What Is Post-Traumatic Stress Disorder?

For many people who witness or experience a shocking, scary or dangerous event, flashbacks, nightmares, anxiety or mentally reliving the event are temporary symptoms. When those symptoms don’t go away and become debilitating, a person may be diagnosed with post-traumatic stress syndrome (PTSD).

Signs of PTSD

PTSD symptoms in adults may begin shortly after a traumatic event or happen months or years later. The effects of trauma are sometimes short term and can fade over time, especially in persons who practice self-care and have the support of family members and friends. However, the impact of PTSD is lasting for many and can place serious limits on a person’s ability to live a happy and productive life. PTSD symptoms can be debilitating and keep a person from appropriately managing work, school or social interactions.

Medical science recognizes four categories of symptoms for post-traumatic stress disorder:

• Intrusive memories and flashbacks
• Negative alterations in mood
• Changes in arousal and reactivity
• Avoidance symptoms

Intrusive Memories and Flashbacks

Intrusive symptoms and triggers include:

• Recurrent, involuntary, and intrusive distressing memories or dreams of the traumatic event(s).
• Flashbacks that cause the person to act as if the event was recurring.
• Intense or prolonged psychological distress when experiencing dreams, thoughts or flashbacks.
• Persistent avoidance of memories, thoughts, feelings or reminders of the event.

Negative Alterations in Mood

Evidence for negative mood changes includes:

• Inability to remember important aspects of the event.
• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world that leads the individual to blame him or herself or others.
• Persistent fear, horror, anger, guilt, or shame.
• Markedly diminished interest or participation in significant activities.
• Feelings of detachment or estrangement from others.
• Persistent inability to experience positive emotions.

Changes in Arousal and Reactivity

Changes in emotional and physical reactions may include:

• Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
• Reckless or self-destructive behavior
• Hypervigilance
• Exaggerated startle response
• Problems with concentration
• Sleep disturbance

Avoidance Symptoms

The fourth category of PTSD symptoms is avoidance. Examples include:

• Persistent or recurring feelings of detachment from oneself or from one’s surroundings.
• A refusal to engage in situations that remind one of a previous trauma.
• An unwillingness to think or talk about a traumatic event.

How Do PTSD Symptoms Differ for Men and Women?

PTSD affects both men and women. There are, however, some differences in the way the sexes experience this condition.

PTSD Symptoms in Women

Women are more likely than men to develop PTSD, and with a greater degree of intensity. The causes of PTSD in women are often related to physical or sexual abuse, though men can suffer from these as well.

PTSD Symptoms in Men

Men are less likely than women to develop PTSD but remain at risk. The causes of PTSD in men are similar to those in women but skew more toward physical danger as experienced in combat or in hazardous occupations.

Diagnosis

Diagnosing PTSD requires thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for PTSD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your symptoms indicate the condition.

How Do Doctors Test for PTSD?

Diagnostic tests include:

Physical examination: Your physician will perform a physical exam and ask questions about your health to determine if your symptoms could be linked to an underlying physical health problem. Bloodwork and other lab tests may be included as part of your exam. 

Psychiatric evaluation: Your behavioral health provider will ask about your symptoms, thoughts, feelings and behavior patterns as well as the event(s) that led up to the symptoms. You will be asked about your personal and family history of mental illness, anxiety disorders and other mood disorders. 

The DSM-5 criteria used to diagnose PTSD are:

• One or more intrusion symptoms.
• Two or more mood-alteration symptoms.
• Two or more arousal and reaction symptoms.
• One or more avoidance symptoms.

To rule out the possibility of a short-term response to trauma, documented symptoms must have occurred over a period one or more months.

PTSD Causes

PTSD is generally caused by the firsthand experience of a traumatic event, either as a participant or as a witness. Common traumas include:

• Combat
• Criminal threats or assault
• Physical abuse
• Extreme verbal abuse
• Sexual violence
• Accidents
• Natural disasters

PTSD can also be a response in persons with a relative or close friend who experienced a traumatic event, even if they were not present when it occurred.

Risk Factors

People of all ages can experience PTSD. Risk factors that could make it more likely for development of PTSD can include: 

• Gender: Women are more likely to experience PTSD than men.
• Jobs: People in jobs that increase the risk of being exposed to traumatic events, like military personnel or first responders, have an increased risk of developing PTSD.
• Extra stress after an event: Those who experience a shocking, scary or dangerous event and who have additional stress such as injury, loss of a loved one or loss of home or job after the event are more likely to experience PTSD.
• Other mental health problems: Anxiety or depression can contribute to developing PTSD.
• Substance abuse: Excessive drinking or drug use can increase the risk of PTSD.

Prevention

Because traumatic events are largely unpredictable, PTSD cannot be readily prevented. There are, however, steps that you can take to lower the risk of developing PTSD in the aftermath of a traumatic experience. These steps, known as “protective factors”, include:

• Seek care and assurance from friends and family.
• Investigate local support groups.
• Develop a coping strategy for the possible onset of PTSD.
• Give yourself credit for a positive response to a potentially negative situation.
• Help others like yourself, as a way of reconnecting with other people and reducing the sense of personal isolation.

Prognosis

PTSD will not simply ‘go away’. Fortunately, it is a treatable condition. In recent years, new approaches combined with a better understanding of the psychological mechanisms involved have resulted in improved forms of treatment. Learning to control the impact of PTSD takes time, but many patients have been able to regain their footing as healthy and productive individuals.

Treatment

Most people with PTSD benefit from a combination of medication and psychotherapy delivered by a psychiatrist, psychologist or other behavioral health professional. The primary focus of this treatment is helping the traumatized individual regain a sense of control over his or her life. Also important is learning to recognize PTSD symptoms for what they are, which can act as a first step in diminishing their impact in the patient’s life.

Psychotherapy

Working with a therapist experienced in treating PTSD can reduce the symptoms associated with PTSD, help with family, job or social problems, and provide coping skills to control fear and symptoms. 

PTSD Medication

Medication can help treat PTSD symptoms and is typically prescribed along with therapy. You may need to try a few different medications, or medication combinations, before you find the one that’s right for you. Some medications will treat certain symptoms, for example, PTSD anger medication. Some medications take a few weeks before their full effect is obvious. Some cause side effects for certain patients. If you experience any side effects, it’s important to talk to your provider immediately but not to abruptly stop taking the medication, which could cause a worsening of symptoms.

Common medications prescribed for PTSD include:

• Antidepressants: These medications may be prescribed to help manage the sadness, worry, anger or feeling numb inside that is caused by PTSD.
• Sedatives: These medications may be recommended for a short term to help with severe episodes of anxiety or until antidepressants take effect.
• Sleep medications: Certain sleep medications may be prescribed to reduce nightmares associated with PTSD.

How to Improve PTSD

Lifestyle Changes

Lifestyle changes along with therapy and medication can help treat PTSD symptoms and triggers. Specific lifestyle changes that are recommended include:

• Physical activity: Regular exercise helps reduce stress and improve mood.
• Avoid alcohol and drugs: Self-medicating with alcohol or drugs can interfere with medical treatment and prevent healing.

PTSD Complications

Early and ongoing treatment is key to managing PTSD. Left untreated, complications can arise, including:

• Drug and alcohol abuse
• Depression
• Anxiety
• Suicide
• Social, occupational and physical disability

FAQ

What Is Living with PTSD Like?

Living with PTSD can be difficult and demanding. Suffering from anxiety, depression, loss of focus, or sudden emotional outbursts can make daily responsibilities a challenge. Relationships, too, are complicated by feelings of isolation, mistrust, or guilt.

What Are the Five Main Symptoms of PTSD?

According to Rogers Behavioral Health, there are five main symptoms of PTSD:

• The experience of trauma
• Re-experiencing trauma
• Avoidance of unwanted memory triggers
• Negative changes in self-evaluation and thought patterns
• Sustained difficulty in dealing with anxiety

Can You Self-Treat PTSD?

You can’t cure PTSD through self-treatment but there are positive steps that you can take to minimize and gradually reduce its effect on your life. There are a variety of self-help techniques available, from a commitment to healthy diet and exercise, to the avoidance of drug and alcohol dependency, to the development of effective coping strategies and close relationships with family and friends. You should also seek out professional care, which might include some form of therapy and, if appropriate, doctor-prescribed medications.

Why Is PTSD So Hard to Treat?

The recovery from trauma can be a long and challenging process. The causes and symptoms of PTSD are complex and varied, and people have a range of responses to therapy, which is the most common form of treatment for this condition.