find a combination of two approaches—psychotherapy and medication—yields the best results.
Receiving support and compassion immediately after a traumatic event is also critical. Some people will want to talk about the event, while others will find it troubling and overwhelming. It’s not helpful to force anyone to discuss a traumatic event until they are ready.
There are many different types of psychotherapy. Some psychotherapy approaches involve returning your attention to the traumatic event and can be provocative and challenging. However, when they are done well as part of a coordinated treatment approach they often result in fewer symptoms.
Research indicates that there are several therapeutic approaches that are more effective than others in addressing the symptoms of PTSD:
Cognitive Processing Therapy is a type of cognitive behavioral therapy (CBT) that works to address the negative thinking and self-blame symptoms that may come with having PTSD . There is specific training for the psychotherapist and materials to guide this treatment.
Eye Movement Desensitization and Reprocessing (EMDR) was specifically designed to treat trauma. This therapy uses measured exposure to traumatic memories with alternating stimuli (eye movements are one of several options) in structured sessions with a health care professional certified to perform EMDR.
Exposure Therapy is a type of psychotherapy that enables a skilled practitioner to help people safely face what they find traumatizing so they can learn to cope effectively. One technique used in exposure therapy involves virtual reality programs that allow a person to experience the situation in which they experienced trauma to help process it.
Group Therapy with others who have similar experiences can help build resilience when someone feels alone and isolated. Group therapy helps lessen shame and provide support, as well as reduce feelings of helplessness. Groups for survivors of sexual assault and combat experiences frequently have members living with PTSD and related symptoms.
Ask your therapist if they are familiar with, or have been trained in, these specific techniques. If their answer is no, ask what approach they use in trauma psychotherapy. There are other effective approaches, but it is helpful to understand your health care professional’s experience in addressing PTSD. Consider asking your therapist, primary care doctor or health plan provider for a referral to a specialist in these treatments if you conclude they are the best match for you.
There is no one medication that treats all the symptoms of PTSD, yet some medications can help with some symptoms and also increase the effectiveness of psychotherapy. When selecting a medication, you should also consider the presence of any other conditions such as depression or anxiety and how they may be impacted.
Antidepressants can be useful to help reduce symptoms of PTSD. Some serotonin reuptake inhibitors (SSRIs) have been approved by the FDA for the treatment of PTSD in adults and are often the first line of treatment. Be sure to be informed about medication uses and side effects, and ask your doctor about the latest research in this field.
Other medication approaches are also available, although some are not FDA-approved specifically for the treatment of PTSD symptoms. Ask your doctor for more information about all medication options available.
Other biological interventions. Many states that have legalized marijuana for medical use, and it includes an indication for PTSD. To date, there has not been a randomized controlled trial on the effectiveness of marijuana for PTSD, so it’s difficult to assess its potential viability as a treatment. Research is also underway to assess the potential use of Methylenedioxymethamphetamine (MDMA) to augment psychotherapy for PTSD. MDMA is currently not legal in the U.S.
Complementary Health Approaches
Recently, many health care professionals have begun to include complementary and alternative methods into treatment regimens. Some methods that have been used for PTSD include:
Mindfulness and meditation strategies and practices
Service dogs are another option for non-traditional therapy for people experiencing PTSD. A service dog is by a person’s side 24 hours a day to help navigate daily stressors. Most animals come to the person pre-trained with a set of commands. The owner can rely upon the dog for help and as a reality grounding tool, which can help prevent a re-experience or other symptoms. These animals can also serve as a social buffer, an incentive to exercise and a de-escalation tool during times of stress.