What Does PTSD Mean? Understanding Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is a mental health condition that can develop in individuals who have experienced or witnessed a traumatic event. This event could be a single occurrence, a series of events, or a set of overwhelming circumstances that the person perceives as emotionally or physically threatening or harmful. The impact of trauma can extend to various aspects of life, affecting mental, physical, social, and even spiritual well-being. Events that can lead to PTSD include natural disasters, serious accidents, acts of terrorism, war and combat situations, rape or sexual assault, historical trauma, domestic violence, and bullying.

Historically, PTSD has been referred to by different names, reflecting the context of the times. During World War I, it was known as “shell shock,” and after World War II, it was termed “combat fatigue.” However, it’s crucial to understand that PTSD is not exclusive to war veterans. It can affect anyone, regardless of their ethnicity, nationality, cultural background, or age. In the United States, PTSD affects approximately 3.5 percent of adults annually. The prevalence is even higher among adolescents aged 13 to 18, with about 8% experiencing PTSD in their lifetime. It’s estimated that one in eleven people will be diagnosed with PTSD at some point in their lives. Notably, women are twice as likely to develop PTSD compared to men. Certain ethnic groups, including U.S. Latinos, African Americans, and Native Americans/Alaska Natives, are disproportionately affected and exhibit higher rates of PTSD than non-Latino whites.

Individuals with PTSD experience persistent and distressing thoughts and feelings related to their traumatic experience, even long after the event has passed. They may re-experience the trauma through vivid flashbacks or nightmares. Feelings of sadness, fear, or anger are common, and they might feel emotionally detached or alienated from others. People with PTSD may actively avoid situations, places, or individuals that remind them of the trauma. They can also exhibit heightened reactivity to ordinary stimuli, such as loud noises or accidental physical contact, triggering strong negative responses.

For a formal diagnosis of PTSD, exposure to a traumatic event is a prerequisite. This exposure can occur in several ways: directly experiencing the traumatic event, witnessing it happening to others, or learning that a traumatic event occurred to a close family member or friend. In some cases, PTSD can also arise from repeated exposure to graphic or disturbing details of trauma, such as that experienced by law enforcement officers involved in child abuse cases.

PTSD Symptoms and How It’s Diagnosed

The symptoms of PTSD are categorized into four main clusters, and the intensity of these symptoms can vary significantly from person to person.

Intrusion Symptoms: These involve the re-experiencing of the traumatic event. Intrusive thoughts are a hallmark, including recurrent, involuntary memories, distressing dreams, or flashbacks. Flashbacks can be so intense that individuals feel as though they are reliving the traumatic experience in real-time, or seeing it unfold before their eyes.
Avoidance Symptoms: Individuals with PTSD often try to avoid anything that might trigger memories of the trauma. This avoidance can extend to people, places, activities, objects, and situations associated with the event. They may consciously attempt to suppress memories or thoughts of the traumatic event and might resist discussing what happened or how they feel about it.
Negative Alterations in Cognition and Mood: This category encompasses negative thoughts and feelings that develop or worsen after the trauma. It can include an inability to recall key aspects of the traumatic event, negative thoughts and feelings leading to persistent and distorted beliefs about oneself or others (e.g., “I am to blame,” “The world is unsafe,” “No one can be trusted”). Distorted thoughts about the causes or consequences of the event can lead to misplaced self-blame or blaming of others. Ongoing negative emotions like fear, horror, anger, guilt, or shame are common. Individuals may experience a diminished interest in previously enjoyed activities, feelings of detachment or estrangement from others, or an inability to experience positive emotions like happiness or satisfaction.
Alterations in Arousal and Reactivity: These symptoms relate to changes in emotional reactions and arousal levels. They can manifest as irritability and angry outbursts, reckless or self-destructive behavior, hypervigilance (being excessively watchful of one’s surroundings), an exaggerated startle response, difficulty concentrating, or sleep disturbances.

It’s important to note that experiencing some of these symptoms in the days immediately following a traumatic event is a common reaction. However, to meet the diagnostic criteria for PTSD, these symptoms must persist for more than one month and cause significant distress or impairment in the person’s daily life. While symptoms often emerge within three months of the trauma, they can sometimes appear later and can last for months or even years. PTSD frequently co-occurs with other mental health conditions such as depression, substance use disorders, memory problems, and other physical and mental health issues.

Several conditions share similarities with PTSD, and understanding their differences is important for accurate diagnosis and treatment. These include acute stress disorder, adjustment disorder, disinhibited social engagement disorder, and reactive attachment disorder.

Acute Stress Disorder: Like PTSD, acute stress disorder develops in reaction to a traumatic event and shares similar symptoms. The key distinction is the timeframe: acute stress disorder is diagnosed when symptoms occur between three days and one month after the traumatic event. Individuals with acute stress disorder may re-experience the trauma, have flashbacks or nightmares, and feel emotionally numb or detached. These symptoms cause significant distress and interfere with daily functioning. It’s noteworthy that approximately half of individuals with acute stress disorder will go on to develop PTSD. Acute stress disorder is observed in a significant percentage (19%-50%) of individuals who experience interpersonal violence, such as rape, assault, or domestic violence. Psychotherapy, particularly cognitive behavior therapy, can be effective in managing symptoms and preventing the progression to PTSD. Medications like SSRI antidepressants may also be used to alleviate symptoms.

Adjustment Disorder: Adjustment disorder arises in response to a stressful life event or series of events. The emotional or behavioral symptoms experienced are disproportionately severe compared to what would typically be expected for the nature of the stressor. Symptoms can include feelings of tension, sadness, or hopelessness, social withdrawal, defiant behavior, impulsive actions, and physical symptoms like tremors, palpitations, and headaches. These symptoms cause significant distress or impairment in important areas of life, such as work, school, or social interactions. Adjustment disorder symptoms emerge within three months of the stressful event and typically resolve within six months after the stressor or its consequences have ceased. Stressors can be single events (like a relationship breakup) or multiple events with cumulative effects. They can be recurring, continuous (e.g., chronic illness), or affect individuals, families, or entire communities (e.g., natural disasters). It’s estimated that 5% to 20% of individuals in outpatient mental health treatment are diagnosed with adjustment disorder. Psychotherapy is the primary treatment approach.

Disinhibited Social Engagement Disorder: This disorder occurs in children who have experienced severe social neglect or deprivation before the age of two. It can arise from a lack of basic emotional needs for comfort, stimulation, and affection, or from frequent changes in caregivers that prevent stable attachments. Disinhibited social engagement disorder is characterized by a child’s overly familiar and sometimes inappropriate behavior towards unfamiliar adults. For instance, a child might readily go off with a stranger with little or no hesitation. Developmental delays, including cognitive and language delays, often accompany this disorder. Improving the caregiving environment is crucial, although some children may experience persistent symptoms even with better care. The prevalence is unknown but thought to be rare. Treatment focuses on supporting caregivers to provide a secure attachment figure for the child.

Reactive Attachment Disorder: Similar to disinhibited social engagement disorder, reactive attachment disorder develops in children who have experienced severe social neglect or deprivation in their early years. It stems from a lack of basic emotional needs or repeated changes in caregivers. Children with reactive attachment disorder are emotionally withdrawn from adult caregivers. They rarely seek comfort, support, or protection from caregivers and may not respond to comforting when distressed. They exhibit limited positive emotions during interactions with caregivers and may display unexplained fear or sadness. Symptoms appear before age 5. Developmental delays are also common. Reactive attachment disorder is uncommon, even among neglected children. Treatment involves therapy to strengthen the relationship between the child and their primary caregivers.

PTSD Treatment Options

It’s essential to emphasize that not everyone who experiences trauma develops PTSD, and not all individuals with PTSD require professional treatment. For some, PTSD symptoms naturally decrease or disappear over time. Others find relief and recovery through their support systems, including family, friends, or religious leaders. However, many individuals with PTSD benefit significantly from professional treatment to overcome the intense and debilitating psychological distress associated with the condition. It’s crucial to remember that trauma-related distress is not the individual’s fault, and PTSD is a treatable condition. Seeking treatment early improves the chances of successful recovery.

Psychiatrists and other mental health professionals employ various evidence-based methods to help individuals recover from PTSD. Both psychotherapy (talk therapy) and medication are proven effective treatments for PTSD.

Cognitive Behavioral Therapy (CBT) for PTSD

Cognitive Behavioral Therapy (CBT) is a highly effective form of psychotherapy for PTSD. Several types of CBT are specifically used to treat PTSD, including Cognitive Processing Therapy, Prolonged Exposure Therapy, and Stress Inoculation Therapy.

Cognitive Processing Therapy (CPT): CPT is a specific type of CBT designed to treat PTSD and related symptoms. It focuses on modifying unhelpful negative emotions (like shame or guilt) and beliefs (such as “I am damaged,” “The world is dangerous”) that arise from the trauma. Therapists guide individuals to confront distressing memories and emotions in a safe and structured manner.
Prolonged Exposure Therapy (PE): PE involves repeated, detailed recounting of the traumatic experience or gradual exposure to symptom triggers in a safe, controlled environment. This helps individuals confront and gain control over their fear and distress, and develop coping mechanisms. Virtual reality programs are sometimes used in PE, particularly for veterans with PTSD, allowing them to re-experience battlefield scenarios in a therapeutic setting.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): TF-CBT is an evidence-based treatment model specifically designed for children and adolescents with PTSD. It integrates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques.
Eye Movement Desensitization and Reprocessing (EMDR) for PTSD: EMDR is a trauma-focused psychotherapy typically administered over about three months. It helps individuals reprocess traumatic memories so they are experienced differently. After a thorough assessment and treatment planning, the therapist guides the patient through questions about the traumatic memory while simultaneously directing eye movements, similar to those during REM sleep. This is done by having the patient follow the therapist’s fingers or a light bar moving back and forth. These eye movements are brief, and during sessions, individuals may experience shifts in thoughts, images, and feelings. Over repeated sessions, the memory tends to change and becomes less negatively charged.
Group Therapy: Group therapy provides a supportive and non-judgmental environment for survivors of similar traumatic events to share their experiences and reactions. Group members realize they are not alone in their responses and emotions. Family therapy can also be beneficial as PTSD can impact the entire family system.

Other forms of psychotherapy, such as interpersonal, supportive, and psychodynamic therapies, address the emotional and interpersonal aspects of PTSD. These may be suitable for individuals who prefer not to directly confront reminders of their trauma.

PTSD Medication

Medications can be a valuable part of PTSD treatment, helping to manage specific symptoms. Symptom relief from medication can enable individuals to engage more effectively in psychotherapy.

Antidepressants, particularly SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), are commonly prescribed to treat the core symptoms of PTSD. They can be used alone or in combination with psychotherapy or other treatments.

Other medications might be used to reduce anxiety and agitation or to address nightmares and sleep problems, which are common in PTSD.

Complementary and Alternative PTSD Treatments

Complementary and alternative therapies are increasingly being used to support PTSD treatment. These approaches offer treatment options outside of conventional mental health clinics and may involve less verbal disclosure than psychotherapy. Examples include acupuncture, yoga, and animal-assisted therapy.

Peer support groups, where individuals with PTSD can share experiences and feelings with others who have similar experiences, can also be highly beneficial in addition to professional treatment.

Physician Review:

Monica Taylor-Desir, M.D., M.P.H., DFAPA
November 2022

References:

American Psychiatric Association. (2022). Trauma- and Stressor-Related Disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
Bichitra Nanda Patra and Siddharth Sarkar. Adjustment Disorder: Current Diagnostic Status. Indian J Psychol Med. 2013 Jan-Mar; 35(1): 4–9.
Harvard Medical School. (2007). National Comorbidity Survey (NCS). (2017, August 21). Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.
National Library of Medicine: MedlinePlus. Adjustment Disorder.
American Academy of Child and Adolescent Psychiatry. Facts for Families: Attachment Disorders.
Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9.>
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

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