PTSD

Post Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a trauma- and stress-related disorder characterized by severe anxiety and occurring after a traumatic experiencing or witnessing a terrifying event. The activating event may involve a real or perceived threat of injury or death. 

PTSD occurs as a response to chemical and neuronal changes in the brain due to the exposure to the threatening event. Those diagnosed with PTSD feel a heightened sense of danger as their trauma response- fight, flight, fawn, or freeze- is altered. This can cause a person to feel increasingly fearful, stressed and/or unsafe. Individuals experience difficulty transitioning back to daily functioning due to the reminder of the event. 

Circumstances commonly related to PTSD include:

✅ accidents
✅ military combat
✅ physical assault or abuse
✅ victim of crime
✅ sexual assault or abuse
✅ emotional abuse
✅ natural disasters
✅ loss of a loved one

Causes of Post Traumatic Stress Disorder

The root cause of PTSD is the witnessing of a terrifying event. However not everyone who witnesses a terrifying event develops PTSD. Most people do not have problems afterward but a small percentage of people develop PTSD.

PTSD is thought to change neural brain pathways in the brain. Researchers hypothesize those with smaller hippocampal volume are more susceptible to PTSD. Other research suggests PTSD occurs when chemicals in the brain are disrupted by an extreme stress response. A person’s level of support can help determine how the stress of the incident is realized- the more support, the less risk of PTSD.

Here are some other reasons thought to make a person more likely to develop PTSD:

💡 history of mental illness
💡 history of substance abuse
💡 injured in an attack
💡 witnessing someone being injured
💡 increased stress after activating incident

Misconceptions About Post Traumatic Stress Disorder

Emotional reactions after a challenging event are natural and expected. Scary events often cause a temporary hard-time or period of adjustment. That period doesn’t always deem the onset of PTSD. The following are some false assumptions and myths about PTSD:

🚫 all trauma lead to diagnosis
🚫 makes you crazy, dangerous, violent
🚫 instant onset after a traumatic event
🚫 therapy does not help
🚫 for only military veterans
🚫 will not affect family / loved ones 
🚫 only for near-death experiences
🚫 cannot be vicarious 
🚫 sign of weakness
🚫 cannot affect children
🚫 trauma can be managed individually
🚫 parents’ trauma will not affect children
🚫 trauma cannot be treated
🚫 trauma reactions last forever 
🚫 leads to gun violence
🚫 untreatable

Signs and Symptoms of Post Traumatic Stress Disorder

The onset of signs and symptoms associated with PTSD tend to arise following traumatic life events. Each individual’s experience of PTSD is unique to them. Even when multiple people experience the same or a similar trauma, they can be affected in different ways. The symptoms associated with PTSD tend to negatively affect an individual’s day-to-day functioning, despite not being in immediate danger. Common noticeable changes in cognition, mood, and behaviors may include: 

🚩 flashbacks
🚩 low self-esteem
🚩 intrusive memories
🚩 distress discussing event
🚩 difficulty completing daily tasks
🚩 intense reactions
🚩 isolation
🚩 avoidance of event reminders 
🚩 self harm
🚩 angry outbursts
🚩 thoughts of suicide
🚩 irritability
🚩 sleep disruptions due to nightmares
🚩 trouble concentrating 
🚩 hypervigilance or “being on guard”
🚩 hopelessness
🚩 guilt and shame
🚩 feeling emotionally “numb”
🚩 negative changes in mood & cognition

Diagnosing Post Traumatic Stress Disorder

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a guideline for practitioners to evaluate symptoms leading to a diagnosis. There is not a test to evaluate for PTSD. Therefore a mental health professional is best qualified to diagnose PTSD. The symptoms presented below from DSM-5 are used to evaluate adults, adolescents, and children older than 6 years of age:  

⚠️ presence of one or more re-experiencing symptom:

    • intrusive memories
    • recurrent distressing dreams
    • dissociative reactions
    • intense psychological or physiological distress with reminder of the event

⚠️ presence of one or more avoidance symptom:

    • avoiding distressing memories of event
    • thoughts 
    • external reminders, such as people, places, or objects

⚠️ presence of two or more arousal and reactivity symptoms:

    • dissociative amnesia
    • exaggerated negative beliefs
    • distorted cognitions about traumatic event
    • persistent negative emotional state
    • diminished interest in activities
    • detachment from others 
    • persistent inability to experience positive emotions

⚠️ presence of two or more cognition and mood symptoms:

    • irritable behavior 
    • angry outburst
    • self-destructive behavior
    • hypervigilance/ exaggerated startle response
    • problems with concentration 
    • sleep disturbances 

Symptoms must be interfering with daily activities- going to work or school, engaging with friends and loved ones, etc…

Conditions Commonly Mistaken for Post Traumatic Stress Disorder

Many other mental health conditions include symptoms that are closely related to PTSD.  It is also possible for other mental health conditions to be comorbid with PTSD.  It is always best and recommended to speak with your medical provider regarding questions related to your mental health as these diagnoses are commonly mistaken for PTSD:

✳️ adjustment disorder is a commonly mistaken for PTSD due to the event of a traumatic experience or period of transition. 
 ✳️ acute stress disorder involves a reaction to a stressor as restricted to a duration of 3 days to a month following the event. 
✳️ generalized anxiety disorder presents with similar symptoms to PTSD: avoidance, irritability, arousal, and dissociation are not related to a specific trauma.
✳️ obsessive-compulsive disorders show similar patterns of unrelated, intrusive thoughts, but the thoughts tend to meet criteria for obsessions. 
✳️ major depressive disorder may or may not be present in symptoms of PTSD and should solely be diagnosed if there are no present symptoms of PTSD.
✳️ dissociative disorders may or may not also be linked to an exposure to a traumatic event suggesting a potential co-occurring diagnosis of PTSD with dissociative symptoms. 
✳️ psychotic disorders including schizophrenia, brief psychotic disorder, bipolar with depressive and mania features, delirium related to substances or medications and medical conditions that cause psychosis- can be mistaken for PTSD flashbacks symptoms as they may be assumed as illusions, hallucinations, and dellucision.
✳️ traumatic brain injuries can be considered traumatic events as the neurological damages are a result of the trauma though not the case. PTSD symptoms may co-occur with brain injuries, may present after a traumatic accident causing the injury, or can be mistaken for brain injuries.

Treating Post Traumatic Stress Disorder

It is important to address the symptoms that appear, as trauma responses do not heal on their own. Additionally it is always recommended that PTSD treatment is sought out immediately. 

Common treatment consists of medication management and specific therapeutic models such as eye movement desensitization and reprocessing (EMDR), which the individual recalls traumatic event(s) while eyes are instructed by a therapist. Another common therapeutic model is exposure therapy, in which a client is slowly recalling and experiencing the traumatic events with the support from a safe therapeutic space and relationship.  

  Common treatment plans for PTSD may include:

🧬 psychotherapy
🧬 hypnotherapy 
🧬 medication management
🧬 sex therapy
🧬 exposure therapy
🧬 mindfulness
🧬 peer support groups
🧬 yoga therapy
🧬 cannabis
🧬 EMDR

Healthcare Professionals Who Treat Post Traumatic Stress Disorder

For the best results in a successful treatment of PTSD, seek providers that specialize in the assessment, treatment, diagnosis, and continuing support of patients diagnosed with PTSD. 

Many medical and mental health providers are familiar with the diagnosis of PTSD.  However if your chosen provider is not, they should always provide a knowledgeable referral source. Specialized providers will have the capabilities to diagnose using various testing methods to decrease the likelihood of misdiagnoses and unnecessary treatments. 

If you choose to utilize medication, psychotherapy should always be incorporated in treatment planning. 

The following are professionals involved in the treatment of PTSD:

🧠 psychologist
🧠 crisis therapist or services
🧠 psychiatrist
🧠 family based teams
🧠 psychotherapist
🧠 intensive home-based therapy
🧠 certified EMDR therapist
🧠 neurologist 
🧠 certified sex therapist
🧠 nurse practitioner

Recognizing Immediate Need for Post Traumatic Stress Disorder Treatment

PTSD is a serious disorder that ranges widely in severity. Suicide is a real threat. If there is a sense that something is “off” or “does not feel right” then follow the intuition and seek support. The following warning signs should alert you to the immediate need for treatment:

🚨 talking about wanting to die
🚨 searching for way to kill yourself
🚨 buying a gun or other weapon
🚨 expressing hopelessness or having no reason to live
🚨 talking about feeling stuck or trapped
🚨 being in unbearable pain
🚨 stating feeling like being a burden to others
🚨 increased use of drugs and/or alcohol
🚨 reckless behavior
🚨 increased anxiousness
🚨 change in sleeping pattern
🚨 withdrawn or isolated
🚨 displaying rage 
🚨 talking about revenge
🚨 extreme mood swings

Post Traumatic Stress Disorder Professional Organizations

Provided are some resources to help the start of seeking support for PTSD. Though these are national links, consider narrowing options down by searching in your current location. 

https://www.psychologytoday.com/us/blog/trauma-and-hope/201703/different-types-trauma-small-t-versus-large-t
https://pubmed.ncbi.nlm.nih.gov/23750758/
https://www.verywellmind.com/dialectical-behavior-therapy-1067402
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310322/
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Arlington, VA. American Psychiatric Publishing, 2013. Print.
Rothbaum, Barbara Olasov, et al. Early Intervention May Prevent the Development of PTSD: A Randomized Pilot Civilian Study with Modified Prolonged Exposure. Biological Psychiatry, December 1, 2012.
How Common is PTSD?” US Department of Veterans Affairs, Accessed January 8, 2018.
Dohrenwend, Bruce. “Why Some Soldiers Develop PTSD While Others Don’t?” Association for Psychological Science, February 21, 2013.
Bernhard, Toni. “Five Common Misconceptions About Trauma: How the science of post-traumatic growth revolutionizes our approach to trauma.” Psychology Today, October 27, 2015.
Logue, M. W., van Rooij, S., Dennis, E. L., Davis, S. L., Hayes, J. P., Stevens, J. S., Densmore, M., Haswell, C. C., Ipser, J., Koch, S., Korgaonkar, M., Lebois, L., Peverill, M., Baker, J. T., Boedhoe, P., Frijling, J. L., Gruber, S. A., Harpaz-Rotem, I., Jahanshad, N., Koopowitz, S., … Morey, R. A. (2018). Smaller Hippocampal Volume in Posttraumatic Stress Disorder: A Multisite ENIGMA-PGC Study: Subcortical Volumetry Results From Posttraumatic Stress Disorder Consortia. Biological psychiatry, 83(3), 244–253. https://doi.org/10.1016/j.biopsych.2017.09.006