Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.
Who gets PTSD
Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger. Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can also cause PTSD.
What are the signs and symptoms of PTSD
Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use or other illness.
The course of the disorder varies. Some people recover within 6 months, while others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders. To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms
Re-experiencing symptoms include:
• Experiencing flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
• Having recurring memories or dreams related to the event
• Having distressing thoughts
• Experiencing physical signs of stress
Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.
Avoidance symptoms include:
• Staying away from places, events, or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings related to the traumatic event
Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident.
Arousal and reactivity symptoms include:
• Being easily startled
• Feeling tense, on guard, or on edge
• Having difficulty concentrating
• Having difficulty falling asleep or staying asleep
• Feeling irritable and having angry or aggressive outbursts
• Engaging in risky, reckless, or destructive behaviour
Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.
Cognition and mood symptoms include:
• Having trouble remembering key features of the traumatic event
• Having negative thoughts about oneself or the world
• Having exaggerated feelings of blame directed toward oneself or others
• Having ongoing negative emotions, such as fear, anger, guilt, or shame
• Losing interest in enjoyable activities
• Having feelings of social isolation
• Having difficulty feeling positive emotions, such as happiness or satisfaction
Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead a person to feel detached from friends or family members.
What are the risk factors for PTSD
Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; others become important during and after a traumatic event. Risk factors that may increase the likelihood of developing PTSD include:
• Being exposed to previous traumatic experiences, particularly during childhood
• Getting hurt or seeing people hurt or killed
• 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 personal or family history of mental illness or substance use
Resilience factors that may reduce the likelihood of developing PTSD include:
• Seeking out support from friends, family, or support groups
• Learning to feel okay with one’s actions in response to a traumatic event
• Having a coping strategy for getting through and learning from the traumatic event
• Being prepared and able to respond to upsetting events as they occur, despite feeling fear
Treatment through Psychotherapy
Psychotherapy includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviours. Psychotherapy can provide support, education, and guidance to people with PTSD and their families.
Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.
One common type of psychotherapy, called cognitive behavioural therapy, can include exposure therapy and cognitive restructuring:
• Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
• Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened. They may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.