PTSD: What We Do and Don’t Know

April 19, 2021

A drawing of a young man who looks like her might have gone through something.
Reading Time: 8 minutes

PTSD, post-traumatic stress disorder, can cause upsetting/unwanted physical and emotional reactions in people who have experienced a frightening or unexpected event. Combat veterans and first responders are high-risk professions regarding PTSD; that said, people from all walks of life can develop a post-traumatic response, one that does or doesn’t interfere with daily functioning

Humans generally experience events in three stages:

  1. The event transpires
  2. You process the event, consciously and/or unconsciously
  3. You come to terms with the event through acceptance

Sometimes we experience something so horrific or stressful that our brains can’t make sense of what’s happened. Because we are unable to move through the second stage of processing, our brain can return us to the exact same emotional and physical state as when the traumatic event occurred, especially when triggered.

Factors that increase the likelihood of developing PTSD include inherited mental health risks, personality factors, and biological factors. The symptoms vary drastically from person to person. They can emerge soon after the traumatic event or years later. PTSD sufferers may try to hide their symptoms from close friends and family. They may not even share that they’ve suffered a traumatic event.

This guide will help PTSD patients and their families understand the disorder and what can be done to manage it.

What causes PTSD?

PTSD is a mental health condition and diagnosis resulting from a physically or emotionally damaging event or life situation. The triggering life situation needn’t be a specific event; the sudden death of a loved one could be a triggering event, and so could a long period of emotional abuse.

The event or situation does not cause PTSD. Two people who experience the same traumatic event both will not necessarily both develop clinical levels of stress surrounding it.

What are some risk factors of PTSD?

The National Institute of Mental Health has identified these risk factors for developing post-traumatic stress disorder:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse

Is PTSD a disability?

Yes, PTSD is considered a disabling condition by the Social Security Administration and by the United States Department of Veterans Affairs. Those living with PTSD who qualify, and have documented evidence of their condition, may be eligible for payment of disability benefits.

Getting disability benefits can be a long process, even if a patient meets all the criteria. Eligible patients are sometimes even rejected the first time they apply; still, if they keep trying, they may be able to get their benefits.

To receive Social Security Benefits, someone living with PTSD must meet these qualifications:

Medical Documentation of all of the following

  • Exposure to actual or threatened death, serious injury, or violence
  • Subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams, or flashbacks)
  • Avoidance of external reminders of the event
  • Disturbance in mood and behavior, and
  • Increases in arousal and reactivity (e.g., exaggerated startle response, sleep disturbance).

And

Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning

    • Understand, remember, or apply information
    • Interact with others
    • Concentrate, persist, or maintain pace
    • Adapt or manage oneself

Or

The disorder is persistent—you have a medically documented history going back at least two years that includes both treatment, therapy, or support.

You must also meet the marginal adjustment criteria—that is, have limited ability to deal with changes to your daily life (such as those that holding a job would require).

What are the criteria for a diagnosis of PTSD?

There are 20 criteria for a diagnosis of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V):

  • Intrusive distressing memories of the traumatic event
  • Nightmares about the traumatic event
  • Flashbacks, where the person feels that the event is occurring again
  • Strong emotional reactions when exposed to reminders of the event
  • Strong physical reactions when exposed to reminders of the event
  • Trying to avoid thinking about the event
  • Trying to avoid external reminders associated with the event
  • Amnesia regarding the event
  • Exaggerated negative beliefs about oneself, others, or the world
  • Distorted or exaggerated blaming of the event on oneself or others
  • Persistent negative emotions such as fear or anger
  • Diminished interest in socializing or other activities
  • Feelings of detachment from others
  • Inability to experience positive emotions
  • Irritable behavior and angry outbursts
  • Reckless or self-destructive behavior
  • Hypervigilance
  • Exaggerated startle response
  • Problems with concentration
  • Sleep disturbance

A patient doesn’t need to experience all of these symptoms in order to meet the criteria for PTSD.

What does a post-traumatic episode feel like?

There’s stress and then there’s panic, the same symptom amplified to a pathological level. Some people who suffer from PTSD experience panic attacks. These can include flashbacks to the traumatic event, or severe physical reactions.

How long does PTSD last?

PTSD was once considered a chronic disease and the treatment focused on treating the symptoms. Now, newer therapies—especially a category known as trauma-focused psychotherapies—help patients process the trauma they experienced and treat the root cause of the disorder.

The National Center for PTSD has been studying massed treatment, where twelve PTSD therapy sessions, which would normally take place over six weeks, is compressed into just five days.

Studies have shown that holding intensive sessions every day can be as effective as the typical weekly format, and may actually be more effective for some people.

“With massed treatment, a person commits to the five days, clears his or her schedule, and sees that the light at the end of the tunnel is within reach…From a clinical perspective, it is truly remarkable to watch recovery take place in just one week.” – Tara Galovski, PhD (Director of the National Center for PTSD’s Women’s Health Sciences Division)

While results like these are very encouraging, there is no way to accurately predict how fast someone will recover from PTSD. The most important thing in seeking treatment is to stick with it—without specific, stress-inducing expectations in mind.

A drawing of a young man who looks like her might have gone through something.

Untitled Portraiture by Alessia Avellino

Who’s most likely to suffer from PTSD?

Anyone who is likely to experience traumatic events is more likely to develop PTSD.

The disorder was first identified in Vietnam War combat veterans. In combat, after all, it’s possible to experience many of the risk factors listed above (dangerous events, getting hurt, seeing another person getting hurt, extreme fear) all in a single day or even within a few minutes.

As PTSD research became more prevalent, medical professionals began to understand that noncombat traumatizations can also trigger the disorder.

A 2013 study identified occupations that are high risk for PTSD.

  • Police officers
  • Firefighters
  • Ambulance personnel
  • Healthcare professionals
  • War correspondents
  • Employees at retail establishments at high risk of armed robbery

Women are more likely to be diagnosed with PTSD than men and no one can say exactly why. (APA) It may have to do with the nature of the trauma that women experience. For example, women are far more likely to experience sexual assault than men. (NAMI)

Can children suffer from PTSD?

Starting at around eight years of age, children who experience traumatic events show reactions similar to those of adults. (NCBI)

The latest edition of the DSM, which psychiatrists and some therapists use to diagnose PTSD, makes a distinction between people under the age of six and the rest of us.

For children younger than age six, the primary events that lead to PTSD include witnessing death, serious injury and sexual violation—something experienced, witnessed, or something discovered second-hand.

The diagnostic criteria for adults is slightly different: see ADAA.

Psychotherapy for PTSD

Psychotherapeutic treatment consists of meetings with a counselor, who will recommend a treatment plan for you. There are several strategic approaches to PTSD cases, but they share a common goal: to help the client successfully process/integrate/own the traumatic memory.

Many people experience traumatic events in their lifetime, but not all develop PTSD. It’s thought that these people are able to process and move past the traumatic experience without experiencing long-term stress symptoms, many with the help of psychotherapy supporting the natural healing process.

These are two of the most common treatment options for PTSD:

Cognitive Therapy or Cognitive Behavioral Therapy (CBT)

This form of therapy is very common and used to treat a range of mental and emotional problems. Fundamentally, CBT is about changing behavior. A patient and their therapist will discuss the traumatic event and the feelings that go with it, among other things. Then they will work on strategies to help the patient handle the negative feelings and thoughts. Practicing relaxation, coping, resilience, stress management, and assertiveness, the patient develops a toolkit that provides a better life.

Exposure Therapy

Exposure therapy helps patients safely re-experience their stressors, elements that trigger traumatic memories. The goal is to learn how to cope with these memories effectively. Exposure therapy is often used in conjunction with cognitive behavioral therapy for patients who experience flashbacks or nightmares.

Since the early 2000s, virtual reality simulation technology has been used in exposure therapy. Some researchers find it to be transformative technology in the treatment of PTSD:

“Clinicians can now create simulated environments that mimic the outside world and use them…to immerse patients in simulations that support the aims and mechanics of a specific assessment or therapeutic approach.” (USC)

Medication for PTSD

A class of medications called selective serotonin reuptake inhibitors (SSRIs), aka antidepressants, are the most common drugs used to treat PTSD patients. Some of the well-known brands include Zoloft and Paxil, both of which have been shown in clinical trials to improve outcomes for PTSD patients.

A drug called Prazosin, which was designed to treat high blood pressure, has been shown in some studies to lessen nightmares and flashbacks in PTSD patients. However, the results of a large clinical trial released in 2018 showed that Prazosin to be no more effective than a placebo.

PTSD is rarely treated with medication alone because medication only addresses the symptoms of PTSD, and not the root cause. Medical experts believe that successful psychotherapy is the best path to long-term recovery for PTSD patients.

How to Help Someone with PTSD

You’re doing it now. Just by reading this guide, you’ve made an important positive step toward helping someone with PTSD. Learn as much as you can about the disorder to help you understand what they are going through, and be an informed resource as they make treatment decisions.

The National Center for PTSD suggests these other important ways to support a friend or family member:

  • Assist with their care. Offer to accompany them to doctor visits, and help them track medicines they need to take and upcoming appointments.
  • Be a listener. Tell them you want to hear what they have to say. If they don’t want to talk, that’s okay too.
  • Plan social activities outside the home with friends and family that the person will enjoy.
  • Suggest physical activities you can do together, like taking a walk.
  • Encourage the person to speak to other close family members and friends.
  • Take care of your own mental health by reaching out for support if you need it, from a therapist or support group perhaps.

What should you not do?

Here are some behaviors to avoid when helping support someone with PTSD:

  • Don’t interrupt the person when they are talking about how they feel.
  • Don’t criticize them (or let them get away with criticizing you).
  • Avoid blame and negative talk. Staying away from these behaviors is a key part of healing from PTSD.
  • Don’t give advice unless the person asks for it.
  • Don’t feel bad or guilty if things don’t seem to be going well.
  • Don’t give up your outside friends and interests.

Get help with PTSD right now.

If you start to feel overwhelmed, call the U.S. Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-HELP (4357). They get nearly 1 million calls per year from people seeking treatment for mental health or substance abuse issues, and can refer you to a local provider who can help. Another option for military families is the Veterans Crisis Line at 1-800-273-8255 (press 1). There is also a chat and text option. Both of these services are available 24/7, and are completely confidential.

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Karla Leopold
2 months ago

Great article! Very informative and accurate. It would be wonderful if people would read this, share it and post it on appropriate walls. Thank you for writing this.

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