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Post-traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a trauma and stressor-related disorder anxiety disorder that develops after a traumatic event. PTSD has also been called "shell shock" or "battle fatigue."
The exact cause of PTSD is unknown. PTSD is triggered by exposure to a traumatic event. Situations in which a person feels intense fear, helplessness, or horror are considered traumatic. PTSD has been reported in people who experienced:
- Physical assault
- Natural disaster such as earthquakes, hurricanes, or fires
- Sexual abuse
- Motor vehicle accidents
- Animal attack
Researchers are studying how problems with synapses in the brain may be linked to PTSD.
Not everyone who experiences a traumatic event will develop PTSD. Symptoms of PTSD are more likely to occur if the person has:
- Previous traumatic experiences
- A history of being physically abused
- Poor coping skills
- Lack of social support
- Existing ongoing stress
- A social environment that produces shame, guilt, stigmatization, or self-hatred
- Alcohol use disorder
- Family history of mental health problems
People with PTSD experience symptoms of anxiety following a traumatic event. These symptoms fall into 3 categories:
Re-experiencing of the event:
- Dreams or nightmares
- Intrusive memories
- Anxious reactions to reminders of the event
- Avoidance of external reminders of the event, such as places, people, or situations
- Efforts to avoid feelings, thoughts, or memories related to the event
Negative changes in mood and cognition related to trauma:
- Difficulty remembering relevant details of the trauma
- Difficulty falling asleep or staying asleep
- Anger and irritability
- Difficulty concentrating or paying attention
- Being easily startled
People with PTSD may also have:
- Substance abuse problems
- Physical symptoms, such as pain, rapid breathing or heart rate, and sweating
- Depression or anxiety
- Relationship problems
You will be asked about your symptoms and medical history. This may be done by using a structured interview and/or a questionnaire. You will also likely be given a psychological assessment. PTSD will be diagnosed if you have:
- Symptoms of PTSD, which have lasted for more than one month
- Both emotional distress and disturbed functioning (like problems at school, work, or home) due to the symptoms
PTSD is categorized according to when symptoms occur and how long they last. There are 3 types of PTSD:
- Acute—symptoms last between 1-3 months after the event
- Chronic—symptoms last more than 3 months after the event
- Delayed onset—symptoms do not appear until at least 6 months after the event
There are many treatments available to help manage PTSD. General goals include learning how to cope with symptoms, reducing symptoms, and strategies to improve relationships with family or friends. Treatment will also focus on any other conditions you may have, such as depression or substance abuse. The length of treatment will depend on the individual but can range from a few months to a few years. Treatment can often include a combination of approaches.
Cognitive-behavior therapy (CBT) is a very effective type of counseling for PTSD. Therapy focuses on:
- Learning about your current PTSD symptoms
- Better awareness of thoughts, feelings, and negative patterns
- Learning coping skills to manage thoughts about the trauma and current day challenges
- Understand and find the balance between your beliefs before the trauma and beliefs after the trauma
There are a few different types of CBT including:
- Cognitive processing therapy (CPT)—Focuses on better understanding and management of distressing thoughts. The therapy focuses on the changes to your thought pattern since the trauma and how this change affects how you act and feel.
- Prolonged exposure therapy—Uses repeated discussion of the trauma with a therapist. The goal is to decrease negative feelings from the trauma, help you develop relaxation skills during stressful times, and eventually decrease the influence of the memory. Though it sounds basic, this process should be done with a therapist to help introduce traumatic memories in a safe method and safe place.
Eye Movement Desensitization and Reprocessing (EMDR)
During this type of therapy, you are asked to talk about the traumatic event, including your memories, feelings, and sensations. While talking, you will be asked to do simple tasks like hand-tapping, following therapist's hand with your eyes, or listening to tones through headphones. The reason why is not clear, but repeating the story with the physical distraction allows your brain to process the trauma in a different way. In effect the process overwrites some of the negative thought processes related to the trauma.
Other therapeutic options that may help include:
- Stress inoculation therapy (SIT)—During this type of therapy you will be trained in relaxation techniques, positive reframing of negative thoughts, and assertive communication.
- Group meetings—Meeting in a group with other survivors of trauma can be an effective form of therapy for people with PTSD.
- Family therapy—May improve relationships between family members, give family members support, and help family understand your PTSD challenges.
- Mindfulness meditation—Paying attention to breathing and focusing on present experiences may help you manage stress.
Medication can help manage some symptoms while you go through counseling or during a crisis period. They may help manage anxiety, depression, and insomnia . Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) are often prescribed.
The events that trigger PTSD cannot be predicted or prevented. However, there are some factors that might prevent PTSD from developing after a traumatic event, such as:
- Working with a cognitive-behavioral therapist
- Having a strong network of social support
Anxiety and Depression Association of America
National Center for PTSD—US Department of Veterans Affairs
Canadian Psychiatric Association
Canadian Psychological Association
Jeffereys M. Clinician's guide to medications for PTSD. National Center for PTSD—US Department of Veterans Affairs website. Available at: https://www.ptsd.va.gov/professional/treatment/overview/clinicians-guide-to-medications-for-ptsd.asp. Updated November 17, 2017. Accessed January 31, 2018.
Post-traumatic stress disorder. American Psychiatric Association website. Available at: http://www.apa.org/topics/ptsd/index.aspx. Accessed January 31, 2018.
Posttraumatic stress disorder (PTSD). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114915/Posttraumatic-stress-disorder-PTSD . Updated June 26, 2017. Accessed January 31, 2018.
Treatment. National Center for PTSD—US Department of Veterans Affairs website. Available at: http://www.ptsd.va.gov/public/treatment/therapy-med/index.asp. Accessed January 31, 2018.
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10/12/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114915/Posttraumatic-stress-disorder-PTSD : Polusny MA, Erbes CR, Thuras P, et al. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA. 2015;314(5):456-465.
- Reviewer: EBSCO Medical Review Board Adrian Preda, MD
- Review Date: 11/2018
- Update Date: 01/26/2016