PTSD: What you need to know

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Symptoms usually start within 3 months of the traumatic event, but they can begin later.

For a person to receive a diagnosis of PTSD, they must meet criteria that are set out in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) by the American Psychiatric Association (APA).

According to these guidelines, the person must:

1. experience exposure to death or a personal death threat, a serious injury or sexual violence whether directly, as a witness, by it happening to a loved one, or during professional duties
2. experience the following for more than 1 month:
   • one or more intrusion symptoms
   • one or more avoidance symptoms
   • two or more symptoms that affect mood and thinking
   • two or more arousal and reactivity symptoms that began after the trauma

Here are some examples of these four types of symptoms:

Intrusion symptoms:

• nightmares
• flashbacks and a sensation that the event is happening again
• fearful thoughts

Avoidance symptoms:

• refusing to discuss the event
• avoiding situations that remind the person of the event

Symptoms that affect mood and thinking:

• inability to remember some aspects of the event
• feelings of guilt and blame
• feeling detached and estranged from others and emotionally and mentally numbed
• having reduced interest in life
• difficulty concentrating
• mental health problems, such as depression, phobias, and anxiety

Arousal and reactivity symptoms:

• difficulty sleeping
• irritability and angry outbursts
• hypersensitivity to possible dangers
• feeling tense and anxious

In addition, these symptoms must cause a person distress or difficulty coping with work or relationships, and the symptoms must not be due to the use of medications or other substances or another health condition.

Physical symptoms

There may also be physical symptoms, but the DSM-5 criteria do not include these:

• physical effects, including sweating, shaking, headaches, dizziness, stomach problems, aches and pains, and chest pain
• a weakened immune system, which can lead to more frequent infections
• sleep disturbances that can result in tiredness and other problems

A person may experience long-term behavioral changes that contribute to problems at work and a breakdown in their relationships. They may start to seek numbing behaviors, such as misusing alcohol, drugs, or medications.

Children and teens

In those 6 years of age or under, symptoms may include:

• bed wetting after learning to use the bathroom
• an inability to speak
• acting out the event in their play
• being clingy with an adult

However, children between the ages of 5 and 12 years may not have flashbacks. They may be able to remember the event clearly. However, they may remember it in a different order or feel that there was a sign that it was going to happen.

They may also act out or express their trauma through their play, drawings, and stories. They may have nightmares and act irritable and may find it hard to go to school, study, or spend time with friends.

Starting from 8 years of age, children’s reactions are generally similar to adults.

Between the ages of 12 and 18 years, the child may show disruptive, disrespectful, impulsive, or aggressive behavior.

They may feel guilty for not acting differently during the event, or they may consider revenge.

Children who have experienced sexual abuse are more likely to:

• feel fear, sadness, anxiety, and isolation
• have a low self-esteem
• behave in an aggressive manner
• display unusual sexual behavior
• hurt themselves
• misuse drugs or alcohol

Screening

As part of the diagnostic process, a healthcare professional may give the person a screening test to assess whether or not they have PTSD.

A screening session can take 45–60 minutes. Healthcare professionals may take longer to assess the condition if there are legal implications or if a disability claim depends on it.

If symptoms disappear after a few weeks, the person may receive a diagnosis of acute stress disorder.

PTSD tends to last longer. Its symptoms are more severe and may not appear until some time after the traumatic event.

PTSD can develop after a traumatic event.

Examples include:

• military service
• natural disasters
• serious accidents
• terrorist attacks
• loss of a loved one, whether or not this involved violence
• rape or other types of abuse
• personal assault
• being a victim of crime
• receiving a life threatening diagnosis

Any situation that triggers fear, shock, horror, or helplessness can lead to PTSD.

There are several other conditions related to PTSD, including acute stress disorder, adjustment disorder, and disinhibited social engagement disorder.

Acute stress disorder

Acute stress disorder (ASD) is a mental health condition that can occur after a traumatic event. Symptoms are similar to PTSD, so many people confuse the two.

However, with ASD, symptoms typically begin immediately after the trauma and can last from 3 days to 1 month after the trauma exposure.

Symptoms typically include:

• flashbacks
• nightmares
• disassociation or numbness
• feelings of detachment from their usual functioning

The disorder can be relatively mild or severe.

According to the APA, an estimated 13–21% of people who survive traffic accidents and 20–50% of survivors of assault, rape, or mass shootings go on to develop acute stress disorder.

Treatment for acute stress disorder focuses on controlling symptoms and preventing them from getting worse. Those who do not receive treatment may develop PTSD.

Adjustment disorder

A stressful life event like the death of a loved one or a divorce can cause adjustment disorder. Symptoms of adjustment disorder include:

• depression
• anxiety
• confusion
• irritability

It can also result in physical conditions, such as headaches, muscle tension, and nausea.

The symptoms of an adjustment disorder can vary depending on the individual. Some disorders may last for several months after a stressful event while others may experience symptoms for only a few weeks. In people with adjustment disorder, the symptoms appear within 3 months of the stressor.

Treatment for adjustment disorder may include psychotherapy.

Disinhibited social engagement disorder

Disinhibited social engagement disorder is a rare attachment disorder that can occur after a child experiences prolonged trauma before they are 2 years old.

It can happen if a child does not receive adequate care and support in their early years or if they experience multiple changes in caregivers — for example, if they frequently change foster homes. This can make it difficult for them to form stable attachments.

A child with disinhibited social engagement disorder may display inappropriate or overly familiar behaviors with unfamiliar adults. For example, they may willingly walk off with an unfamiliar adult without hesitation.

A child’s symptoms may improve with a stable and positive home environment. However, some children may continue to experience symptoms into adolescence. Developmental delays may also occur.

Treatment may involve placing the child in a safe home environment and undergoing family counseling or therapy.

It remains unclear why some people develop PTSD while others do not. However, the following risk factors may increase the chances of a person experiencing symptoms:

• having additional problems after an event, for example, losing a loved one and losing a job
• lacking social support after an event
• having a history of mental health problems or substance misuse
• experience of abuse, for example, during childhood
• getting a physical injury, possibly as a result of the event

What reduces the risk?

Scientists are looking at resilience factors that may help people recover from or avoid PTSD more effectively.

These include:

• seeking out and receiving support from others
• having or developing positive coping strategies
• being able to feel good about their actions when facing difficulty

Many people experience symptoms after a traumatic event, such as crying, anxiety, and difficulty concentrating, but this is not necessarily PTSD.

Prompt treatment with a qualified professional can help prevent the symptoms from getting worse.

A person should consider treatment if:

• their symptoms persist for more than a month
• their symptoms are severe enough to prevent them from returning to their normal life
• they consider harming themself

Treatment usually involves psychotherapy and counseling, medication, or a combination.

A healthcare professional will specially tailor options for psychotherapy for managing trauma. They include:

• Cognitive processing therapy (CPT): Also known as cognitive restructuring, the individual learns how to think about things in a new way. Mental imagery of the traumatic event may help them work through their trauma to gain control of their fear and distress.
• Prolonged exposure therapy: This teaches people with PTSD to approach their thoughts and feelings about a traumatic event. Discussing the event and gradually confronting the cause of their fear in a safe and controlled environment may help the person feel more in control.

Medications

Doctors can prescribe a group of antidepressants, selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), to treat PTSD.

Examples of these medications include:

• sertraline
• fluoxetine
• paroxetine
• venlafaxine

According to the U.S. Department of Veterans Affairs, these medications are the most effective for treating PTSD.

Experimental therapies

Research suggests that the following therapies may help, but further evidence is necessary to confirm their safety and effectiveness.

• Eye movement desensitization and reprocessing (EMDR): Recalling the event while focusing on an external stimulus, such as a moving light, causes the eyes to move side-to-side, which may help lower distress levels for people with PTSD. This allows the individual to have more positive emotions, behaviors, and thoughts.
• MDMA: Scientists are currently researching whether the pharmaceutical version of the recreational drug, ecstasy, may help people with severe PTSD learn to deal with their memories more effectively by encouraging a feeling of safety.
• Video games: A 2017 study links playing military first-person shooting video games with fewer symptoms in some veterans with PTSD. However, the researchers do not recommend using these video games in place of regular therapy.

Active coping is a key part of recovery. It enables a person to accept the impact of the event they have experienced and take action to improve their situation.

The following can help a person achieve this:

• learning about PTSD
• understanding that an ongoing response is normal and that recovery takes time
• accepting that healing does not necessarily mean forgetting
• gradually feeling less bothered by symptoms and having confidence in the ability to cope with the bad memories is the goal of healing

Other things that can help include:

• finding someone to confide in
• spending time with other people who know what has happened
• letting people know what might trigger symptoms
• breaking down tasks into smaller parts to make them easier to prioritize and complete
• getting physical exercise, such as swimming, walking, or yoga
• practicing relaxation, breathing, or meditation techniques
• listening to quiet music or spending time in nature
• understanding that it will take time for symptoms to go away
• accepting that PTSD is not a sign of weakness and that it can happen to anyone
• participating in enjoyable activities that can provide distraction

Many helplines and facilities are available for people who are or who may be experiencing the symptoms of PTSD. However, if you need immediate, emergency help to prevent you from hurting yourself or others, please call 911.

Here are some numbers that may be useful:

• National Suicide Prevention Lifeline: 1-800-273-TALK or 988
• National Domestic Violence/Child Abuse/Sexual Abuse: 1-800-799-SAFE
• National Youth Crisis Hotline: 1-800-442-HOPE

If you are looking for a therapist, find someone qualified and experienced in the field of PTSD. The Sidran Institute is a nonprofit organization that provides help to people who have undergone traumatic events and offers tips on how to find a suitable therapist.

PTSD can lead to some complications and comorbidities.

People with PTSD have an increased risk of developing:

• mood disorders
• anxiety and panic disorders
• neurological disorders, including dementia
• substance misuse disorders

People with PTSD may have other health problems, such as depression, anxiety, personality disorder, or the misuse of substances, such as alcohol or drugs. People with PTSD also have a higher risk of suicidal ideation and attempts.

Employers of people working in professions where traumatic events are likely to occur, such as the military and emergency services, may offer training or counseling to help their employees reduce the risk of PTSD or cope.

In the emergency medical services (EMS), a form of debriefing, known as critical incident stress management (CISM), takes place after certain events to try to minimize the risk of stress and PTSD development.

Post-traumatic stress disorder is a mental health condition that can occur after a person experiences or witnesses a traumatic event.

A person with PTSD may experience intrusive thoughts and memories. They may consciously or unconsciously avoid places or people that remind them of the trauma. A person may also experience difficulty sleeping and feel tense, anxious, and irritable.

A person should see a doctor if they develop symptoms that disrupt their home, work, or social life after experiencing a traumatic event. A healthcare professional will be able to diagnose PTSD and provide support.

Treatments for PTSD include psychotherapy and medication.