What is Posttraumatic Stress Disorder?
What is Posttraumatic Stress Disorder (PTSD)?
Understanding the Condition, Its Symptoms, Risk Factors, and Treatment Options
Written by Alex Penrod, MS, LPC, LCDC - Licensed Professional Counselor in the state of Texas and Certified Clinical Trauma Professional II
What is Posttraumatic Stress Disorder (PTSD)?
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after an individual experiences or witnesses a traumatic event. It was first recognized as "shell shock" in war Veterans, but has since been recognized as a condition that can develop in anyone exposed to severe and life-threatening events. PTSD can have a profound impact on an individual's daily life, everyday activities, relationships, and overall functioning, impacting physical health and leading to mental health problems.
This page provides an overview of PTSD, including:
Definition of PTSD
Symptoms
Diagnostic Criteria
Prevalence Among Various Populations
Risk and Protective Factors
Common Co-occurring Disorders
Evidence-Based PTSD treatments
Recovery Rates
Definition of PTSD
PTSD is characterized by intense, distressing thoughts, emotions, and reactions related to a traumatic experience. A traumatic event can include military combat, physical assault, physical abuse, sexual abuse, natural disasters, car accidents, domestic violence, or other life-threatening highly stressful events. People with PTSD may involuntarily relive the traumatic event through flashbacks, upsetting memories, or nightmares, avoid reminders of the trauma, experience negative thoughts, beliefs, and moods, and have a hard time managing heightened nervous system arousal.
These symptoms may occur briefly in Acute Stress Disorder immediately following a traumatic event, but if they continue for more than 30 days a person may be developing PTSD. People can experience some of the clinical features of PTSD in response to less severe non-life-threatening events, but this may fall into the category of an adjustment disorder.
The defining features of PTSD are exposure to a traumatic event and the specific symptoms of post-traumatic stress disorder occurring for more than 30 days.
Symptoms of PTSD
Post-traumatic stress disorder symptoms are typically grouped into four main categories:
Intrusive Thoughts: These include recurrent, involuntary memories, flashbacks, or distressing dreams related to the traumatic event. In severe cases, flashbacks may feel so vivid that the person feels as if they are reliving the event.
Avoidance Symptoms: Individuals with PTSD often go to great lengths to avoid reminders of the traumatic event. This could involve behavioral symptoms like avoiding certain places, people, activities, or even thoughts and feelings associated with the trauma.
Negative Changes in Mood and Thoughts: This includes symptoms like feelings of guilt, shame, fear, or hopelessness. Sometimes even positive emotions are difficult to tolerate. Individuals may experience distorted beliefs about themselves or others, such as believing they are to blame for the trauma or that the world is entirely unsafe. They may also have difficulty recalling important memories of the event.
Hyperarousal and Reactivity: People with PTSD may feel constantly "on edge," with increased heart rate, and easily startled. Symptoms can include irritability, angry outbursts, reckless behavior, difficulty sleeping, and problems with concentration.
Diagnostic Criteria for PTSD
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR), a diagnosis of PTSD is made by a mental health professional based on the following criteria:
Exposure to Trauma: The person must have been exposed to actual or threatened death, serious injury, or sexual violence. This exposure can be direct, witnessed, or indirectly experienced through close friends or family members.
Presence of Intrusion Symptoms: At least one intrusive re-experiencing symptom (e.g., flashbacks, nightmares, intrusive memories) related to the trauma must be present.
Avoidance: At least one symptom of avoidance must be present, such as avoiding distressing memories, thoughts, feelings, or external reminders of the trauma.
Negative Alterations in Cognition and Mood: At least two symptoms, such as persistent negative emotional states, distorted beliefs, or detachment from others, must be present.
Marked Alterations in Arousal and Reactivity: At least two symptoms related to hyperarousal, such as irritability, hypervigilance, or an exaggerated startle response, must be present.
Duration: Symptoms must persist for more than one month.
Significant Distress or Impairment: The symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning.
Not Attributable to Substance Use or Medical Conditions: The symptoms must not be the result of substance use, medication, or other medical conditions.
Prevalence of PTSD Among Various Populations
PTSD can affect anyone who has experienced a traumatic event, but certain populations are more at risk:
General Population: In the general population, the lifetime prevalence of PTSD is estimated to be around 6-8%. Women are twice as likely to develop PTSD as men, potentially due to a higher risk of exposure to certain types of trauma, such as sexual assault.
Military Veterans: Veterans are at a significantly higher risk of developing PTSD due to exposure to combat and military-related trauma. National Center for PTSD estimates suggest that 10-30% of military veterans may experience PTSD at some point in their lives.
First Responders: Police officers, firefighters, paramedics, and other first responders are frequently exposed to traumatic events in the line of duty, which increases their risk for PTSD. Estimates suggest that 10-20% of first responders may develop PTSD.
Survivors of Sexual Assault and Domestic Violence: Survivors of sexual assault, childhood abuse, or domestic violence have a high risk of developing PTSD. Studies indicate that up to 50% of sexual assault survivors may experience PTSD at some point.
Refugees and Asylum Seekers: Individuals fleeing war, persecution, or violence are at high risk for PTSD due to repeated trauma and ongoing stressors. The prevalence of PTSD in refugee populations can be as high as 30-50%.
Risk Factors for Developing PTSD
Several factors can increase an individual's risk of developing PTSD after a traumatic event. These risk factors can be categorized into pre-traumatic, peri-traumatic, and post-traumatic factors:
Pre-Traumatic Risk Factors:
Personal or Family History of Mental Illness: A history of anxiety, depression, or other mental health disorders can increase the risk of developing PTSD.
Childhood Trauma: Individuals who have experienced trauma during childhood, such as abuse or neglect, are more likely to develop PTSD after a traumatic event in adulthood.
Personality Traits: Certain personality traits, such as a tendency towards neuroticism or a lack of resilience, can increase susceptibility to PTSD.
Lack of Social Support: A limited social support network or poor relationships with family and friends can elevate the risk of PTSD following a trauma.
Gender: Women are generally at a higher risk of developing PTSD, potentially due to a higher likelihood of experiencing trauma like sexual assault.
Peri-Traumatic Risk Factors:
Severity of Trauma: The more severe or life-threatening the traumatic event, the higher the likelihood of developing PTSD.
Perceived Threat to Life: If an individual perceives their life to be in imminent danger during the traumatic event, the risk of PTSD is increased.
Dissociation During Trauma: Experiencing dissociation (feeling detached from reality) during a traumatic event is associated with a higher risk of developing PTSD.
Post-Traumatic Risk Factors:
Lack of Access to Support Services: Limited access to psychological support, counseling, or other mental health services can increase the risk of PTSD.
Ongoing Stress or Exposure to Trauma: Continued exposure to stress or additional traumatic events can exacerbate PTSD symptoms.
Negative Coping Strategies: Maladaptive coping mechanisms, such as substance abuse, avoidance behaviors, and self-destructive behavior, can increase PTSD risk.
Protective Factors Against PTSD
While several risk factors can increase the likelihood of developing PTSD, certain protective factors can help reduce the risk or severity of PTSD symptoms:
Strong Social Support: A supportive network of friends, family, or community members can help buffer against PTSD by providing emotional support, validation, and a sense of belonging. Family therapy can be important for learning how to support a loved one with PTSD.
Effective Coping Strategies: Positive coping mechanisms, such as problem-solving, emotional regulation, mindfulness, and seeking support, can reduce the impact of trauma and lower PTSD risk.
Resilience: Resilience is the ability to adapt well in the face of adversity, trauma, or stress. Individuals with higher levels of resilience are less likely to develop PTSD.
Access to Mental Health Care: Timely access to mental health care, including therapy and counseling, can prevent PTSD from developing or reduce its severity.
Psychoeducation: Understanding PTSD, its symptoms, and its treatments can empower individuals to seek help and engage in their recovery process.
Common Co-Occurring Disorders with PTSD
PTSD often coexists with other psychiatric disorders and mental health conditions, which can complicate diagnosis and treatment:
Depression: Major depressive disorder (MDD) is one of the most common co-occurring disorders with PTSD. It is characterized by persistent feelings of sadness, hopelessness, and loss of interest in previously enjoyed activities. Up to 50% of individuals with PTSD may also experience MDD. When depression leads to suicidal thoughts, it's vital to seek crisis services such as the Crisis Lifeline (dial 988) and follow-up with treatment.
Anxiety Disorders: Generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and other anxiety disorders frequently co-occur with PTSD. The heightened state of fear and hypervigilance in PTSD can exacerbate anxiety symptoms.
Substance Use Disorders: Individuals with PTSD may turn to drug or alcohol use as a way to cope with their symptoms, leading to substance use disorders. Estimates suggest that up to 40-50% of people with PTSD also struggle with substance use.
Dissociative Disorders: Dissociative symptoms, such as depersonalization or dissociative amnesia, are common in PTSD, especially in cases involving complex trauma or repeated trauma. Dissociative identity disorder (DID) may also co-occur in more severe cases involving child abuse and complex PTSD.
Personality Disorders: Individuals with PTSD, particularly those who have experienced chronic trauma in childhood, may have co-occurring personality disorders, such as borderline personality disorder (BPD).
Evidence-Based Treatments for PTSD
There are several evidence-based and effective treatments for PTSD endorsed by organizations such as the American Psychiatric Association. These include talk therapy, trauma focused psychotherapies, and medications with strong evidence from randomized controlled trials. The choice of treatment depends on the individual's symptoms, co-occurring disorders, and personal preferences.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): TF-CBT is a structured, short-term treatment that focuses on helping individuals process and reframe their traumatic memories. It involves techniques such as cognitive restructuring, exposure therapy, and stress management.
Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a therapy that involves recalling distressing memories while engaging in bilateral stimulation (eye movement, alternating tones, or tapping). This process is thought to help reprocess traumatic memories and reduce their emotional charge.
Prolonged Exposure Therapy (PE): Prolonged exposure therapy involves repeatedly talking through the trauma in a safe and controlled environment. This process helps individuals confront their fears and reduce avoidance behaviors, leading to symptom reduction.
Cognitive Processing Therapy (CPT): CPT is a form of cognitive behavioral therapy that is targeted at shifting the negative beliefs or "stuck points" that result from traumatic experiences using common CBT techniques.
Medication: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) are often prescribed to help manage PTSD symptoms. Other medications, such as mood stabilizers, anti-anxiety medications, and sleep aids, may also be used depending on the individual’s needs.
Group Therapy: Group therapy and support groups allow individuals to connect with others who have experienced similar traumas. Sharing experiences in a supportive environment can provide validation, reduce isolation, and promote healing.
It's important to note, that unlike other mental health conditions where medication is often viewed as a main treatment, psychotherapy is the primary treatment for PTSD with medications offering supplementary support. Treatment often involves trauma-focused psychotherapists and healthcare providers who can prescribe medication sharing health information and working together. Many healthcare professionals are able to recognize PTSD, but trauma-focused psychotherapists have dedicated themselves to providing specialized psychotherapy. Click here to learn more about PTSD treatment.
Recovery Rates for PTSD
Recovery from PTSD varies widely depending on factors such as the severity of symptoms, the type of trauma experienced, co-occurring disorders, and access to treatment. With appropriate treatment, many people experience significant symptom reduction and an improved quality of life.
Short-Term Treatment Outcomes: Research shows that approximately 50-70% of individuals who undergo trauma-focused therapies like TF-CBT, EMDR, or PE experience a significant reduction in PTSD symptoms within 12 to 16 weeks of treatment.
Long-Term Recovery: Long-term recovery rates can vary. Some individuals may achieve full remission, while others may continue to experience symptoms that fluctuate over time. Ongoing therapy, medication management, and support can help maintain recovery and prevent relapse.
Impact of Comorbidities: Individuals with co-occurring disorders (e.g., depression, anxiety, substance use disorders) may have a more challenging recovery trajectory. Integrated treatment approaches that address both PTSD and co-occurring disorders can lead to better outcomes.
Conclusion
PTSD is a complex and challenging condition, but recovery is possible with the right combination of evidence-based treatments and support. Understanding the symptoms, diagnostic criteria, prevalence, and effective PTSD treatments can empower individuals to seek the help they need and take steps toward healing and recovery. If you or a loved one is struggling with PTSD, reaching out for therapy can be a crucial first step on the path to recovery. I would be honored to assist you on the journey to healing. If you’re interested in learning more about how I can help you consider visiting my home page, therapeutic approach page, frequently asked questions, or learn about Eye Movement Desensitization and Reprocessing (EMDR) therapy by visiting my page on the neuroscience behind EMDR.
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Disclaimer: all references to medications are for educational purposes only and should not be taken as medical advice for the diagnosis or treatment of any disease or medical condition. Consult with a licensed prescriber to explore your options and receive personalized guidance.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
National Institute of Mental Health (NIMH). (2022). "Post-Traumatic Stress Disorder." NIMH Website.
U.S. Department of Veterans Affairs. (2021). PTSD: National Center for PTSD. VA Website.