Post Traumatic Stress Disorder(PTSD) can happen to anybody after experiencing a traumatic event causing them to feel fearful, shocked, or helpless. It’s a normal reaction to feel anxious and scared after having to experience  trauma. 

However, when a person starts having flashbacks, nightmares, or intrusive memories about such events as the 9/11 terrorist attacks, natural disasters, war, violent personal attacks like rape, or other life-threatening situations, it’s better to consult a doctor. 

What is Post-Traumatic Stress Disorder (PTSD)?

PTSD is a trauma or stress-related disorder that happens when a person experiences a life-threatening situation or an event in which death occurred. It mostly occurs to people who have suffered through violence or war, like military troops, rescue workers, survivors of shootings, bombings, and rape victims. Even family members of such victims may develop the disorder or become vulnerable to compassion fatigue, also known as secondary or vicarious trauma.

It affects about eight million American adults (including childhood), and most women are more susceptible to PTSD than men. It is also frequently accompanied by depression, substance use disorder, and anxiety disorders. It’s known as acute stress disorder when symptoms develop immediately after trauma and last up to a month, but when it persists over a month, it’s PTSD. 

Some people can also have a delayed expression of PTSD when symptoms arise six months or more after the trauma. Even if PTSD obstructs the regular life of a person, timely treatment can help them recover back.

According to the American Psychological Association (APA) and Statistical Manual Fifth Edition (DSM-5), to receive a diagnosis of PTSD, a person must meet these guidelines: 

1. Experiencing traumatic events directly or witnessing it happen to a loved one or as a result of professional duties –

• Death or Impending death 
• Grave Injury 
• Sexual Violence

1. Experiencing these symptoms for more than one month

• One or more intrusion symptoms
• One or more avoidance symptoms
• Two or more symptoms related to mood & thinking
• Two or more symptoms related to arousal & reactivity that began after trauma

Symptoms 

People with PTSD tend to re-experience the traumatic events when they get exposed to a similar situation, place, or object related to it.  Anniversaries of the event or any such similarities to the circumstances can trigger symptoms of PTSD. 

Intrusion Symptoms – Related to Reliving the Traumatic Event:

• Nightmares or distressing memories
• Flashbacks or behaving as if the events were happening all over again in actuality
• Dissociative reactions or losing awareness of the current circumstances
• Experiencing intense emotions or fearful thoughts

Avoidance Symptoms:

• Avoiding conversations or refusing to discuss the event
• Dodging people or places related to the event
• Avoiding thoughts and feelings about the event
• Avoiding activities associated with the event

Arousal and Reactivity Symptoms:

• Sleeping issues like difficulty falling or staying asleep
• Irritability & displaying anger outbursts
• Difficulty in concentrating
• Oversensitivity to dangers
• Hypervigilance (Excess awareness)
• Easily startled feeling

Related to Mood & Thinking:

• Facing difficulty to remember vital details of the original trauma
• Detached or estranged feelings from others and surroundings
• Numb feelings – emotionally and mentally
• Lack of interest in social activities or reduced interest in life
• Concentration issues
• Inability to experience positive moods
• Pessimistic feeling for future
• Displaying mental health issues like depression, anxiety, and phobias

Symptoms not included in the DSM-5 criteria but can occur in PTSD:

Physical Symptoms:

• Physical effects like sweating, shaking, headaches, dizziness, stomach problems, aches & pains, and chest pain
• Weakened immune system leading to frequent infections
• Sleeping issues causing tiredness and other physical problems

Other Symptoms:

• Depersonalization – It’s feeling like an outsider or observer to one’s body and thoughts
• Derealization – experiencing unreality of surroundings

PTSD Symptoms in Children & Teens:

Most children recover faster than adults from experiencing traumatic events; however, some events could cause PTSD in children and teens. These events are:

• Physical, sexual, or emotional abuse
• Being a victim or witness to any violence or crime
• Severe illness or sudden death of a close family member or a friend
• Natural disasters or mishaps
• Critical car accidents

Children may develop symptoms of PTSD that are different from adults:

Symptoms In Children 6 Years or Under:

• Bedwetting (after learning to use a restroom)
• Inability to speak
• Acting out the event through play
• Being over-attached with an adult

Symptoms In Children between the age group of 5 to 12 years:

They may not experience flashbacks or difficulty in remembering the details of the event. However, they may remember the event in a different order like a feeling of – ‘ some bad things are going to happen.’

Other symptoms include:

• Acting out the trauma or express it through play, pictures, and stories
• Nightmares
• Irritability
• Having a hard time to go and pay attention to activities in school
• Difficulty in socializing with friends
• Difficulty in concentrating on studies

The symptoms of PTSD in children like restlessness, trouble to pay attention, and staying organized can often be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD) and can lead to an inaccurate treatment. 

Mostly children above the age of 8 years display symptoms similar to adults, but those above 12 to 18 years may also show disruptive, disrespectful, impulsive, or aggressive behavior. 

Symptoms in Teens:

• Reliving the traumatic event continuously in thoughts and plays
• Nightmares 
• Sleeping issues
• Feel upset every time they remember the event
• Absence of positive emotions
• Intense-continuing fear or sadness
• Irritability and anger outbursts
• Look for likely threats 
• Get easily startled
• Acting helpless, hopeless, or withdrawn
• Feel guilty for not behaving differently during the event
• Denial or feeling of mental and emotional numbness
• Avoidance symptoms
• May even develop feelings of revenge

Additionally, children who have experienced sexual abuses are more likely to display PTSD symptoms like:

• Feelings of fear, sadness, and anxiety
• Look for isolation
• Develop a low sense of self-worth
• Behave aggressively
• Display unusual sexual behavior
• Physically hurt themselves
• Indulge in substance abuse like drugs or alcohol

Causes & Risk Factors

The actual cause of PTSD is still unknown, but it changes the stress response of a body. It affects the stress hormones and other chemical levels in the body that carries information between the nerves. Those who have suffered childhood abuse can develop PTSD even years later, after the trauma. 

Moreover, externalizing behaviors or anxiety issues, family history of psychiatric illness, inappropriate coping mechanisms, family instability or financial stress may greatly impact the experience of traumatic events and even worsen the outcome. 

Examples of Mentally Disturbing or Traumatic Events 

• Military confrontation
• Natural disasters
• Serious accidents
• Terrorist attacks
• Loss of a loved one, either natural or unnatural, involving violence
• Rape or other sorts of abuses
• Personal assault
• Being a victim of crime
• Receiving a life-threatening diagnosis

Apart from these situations, any circumstances that trigger fear, shock, horror, or helplessness in a person can make them vulnerable to PTSD. 

Some Factors That Cause PTSD 

Psychological Factors: 

People who are struggling with other mental illnesses like anxiety and depression are more likely to become vulnerable to PTSD. 

Genetic Factors :

People with close relatives struggling with anxiety disorders may become more vulnerable to developing PTSD after a traumatic event.

Physical Factors:

Brain imaging studies and research indicated changes in brain structure (amygdala and hippocampus) areas responsible for regulating emotions and fear. Those people with PTSD have a loss of volume in these structures compared to others.

Environmental Factors:

People who have a history of trauma & stress, children who grew up in a constant traumatic environment, and families struggling with addiction issues, are more susceptible to PTSD.

However, not every person who lives through a traumatic event develops PTSD. Risk factors make a person more vulnerable to PTSD, whereas resilience factors help them recover from or avoid PTSD more effectively.

Risk Factors That May Aggravate The Chances Of Experiencing PTSD:

• Additional problems like flashbacks, difficulty sleeping, or anxiety after a traumatic event, for example, losing a loved one and losing a job
• Lack of social support after experiencing a disturbing event or trauma 
• History of mental health problems like depression or substance use
• Childhood experience of abuse or witness of a traumatic event
• Poor physical health, before or as a result of a mentally disturbing event

Resilience Factors That Boost Recovery After Trauma:

• Having or seeking out support from other people like family and friends
• Becoming a part of a support group after a traumatic event
• Developing coping mechanisms to deal with a distressing event and learning from it 
• Learning to feel good about our actions in the face of a danger
• Becoming able to act and respond despite feeling fear

When To Seek Medical Advice in PTSD?

Crying, anxiety, and difficulty concentrating are part of natural human behavior to deal with trauma or loss. It does not necessarily mean the person has PTSD, but a prompt response from people around the victim can prevent symptoms from getting worse.

Consider the following indicators for seeking medical advice in PTSD:

• If the person portrays various PTSD symptoms (as per ADA and DSM-5 guidelines) for more than a month
• If the symptoms are severe enough to prevent the person from returning to routine life
• If the person considers harming themselves

Immediate consultation with a qualified professional can expedite the treatment process and let the person recover faster. 

Screening Process:

As a part of the diagnostic process, a person may undergo a screening test to detect whether they have PTSD or not. It can last for 15 minutes or a number of one-hour sessions. The long assessment sessions mainly aid when legal implications or disability claims depend on it. 

PTSD symptoms are more severe, last longer than acute stress disorders (which lasts for a few weeks), and might not appear right after the event. However, with appropriate, timely treatment, people can recover within six months. In severe cases, some people may continue to experience symptoms of PTSD for years. 

Treatment:

The treatment of PTSD  begins with a detailed evaluation and development of a treatment plan by the doctor after meeting the person. There is no set pattern for treatment, but doctors tailor it to meet the unique requirements of the patient. The main treatment procedure includes psychotherapy, medications, or both. 

Depending upon the trauma, symptoms, and the need of the individual, health care professionals try different treatment combinations to allow them to lead a more balanced and functional life. 

Psychotherapy – CBT

Cognitive Behavior Therapy (CBT) is one of the most effective treatments for PTSD. It has several parts including –

Cognitive processing therapy (CPT):

It’s also known as cognitive restructuring therapy, wherein an individual learns to reason about things in a new way. They make sense of their memories and experiences and, at times, reminiscence the event differently than how it happened. The therapist helps them to look at events realistically without shame or guilt about what is not their fault.

Exposure Therapy:

This therapy works on the coping mechanism of an individual. A therapist exposes the PTSD patient to the memory of the trauma in a safe and controlled environment. They use mental imagery, writing, or visits to the place of events as tools to help the individual have a sense of more control over their thoughts and feelings.

Stress Inoculation Training:

In this therapy, an individual works with a therapist on reducing PTSD symptoms and learning how to reduce anxiety when confronting anxiety-provoking situations. Like CPT, it helps a person look at their experiences healthily.

Other Psychotherapies

Psychodynamic Psychotherapy:

It is a therapy that focuses on identifying, accepting, understanding, expressing, and overcoming negative, contradictory feelings and repressed emotions in a patient. It improves their interpersonal experiences and relationships. It helps patients understand how repressed trauma emotions affect their current decision-making, behavior, and relationships. 

Family Therapy:

It is about educating the survivors and their families about recognizing PTSD associated symptoms. It focuses on the relationships between the trauma survivor and the family members. It helps them in having clear communications among themselves for safely expressing emotions. The therapist works on the family to learn new ways to cope with tragedy and enable them to get through a tough time. 

Group Therapy:

It is ideal for trauma survivors who seek help and support while sharing traumatic material in a safe environment. Telling their story directly about the grief, guilt, and anxiety associated with the trauma facilitates survivors to cope with their symptoms, memories, and lives.

Eye Movement Desensitization and Reprocessing (EMDR):

It’s eight-phase psychotherapy that helps patients process and resolves traumatic events. Through a specific side-to-side eye movement, a patient concentrates on emotionally-troubling issues from the trauma and lowers their distress levels. It helps them have more positive emotions, behaviors, and thoughts.

Brief Eclectic Psychotherapy (BEP):

It combines various CBT techniques with therapeutic activities like writing about the trauma, examining how the experience of trauma changed the patient, and conducting a goodbye ritual to mark the end of therapy as well the phase of life dominated by the experience of trauma.

Narrative Exposure Therapy (NET):

In this treatment procedure, the therapist guides a patient to establish a chronological narrative of their life, focusing specifically on their traumatic experiences. It refines the memory of a traumatic episode of a patient by placing it in the broader context of their life.

Other Experimental Therapies

MDMA:

Scientists are currently researching this treatment option and its effectiveness in managing PTSD. It revolves around taking recreational drugs or ecstasy to help people learn to deal with their memories and acquire the feeling of safety.

Cortisone Hormone Therapy:

It revolves around high-dose cortisol-based treatments given to people soon after a trauma occurs and reduces the risk of PTSD. 

Computer Games:

Particularly for veterans with PTSD, playing some computer games can benefit them in dealing with the symptoms. However, researchers do not recommend using it as a replacement for regular therapy.

Medications

Selective serotonin reuptake inhibitors (SSRIs), mostly given for the treatment of depression, anxiety, and sleep problems, often are used in PTSD apart from antidepressants. It helps in controlling PTSD symptoms like sadness, worry, anger, and numbness of feelings. 

An adjustment in dosage or a switch to another SSRI must only be done while working collaboratively with your doctor. However, medications have side-effects and affect everyone differently. Therefore, if you see any unusual reactions, report to a doctor immediately.

The most common side effects of antidepressants:

• Headaches
• Nausea
• Sleeplessness or drowsiness (Might occur during the first few weeks but goes away later or requires dose adjustments)
• Agitation or Jittery feelings
• Sexual problems (both men and women) like reduced sex drive and difficulties in having or enjoying sex

Self-Help Active Coping

Developing coping mechanisms enables a person to accept the impact of the traumatic event. Recovery from any such event takes time, but two this can help a PTSD patient – 

• Acquiring information about PTSD and understanding it as an ongoing response
• Accepting that healing does not mean forgetting the trauma; alternatively, it’s developing the ability to cope with the bad memories.

Things that can help in coping:

• Having someone to confide in
• Joining a group of other people who know about the trauma
• Informing people in advance about what might trigger symptoms
• Breaking bigger tasks into smaller parts to make it easy to prioritize and complete
• Doing physical exercises like swimming, walking, or yoga
• Practicing relaxation, breathing exercises, or meditation techniques
• Listening to soft, relaxing music 
• Spending time in nature
• Being patient and understanding that it will take time for PTSD symptoms to go away
• Accepting the fact that PTSD is not a sign of weakness and can happen to anyone
• Participating in recreational activities that render a distraction