PTSD

Meaning of PTSD

Many of us will experience at least one traumatic event in our lifetimes. While many of us will likely be able to move past that experience after some time, some of us will have a harder time. In fact, about 5 to 10 percent could develop a condition called post-traumatic stress disorder (PTSD).

People with PTSD are often challenging four basic assumptions we all make about the world:

1. "The world is fair and just" - Experiencing a traumatic event can cause a person to question the belief that people get what they deserve. "Why do bad things happen to good people?"

2. "You can safely trust others" - Especially if the traumatic event was caused by a loved one or close friend, people with PTSD may question their judgment in character and feel they can't trust themselves or anyone else.

3. "You can be effective in the world" - People with PTSD may start to question if they can make any difference in the world. Since they couldn't stop the traumatic event from happening, they begin to doubt their ability to keep themselves and others safe.

4. "Life has meaning and purpose" - Many people believe they have a purpose in life. But following a traumatic event, they may begin to question these beliefs and feel like their existence is meaningless.

PTSD can resemble depression, Freepik.com

PTSD Risk Factors

If not everyone who experiences a traumatic event develops PTSD, then what are the risk factors that make the 5 to 10 percent vulnerable? Certain people can be predisposed to developing PTSD due to genetics and even gender (women are more likely to develop PTSD than men). People with a previous psychiatric disorder are also at greater risk.

Other risk factors include:

• Lower socioeconomic status

• Race

• Lack of education

• Previous trauma

• Family history of mental illness

The severity of the event can make a big difference. The more severe or dangerous the event, the more likely a person is to develop PTSD.

We all experience events and fear differently. How much a person perceives their life to be at risk also plays a large role in whether they develop PTSD.

Symptoms of PTSD

After a traumatic event, many of us would be affected by it for some time after. It would take us time to process what we experienced and to recover from such an emotional experience. We may have a few nightmares for a couple of days after the event or have difficulty sleeping. But at what point do symptoms become a concern and begin to resemble post-traumatic stress disorder?

1. Re-experiencing: People with PTSD frequently relive their traumatic experiences. This can come in the form of flashbacks or even nightmares. They experience the same distressing images and sensations.

2. Avoidance: People with PTSD do everything they can to avoid anything and everything that reminds them of the traumatic event. They may even avoid talking or thinking about it at all. This could mean avoiding crowds, driving, certain movies -- anything that could potentially bring those memories to the surface.

3. Negative or distorted thoughts and mood: Before the traumatic event, you might have been someone who saw the glass half full and enjoyed life. After the event, you almost always feel numb, and you start to expect bad things to happen. People with PTSD experience more negative thoughts following the event, including feelings of guilt or shame for not stopping the traumatic event from happening. You may experience other cognitive issues such as memory loss regarding the event.

4. Hyperarousal: People with PTSD may be jittery and on edge. They might feel like they have to constantly look over their shoulder for danger. They may become angry or irritable out of nowhere and often have difficulty sleeping or concentrating on anything.

While many people with PTSD will have these symptoms and present them as expected, not everyone is the same. For one, cultural expressions of symptoms can differ. People from cultures that do not value expressiveness may better hide their symptoms or act as though the event did not affect them at all. Symptoms of PTSD can look different in children as well. Children may relive the trauma through play, such as acting it out with stuffed animals or drawing images of the event. Also, they may revert to younger behaviors such as thumb-sucking, baby talk, or bedwetting.

Children can have PTSD as well, Freepik.com

PTSD Diagnosis

The DSM-5 has specific criteria for someone to be diagnosed with post-traumatic stress disorder. First, to receive a PTSD diagnosis, you had to have experienced a traumatic event. The DSM-5 recognizes that direct exposure to the traumatic event is not required. You could have witnessed or just learned of trauma and could still be diagnosed with PTSD. Remember that someone's perceived threat of danger can make a difference.

Next, you would have to have experienced all four of the symptoms we discussed above (re-experiencing, avoidance, negative or distorted thoughts/mood, and hyperarousal). Reference the chart for the specific DSM-5 criteria for these symptoms.

To be diagnosed with PTSD, you had to have been experiencing these symptoms for more than one month since the event. Anything less than this is considered acute stress disorder. Symptoms must be interfering with your life in some way. Maybe your social life is taking a hit, or your performance at work is beginning to decline. Also, symptoms cannot be due to any medication, substance use, or other illness.

PTSD Test

Psychologists may use testing to identify any symptoms to make a diagnosis. A PTSD test can be administered by a professional or self-administered.

Not only does the CAP-5 help clinicians make a diagnosis, but it also provides additional information regarding the onset, impact, and severity of the patient's symptoms.

A frequently used self-assessment to diagnose PTSD is the Davidson trauma scale (DTS). This test has 17 items that ask you to rate each symptom on a four-item. It rates key areas, including physiological arousal, anger, and emotional numbness.

PTSD Treatment

Research on post-traumatic stress disorder has grown significantly in recent years. As a result, several treatments have proven effective in reducing symptoms of PTSD and creating a path toward healing. PTSD treatment can include drug therapy, cognitive-behavioral therapy, eye movement desensitization and reprocessing (EMDR), or social support/interpersonal therapy.

Drug Therapy

Since PTSD can be considered an anxiety disorder and is often comorbid with depression, similar anxiety and depression drug therapies have been used to help treat PTSD. These medications are called selective serotonin reuptake inhibitors (SSRI). Examples of SSRIs that are often prescribed for PTSD are sertraline (Zoloft) or paroxetine (Paxil).

The benefit of using SSRIs to treat PTSD is that they can also relieve a person's comorbid symptoms of depression. However, like most anxiety disorders, using medication to help reduce symptoms can also mean that they will rapidly return once a person stops using the medication. For this reason, solely using medication to treat PTSD has not been recommended and should be combined with another type of treatment that can address the psychological and social factors of their condition.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is a type of therapy that combines behavioral and cognitive approaches to treatment. This is one of the most effective types of treatment for PTSD and can be administered in either an individual or group therapy setting. The goal of treatment is often trauma-focused, meaning that the focus is on helping a person face their trauma head-on in order to begin processing their experience.

One of the most identifiable symptoms of PTSD is a person's avoidance of anything that reminds them of the traumatic event. Behavioral techniques might include forms of exposure therapy commonly used for avoidance symptoms in other anxiety disorders.

During this process, the therapist will also emphasize relaxation and breathing techniques to help reduce arousal symptoms.

Behavioral techniques are then paired with cognitive techniques in which the therapist challenges the cognitive distortions resulting from the traumatic event. One cognitive technique commonly used to help treat PTSD is psychoeducation, in which the patient is educated about the nature of their symptoms. The therapist will help the patient better understand the meaning of their traumatic experiences. From here, the therapist can help the patient begin to dismantle and reframe cognitive challenges following the event, such as feelings of guilt and shame.

Eye Movement Desensitization and Reprocessing (EMDR)

Another trauma-focused therapy that effectively treats PTSD is eye movement desensitization and reprocessing (EMDR).

EMDR was originally designed to reduce distress symptoms due to traumatic memories. But it is also effective in reshaping negative beliefs and reducing physiological arousal.

EMDR is based on the assumption that the brain naturally moves toward mental health. Traumatic events cause some kind of block or imbalance to that system but once removed (through EMDR), the brain is free to continue down the path toward healing.

Social Support/Interpersonal Therapy

While trauma-focused treatment effectively treats PTSD, it is not the only therapeutic approach that can treat PTSD. One of the risk factors for developing PTSD is a lack of social support. So it would make sense why increasing social support can aid in reducing symptoms of PTSD. Interpersonal therapy, a type of psychotherapy that focuses on improving social relationships and interactions, can be almost as effective as trauma-focused treatments with an added bonus of lower dropout rates. In other words, fewer people prematurely discontinue treatment).

Rather than having you confront the traumatic event directly, interpersonal therapy will focus on helping you feel as safe as possible. This is especially important in cases of domestic abuse. Interpersonal therapy can also be administered either in individual or group therapy. Group therapy has the added benefit of a "built-in" support system where members can share in solidarity, hearing from other people who have experienced similar trauma.