Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) entails experiencing a trauma that is defined as a distressing or deeply disturbing experience. PTSD is a disorder that can develop when you experience a dangerous, scary, or shocking event.1, 2
What Causes Post-Traumatic Stress Disorder?
When you experience a traumatic event, it triggers a “fight-or-flight” response in your sympathetic nervous system.3
Triggering the fight-or-flight response is your body’s way to protect itself from potential harm. This response creates physiological changes in your body. Your body releases hormones such as epinephrine and norepinephrine to increase alertness, heart rate, blood pressure, and breathing.3 This puts a pause on the parasympathetic system or “rest and digest” part of your nervous system.3
It is normal to have feelings of fear during and after a traumatic situation. In some cases, these feelings go away after the situation and the body returns to its resting state or what is referred to as homeostasis.3 In this state, your body continues to function optimally, with levels of stress hormones returning to normal limits. If this happens, then you have naturally recovered from the traumatic event.3
However, sometimes the body is unable to go back to homeostasis after the traumatic event. As a result, it may continue in fight-or-flight mode until you can receive treatment. Sometimes the body returns to homeostasis, but fight or flight symptoms may start later on.4
Being triggered or experiencing a trigger can recreate the fight or flight symptoms. A trigger is anything that would serve as a stimulus to elicit the fight or flight reaction in your body. For example, re-experiencing the traumatic event as a result of seeing something that reminded you of it.3, 4
Sometimes the symptoms come and go based on if there is a re-experiencing of the traumatic event (your own memory or recollection of the event) or if you experience a new traumatic event.3,4
PTSD can also be caused by non-traumatic events. For example, if you experience the unexpected death of a loved one.2,4
PTSD Symptoms and Signs
There are a few key signs and symptoms of PTSD. There are trait and state characteristics. Trait characteristics are long-lasting and relate to your personality. They refer to your core being, whereas state characteristics refer to your current state of being, feelings, or reactions.5
PTSD symptoms largely refer to state characteristics. Hence, they do not change your personality or alter your trait characteristics.5
There are four main categories of PTSD symptoms:4
- Re-experiencing symptoms
- Reactivity and arousal symptoms
- Avoidance symptoms
- Mood and cognition symptoms
Re-experiencing symptoms may cause difficulties in your everyday routine. These symptoms can originate from your own thoughts and feelings. There might be objects, words, or situations that are reminders of the traumatic event you experienced. This could trigger symptoms in this category.4, 6
Re-experiencing symptoms include:4, 6
- Scary or frightening thoughts
- Flashbacks (this is where you relive the trauma repeatedly and includes physical symptoms such are sweating and elevated heart rate)
- Bad dreams
- Reliving the event
Reactivity and Arousal Symptoms
Symptoms in the category of reactivity and arousal are typically constant. Rather than being triggered by things that remind you of the traumatic event, you can feel these symptoms if you feel stressed or angry (the stress or anger or your feeling state would be the trigger). Such symptoms can make it difficult for you to do daily tasks such as concentrating, eating, and sleeping.4,6
Reactivity and arousal symptoms include:4, 6
- Difficulty sleeping
- Angry outbursts
- Easily startled
- Feeling tense or being “edgy”
If you become triggered, you may stay away from things or people who remind you of the trauma that you experienced. For example, you may take an alternate route to work to avoid a street you used to drive on, may stop speaking to people associated with the event, or stay away from certain foods that were eaten or clothing that was worn around the time of the event.4, 6
Avoidance symptoms include:4, 6
- Staying away from objects, events, and places that remind you of the traumatic experience
- Avoiding feelings or thoughts related to the traumatic event
- Avoiding things that remind you of the event
Mood and Cognition Symptoms
If you are experiencing these symptoms, you may feel detached or alienated from your primary support groups such as family and friends. These may begin to worsen after the traumatic event and are separate from/do not relate to an injury, substance misuse, or other co-morbid disorder.4,6
Mood and cognition symptoms include:4, 6
- Developing negative thoughts about yourself or the world
- Difficulty remembering the main details of the traumatic event
- Loss of interest in pleasurable activities
- Feelings such as guilt or blame
- Having more negative thoughts and feelings than before
If you have PTSD or PTSD symptoms, there are several effective treatments. Two main therapies include medication and psychotherapy (also known as talk therapy). Research shows that using both concurrently can also be effective, especially in cases where receiving one of these alone is not providing relief.4, 7
You may need to try different treatments to find what works the best for your symptoms and situation. But there are many options, and research shows that recovery is very possible so that you can resume your activities of daily living or the symptoms do not hinder your daily responsibilities. It is possible, too, to return to the things you enjoyed doing before the trauma.4, 7
When Does Post-Traumatic Stress Disorder Start?
It is natural for you to experience these symptoms for up to a few weeks after experiencing the event. These symptoms can last for longer than a month. If this is the case, it might be PTSD, especially if they are substantially impacting your ability to do activities of daily living (ADL).4, 6
Symptoms must last more than a month and be severe enough to interfere with relationships, work, or major life responsibilities to be considered PTSD.4, 6
PTSD symptoms may come and go as well. You should seek treatment if the symptoms persist and affect your day-to-day life. This is because you might risk developing other conditions (co-morbid disorders) such as depression, anxiety, and substance misuse).4, 6
Research indicates that anyone can develop PTSD at any age.4, 6
If you experience a trauma, you may develop PTSD. A list of people who might develop PTSD would be:4, 6
- War veterans
- Anyone experiencing physical or sexual assault, abuse, disaster, accident, or other serious events of this kind
Symptoms can begin early, within three months of the traumatic incident. However, sometimes signs and symptoms can begin years after the event.4, 6
How Long Can Post-Traumatic Stress Disorder Last?
Successful recovery rates have been documented for as little as 6 months of treatment.4,7 However, sometimes symptoms can last for a significantly longer time. In some cases, PTSD can become chronic.4, 7
The length of treatment varies depending on risk factors such as:4,7
- If you are currently living through trauma and dangerous events (here, it would be important to change your situation so that this can discontinue)
- The number of times/occurrences you experience the trauma
- If you were physically hurt as a result of the trauma
- History of childhood trauma
- Seeing another person hurt, or a dead body
- Social support (existence of strong social support has been shown to be a predictor of success in treatment, while having little or no social support is a risk factor)
- Feelings of extreme fear, horror, and/or helplessness
- History of a co-morbid disorder such as mental illness or substance misuse
- Presence of other life stressors (particularly if it occurs soon after the traumatic event/experience
Who Diagnoses Post-Traumatic Stress Disorder?
Properly credentialed professionals such as physicians, psychiatrists, psychologists, and mental health workers (counselors and therapists) can diagnose PTSD.4,6,7
The credentialed profession may utilize the International Classification of Diseases, Version 11 (ICD-11). This is a manual that sets the international standard for analysis, reporting, systematic recording, and interpretation and comparison of mortality data. Medical personnel will use the PTSD code in this manual.4, 6, 7
The Diagnostic and Statistical Manual, fifth edition (DSM-5), is the current handbook utilized by behavioral and mental health professionals to diagnose conditions such as PTSD. It is the gold standard and provides detailed criteria for the professional to follow to make the diagnosis.4, 6, 7
A healthy approach to discussing the diagnosis with you is to assure you that the diagnosis does not define you. Oftentimes, professionals will use human-centric language, emphasizing that a patient is a person experiencing PTSD.
How Do I Get a PTSD Test?
If you choose to seek treatment with a credentialed professional, upon entering treatment, you will complete an intake assessment with the professional. The intake usually includes the professional collecting demographic information (age, gender, etc.), medical and psychiatric history, relevant family history, history of the trauma experienced, and your current signs and symptoms.4, 7
Depending on if you go to the ER, inpatient, or outpatient setting, that is where the intake would take place.
If you choose to schedule an appointment with your PCP, they may give you the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). This is a five-item screen, designed to be given in a primary care setting so that your PCP can decide how to best help you.8,9
Sometimes discussing the event during the intake process can be triggering. You might want to bring a family member or friend for emotional support. This has been shown to minimize the triggering effects. Your provider will be asking you questions so that you can receive the most effective treatment.8, 9
Where to Find Post-Traumatic Stress Disorder Treatment
If you are not sure where to start your treatment, you can ask your Primary Care Physician (PCP). Another great source is the National Institute on Mental Health’s (NIMH) Help for Mental Illnesses page.4, 7
If you have insurance, you can check the back of your insurance card for the referral phone line. You can call the phone line and request a list of covered providers for PTSD. If your insurance company provides you with online resources and a portal, you can log into the portal and search for providers as well.4, 7
If the symptoms are severely debilitating, you may go to an emergency room (ER) for immediate treatment and request a referral for further treatment, including medication, psychotherapy, or a combination of both.4, 7
Medications can include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SSNRIs). Both are classified as antidepressant medications.4, 6 Medications can be listed as a brand name or generic name.
Research shows that the following four medications are the most effective for PTSD treatment are:4, 6
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
- Fluoxetine (Prozac)
Your treatment provider may use other medications in conjunction with these depending on if you have other symptoms or comorbid conditions.
The prescription process is usually dynamic and you are encouraged to be honest with your provider. This way, they can prescribe what will work best for you. The medications can assist with your mood and feelings of worry, anger, sadness, and “going numb” or detachment. If you are experiencing insomnia, nightmares, and other sleep disturbances, the provider may prescribe medications to help with that as well.
Psychotherapy is another treatment that has been shown to help treat PTSD.4,6 Sometimes, psychotherapy is referred to as talk therapy. It involves talking with a credentialed mental health provider. It can occur one-on-one and in-person, on the phone, and/or remote video (on a secure and private platform). Psychotherapy can also be done in a group setting.
Therapy usually lasts 6-12 weeks; however, you will work with your provider to create an individualized treatment plan. It can be shorter or longer based on your needs.4 Your provider might also refer you to community self-help groups and involve your social supports (family and friends). Research shows improved outcomes when there is social support.4
Talk therapy can teach you to react to triggers in a useful manner so that your symptoms are minimized.
Things that you may learn in treatment are:4, 6
- Relaxation strategies and techniques
- Trauma and its effects on the body
- Developing healthy self-care habits (sleep hygiene, nutrition, exercise)
- Identifying and processing moods, feelings, and emotions you have about the experience
- Creating a safety plan and having quick access to it (who you can call, where you can go, what you can do when triggered)
- Modulating your reactions to PTSD symptoms
- Lowering the effects of triggers so that they have a lower impact on your day-to-day responsibilities and activities
Cognitive-behavioral therapy (CBT) is a type of psychotherapy that has been shown to be effective in treating PTSD. CBT helps you to reframe your thoughts around the traumatic experience, which in turn helps you to adjust your behaviors.4
Two types of CBT have been shown to be most effective.
Exposure therapy: In this therapy, you would work with your provider to safely be “exposed” to the trauma you experienced. Through the safe re-experiencing, you would work with your provider to learn and utilize coping skills so that your symptoms around the experience would be reduced, thereby allowing you to have a decrease in symptoms.4
Some safe methods utilized in exposure therapy include writing, imagining, or visiting the place where the experience/event occurred. You would be supported through the process.
Cognitive restructuring: Due to how trauma memories get stored in the brain, you may remember the traumatic event differently than how it happened. You may also have associated feelings of shame and guilt around the event, even though it was not your fault. By restructuring or reformatting how you remember the event, you would increase your sense of what occurred. In other words, your provider would assist you with viewing the event from a different perspective, whereby it did not execrate PTSD symptoms.4
Many other types of treatment could be utilized to assist with PTSD symptoms. They are referred to as, trauma-informed care.4,6
When you start your search for treatment, you can utilize that terminology to request a referral.
Treatment has been effective because it helps to equip you with coping techniques to manage your symptoms but also to reframe the event and/or your interpretation of it.4,6,7
Whether you or a loved one feels that treatment is the right fit or you’re unsure of where to start, you can contact a treatment specialist at 800-598-5053 (Who Answers?) .
- Merriam-Webster Dictionary. (n.d.). Trauma Definition.
- U.S. Department of Veterans Affairs. (n.d.). PTSD: National Center for PTSD.
- Wingenfeld, K. Whooley, M.A., Neylan, T.C., Otte, C., & Cohen, B.E. (2014). Effect of Current and Lifetime Posttraumatic Stress Disorder on 24-Hour Urinary Catecholamines and Cortisol: Results from the Mind Your Heart Study. Psychoneuroendocrinology, 55, 83-91.
- National Institute of Mental Health (2019). Post-Traumatic Stress Disorder.
- Read, J.P., Wardell, J.D., & Colder, C. R. (2013). Reciprocal Associations Between PTSD Symptoms and Alcohol Involvement in College: A Three-Year Trait-State-Error Analysis. Journal of Abnormal Psychology, 122(4), 984-997.
- Medline Plus. (n.d.). Post-Traumatic Stress Disorder.
- National Center for PTSD. (2019). Understanding PTSD and PTSD Treatment.
- U.S. Department of Veterans Affairs. (n.d.). PTSD Screen Instruments.
- U.S. Department of Veterans Affairs. (n.d.). Primary Care PTSD Screen for DSM-5 (PC-PTSD-5).