PTSD – Post Traumatic Stress Disorder

PTSD – Post Traumatic Stress Disorder.
PTSD – Post traumatic stress disorder is a word you might have heard of in the news or from friends and family, and wondered what it is, or whether you or someone you know or ever known has it.

What is PTSD – Post Traumatic Stress Disorder

Posttraumatic stress disorder (PTSD) can occur after someone goes through a traumatic event like combat, assault, or disaster. Most people have some stress reactions after a trauma. If the reactions don’t go away over time or disrupt your life, you may have PTSD.

Post Traumatic Stress Disorder Definition

What is the meaning of PTSD? PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. Read more about PTSD Definition.

Can Children have PTSD?

Children can have Post Traumatic Stress Disorder too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of Post Traumatic Stress Disorder symptoms in children:

  • Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma through play.
  • Children, ages 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
  • Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

What Other Problems do People with Post Traumatic Stress Disorder Experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems. what_is_ptsd What is PTSD

Will People with Post Traumatic Stress Disorder Ever get Better?

“Getting better” means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.

PTSD Test

PTSD Symptom Scale – Interview (PSS-I)
Foa, Riggs, Dancu, & Rothbaum, 1993

Description :

The PSS-I is a 17-item semi-structured interview that assesses the presence and severity of DSM-IV PTSD symptoms related to a single identified traumatic event in individuals with a known trauma history.

The PSS-I takes about 20 minutes to administer and can be administered by lay interviewers trained to recognize the clinical picture in traumatized persons. Each item is assessed with a brief, single question. There are no probes or follow up questions.

Interviewees are asked about symptoms they have experienced in the “past two weeks.” This time frame differs from the standard one-month time frame of other measures. For each item, the interviewer assigns a rating to reflect a combination of frequency and severity (from O = “not at all” to 3 = “5 or more times per week/very much”).

Sample Item

Have you had recurrent or intrusive distressing thoughts or recollections about [the event]? 0 = not at all 1 = Once per week or less/a little bit 2 = 2-4 times per week/somewhat 3 = 5 or more times per week/very much Measure availability: We provide information on a variety of measures assessing trauma and Post Traumatic Stress Disorder.

These measures are intended for use by qualified mental health professionals and researchers. Measures authored by National Center staff are available as direct downloads or by request. Measures developed outside of the National Center can be requested via contact information available on the information page for the specific measure.

Post Traumatic Stress Disorder Symptoms

Symptoms of PTSD may disrupt your life and make it hard to continue with your daily activities. You may find it hard just to get through the day. There are four types of PTSD symptoms:

Reliving the event (also called re-experiencing symptoms)

Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example:

  • You may have nightmares.
  • You may feel like you are experiencing the event again. This is called a flashback.
  • You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.

Avoiding situations that remind you of the event

You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example:

  • You may avoid masses because they feel dangerous.
  • You may avoid driving if you were in a car accident or if your military convoy was bombed.
  • If you were in an earthquake, you may avoid watching movies about earthquakes.
  • You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event.

Negative changes in beliefs and feelings

The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following:

  • You may not have positive or loving feelings toward other people and may stay away from relationships.
  • You may forget about parts of the traumatic event or not be able to talk about them.
  • You may think the world is completely dangerous, and no one can be trusted.

Feeling keyed up (also called hyperarousal)

You may be jittery or always alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal. For example:

  • You may have a hard time sleeping.
  • You may have trouble concentrating.
  • You may be startled by a loud noise or surprise.
  • You might want to have your back to a wall in a restaurant or waiting room.

What should I do if I have symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event. But for some people, they may not happen until months or years after the trauma. Symptoms may come and go over many years. So, you should keep track of your symptoms and talk to someone you trust about those symptoms. If you have symptoms that last longer than four weeks, cause you great distress, or disrupt your work or home life, you probably have PTSD. You should seek professional help from a doctor or counselor.

Complex PTSD

Many traumatic events (e.g., car accidents, natural disasters, etc.) are of time-limited duration. However, in some cases, people experience chronic trauma that continues or repeats for months or years at a time. The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma.

People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in their self-concept and the way they adapt to stressful events. Dr. Judith Herman of Harvard University suggests that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma (1). Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS)(2).

A work group has also proposed a diagnosis of Developmental Trauma Disorder (DTD) for children and adolescents who experience chronic traumatic events (3). Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met diagnostic criteria for PTSD, Complex PTSD was not added as a separate diagnosis classification (4). However, cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations.

What Types of Trauma are Associated with Complex PTSD?

During long-term traumas, the victim is generally held in a state of captivity, physically or emotionally, according to Dr. Herman (1). In these situations, the victim is under the control of the perpetrator and unable to get away from the danger. Examples of such traumatic situations include:

  • Concentration camps
  • Prisoner of War camps
  • Prostitution brothels
  • Long-term domestic violence
  • Long-term child physical abuse
  • Long-term child sexual abuse
  • Organized child exploitation rings

Additional Symptoms That can be seen in Complex PTSD

An individual who experienced a prolonged period (months to years) of chronic victimization and total control by another may also experience the following difficulties:

  • Emotional Regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  • Consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
  • Self-Perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  • Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Relations with Others. Examples include isolation, distrust, or a repeated search for a rescuer.
  • One’s System of Meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.
  • What other difficulties are faced by those who experienced chronic trauma?

Because people who experience chronic trauma often have additional symptoms not included in the PTSD diagnosis, clinicians may misdiagnose PTSD or only diagnose a personality disorder consistent with some symptoms, such as Borderline, Dependent, or Masochistic Personality Disorder.

Care should be taken during the assessment to understand whether symptoms are characteristic of PTSD or if the survivor has co-occurring PTSD and personality disorder. Clinicians should assess for PTSD specifically, keeping in mind that chronic trauma survivors may experience any of the following difficulties:

  • Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
  • Survivors may use alcohol or other substances as a way to avoid and numb feelings and thoughts related to the trauma.
  • Survivors may engage in self-mutilation and other forms of self-harm.
  • Survivors who have been abused repeatedly are sometimes mistaken as having a “weak character” or are unjustly blamed for the symptoms they experience as a result of victimization.

PTSD Treatment

Whether you just returned from a deployment or have been home for 40 years, it’s never too late to get help for posttraumatic stress disorder (PTSD). Getting counseling or treatment can help you manage your symptoms and keep them from getting worse. Sometimes the sign of guilt lingers for years before he/she snaps.

Treatment for Complex Post Traumatic Stress Disorder

Standard evidence-based treatments for PTSD are effective for treating PTSD that occurs following chronic trauma. At the same time, treating Complex PTSD often involves addressing interpersonal difficulties and the specific symptoms mentioned above. Dr. Herman contends that recovery from Complex PTSD requires restoration of control and power for the traumatized person. Survivors can become empowered by healing relationships which create safety, allow for remembrance and mourning, and promote reconnection with everyday life.

What Treatments are Available?

There are two main types of treatment, psychotherapy (sometimes called counseling or talk therapy) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for Post Traumatic Stress Disorder

Psychotherapy, or counseling, involves meeting with a therapist. Trauma-focused psychotherapy, which focuses on the memory of the traumatic event or its meaning, is the most effective treatment for Post Traumatic Stress Disorder. There are different types of trauma-focused psychotherapy, such as:

  • Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
  • Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
  • Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.

Medications for Post Traumatic Stress Disorder

Medications can be effective too. Some specific SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are used for depression, also work for Traumatic Stress Disorder. These include sertraline, paroxetine, fluoxetine, and venlafaxine.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for Post Traumatic Stress Disorder treatment because they do not treat the core symptoms and can be addictive.

References

    1. Foa, E., Riggs, D., Dancu, C., & Rothbaum, B.(1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459-474. doi: 10.1007/BF00974317
    2. Foa, E & Tolin, DF (2000). Comparison of the PTSD Symptom Scale-Interview Version and the Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 13, 181-191. doi: 10.1023/A:1007781909213
    3. Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
    4. Ford, J. D. (1999). Disorders of extreme stress following war-zone military trauma: Associated features of Posttraumatic Stress Disorder or comorbid but distinct syndromes? Journal of Consulting and Clinical Psychology, 67, 3-12.
    5. van der Kolk, B. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.
    6. Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 10, 539-555.
    7. PTSD.va.gov/Spanish
    8. PTSD.va.gov