Post-traumatic stress disorder (PTSD): A straight-talking, informative guide

What Is Post-traumatic Stress Disorder (PTSD)?

PTSD is a condition, categorized as a Trauma- and Stressor-Related Disorder, that some people develop after exposure to a traumatic event. It is an ongoing and intense physical and emotional response. 

It’s normal to have distressing memories, trouble sleeping, or feel a range of emotions after this type of event. However, if the feelings and symptoms last more than a few months, it may be PTSD. Although often connected to war veterans and survivors, it can happen to anyone who has experienced trauma.

What Are the Causes of PTSD?

PTSD occurs as a result of exposure to traumatic events. It’s important to remember that PTSD isn’t always caused by a traumatic event that physically happens to you. Some people develop PTSD after witnessing a friend or loved one experiencing harm or being put in a dangerous situation. The unexpected death of someone close to you can also lead to PTSD.

What Classifies as a Traumatic Event?

There is no one exhaustive list of trauma-related stimuli. They are described as situations that cause fear, helplessness, serious injury, or a threat of injury or death. It could be one event or a series of events. It could be something you are involved in or witness. 

Examples of traumatic events that may lead to PTSD include:

• Violent physical or sexual assaults
• Military combat 
• Living through, witnessing, or experiencing war
• Being involved in a terrorist attack
• Being held hostage
• Natural disasters such as earthquakes or tsunamis
• Accidents (like road traffic accidents)
• Ongoing physical, sexual, or psychological abuse or harassment
• Traumatic childbirth
• Frequently witnessing distressing events (for example, when working in the military or emergency services)
• Seeing another person being abused, hurt, or killed
• Witnessing community violence or acts of unsafe activities in one’s community
• Experiencing any situation where you are fearful for your life

What Are the Symptoms of PTSD?

Symptoms of PTSD usually appear soon after a traumatic event; however, in some cases, they might not appear until weeks, months, or even years later. Not everyone has the same symptoms, and people experience symptoms in their own way. PTSD symptoms are categorized into four different types. 

1. Re-experiencing symptoms (re-living the event). There are symptoms like nightmares, flashbacks, frightening thoughts, and emotional/physical reactions to bad memories. A noise, sight, or smell may also cause you to re-live the event (these are called triggers).
2. Avoidance symptoms (avoiding things that remind you of the event). Choosing to stay away from people, activities, or places that remind you of the trauma are all avoidance symptoms. They may also include avoiding talking about the event, suppressing feelings, or feeling detached.
3. Hypo-arousal and reactive symptoms. Some people may feel like they are constantly alert and looking out for danger. Difficulty sleeping, feeling edgy, irritability, or being easily startled are other reactivity symptoms. Outbursts of anger, driving aggressively, and abuse of drugs/alcohol might also occur. 
4. Cognition and mood symptoms (new harmful feelings since the event). These are negative thoughts and depressive feelings. Distorted feelings of guilt or blame. You may find you have lost interest in activities you used to enjoy, and feel estranged, isolated, or suicidal. Feeling you cannot trust anyone is often experienced, and you may forget the specifics of the traumatic event or not be able to talk about it. “Having fragmented recollection of the traumatic event may be that your brain is attempting to save you from recalling the traumatic event, as your brain is often trying to protect you from re-experiencing the event that was frightening or threatening,” Christine Ridley, Licensed Clinical Social Worker (LCSW) at Thriveworks. “The brain has wonderful built-in defense mechanisms for us! However, these built-in defense mechanisms may also provoke confusion or fear of not recalling memories properly.” 

Dissociative PTSD subtypes also exist, which come with dissociative symptoms like depersonalization and/or derealization – more on that soon.

What Are the Physical Effects of PTSD?

Some people with PTSD experience physical symptoms similar to what people with anxiety experience. This is because, when we are under stress, our body releases the hormones cortisol and adrenaline. With PTSD, some people continue to produce these hormones when they are no longer in a dangerous or stressful situation. These physical symptoms include:

• Feeling your heart is racing
• Headaches
• Lightheadedness/dizziness
• Chest pains
• Stomach aches or feeling sick
• Pins and needles
• Fast breathing
• Sweating or hot flushes
• Teeth grinding
• Sleep problems
• Panic attacks
• Feeling restless
• A change in sex drive
• Needing the toilet more or less frequently

PTSD Diagnosis Criteria

While the above encompasses the most common PTSD symptoms, the following criteria as outlined in the DSM-5 must be met in order for a post-traumatic stress disorder diagnosis to be made (in those older than 6 years of age):

• The individual was exposed to actual or threatened death, serious injury, or sexual violence in at least one of the following ways:
  • He or she was a victim of the traumatic event.
  • He or she witnessed, in person, the event as it happened to others.
  • The individual learned the traumatic event happened to a close family member or friend. When it comes to the actual or threatened death of a close family member or friend, the events must have occurred violently or accidentally.
  • He or she experienced repeated or severe exposure to harsh details of the traumatic exposure. For example, EMTs finding dead bodies or collecting human remains.
• The individual experiences at least one of the following intrusion symptoms associated with the traumatic event, beginning after the traumatic event occurred:
  • Recurrent and involuntary distressing memories of the traumatic event that intrude his or her mind. (Note: In children older than 6 years old, repetitive play or games may involve themes of the traumatic event(s) they experienced.)
  • Recurrent distressing dreams involving the traumatic event. (Note: Children may simply have scary dreams without related or recognizable content.)
  • Dissociative reactions, such as flashbacks, where the individual feels or acts as if the traumatic event were occurring again.
  • Intense or prolonged psychological distress when exposed to cues that symbolize or resemble the traumatic event.
  • Strong physiological reactions to the aforementioned cues.
• The individual goes out of his or her way to avoid stimuli associated with the traumatic event, as demonstrated by at least one of the following:
  • He or she puts in an effort to avoid distressing thoughts, feelings, and memories associated with the traumatic event.
  • He or she puts in an effort to avoid external reminders—people, conversations, situations, places—that bring about distressing thoughts, feelings, and memories associated with the traumatic event.
• The individual experiences negative alterations in thoughts and moods associated with the traumatic event, beginning or worsening after the event occurred, as demonstrated by at least two of the following:
  • An inability to remember important aspects of the traumatic occurrence, usually due to factors like amnesia, head injury, or alcohol
  • Persistent and exaggerated negative beliefs or expectations.
  • Persistent distorted thoughts and views about the causes as well as consequences of the traumatic event that result in self-blame.
  • Persistent negative emotional state, such as fear or anger.
  • A diminished interest or involvement in significant activities.
  • Feelings of detachment from others or estrangement from loved ones.
  • Persistent inability to experience positive emotions, like happiness, love, and fulfillment.
• The individual has marked alterations in arousal and reactivity associated with the traumatic event, which begins or worsens after the event occurred, as proven by at least two of the following:
  • Angry outburst and irritable behavior, which is typically expressed verbally or physically toward other people or objects
  • Reckless, careless, or self-destructive behavior
  • Hypervigilance
  • An excessive startle response
  • Difficulty concentrating
  • Sleep disturbance, which may involve difficulty falling or staying asleep
• The disturbance lasts longer than 1 month.
• The disturbance causes clinically significant distress and/or impairment in normal areas of functioning.
• The disturbance cannot be attributed to the physiological effects of a substance or another medical condition.

It’s important to specify whether the post-traumatic stress disorder is…

…with dissociative symptoms, which means the individual has symptoms that meet the criteria for the disorder and experiences persistent or recurrent symptoms of either of the following in response to the stress:

• Depersonalization: The individual consistently feels detached from his or her body or mind (e.g., feels like they’re in a dream, or time is moving in slow motion). “This is sort of like an out-of-body experience,” says Ridley. “Another example may be watching yourself re-experience the traumatic incident.”
• Derealization: He or she feels like his or her surroundings aren’t real (e.g., the world around the individual appears distorted or unreal)

…with delayed expression, which is where the individual does not meet full criteria until at least 6 months after the traumatic event occurred.

PTSD DSM-5 Code: What Is the Diagnosis Code for PTSD?

The PTSD DSM-5 code is 309.81 (F43.10). Diagnostic codes of the like are used for medical record keeping. They’re outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), for medical and mental health professionals’ easy reference when diagnosing and treating mental health disorders. 

How Common is PTSD?

You may think experiencing trauma isn’t that common. However, it is quite the opposite. In fact, 60% of men and 50% of women are estimated to experience trauma at some point in their life. Furthermore, the National Center for PTSD states that approximately 6 out of every 100 people will experience PTSD at some point in their lives. And over the last year, PTSD affected 3.6% of adults in the United States (US). This is equivalent to around 8 million adults experiencing PTSD symptoms every year. 

PTSD is more common in women than men. This is due to sexual assault being the most frequent type of traumatic experience reported by women with PTSD. Approximately 8 in every 100 women develop PTSD sometime during their lifetime compared with 4 in every 100 men.

Who Is at Risk of Developing PTSD?

Not everyone who lives through a traumatic event develops PTSD. It is entirely normal to cycle through a range of emotions after a traumatic event. However, most people will fully recover and not develop PTSD. 

That said, there are risk factors that make some people more likely to develop PTSD than others. PTSD is seen to be more common after certain types of trauma, such as combat and sexual assault. Risk factors that make experiencing PTSD more likely include:

• Living through a prolonged traumatic event (such as war or being held hostage)
• Childhood trauma or abuse
• A previous history of mental illness or substance abuse
• Getting severely injured
• Repeatedly witnessing traumatic events (such as when working in the military or emergency services)
• Seeing another person get hurt, abused, or seeing a dead body
• Having little or no social support 
• Added stress after a traumatic event (such as grieving the loss of a loved one, ongoing pain, or loss of a job)

What Are the 5 Stages of PTSD?

PTSD affects everyone differently. There are five different stages of PTSD, and as you pass through the stages, symptoms can come and go. The stages of PTSD aren’t fixed. You may find you go from one to another, back and forth, throughout your recovery journey. Everyone has their own journey. The five stages of PTSD are:

1. The impact stage (emergence stage): directly follows the traumatic event. This is the immediate stage where a person struggles to deal with what has just happened. It can include experiencing things such as shock, hypervigilance (the elevated state of constantly assessing potential threats around you), fear, anxiety, and guilt. 
2. The denial stage (numbing stage): is a stage that not everyone experiences. It’s where someone tries to protect themselves by denying that the traumatic event ever happened. It’s a way of avoiding feeling the emotions connected to the event. But, it does have to be dealt with to move forward in recovery. 
3. The rescue stage: is the beginning of coming to terms with what has happened. This stage is about acknowledging the traumatic event. It might even include returning to the location of the trauma. However, it involves dealing with a significant amount of ongoing emotions and physical effects. It can be the most challenging and sometimes the most destructive stage. 
4. The immediate recovery stage (short-term recovery):  is the beginning of healing. People start to return to a more ‘normal’ life in this stage, rather than just surviving. There are two sub-stages of this phase. In one case, a person might be humbled by the outpouring of love and support that they have experienced. However, on the other hand, people may be disappointed in the lack of care or concern shown to them by others. Physical and emotional symptoms still continue throughout this phase. 
5. The long-term reconstruction stage (long-term recovery): is all about implementing a recovery program. It is about rebuilding life again. However, also continuing to deal with personal problems post the traumatic event. In this stage, people begin to implement coping mechanisms to address symptoms. Some people find they begin to look forward to their lives. But, some can become concerned about the future presenting feelings such as fear, resentment, and depression. This is often the longest stage and learning to implement coping strategies is a vital part of continuing to deal with life. 

How Does PTSD Impact a Person's Life?

PTSD impacts everyone’s life differently. There is a vast range of emotional and physical symptoms. Below are a few examples of how PTSD can affect life; however, no person’s story is the same as the next.

People with PTSD can have trouble in relationships with family or friends. “This is due to mistrust following traumatic events and developing cognitions such as, ‘The world is not safe,’” Ridley explains. “These individuals then isolate themselves out of fear of frightening events or experiences recurring and wanting to protect themselves from ever experiencing similar trauma again.”

For caregivers, their symptoms might also directly impact their children. Children may not understand what is happening if their parent is having re-experiencing symptoms. Or, a parent with PTSD might not feel like joining in family events or doing fun activities. If you have PTSD, it can be hard to have “good” feelings. Some people simply feel like they can no longer enjoy life. 

PTSD symptoms make it hard for someone to function like they usually would. They may be afraid of going out of the house, experience panic attacks, avoid social situations, be easily startled, or have symptoms triggered by specific sounds or smells. 

Some people with PTSD turn to alcohol or drug abuse which can lead to losing their job, home, or close relationships. Others may not be able to work because of other physical or emotional symptoms. Symptoms can make it hard to do something seen as simple, like a grocery shop, meaning a person with PTSD might not care for themselves properly. 

Symptoms can interfere with work, home life, relationships, self-care, physical health, mental health, and social life. 

Can PTSD Be Cured?

PTSD can be treated but not cured. Treatment means you can learn to effectively manage symptoms, restore normal functioning, and get back to living your life. For some people, symptoms might be alleviated completely. For those whose symptoms do not completely go away, they often see significant improvements with treatment and experience a much better quality of life.

How Is PTSD Treated?

There are several effective treatments for PTSD. Two of the most recommended and researched trauma therapies are:

• Trauma-focused cognitive behavioral therapy (TF-CBT).  “Cognitive behavioral therapy (CBT) focuses on the relationship among thoughts, feelings, and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts, and feelings that lead to difficulties in functioning,” according to The American Psychology Association. TF-CBT is a type of CBT that has been specifically adapted for PTSD.
• Eye movement desensitization and reprocessing (EMDR). The treatment involves making eye movements while thinking about the traumatic event. EMDR helps change the negative way you think about a traumatic experience. It creates a similar effect to the way your brain processes memories and experiences when you are asleep. It can help reduce symptoms such as being easily startled. 

“With help from therapies such as trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) therapy, individuals may be able to reprocess trauma in a safe and therapeutic way,” says Ridley. Other therapies that might be recommended include: 

• Cognitive processing therapy
• Prolonged exposure therapy
• Brainspotting 

For some people, specific medication can help alongside other therapies. Medication can help people to manage their anxiety, depression, or other symptoms that can occur alongside their PTSD symptoms. 

Treatment is a different process for everyone. You may think that you don’t need treatment. However, when PTSD isn’t treated, it usually doesn’t go away and may even get worse. Most people find treatment helps them to live a better quality of life. 

How Do You Manage PTSD in Your Everyday Life?

PTSD can be overwhelming. Here are a few things that might help in addition to seeking professional treatment in the form of therapy and/or medication:

• Find people you can confide in. You don’t have to talk about the traumatic event, but you might want to talk about how you currently feel. 
• Understand your triggers. Triggers are different for everyone. They can be as simple as a specific anniversary or date. In that case, try to plan ahead and put coping strategies in place when you know a trigger date is coming up. If your triggers relate to smells, noises, or places, you might want to think about these before going to a specific event. That way, you can plan ahead in case you think you might experience your triggers at an event. 
• Learn to identify your flashbacks. Flashbacks can be distressing. Keeping a diary might help you to spot a flashback pattern or triggers that are causing flashbacks, and things like focusing on your breathing, comforting yourself, telling yourself you are safe, and learning grounding techniques can help you get through a flashback. A professional can also help you learn coping strategies to deal with your specific flashbacks. 
• Find peer support. Some people find talking to others who have had similar experiences helps. There may be a peer support group near you. But, if not, there are many online peer support groups too.
• Look after your body and physical health. The physical and emotional symptoms of PTSD can be exhausting on the mind and body. Looking after your physical health can help by eating a healthy diet, exercising, and spending time outdoors. 
• Avoid negative coping strategies. Try to avoid turning to alcohol or drugs to cope with your emotions. What feels like a quick fix can make the situation worse in the long run.
• Be kind to yourself. With PTSD, it can be easy to judge and put pressure on yourself. Try to be patient. It takes time and support to alleviate the symptoms of PTSD. Allow yourself time to recover.