Understanding PTSD

Post-traumatic Stress Disorder, or PTSD, is a mental health condition that develops after exposure to a traumatic event or learning about a traumatic event that happened to a close family member or friend. Most people have a lot of distress right after a trauma happens but begin to feel better over time. For people living with PTSD, the distress remains long after the traumatic event and they experience symptoms that significantly affect their lives.¹ For these people, it is almost as if the trauma is still happening, all the time, everywhere, long after it has passed.² For instance, a veteran returning from combat might experience flashbacks and heightened anxiety triggered by loud noises, which can interfere with everyday activities and relationships.

About 6% of the U.S. population will have PTSD at some point in their lives.³ This page will delve into the causes, symptoms, and treatments available for those living with PTSD.

What causes PTSD?

Traumatic experiences cause PTSD. Almost everyone lives through something traumatic at some point in life. About 70% of people around the world will experience at least one traumatic event in their lifetime.² When someone has PTSD, they experience memories or dreams that are so distressing they have an impact on an individual's ability to function in their daily life.¹ Symptoms of PTSD can emerge early on after the event and usually begin within 3 months but for some, they can develop later. Healthcare professionals can diagnose PTSD if the symptoms last for at least 30 days. Some factors contribute to an individual’s response to trauma and the likelihood for that trauma to cause PTSD, such as⁴:

• Culture: A person’s values, beliefs, and way of seeing the world.
• Social Support: Whether or not an individual has a network of people in their lives who are truly supportive.
• Developmental Stage: Whether a person is a child, teenager, or adult

The severity and causes of PTSD are influenced by the type of traumatic event and circumstances surrounding the actual event or events (sociocultural or otherwise). For example, did the traumatic event happen when the individual was a child? (Developmental Stage). Was there a perpetrator who was not held accountable? (Culture/Value - justice) Were they in a war zone? (Lack of resources, support, violent and prolonged exposure). Were they exposed to genocide? (violent and prolonged exposure, racism and/or religious persecution).

It’s important to note that trauma in childhood can have long-lasting effects. In a CDC-Kaiser Adverse Childhood Experiences Study, early childhood trauma showed a long-term negative impact on physical health, and the likelihood of developing mental health and substance use disorders, as well as a higher risk of suicide.⁵

What is Trauma?

Trauma is a threatening event or series of events that is emotionally or physically harmful, which may include: violence, abuse, neglect, natural disasters, or losing a loved one due to a traumatic event.⁴

Trauma can be experienced directly by a person, such as an experience where they might have felt frightened for their life, were injured physically or sexually, or were afraid they would be. Indirect trauma might occur when an individual witnesses a trauma - or hears about it happening to someone they care about. First responders - often directly witness or are exposed to traumatic events. Clergy, therapists, & social workers - commonly experience vicarious trauma (also known as secondary trauma) by listening to others' traumatic experiences.^{1, 2, 4}

Symptoms of PTSD

Some common reactions to trauma can include feelings of fear, anxiety, humiliation, guilt, shame, or betrayal.5 A mental health provider might diagnose a person with PTSD if that individual has lived through an awful experience and has specific symptoms for more than one month.¹

Symptoms of PTSD include:

• Intrusion or re-experiencing symptoms: This is the memory of the trauma coming back. It can show up as unwanted memories, nightmares, flashbacks, or feeling horrible after being reminded of it.¹
• Avoidance symptoms: Individuals experiencing these symptoms go out of their way to avoid anything that reminds them of what happened. Some people avoid things like thinking about the trauma, while others avoid people, places, or anything else that may trigger their memory.¹
• Negative changes in thoughts or feelings: These symptoms might seem like depression, with negative thoughts focusing on not feeling safe or blaming oneself and behaviors such as lack of interest in things a person once enjoyed, self-isolation, or disconnection from others. Symptoms might also include the inability to remember aspects or elements of the traumatic experience.¹
• Changes in reactivity or arousal: These symptoms might manifest as irritability, risk-taking, or acting in a self-destructive manner. An individual may also have difficulty concentrating,always be “on guard”, or tense, on edge, or easily startled.¹

A person can also develop additional signs and symptoms such as:⁴

• Frequently feeling nervous
• Physical symptoms like stomach upset
• Upsetting thoughts
• Hypervigilance
• Sleeplessness or insomnia
• Feeling numb

These symptoms can worsen with thoughts and reminders of the traumatic event, therefore, people may try to avoid anything that reminds them of the event⁵ but can also be triggered for no external reason at all.⁴

PTSD Treatment

Evidence-based therapies like Cognitive Processing Therapy, Prolonged Exposure, or Eye-Movement Desensitization and Reprocessing are effective PTSD treatments. The term evidence-based means it’s a therapy that has been studied by experts, the scientific data show the outcomes are effective, and many people’s conditions are improved through therapy. Each of these therapies can start delivering results for PTSD relatively quickly. They are treatments that typically take about three months of weekly therapy.²

More recent studies have also shown that alternative interventions like cognitive behavioral therapy for PTSD (CBT for PTSD), narrative exposure therapy (NET) and written exposure can also be helpful in managing symptoms of PTSD.⁶

• Cognitive Processing Therapy (CPT): During CPT people learn to notice how trauma has changed their lives, especially how it has changed their thoughts about themselves, other people, and the world around them. A therapist helps people notice these thoughts, assess whether they are true, and consider other ways to think.⁷
• Prolonged Exposure (PE): During PE therapy, an individual with PTSD tells the story of the trauma from memory. As the person repeats the story, the memory eventually becomes less powerful. A therapist also helps people practice facing situations that feel dangerous but probably aren’t, typically the situations they have avoided as part of their PTSD.⁸
• Eye-Movement Desensitization and Reprocessing (EMDR): During EMDR, individuals talk about the memories that have been most difficult for them with a trained therapist while something repetitive is happening in front of them, causing repetitive eye movement that desensitizes the telling of the story. Therapists can also help individuals shift their feelings about traumatic memories and how people think about themselves in relation to those memories - called reprocessing.⁹

PTSD Medication

In some cases, individuals living with PTSD are prescribed medication in combination with psychotherapy. Antidepressants known as selective serotonin reuptake inhibitors(SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) affect chemicals in the area of the brain known to impact thinking and reduce anxiety and depression. For many people experiencing PTSD, these medications can help reduce the thoughts that feel stuck, like when someone thinks “No place is safe,” or “I can’t handle this.” The medications can also reduce some of the irritability, sadness, agitation, and fear that might make treatment difficult.^2,10

Other medications are sometimes used to help with sleep, nightmares, or physical symptoms someone with PTSD might have. Those medications may help people feel more comfortable but they don’t directly treat the diagnosis of PTSD. It’s important to work with a medical provider to understand how each medication works and how it might affect symptoms.^2,10

Psychedelic drugs like MDMA, ketamine, and psilocybin are being explored for their potential to treat treatment-resistant mental health conditions such as PTSD and major depressive disorder. Although initial studies have shown encouraging results, larger clinical trials are required to confirm their safety and effectiveness. Currently, the evidence is insufficient for FDA approval, but promising findings suggest these therapies might soon be integrated into clinical practice. This topic has gained significant attention due to the high percentage of individuals not responding to conventional treatments, highlighting the urgent need for more effective solutions.¹¹

Summary

PTSD is caused by traumatic experiences that can lead to debilitating symptoms such as intrusive thoughts, avoidance behaviors, and heightened emotional responses. These symptoms can profoundly disrupt an individual's life, making professional diagnosis and treatment essential. Evidence-based therapies like Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Eye-Movement Desensitization and Reprocessing (EMDR) have proven effective for treating PTSD. Medications, particularly SSRIs and SNRIs, can also help manage symptoms. With proper treatment and support, individuals with PTSD can work toward recovery.