Post-Traumatic Stress Disorder: Symptoms, Causes, & Treatment

What Is PTSD?

Post-traumatic stress disorder is a condition brought on by an exposure to a traumatic, threatening, or dangerous life situation. The person can witness the events directly, see them happen to others, or hear about tragic events happening to loved ones.

After the events, PTSD creates a powerful range of unwanted symptoms that affect one’s thoughts, behavior, comfort levels, and moods. Symptoms may appear all at once for some while others experience the five stages of PTSD one at a time. PTSD can impact all aspects of your life and severely damage your daily functioning.

How Common Is PTSD?

Here are some recent statistics on the prevalence of PTSD:^1,6

• Approximately 8 out of every 100 people will have PTSD at some point in their lifetime.
• Approximately 8 million adults have PTSD during a given year.
• About 10% of women will develop PTSD during their lifetime compared to approximately 4% of men who will develop PTSD during their lifetime.
• Prevalence rates tend to be higher among LGBTQ+ individuals. Rates of PTSD in this group could be as high as 47.6%

PTSD Symptoms

PTSD symptoms can severely impact someone’s wellbeing. Traumatic events can hijack emotions, thoughts, and behaviors which, in turn, impacts self-esteem, relationships with others, and possibly the ability to live up to one’s potential. All genders and ages are susceptible to suffering from PTSD. While symptoms can vary from person to person, there are some common social and psychological symptoms that disrupt daily living.

Intrusive Memories & Reliving the Trauma

People diagnosed with PTSD experience recurrent, involuntary, and intrusive thoughts of the trauma experience(s), regardless of their attempts at avoidance or distraction.

Hypervigilance

Those with PTSD also tend to have a heightened, often exaggerated, sensitivity to potential threats. This results in exaggerated reactivity to perceived threats, difficulties with memory, inability to focus, difficulty sleeping, or even a sense of detachment from the world around them, which creates professional and social difficulty and leads to a heightened cycle of isolation.

Avoidance

People with PTSD could go out of their way to avoid any reminders of the trauma. This could include avoiding people, places, situations, and anything else connected to the trauma. Depending on how widespread the avoidance coping is, a person could avoid entire sections of town or certain types of weather to limit exposure to the trauma.

Negative Changes in Thinking & Mood

Encroachment of negative thoughts and feelings can unexpectedly arise at any time without warning. Individuals who develop PTSD often exhibit characteristics such as depression, a sense of unease, blunted affect, anger, aggression, hyper-independence, or dissociation from emotions. Individuals with PTSD can also struggle with maintaining positive self-concept and may carry the belief they are “damaged” or “will never be able to fit in.” Also, people living with PTSD are at higher risk for reckless behavior, suicide attempts, and other difficulties, such as adjustment disorder, anxiety, major depression, conduct disorders, and substance use.

Physical Symptoms

For the person with PTSD, the body is hypervigilant in perceiving danger. For example, a trauma trigger such as an unexpected loud noise, a certain smell, a tone of voice, or a facial expression might trigger the body’s response system to signal danger. An individual without PTSD will hear a startling noise, become alert, figure out what made the noise and will then return back to what they were doing. In contrast, the person affected by PTSD will hear the noise, but instead of simply becoming alert, their fight, flight, or freeze survival response will kick in and the body will elicit a trauma response, blocking the brain from a quick recovery.

PTSD Symptoms in Women

Women and men will experience similar symptoms of PTSD, but women may display them differently. Women may become more isolated and present with sadness. They may blame themselves and show an exaggerated startle reaction.

PTSD Symptoms in Men

Men could show more anger, aggression, and violence as a response to PTSD symptoms. They could become more reckless and destructive as a response to the condition. Men may also turn towards alcohol and other drugs as a way to self-medicate and conceal the symptoms of their PTSD.

Signs of PTSD to Watch For

Signs of PTSD could present all at once or slowly and overtime. People may notice these changes from a loved one’s normal functioning, or they could be hidden and kept secret.

Some of the most common signs of PTSD to watch for include:

• Major changes to sleep, diet, or relationship patterns
• Appearing secretive or changing plans
• Missing work or not following through with commitments
• Significant mood swings
• Being unable or unwilling to explain their thoughts and feelings
• Increased nightmares or trying to avoid sleep
• An inability to trust others

What Causes PTSD?

If two people are exposed to the same trauma, one could have severe PTSD and the other could be fine. It can be challenging to know or accurately predict who will and who will not have symptoms.

Certainly the traumatic event is the root cause of PTSD, so limiting a person’s exposure to trauma, especially repeated trauma, can dramatically improve their ability to avoid PTSD.

Risk Factors for Developing PTSD

The risk factors for developing PTSD are separated into three groups: Pretraumatic, peritraumatic, and posttraumatic.

Pretraumatic factors include:

• The person’s temperament and how they respond to stress
• Environmental issues, like their childhood, culture, and social support
• Genetic issues, like family history of mental health conditions

Peritraumatic factors include:

• The severity of the trauma
• What or who caused it
• If dissociation was present

Posttraumatic factors include:

• The person’s use of coping skills
• The feedback and changes in the environment following the events

What Reduces the Risk?

All traumas are challenging to manage. However, a single, random trauma of low magnitude will be much easier to manage than repeated, intentional traumas perpetrated by a loved one or caregiver.

Protective factors can help reduce the risk of PTSD. When a person has a limited mental health history, supportive loved ones, and access to healthy coping skills, they are in a better position to experience fewer consequences from the events.

Types of PTSD

Though there may be some information that separates PTSD into different categories, there is only one recognized form of PTSD. At times, professionals may use terms like complex PTSD or uncomplicated PTSD, but these conditions are all on the same PTSD spectrum with slight differences.

Related Conditions

Several recognized mental health conditions share a connection to PTSD:

• Acute Stress Disorder: PTSD symptoms that only last for up to 30 days after the traumatic event. Any longer and the condition becomes PTSD.
• Adjustment Disorder: A person, especially a child, who does not meet the full definition of PTSD may receive an adjustment disorder diagnosis.
• Disinhibited Social Engagement Disorder (DSED): A condition arising from childhood trauma in the form of neglect, DSED is marked by impulsivity and frequent interactions with unfamiliar people.
• Reactive Attachment Disorder (RAD): Also stemming from neglect, RAD involves a child who is withdrawn from adults.

Getting a PTSD Diagnosis

To be diagnosed with PTSD, symptoms should appear within three months of the experienced trauma. In some cases, there may be a delayed expression of symptoms that can delay meeting the criteria to receive a PTSD diagnosis. Symptoms of PTSD may occur for as little as three months or through the duration of one’s life. It is not fully understood why some individuals recover from PTSD quicker and more successfully than others, though recovery from PTSD is likely due to a number of factors, such as effectiveness of medications, quality of therapeutic interventions, life stressors, and the balance of risk and protective factors.

According to the DSM-5, assessment criteria for PTSD includes exposure to stressor(s) or traumatic events, as well occurrence of intrusive symptoms, such as avoidance, persistent negative thoughts and feelings, PTSD hyperarousal, and reactivity. To meet diagnosis criteria, symptoms must last one month or longer and cause distress or functional impairment related to the trauma. In addition, symptoms should not be due to other influencing factors, such as substance abuse or other non-trauma related mental illness. Because PTSD tends to be complex, treatment is typically needed in order to achieve recovery from intrusive trauma-related symptoms.

Some people with PTSD will quality for disability benefits. The Social Security Administration criteria for receiving disability benefits include having documentation of the diagnosis, limitations in functioning, and a significant impact on daily life.

PTSD Treatment

The most effective treatment for PTSD is a combination of medication and individual counseling. The effects of PTSD vary person to person; therefore, the treatment options— or combination of treatment options—should also be tailored to the person. Because treatment for PTSD can be complex, it is imperative that someone suffering from PTSD seek treatment from a professional mental health provider (e.g., counselor, psychologist, or social worker) who is experienced in treating trauma-related conditions. There can be some trial and error in finding the right combination of treatment methods, so individuals being treated for PTSD have an increased need for mental health support to determine the most suitable treatment.

Psychotherapy

All treatment begins with developing a safe and trusting relationship with the mental health (MH) provider. The therapist begins the counseling process by learning more about who the individual is and what they seek to achieve through counseling. These factors can help distinguish what type of therapeutic methods are most appropriate for the individual.

Therapists trained in trauma-informed practices take precautions to ensure a safe and protective relationship that progresses at the client’s ability level. This method is especially important when working with those impacted by PTSD in efforts to prevent re-traumatization.

• Prolonged Exposure (PE): PE helps clients become able to talk about their trauma in order to manage intrusive and unwanted emotions. By repeatedly talking about aspects of the trauma memories, PE helps clients gain control over their thoughts until thoughts are no longer intrusive.
• Cognitive Processing Therapy (CPT): CPT is a type of cognitive trauma-focused therapy based on understanding how trauma impacts thoughts and feelings with the objective of teaching clients to reframe negative thoughts about trauma experiences.
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): TF-CBT is designed to help children and adolescents with PTSD heal. Key to TF-CBT is a safe, collaborative relationship between the child/adolescent, the parent/guardian(s), and the mental health provider.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR for PTSD involves asking the client to think about upsetting feelings from certain memories while engaging in the EMDR process of focusing on external stimuli and eye movement exercises. EMDR has the ability to help the client rapidly treat repressed memories from the trauma.
• Narrative Exposure Therapy (NET): This form of narrative therapy asks clients to recount life events, but in a way that brings into focus aspects of positive thoughts of self and acknowledgement of human rights. NET is often utilized in small groups or individually.

It should be noted that some, but not all, trauma-focused psychotherapy methods ask clients to talk about the trauma event, but the individual has decision-making power of discussing the trauma at his or her comfort level. Many of the cognitive behavioral techniques do not require conjuring memories of the traumas; rather, they focus on reframing thoughts surrounding the trauma in order to bring about an empowered sense of self.

Medication

Medications often first used to treat PTSD are in the category of selective serotonin reuptake inhibitors (SSRIs). These medications help manage symptoms of anxiety and depression. SSRIs are recognized as effective medications to aid in relief from mood and anxiety disorders. SSRIs are not safe for everyone, especially when there are co-occurring disorders that require medications which might interact adversely with other medications.⁴ There are other types of antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics that will also sometimes be tried for PTSD. These medications are usually selected to try to target a specific symptom of a patient with PTSD.

People seeking medication should consult with their primary care physician or a psychiatrist who specializes in medications for treatment of psychiatric disorders.

Intended Treatment Outcome and Timeline

The ultimate goal of treatment for Post-Traumatic Stress Disorder is to reduce the overall frequency, intensity, and severity of symptoms related to PTSD so that one’s daily function is not impaired. Clinicians who provide treatment for PTSD indicate the goal is not to remove memories or to make life perfect; rather, the goal of treatment is to make the symptoms and memories related to PTSD to become bearable and manageable.

Getting Help for Post-Traumatic Stress Disorder

If symptoms related to a traumatic event impact your ability to live an active life, it is imperative to seek out help from a mental health provider. A natural first step is to visit a primary care doctor to assess the symptoms to ensure that what you are experiencing is not a physical or medical illness. Once physical causes of the symptoms are addressed, you should seek out services from a mental health provider. Many primary care doctors can provide contact information for mental health providers.

When looking for a mental health provider for treatment of PTSD, take your time and seek out someone who has the expertise in trauma-informed care. You may research mental health providers by using an online therapist directory, getting a list of providers from your insurance company, getting a referral from your primary care doctor, and/or getting a recommendation from a colleague, friend, or family member.

The following are essential considerations when finding a medical professional to treat PTSD:

• They are accepting new patients
• They take your insurance plan or offer an affordable cash rate
• They have availability on days that you are available
• They meet your guidelines of characteristics to feel safe and comfortable
• They hold expertise in the area of concern in which you are seeking treatment

How to Cope With PTSD

People who are diagnosed with Post-Traumatic Stress Disorder are able to live fulfilling lives. However, it is imperative to seek out professional treatment. Every person is different when dealing with PTSD, so everyone’s management strategies will vary.

Strategies that can be considered when coping with symptoms of PTSD include:

• Seek professional treatment and consider therapy, medication, and lifestyle changes along the way to help with symptoms related to PTSD
• Build an effective support system that includes people who can support you through this journey, such as your mental health provider, psychiatrist, family, and friends
• Avoid using substances and other negative coping strategies to self-soothe or self-medicate
• Get enough rest— at least 8 hours of sleep a night
• Decrease caffeine intake
• Practice self-care techniques when feeling overwhelmed (e.g., get a massage, positive self-talk, taking a walk, etc.)
• Identify triggers that may cause stress and develop emotion regulation techniques
• Practice relaxation techniques (e.g., deep breathing, prayer, meditation, or yoga)
• Eat a balanced diet
• Incorporate exercise into an everyday routine
• Practice reframing negative thoughts as they come up

Complications of PTSD

Post-Traumatic Stress Disorder can also present with a number of other mental health diagnoses, like depressive disorders, substance use disorders, and other anxiety disorders. Therefore, it is essential for a person who has been exposed to traumatic experiences to seek professional mental health support. During the initial assessment, it is important to share information that will allow the mental health provider to do a thorough evaluation to identify the actual diagnosis and co-occurring disorders that may be present. Once the mental health provider has assessed the client, a treatment plan can effectively be created to help support the client in treatment.

Outlook for Those With PTSD

PTSD is a challenging disorder to treat, but there is always the opportunity for progress. When a person receives professional mental health care, the ability to manage symptoms and maintain a healthy lifestyle is completely possible. Due to the seriousness of PTSD, though, people should never try to treat the conditions themselves. Symptoms are not likely to improve independently.

Can PTSD Be Prevented?

There is no way to prevent PTSD with certainty. There is never a way to guarantee an avoidance of traumatic people or situations. The best people can do is recognize the impact of the events and seek professional mental health care as symptoms arise. Waiting too long can really complicate treatment.

Living With Someone Who Has PTSD

PTSD is a trying condition, and living with someone who has PTSD can be complicated as well. To best support and encourage your loved one:

• Become educated about the condition
• Be open to talking about the situation whenever needed
• Offer space and time whenever needed
• Encourage and assist in scheduling and keeping therapy appointments
• Work to emphasize the need for healthy diet, sleep, and physical activity
• Consider attending treatment yourself to learn better ways to assist your loved one

How to Get Help for a Loved One with Post-Traumatic Stress Disorder

While no one has all of the answers, there are things you can do to help a loved one impacted by PTSD. In addition to connecting yourself and the individual suffering from PTSD with crucial, life-saving mental health resources, the following tips are essential for individuals looking to help anyone affected by PTSD:

• Accompany your loved one to doctor’s visits
• Encourage your loved one to maintain prescribed medications and counseling appointments
• Show unconditional positive regard, compassion, and listening
• Avoid giving advice or making judgments
• Plan activities with your loved one
• Give space if needed
• Practice self-care and maintain boundaries that are healthy for you
• Don’t push them to tell you about their trauma
• If a veteran with PTSD, contact the Veterans Crisis Line at 1-800-273-8255
• For emergency situations, call 911, as well as the Suicide Prevention Lifeline at 1-800-273-8255.

How to Get Help for a Child with Post-Traumatic Stress Disorder

Treatment for children with PTSD includes cognitive behavioral techniques, particularly trauma- focused cognitive behavior therapy, in addition to techniques developmentally appropriate for children and adolescents. Additional therapies developed specifically for children as young as three who have experienced trauma include the Oaklander Model of Play Therapy and Theraplay. Similar to EMDR, these models require therapists to seek additional training and certification.

There are many situations that can impact how a child responds to a traumatic event. If a child has experienced trauma, it is important to not only get the child assessed by a mental health provider, but to also work collaboratively with teachers who are with the child, so the right services can be provided. Children who have experienced trauma have higher rates of success when schools adopt trauma-sensitive practices and intentionally develop teacher-student and student-student relationships that are safe, trustworthy, and foster a sense of connectedness.

It is additionally important that classroom curriculum teaches students vocabulary for emotional expression and how to regulate one’s emotions independently or by seeking help. Many schools adopt the trauma-sensitive practice of providing access to self-directed calming spaces in the classroom, known as Calming Corners and Safe Spaces.

PTSD Screening, Tests, & Self-Assessment Tools

While individuals cannot self-diagnose PTSD, it is important to be mindful of available resources that assist with identifying signs and symptoms. These should not be a substitute for professional help or a clinical diagnosis, but may be useful for those looking for more information.

Resources where you can learn more about symptoms of PTSD include:

• Mental Health America provides a screening tool for PTSD
• The National Center of PTSD provides some useful information on screening tools
• The National Association of Mental Illness provides information, resources, and advice for identifying, treating, and living with PTSD
• The American Psychiatric Association provides great resources to loved ones affected by PTSD
• The PTSD Alliance has various materials to support people who have PTSD

Remember, while these resources and assessment tools may be helpful in identifying signs and symptoms, they are not reliable tools for diagnosing Post-Traumatic Stress Disorder. If you or someone you know is concerned about Post-Traumatic Stress Disorder, seeking professional help from a mental health provider is highly recommended. Licensed professional counselors, social workers, psychologists, or psychiatric medication prescribers are able to determine whether a person is experiencing Post-Traumatic Stress Disorder and also help the person understand this disorder and their options for treatment.