What Are the Different Types of PTSD?

What Is PTSD?

PTSD can occur following someone experiencing, witnessing, learning about, or repeated exposure to a traumatic, violent, or potentially harmful event. To be diagnosed with PTSD, individuals will be experiencing symptoms of an abnormal stress response that must occur for longer than a month. These symptoms are similar to an acute stress disorder. Still, they have much more intensity which prevents them from being able to interact with the world around them and significantly impacting people’s lives.¹

Symptoms of PTSD include intrusive memories, dreams, or thoughts about the event, flashbacks, adverse reactions to similar events as the trauma changes or lack of memory surrounding the event, negative changes in beliefs or moods, and significant changes in new behavior such as avoidance coping.

Some of the different types of PTSD include:

Uncomplicated PTSD

While multiple traumatic events or stressors can influence PTSD, uncomplicated PTSD is a disorder impacted by a single traumatic event. Uncomplicated PTSD generally means no other co-existing mental health conditions such as depression or substance abuse.

Symptoms of Uncomplicated PTSD include:

• Intrusive Thoughts
• Avoidance Behaviors
• Disruptive Mood Changes
• Changed in Cognitive Processing
• Slowed Reaction Time

Example of Uncomplicated PTSD

Uncomplicated PTSD typically develops from a single traumatic event, like a major car accident, where concussions and totaled cars can be grim reminders of what could have happened. People might begin to experience intrusive thoughts multiple times a week, even when they try to avoid thinking about them.

Family and friends may have noticed increased irritability and are easily overwhelmed in loud spaces, becoming moody with them, especially while driving. These mood changes can begin to strain multiple relationships and significantly impact your ability to navigate daily living activities.

Uncomplicated PTSD behaviors after a car accident could include:

• Taking significantly longer routes to avoid the site of the crash
• Driving much slower doesn’t as you can’t react to light changes on the road as quickly
• Easily snapping on friends and family when stressed by the environment

Treatment for Uncomplicated PTSD

Treatment can include cognitive therapy to develop relaxation strategies to reduce  anxiety. Another common approach is exposure therapy. This technique includes exposing oneself to reminders of the trauma in the therapist’s office and then safely working on managing the anxiety responses. Additional communication skills to better share complicated or unexplainable feelings can help prevent emotional outbursts with close ones.

This treatment can be done as an individual or in group therapy. Some psychotropic medications can target specific bothersome symptoms of PTSD, independently or together with therapy sessions.⁴

Dissociative PTSD

Dissociative-type PTSD is not a principal diagnosis, but it is still vital in considering an individual’s potential experience and response to treatment of the disorder. This type of PTSD affects individuals as they also experience continuous or repeated symptoms of dissociation in addition to the primary symptoms of PTSD.¹ It is important to note that these symptoms cannot be diagnosed as part of  PTSD if they are due to the influence of substances or physical health issues.

PTSD Dissociation symptoms include:¹

• Depersonalization: feeling detached from one’s body or mind to the extent of feeling they are observing themselves.
• Derealization: one’s sense that their environment or world feels unreal, disconnected, or even dreamlike.

What Does Dissociative PTSD Look Like?

This type of PTSD is common for those who have experienced significant abuse from family or childhood trauma. If untreated, dissociation can lead to a lifetime of lapses in attention and focus, making it difficult for employers, significant others, and friends to interact with them, potentially damaging their access to available support systems.

Treatment for Dissociative PTSD

Due to the inability to fully engage with your surroundings in dissociative PTSD, a therapist will likely not engage in exposure therapy, based on research published in 2018.² Instead, they may begin with trauma work which can include writing a trauma timeline and exploring negative beliefs that an abusive past may have influenced.³ Psychiatrists who prescribe medication to decrease the severity of dissociation may also help develop grounding techniques to stabilize and bring them back to the present when detachment impairs someone at work, driving, or in general.

Complex PTSD

Complex PTSD (CPTSD) is influenced by multiple traumatic events, including repeated traumas of the same type or separate encounters, and is considered the most severe type.^4,6 Individuals who experience CPTSD may experience PTSD symptoms with more intensity and impairment in their lives with a wide range of anti-social and aggressive behavioral changes.

Some of the symptoms of Complex PTSD include:^4,6

• Verbal or physical aggression
• Impulsive behaviors (sexual and physical, among others)
• Significant mood swings

Those with CPTSD are commonly misdiagnosed to start due to the severity of their symptoms, branching out into criteria seen in other behavioral and mood disorders.

Examples of misdiagnosed disorders associated with Complex PTSD include:⁴

• Borderline Personality Disorder (BPD)
• Impulsive Borderline Personality Disorder (IBPD)
• Antisocial Personality Disorder
• Dissociative Disorders
• Bipolar Disorder

What Does Complex PTSD Look Like?

Sometimes those who face multiple types of abuse from their families cannot entirely remove themselves even after moving out on their own. The child might still be a part of the support networks of their abusers and might still be contacted by them, even when they have expressed wishes to no longer be and continue to put them through emotional abuse. Those with complex PTSD have a higher rate of hospitalization due to actions of self-harm.

It can be challenging to identify and process complex trauma’s impact on someone’s self-worth and self-esteem, leading to impulsivity and destructive thought processes. The additional potential for misdiagnoses with complex PTSD can make finding successful solutions challenging, leading to the heightened stress response when others close to them address that they have a problem.

Treatment for Complex PTSD

Four steps to take when treating complex PTSD are:³

• Coordinate with a psychiatrist to explore medications that could lower feelings of anxiety, irritability, and related depression that can lead to self-harm,
• Develop a safety plan to remove someone from re-occurring trauma, such as establishing no contact with abusive family
• Create a healthy support system to help them learn a better way of communicating needs instead of verbal aggression.
• See a therapist semi-regularly and attend group sessions monthly to ensure consistent management of impulsive behaviors.

Comorbid PTSD

Comorbid PTSD is when individuals experience PTSD with the addition of other co-occurring disorders related to trauma that exist outside of a PTSD diagnosis. It is not uncommon to experience comorbid conditions when diagnosed with a mental illness, especially with PTSD.^4,7

Common co-occurring disorders diagnosed with PTSD include:^4,7

• Substance Use Disorders
• Major Depressive Disorder
• Anxiety Disorders (i.e., Generalized Anxiety Disorder or Social Anxiety Disorder)
• Specific Phobias

Example of Comorbid PTSD

Many veterans returning from combat deployment have family members and friends that observe significant comorbid PTSD symptoms with other disorders such as major depression and substance use disorders.

Without treatment, comorbid PTSD can make it impossible for some veterans to maintain employment, even when working with other veterans who may also be managing their PTSD.

Treatment for Comorbid PTSD

Treatment for this type involves having a multi-disciplinary care team to tackle managing multiple diagnoses of co-occurring disorders simultaneously.

The order for treating comorbid PTSD disorders typically follows:⁸

• Receiving substance treatment to ensure they can be sober and engage with working with an individual therapist.
• Starting prolonged exposure therapy to decrease hypervigilance, anxiety levels, and anger reactions to reminiscent situations of trauma, such as combat and military life.
• Engaging in cognitive therapies to process the negative thoughts and beliefs that influence symptoms of depression or other co-occurring mood disorders.

Do You Think You Might Have PTSD?

Experiencing PTSD can be frustrating and overwhelming, especially if you don’t know why you are experiencing these symptoms. PTSD is a response to significant trauma. The constant need to avoid the challenging emotions surrounding facets of the trauma and the intrusion of PTSD symptoms can significantly impact and impair your quality of life.

Signs that you might have developed symptoms of PTSD include: ¹

• Experiencing, witnessing, or learning about a violent, harmful, or potentially fatal experience, either once or repeatedly.
• Continuous and unwanted intrusive thoughts, memories, and dreams of your trauma.
• Moments where you feel or act like you are in a traumatic event again (also called flashbacks).
• Experiencing emotional, cognitive, or physical reactions to reminders of your trauma.
• Finding yourself avoiding thoughts, memories, feelings, areas, people, or other things that remind you of the trauma.
• Significant changes in your thoughts and moods, especially with changed and negative beliefs about the world, yourself, or others following traumatic experiences.
• Experiencing negative self-talk or inability to feel happiness or positive emotions.
• Irritable and angry feelings or aggressive behaviors and outbursts.
• Self-harm or reckless behavior than begins following a trauma.
• Hypervigilance and jumping at things (sounds, people, areas) that did not startle you in the past.
• Difficulty concentrating.
• Insomnia due to dreams and thoughts of trauma.

Normal Stress Response vs. PTSD

While PTSD symptoms can occur following experiences of trauma, the development of a full-fledged disorder does not always happen. It can be more common to experience a normal stress response when trauma occurs.⁵ Most things that cause life stressors, such as illness, accidents, or surgeries, can influence or trigger a stress response.⁴

Symptoms of a normal stress response include:

• Fearfulness
• Sadness
• Relief
• Anger
• Frequently thinking about the traumatic event
• Jumpiness or sweating
• Difficulty concentrating
• Falling out of a regular self-care routine
• Insomnia
• Feeling detached from others.

Experiencing a normal stress response after trauma can be difficult, and recovery from these symptoms is possible, especially when not experiencing legitimate PTSD. These symptoms differ from PTSD symptoms as they should start to dissipate after several weeks.^4,5 It is essential to manage our stress response to prevent toxic stress by developing healthy stress management tools.

Acute Stress Disorder vs. PTSD

Acute Stress Disorder and PTSD are not as different as they may appear. Specialists will generally diagnose both disorders following a traumatic event or stressor. Additionally, they are diagnosed within the same age range and share identical symptoms. Even though both disorders occur following a traumatic event, they differ in their timeline of symptom longevity.

Therapists can not diagnose an acute stress disorder vs. PTSD until an individual has experienced PTSD-like symptoms for at least three days. These symptoms should begin to decrease or stop around 30 days. Suppose these symptoms continue to occur regularly after a month with no decrease. In that case, a full-fledged PTSD diagnosis is then appropriate. It is estimated that half of the population of individuals diagnosed with PTSD initially were observed to be having symptoms of an acute stress disorder.¹

How Is PTSD Treated?

Although it may seem overwhelming to find, help is available for those experiencing challenges in their life due to PTSD. You can find PTSD treatment for symptoms with either therapy, psychotropic medications, or both. Psychotherapy is considered an effective intervention for those struggling with PTSD symptoms, with a culmination of the group and individual therapy options available.^6,9

Therapy for PTSD

The most common therapy types to treat PTSD include:^6,10,11

• Cognitive Behavioral Therapy (CBT)
• Trauma-Focused CBT (TF-CBT)
• Exposure Therapies
• Cognitive Processing Therapy (CPT)
• Eye Movement Desensitization & Reprocessing Therapy (EMDR)
• Hypnosis

Medication for PTSD

In addition to individual and group therapy, doctors can provide PTSD medication treatment. Medications may treat not only PTSD symptoms but also related symptoms, including depression or sleep issues. Antidepressants are more common for treatment, especially.

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors).^6,11 However, you should talk to your doctor to explore what may work best for you.

Well-known antidepressants used in PTSD treatment include:^6,11

• Zoloft
• Paxil
• Prozac
• Amitriptyline
• Effexor

Less common medications to treat PTSD-related symptoms include:^6,11

• Remeron (Mirtazapine)
• Serzone
• Tofranil
• Nardil

*These medications have a black box warning, the most severe warning from the FDA for the risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Where to Get Help

Treatment options are available to help with PTSD and related symptoms. However, it may be challenging to know how to start. Finding help can begin with locating a therapist and meeting with a primary care doctor. Locating a therapist can sound stressful, especially when you or a loved one may be dealing with the symptoms above, but it is possible to attain post-traumatic growth!

You can begin the search by locating a therapist (LPC, LPCC, LSW, LISW), psychologist (Ph. D.), or psychiatrist (M.D.) who may be able to work with trauma-focused issues and see if you are a good fit. Choosing Therapy’s online directory, where you can filter for specific preferences on demographic, cost, specialty, and cost, can help you gain all the information you may need to help you choose a therapist initially. You can also research online psychiatrist options to find a psychiatrist who can assist you with finding medications that are right for you.

Questions to Ask Your Care Team

In addition to therapy, reaching out to your primary care doctor for therapy referrals and exploring medication options can be helpful. Although it does sound daunting, there are options for PTSD treatment that can reduce the impact of PTSD symptoms on your or a loved one’s life.

Essential questions to ask your care team include:

1. How can I tell if I have complex vs. uncomplicated PTSD?
2. How does it treat PTSD and my related symptoms?
3. How might PTSD medication affect me physically and mentally?
4. Are there potential food or substance interactions I should avoid if I have PTSD?
5. What are the best combinations of psychotherapy and medication for my type of PTSD?
6. Can my prolonged stress turn into PTSD?

Final Thoughts

PTSD is a trauma-based disorder that can significantly impact your life on many levels. This can be difficult to cope with and adjust to daily life. However, you or your loved one are not alone in this. Many people experience PTSD due to traumatic events in their life and have found ways to cope, meet their needs, and return to their quality of life. Help does exist, and it may help you or your loved one in treating these symptoms and finding a way to process and live with PTSD.