Post-traumatic stress disorder, or PTSD, is often thought of in terms of its effect on military veterans who have witnessed or participated in the horrors of war. The reality of this life-altering disorder is that it can occur after any type of trauma, from being a victim of violence to enduring a catastrophic natural disaster to being bitten by a dog as a child. Considering the ubiquitous nature of trauma and the 24.4 million Americans who suffer from this disorder, it’s important to address the stigma surrounding PTSD and the people who experience it day-to-day. When it comes to PTSD, knowledge is empowering for everyone.
What is post-traumatic stress disorder?
The National Institute of Mental Health (NIMH) states that post-traumatic stress disorder “can develop after exposure to a potentially traumatic event that is beyond a typical stressor. Events that may lead to PTSD include, but are not limited to, violent personal assaults, natural or human-caused disasters, accidents, combat, and other forms of violence.” They highlight the fact that while most people will, at some point in their lives, be exposed to an event which fits the criteria of trauma, only a small percentage of people will go on to receive a diagnosis of PTSD.
Types of Post-Traumatic Stress Disorder
Uncomplicated PTSD
This type of PTSD occurs when an individual has experienced loss of life or widespread destruction for an extended amount of time. People suffering from uncomplicated PTSD seek out ways to avoid the traumatic event through denial and this can lead to detachment from people and real world situations.
Complex PTSD
Complex PTSD is a result of repeated, inescapable tragedies that are endured over months and years. As a result of natural coping mechanisms in the brain, sufferers of complex PTSD often have the false belief that if the trauma is never spoken about they will be okay. This belief is caused by the disconnect the survivor has placed between themselves and their trauma.
Acute Stress Disorder
This disorder is defined as the formation of severe anxiety, dissociation, and emotional detachment. Those who suffer from acute stress disorder are likely to avoid anything or anyone who reminds them of the original trauma and may become easily irritated or startled and experience difficulty sleeping.
Comorbid PTSD
Current data shows that the majority of people suffering from PTSD have also been diagnosed with at least one other psychiatric disorder (such as anxiety, depression, or substance abuse). Scientists believe that the higher risk for drug and alcohol abuse in these individuals can be largely explained by the increased likelihood of self-medication.
How is post-traumatic stress disorder diagnosed?
In order for an adult to be diagnosed with PTSD they must meet the following set of criteria as presented in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders):
Exposure
They must have been exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence (such as direct exposure, actually witnessing the trauma, learning a loved one was exposed to trauma, or indirect exposure to trauma through professional duties).
Re-Experiencing
They must have at least one re-experiencing symptom, such as unwanted and upsetting memories, nightmares, flashbacks, emotional distress, and physical reactivity to traumatic reminders.
Avoidance
They must have at least one avoidance symptom, such as avoidance of trauma-related thoughts, feelings, or trauma-related reminders.
Arousal and Reactivity
They must have at least two arousal and reactivity symptoms, such as irritability or aggression, risky or destructive behavior, increased alertness to their surroundings, heightened startle reaction, difficulty concentrating, and difficulty sleeping.
Cognition and Mood
At least two cognition and mood symptoms, such as trouble remembering important features of the event, overly negative thoughts about themselves and the world, exaggerated blame of themselves or others for causing the trauma, negative mood, decreased interest in activities that once brought joy, feelings of isolation, and difficulty feeling happiness.
Post-Traumatic Stress Disorder and Young Children
Young children can be susceptible to PTSD if they have experienced trauma such as death of a loved one, abuse, neglect, war, disaster, and even dog bites (although the symptoms may be slightly different than those of an adult). Young children can have difficulties remembering the correct sequence of events that occurred at the time of the trauma. They might also practice omen formation, which is “a belief that there were warning signs that predicted the trauma.” Other symptoms of childhood PTSD can include a fear or mistrust of strangers and family members, traumatic play (where components of the trauma are acted out), and regressive behavior such as thumb sucking and bedwetting.
Post-Traumatic Stress Disorder and Teens
Teens experiencing PTSD have symptoms that may include separation anxiety, difficulty with impulse control (which can manifest as problems with drugs and alcohol), and aggressive behavior (such as instigating fights with friends and family members).
Post-Traumatic Stress Disorder and Women
Although women have a slightly lower chance of experiencing trauma when compared to men (around 50 percent of women will endure trauma during their lives), women are over two times as likely to develop PTSD. The sad truth is that women have a much higher chance of experiencing rape, sexual abuse, childhood sexual abuse, or physical and mental abuse at the hands of their partners. PTSD symptoms for women can include an overall sense of nervousness, becoming easily frightened, developing anxiety and depression, and avoidant behavior. Women are also more likely to shoulder the blame for incidents of trauma, placing responsibility on themselves even if they were the victim.
Why does post-traumatic stress disorder happen?
Considering the atrocities of war that both soldiers and civilians are exposed to, it’s no surprise that PTSD is most often associated with the military. It’s estimated that, depending on the war in question, anywhere from 11 to 30 percent of veterans have experienced PTSD during their lifetime. Unfortunately, the reality of PTSD is that anyone who experiences trauma is at risk of developing the disorder. Jennifer* is a 30-something teacher, visual artist, wife, and mother who also happens to suffer from PTSD due to the sudden death of her father. She shares:
I have been struggling with PTSD for 17 years. For a long time, I never knew what it was or what was happening to me. When I was 16 I watched my father died of a massive heart attack in front of me. He was lying on the couch downstairs. I was upstairs on the computer and I remember my mom yelling his name over and over. I went downstairs to find him holding his chest and staring at me. It sounded like he was trying to say something but I was just trying to reassure him that the ambulance was on its way and that he was going to be okay. He wasn’t okay. By the time we got to the hospital he had already passed away. This was 17 years ago last November.
It’s important to point out that PTSD-related reactions to situations and people don’t have to directly mirror the circumstances of the original trauma. Jennifer explains that after her father’s death she would panic whenever she had any sense something bad might have happened to a loved one, even it was unrelated to her father’s heart attack:
If anything would happen that related to heath, I would panic. It would take me back to that image of my father in the couch. I now know that people die. They can die at any time and they can die right in front of me. If my mom wouldn’t answer the phone I would automatically assume she was lying on the floor dead or hurt. If I had a pain in my chest, it was a heart attack. That thought, that image of him. Still there. I always just lived with this feeling. These thoughts and extreme fear were a part of my life now. I just assumed I was broken. Actually, I just assumed that everyone was going to die in front of me.
Post-Traumatic Stress Disorder and Motherhood
The effects of PTSD on everyday life can’t be overemphasized. They can be overwhelming, panic-inducing, and life-altering. For mothers, PTSD can be exceptionally difficult to deal with, let alone overcome when they are so busy taking care of their children. When Jennifer had her children, she found herself experiencing panic when she thought of her father’s death and the inevitability of death in general:
After having them (and less sleep) I really found myself having a hard time not thinking about my dad, and how much I loved him and how now I have these little boys that I love so much—more than anything in the world—and what if I lost them like I lost him?
Jennifer says if her kids’ names are called and they don’t answer, it takes her back to the day she was upstairs and her mom was calling her dad’s name:
As a mother, I try to shield my kids from how I feel when I am panicking, but it is impossible. They see me react. They know I am afraid. I feel terrible about it. I worry constantly that I am going to give them fears that are irrational.
The compound nature of anxiety, wherein one small worry quickly escalates into an end-of-the-world scenario in the victim’s mind, can be greatly exacerbated by motherhood. Suddenly, good mental health hygiene practices (such as plenty of sleep, time for self-care, and plenty of partner support) that may have been common practice prior to having children can inadvertently be pushed aside by the demands of motherhood. Jennifer is very familiar with this conundrum, saying, “I also found that with the kids, I am finding it hard to make it to my CBT appointments. I am so busy with work and being a mom that I am not taking care of my mental health nearly as much as I should be.” It’s clear that accessible, affordable treatment is needed for mothers (and others who suffer from PTSD), so what does PTSD treatment look like?
Treatment of Post-Traumatic Stress Disorder: A Multi-Pronged Approach
PTSD is commonly treated with psychotherapy and medication. Different approaches and treatment options include:
Cognitive Behavioral Therapy (CBT)
CBT addresses PTSD patients’ thought patterns and focuses on the mental constructs (like phobias) that are adversely impacting their day-to-day life. Specifically, a therapist will help a patient recognize self-doubt, social anxiety, and fear that the traumatic event will reoccur. CBT can combine talk therapy, journaling, and education about anxiety-management techniques.
Eye Movement Desensitization and Reprocessing (EMDR)
EDMR is a type of therapy that involves processing trauma while following guided movements. Over the course of treatment, the practice eventually helps change your reaction to the traumatic thoughts.
Exposure Therapy
Exposure therapy involves addressing traumatic thoughts directly and can involve discussions with a therapist or physically doing activities related to the original trauma. Exposure therapy is often combined with cognitive behavioral therapy.
Medication
Antidepressants that fall under the SSRI (selective serotonin reuptake inhibitors) heading are the drugs most commonly used to combat the symptoms of PTSD. These include medications such as Celexa, Lexapro, Prozac, Paxil, and Zoloft. Antidepressants are often used in conjunction with psychotherapy.
Alternative Treatments for Post-Traumatic Stress Disorder
While psychotherapy and medication have been proven to be the most effective treatments for PTSD, many people use alternative or complementary therapies as further means to support themselves through their daily lives. Animal therapy, acupuncture, meditation, and guided relaxation are all examples of commonly used alternative or complementary therapies. Although research in these area is limited or inconclusive, the U.S. Department of Veterans Affairs supports the study of these methods and their use when combined with psychotherapy and/or medication.
How are children treated for post-traumatic stress disorder?
Treatment of children who have PTSD utilizes cognitive behavioral therapy and eye movement desensitization in addition to play therapy. Play therapy is used for children ages 3 to 8 and involves the use of natural expression (play) as a therapeutic means for coping with emotional stress and trauma.
How to Support Someone Who’s Struggling With PTSD
Relationships with others are especially crucial for individuals with PTSD and support from friends and family has proven to have a lasting positive effect on individuals coping with PTSD. Why are relationships so important? They can help alleviate guilt that is attached to the incident, they lower the chances of depression and overwhelming anxiety, and they can shift the focus of the individual away from the traumatic event and themselves and onto maintaining healthy relationships with other people. Therapy is also important, both for the person with PTSD and for those doing the supporting, and can take the form of marriage counseling, counseling from a place of religious worship, family education classes, anger management, or group therapy. In addition to in-person sources of support, there are many online organizations that provide help in the form of internet forums, education and awareness, volunteer work, and 1-800 hotlines that provide counseling and support over the phone. Sidran: Traumatic Stress Education & Advocacy provides resources for survivors and their loved ones as well as information for mental health workers and advocates. NAMI (National Alliance on Mental Illness) offers a wealth of information on mental health and illnesses, including PTSD. It also offers information and support for mothers suffering from PTSD. The U.S. Department of Veterans Affairs’ website provides excellent information on the diagnosis and treatment of PTSD as well as resources for loved ones. It also hosts information pertaining to PTSD caused by non-military events. *Some last names have been omitted from this article to respect contributors’ privacy.
