What is Post-Traumatic Stress Disorder (PTSD)?
PTSD, or Post-Traumatic Stress Disorder, is a mental health condition that can develop after someone experiences or witnesses a traumatic event. Traumatic events can include things like combat, sexual or physical assault, a serious accident, natural disasters, or any other situation that involves a significant threat to one's safety or well-being.
People with PTSD often experience a range of symptoms that can include intrusive thoughts or memories about the traumatic event, nightmares or flashbacks, feelings of intense fear or anxiety, difficulty sleeping, and avoidance of people, places, or things that remind them of the trauma. These symptoms can be very distressing and can significantly impact a person's ability to function in their daily life.
The history of PTSD dates back to ancient times, with accounts of soldiers experiencing psychological distress after battle found in ancient Greek and Roman texts. However, it wasn't until the 20th century that PTSD began to be studied and recognized as a distinct mental health condition.
During World War I, soldiers who experienced "shell shock" (the term for PTSD sufferers at the time) were often dismissed as being weak or cowardly. However, after the war, medical professionals began to recognize that these soldiers were experiencing very real symptoms of psychological trauma. Similar patterns were observed during World War II, where soldiers who experienced combat-related trauma were often diagnosed with "combat fatigue" or "battle neurosis".
It wasn't until the Vietnam War, however, that PTSD began to be formally recognized as a mental health diagnosis. In the years following the war, many Vietnam veterans experienced a range of psychological symptoms that were later identified as PTSD. These symptoms included nightmares, flashbacks, avoidance behaviors, and an overall state of hyperarousal.
In 1980, the American Psychiatric Association officially recognized PTSD as a diagnosis in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This recognition was a significant milestone in the history of PTSD, as it helped to increase awareness of the condition and improve access to treatment for those who were affected.
What are the symptoms of PTSD?
The symptoms of PTSD can be broken down into four main categories: intrusive thoughts and memories, avoidance, negative changes in mood and thinking, and changes in physical and emotional reactions. It's important to note that not everyone with PTSD will experience all of these symptoms, and the severity and duration of symptoms can vary widely from person to person.
Intrusive thoughts and memories:
- Recurrent, unwanted distressing memories of the traumatic event
- Nightmares or flashbacks that may feel like reliving the traumatic event
- Intense psychological distress or physiological reactivity when exposed to reminders of the traumatic event
- Avoiding or attempting to avoid anything that reminds the person of the traumatic event, including people, places, or activities
- Efforts to avoid thoughts or feelings associated with the traumatic event
- Feelings of detachment or estrangement from others
Negative changes in mood and thinking:
- Negative thoughts or feelings about oneself, others, or the world
- Feelings of hopelessness or a bleak outlook on the future
- Difficulty experiencing positive emotions
- Decreased interest in activities that used to be enjoyable
- Memory problems or difficulty concentrating
Changes in physical and emotional reactions:
- Hypervigilance or feeling "on edge" or jumpy
- Difficulty sleeping, including trouble falling or staying asleep, nightmares, or restless sleep
- Angry outbursts, irritability, or aggressive behavior
- Self-destructive or reckless behavior
- Physiological reactivity when exposed to triggers that remind the person of the traumatic event, such as a rapid heart rate, sweating, or trembling
It's important to note that these symptoms can occur in response to a range of traumatic events. They may also occur months or even years after the traumatic event occurred. In my case, I recall expressing some of these symptoms as a child shortly after my mom passed away. However, another wave of more intense symptoms presented themselves when I was 27 years old, approximately 17 years after my mom died.
How is PTSD diagnosed?
The diagnosis of PTSD typically involves a thorough evaluation of a person's symptoms and medical history. A mental health professional, such as a psychiatrist or psychologist, is typically responsible for diagnosing PTSD.
To be diagnosed with PTSD, a person must have experienced or witnessed a traumatic event, and must be experiencing symptoms that meet specific criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 criteria for PTSD include:
- Exposure to a traumatic event: The person must have been exposed to actual or threatened death, serious injury, or sexual violence. This exposure can occur through direct experience, witnessing the event, or learning that the event occurred to a close family member or friend.
- Intrusive symptoms: The person must be experiencing one or more of the following intrusive symptoms related to the traumatic event: recurrent, involuntary, and intrusive distressing memories; recurrent distressing dreams; dissociative reactions (e.g., flashbacks) that are triggered by reminders of the traumatic event; intense or prolonged psychological distress or physiological reactivity in response to reminders of the traumatic event.
- Avoidance: The person must be actively avoiding or attempting to avoid reminders of the traumatic event, such as people, places, or activities that are associated with the trauma.
- Negative changes in mood or thinking: The person must be experiencing at least two of the following negative changes in mood or thinking that started or worsened after the traumatic event: negative beliefs or expectations about oneself, others, or the world; persistent negative emotional state; diminished interest in activities; feelings of detachment or estrangement from others; persistent inability to experience positive emotions.
- Changes in physical and emotional reactions: The person must be experiencing at least two of the following changes in physical or emotional reactions that started or worsened after the traumatic event: irritability or angry outbursts; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; problems with concentration; sleep disturbance.
Once a person meets the diagnostic criteria for PTSD, the professional you're working with may use additional assessment tools, such as questionnaires or interviews, to further evaluate the severity of the your symptoms and determine an appropriate treatment plan. There are several standardized assessment tools that may be used to help diagnose PTSD and evaluate the severity of a person's symptoms.
One commonly used assessment tool is the Clinician-Administered PTSD Scale (CAPS), which is a structured interview that assesses the 17 symptoms of PTSD outlined in the DSM-5. The CAPS is considered to be the "gold standard" for assessing PTSD, and is widely used in both research and clinical settings. This was the test that I took when receiving a Complex-PTSD diagnosis.
Another commonly used assessment tool is the PTSD Checklist for DSM-5 (PCL-5), which is a self-report questionnaire that assesses the 20 symptoms of PTSD outlined in the DSM-5. The PCL-5 is often used in military and veteran populations, and has been found to be a reliable and valid measure of PTSD symptoms.
There are also several other assessment tools that may be used to help diagnose PTSD or evaluate the severity of a person's symptoms, including the Impact of Event Scale-Revised (IES-R), the Davidson Trauma Scale (DTS), and the Posttraumatic Diagnostic Scale (PDS).
It's important to note that while these assessment tools can be helpful in diagnosing PTSD, they should be used in conjunction with a clinical interview and other evaluation methods to ensure an accurate diagnosis and effective treatment plan. Please be sure to work with a professional!
How does PTSD affect the brain, body, and lifestyle?
PTSD can have a profound impact on a person's mind, body, and lifestyle.
In the mind, PTSD can cause a range of symptoms, including intrusive thoughts and memories, nightmares, and flashbacks. These symptoms can be very distressing and can make it difficult for a person to focus on their daily tasks or enjoy their usual activities. PTSD can also cause changes in mood and thinking, such as negative thoughts about oneself, others, or the world, feelings of detachment or estrangement from others, and difficulty experiencing positive emotions.
In the body, PTSD can cause a range of physical symptoms, such as hypervigilance or feeling "on edge", difficulty sleeping, and physiological reactivity when exposed to triggers that remind the person of the traumatic event. These symptoms can be exhausting and can take a toll on a person's physical health over time.
In terms of lifestyle, PTSD can cause a person to avoid people, places, or activities that remind them of the traumatic event, which can make it difficult to maintain their social connections and engage in activities that they used to enjoy. PTSD can also cause a person to engage in self-destructive or reckless behaviors as a way of coping with their symptoms. The list of lifestyle impacts is significant:
- Work and career: PTSD can make it difficult for people to focus on their work and perform well in their jobs. It can also cause them to avoid certain types of work or job responsibilities that may trigger their symptoms. This can lead to problems with job retention, advancement, and income.
- Relationships: PTSD can strain relationships with family members, friends, and romantic partners. People with PTSD may withdraw from social activities, have difficulty communicating their feelings, or become irritable or angry with loved ones.
- Physical health: PTSD has been linked to a range of physical health problems, including chronic pain, cardiovascular disease, and immune system dysfunction. This may be due in part to the physiological changes that occur in the body in response to stress.
- Substance abuse: People with PTSD are at increased risk for developing substance use disorders as a way of coping with their symptoms. This can further complicate their mental and physical health.
- Quality of life: Perhaps most significantly, PTSD can have a profound impact on a person's overall quality of life. The distressing symptoms of PTSD can make it difficult for people to enjoy their hobbies, maintain their relationships, and feel a sense of purpose and fulfillment in their lives.
At a neurological level, PTSD is thought to be related to changes in the brain's stress response system. In particular, the overactivation of the amygdala, which is the brain's fear center, and the underactivation of the prefrontal cortex, which is involved in regulating emotions and decision-making, have been linked to the development of PTSD.
Another key mechanism is the way that traumatic events can disrupt the brain's ability to process and integrate information. When a traumatic event occurs, it can overwhelm the brain's normal processing mechanisms and prevent the person from fully integrating the event into their memory. This can lead to intrusive thoughts and memories, flashbacks, and other symptoms of PTSD.
In addition, PTSD has been linked to changes in the structure and function of certain areas of the brain, including the prefrontal cortex, which is involved in regulating emotions and decision-making. Studies have shown that people with PTSD have reduced volume in the prefrontal cortex, as well as reduced connectivity between the prefrontal cortex and other areas of the brain. This can make it more difficult for people with PTSD to regulate their emotions and make decisions, and may contribute to symptoms like avoidance and negative mood. (source, source)
Finally, there is evidence to suggest that the neurobiological changes associated with PTSD may be influenced by genetics and early life experiences. For example, studies have shown that people with a particular variant of the FKBP5 gene, which is involved in regulating the stress response, are more likely to develop PTSD following a traumatic event (source). Similarly, people who experienced childhood trauma may be more susceptible to developing PTSD later in life (source).
What are the different types of PTSD?
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) recognizes a single diagnosis for PTSD, but there are different subtypes of PTSD that can present differently in different individuals. Here are a few examples of subtypes of PTSD:
- Delayed-Onset PTSD: This subtype of PTSD occurs when the symptoms of PTSD do not appear until at least six months after the traumatic event. This can make it difficult for people to recognize that their symptoms are related to the trauma.
- Complex PTSD: This subtype of PTSD is characterized by exposure to prolonged and repeated trauma, such as childhood abuse or neglect. People with complex PTSD may experience a range of symptoms beyond those included in the DSM-5 criteria for PTSD, such as difficulties with emotion regulation, interpersonal problems, and dissociative symptoms.
- Comorbid PTSD: Comorbidity refers to the co-occurrence of two or more disorders in the same individual. People with PTSD may also experience other mental health disorders, such as depression or substance use disorders.
- Acute PTSD: Acute PTSD is a subtype of PTSD that occurs when the symptoms of PTSD last for less than three months. This is in contrast to chronic PTSD, which lasts for more than three months.
It's worth noting that these subtypes of PTSD are not mutually exclusive, and an individual may experience more than one subtype at the same time.
What are the long-term effects of PTSD?
PTSD can have long-term effects on the body, mind, and lifestyle. Here are some examples of these effects, along with references to studies and public examples:
People with PTSD may experience a range of physical health problems over the long-term. Studies have found that PTSD is associated with an increased risk of cardiovascular disease, chronic pain, and autoimmune disorders. For example, a study published in the Journal of Traumatic Stress in 2017 found that veterans with PTSD had a higher risk of cardiovascular disease compared to veterans without PTSD.
In an interview with People Magazine, Lady Gaga shared that she developed a condition called fibromyalgia, which causes chronic pain and fatigue, as a result of experiencing PTSD following a sexual assault. Ongoing research continues to demonstrate that there is a close mind-body connection, and that significant psychological trauma can be associated with various chronic illnesses later in life. (source, source, source)
PTSD can also cause long-term changes in mood, thinking, and behavior. For example, people with PTSD may experience persistent negative thoughts about themselves or the world around them, feelings of detachment or estrangement from others, and difficulty experiencing positive emotions. Studies have also found that people with PTSD are at increased risk for developing other mental health disorders, such as depression and substance use disorders. (source, source, source)
In her memoir "Unfinished," actress Priyanka Chopra Jonas wrote about how she developed depression and anxiety as a result of experiencing PTSD following the death of her father.
PTSD can have a significant impact on a person's daily life, including their relationships, work, and leisure activities. People with PTSD may avoid social situations or certain activities that remind them of the traumatic event, which can make it difficult to maintain social connections or engage in activities that they used to enjoy. Studies have also found that PTSD is associated with higher rates of unemployment and lower income. (source, source)
As an example, in an interview with Rolling Stone, rapper Kendrick Lamar spoke about how he struggles with anxiety and PTSD, and how he copes by taking time off from touring and practicing mindfulness meditation. He's also spoken about his challenges with depression and suicidal thinking stemming from his tough childhood.
What are the various treatments for PTSD and how can someone manage their symptoms?
There are several treatments available for PTSD, including medication, psychotherapy, and an emerging class of alternative treatment options Here are a few examples:
Cognitive Behavioral Therapy (CBT)
CBT is a form of therapy that aims to change negative thoughts and behaviors related to the traumatic event. This type of therapy is delivered in a group or individual setting and can involve exposure therapy, which involves gradually exposing the person to the traumatic memory in a safe and controlled environment.
In these studies (source, source, source), the researchers found that combining CBT techniques such as exposure therapy with cognitive restructuring and relaxation techniques can effectively reduce PTSD symptoms in individuals. They also suggest that this type of therapy may be more effective than other types of psychotherapy or medication in treating PTSD, in some cases.
Prolonged Exposure Therapy
PE is a therapy that is based on the idea that traumatic events are not processed emotionally at the time of the event, and that fear structures can become dysfunctional. PE aims to alter these fear structures so that they are no longer problematic.
Prolonged exposure therapy is typically completed in 8-15 sessions and includes psychoeducation, breathing retraining, and two types of exposure: in vivo exposure and imaginal exposure. Studies have found that individuals randomly assigned to exposure therapy have significantly greater pre- to post-treatment reductions in PTSD symptoms compared to other therapies such as supportive counseling or relaxation training. A meta-analysis found that PE was more effective than non-trauma focused therapies, and that the average PE-treated patient fared better than 86% of patients in control conditions on PTSD symptoms at the end of treatment. PE is considered an effective treatment for PTSD and is recommended by both the American Psychological Association and the VA/DoD guidelines. (source, source)
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a form of therapy that involves recalling traumatic memories while the person tracks the therapist's finger movements or another type of external stimulus. This type of therapy is thought to help reprocess traumatic memories in a less distressing way. Several prior studies have found (source) that EMDR was effective in reducing PTSD symptoms in people who had experienced childhood trauma.
Several types of medications have been used to treat PTSD, including antidepressants and anti-anxiety medications. As this study states, "Medication treatments can be effective in treating PTSD, acting to reduce its core symptoms, as well as associated depression and disability. The findings of this review support the status of SSRIs as first line agents in the pharmacotherapy of PTSD, as well as their value in long-term treatment. However, there remain important gaps in the evidence base, and a continued need for more effective agents in the management of PTSD."
It's worth noting that there are also other forms of treatment for PTSD that don't yet have FDA approval but have shown promise in clinical trials, such as MDMA-assisted psychotherapy and transcranial magnetic stimulation (TMS). A long list of other studies are being conducted to assess the effectiveness of other psychedelics as well including Ayahuasca, Magic Mushrooms (Psilocybin), and LSD.
MDMA is a psychedelic drug that has shown promise in reducing PTSD symptoms when used in conjunction with psychotherapy. A 2018 study published in The Lancet Psychiatry found that MDMA-assisted psychotherapy was effective in reducing PTSD symptoms in veterans. As the study states, "Active doses (75 mg and 125 mg) of MDMA with adjunctive psychotherapy in a controlled setting were effective and well tolerated in reducing PTSD symptoms in veterans and first responders."
Transcranial Magnetic Stimulation (TMS)
TMS is a non-invasive form of brain stimulation that involves using magnetic fields to stimulate nerve cells in the brain. A recent study found that TMS was effective in reducing PTSD symptoms in veterans. This study tested if a new treatment called theta-burst repetitive transcranial magnetic stimulation (TMS) could help veterans with post-traumatic stress disorder (PTSD). 32 veterans with PTSD took part in the study and were randomly assigned to receive either the active treatment or a fake one. Both treatments were given over 10 sessions in 2 weeks. The study found that the veterans who received the active TMS had less PTSD symptoms compared to those who received the fake treatment. The active TMS treatment was generally safe and had few side effects. These findings suggest that theta-burst TMS could be a helpful treatment for people with PTSD, but more research is needed to make sure it's safe and effective in the long term.
Regular physical activity, such as jogging, yoga, or dancing, can help reduce symptoms of PTSD by releasing endorphins and reducing stress. For example, this study concluded that, "...both observational and intervention studies provide support for the notion that aerobic exercise, either alone or in combination with standard treatments, exerts positive mental health benefits among individuals with PTSD. The results are encouraging as positive effects were observed in both civilian and military populations, as well as in both predominately female and male study samples." Other studies have shown positive results when introducing yoga as a form of PTSD treatment.
Mindfulness and meditation
Mindfulness and meditation practices can help reduce symptoms of PTSD by increasing awareness of the present moment and reducing negative thoughts and emotions.
Joining a support group with others who have experienced similar traumatic events can help people with PTSD feel less alone and provide a safe space to share their experiences and coping strategies.
Overall, while there is no single "cure" for PTSD, there are several treatments available that have been shown to be effective in reducing symptoms.
How does age and gender impact the development and expression of PTSD?
Age and gender can both impact the expression and prevalence of PTSD across the population. Here are some examples with statistics and studies:
- Gender: Women are more likely to develop PTSD than men. According to the National Center for PTSD, about 10% of women develop PTSD in their lifetime, compared to 4% of men. Women are also more likely to experience certain types of trauma, such as sexual assault and domestic violence, which may increase their risk for PTSD.
Public example: In her book "Know My Name," author Chanel Miller discusses her experience of developing PTSD after being sexually assaulted on a college campus.
- Age: Older adults may be less likely to develop PTSD following a traumatic event than younger adults. However, older adults who do develop PTSD may experience more severe symptoms and have a harder time recovering.
Public example: In a 2016 interview with People Magazine, actor and activist Ashley Judd discussed how she developed PTSD following a car accident in which she shattered her leg and had to undergo multiple surgeries. Judd, who was in her mid-40s at the time of the accident, described how her recovery from PTSD was more difficult than her physical recovery.
- Gender and age: The prevalence of PTSD can also vary depending on gender and age. For example, a 2018 study published in the Journal of Anxiety Disorders found that women and younger adults were more likely to develop PTSD following a traumatic event than men and older adults.
Public example: In a 2016 interview with The Guardian, Nobel Peace Prize laureate Nadia Murad discussed how her experience of being abducted and enslaved by ISIS as a young woman led to her developing PTSD.
Overall, age and gender can both play a role in the expression and prevalence of PTSD across the population. It's important for mental health professionals to take these factors into account when assessing and treating PTSD.
What are some common misconceptions about PTSD?
Despite its prevalence and extensive research, there are still several misconceptions surrounding PTSD. Here are some common misconceptions about PTSD:
- Only veterans can get PTSD: While it is true that many military veterans experience PTSD, it can affect anyone who has experienced or witnessed a traumatic event, such as sexual assault, physical abuse, a serious accident, or a natural disaster.
- PTSD is a sign of weakness: This is not true. PTSD is a mental health condition that affects individuals regardless of their strength, character, or courage. It is caused by a traumatic event that overwhelms an individual's ability to cope.
- Only people with a history of mental illness can develop PTSD: This is a myth. PTSD can affect anyone, regardless of whether they have a history of mental illness.
- People with PTSD are dangerous: This is not true. People with PTSD are not inherently dangerous. In fact, they are more likely to be the victims of violence than the perpetrators.
- PTSD is curable: While treatment can significantly reduce symptoms and improve quality of life, there is no known cure for PTSD. Recovery is a gradual and ongoing process.
- PTSD symptoms always appear immediately after a traumatic event: While some people may experience symptoms immediately following a traumatic event, others may not develop symptoms until weeks, months, or even years later.
- People with PTSD should just "get over it": This is a harmful and dismissive statement. PTSD is a serious mental health condition that requires treatment and support. Individuals with PTSD need compassion, understanding, and help to recover.