Post-Traumatic Stress Disorder (PTSD) I Psych Central.pdf

SUBSCRIBE Post-Traumatic Stress Disorder (PTSD) Medically reviewed by Jeffrey Ditzell, DO — Written by Hilary I. Lebow — Updated on Jun...

SUBSCRIBE Post-Traumatic Stress Disorder (PTSD) Medically reviewed by Jeffrey Ditzell, DO — Written by Hilary I. Lebow — Updated on June 21, 2021 What is it? Prevalence Causes Risk factors Symptoms Diagnosis Treatment Alternative therapies New research Self-care strategies Complications Coexisting conditions Living with PTSD Resources and support Helping someone with PTSD Recap Post-traumatic stress disorder, aka PTSD, is a serious mental health condition once attributed only to post-war veterans. Today, we know ADVERTISEMENT that it’s so much more. :  Klaus Vedfelt / Getty Images Many of us are familiar with that near-miss feeling. Whether it’s a car that comes a little too close or a medical scare in the emergency room, that near-miss is a memorable experience. When we go through a traumatic event, several systems in the body kick into high gear. The hypothalamus and pituitary gland both send out a rush of stress hormones, preparing us to fight, flee, or freeze. When the danger passes, many people can move on and “shake it off,” so to speak. Yet for some of us, that feeling of being on high alert can persist for weeks, months, or even years, and occur alongside other symptoms. If this resonates with you, know that you’re not alone. Post-traumatic stress disorder (PTSD) is not a rare condition, and with the right management plan, including trauma therapy, you can manage your symptoms. ADVERTISEMENT :  What is PTSD? PTSD is a mental health condition that may occur as a result of witnessing or experiencing a traumatic event. It was added as a diagnosis by the American Psychiatric Association (APA) to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. People who live with PTSD experience an elevated “fight or flight” response. Perceived threats trigger their autonomic nervous system, which leads to chemical alternations in the brain. This creates a sense of danger and other symptoms, even when there is no actual threat or the threat is no longer present. :  PSYCH CENTRAL RESOURCES Get a deeper understanding of trauma and PTSD Sign up for our 5-day series and learn about the science behind trauma from a licensed psychologist. Enter your email START SERIES Your privacy is important to us How common is PTSD? Many people will experience a traumatic event without further complications, but a small percentage go on to develop PTSD. In the United States, 3.6% of adults — about 9 million people — meet the diagnostic criteria for PTSD, according to the National Alliance on Mental Illness (NAMI). PTSD is more prevalent among those in high- stress working environments, like firefighters, first responders, police officers, and military veterans. The number of military veterans with PTSD :  varies by service era: Operation Iraqi Freedom: 11% to 20%, or about 11 to 20 out of every 100 veterans, lives with PTSD Gulf War: 12%, or 12 out of 100 veterans Vietnam War: 15%, or 15 out of 100 veterans In addition, 23% of women use Veterans Affairs (VA) services because of PTSD due to military sexual trauma (MST) during their time of service. Both men (38%) and women (55%) report PTSD due to sexual harassment while in the military. ADVERTISEMENT Causes of PTSD :  PTSD was formerly called “shell shock” or “battle fatigue syndrome,” and many people may be familiar with the condition through its association with war-time veterans. However, PTSD can develop from a range of different scenarios. What ties them together is a real or perceived threat of danger, which may involve a possible loss of life. Some PTSD causes include: natural disaster crime violence serious medical event near-death experience loss of a loved one physical or sexual abuse transportation accidents (car, plane, etc.) In general, any stressful event where you feel fear, shock, horror, or helplessness can cause PTSD. :  ADVERTISEMENT Betterhelp BetterHelp provides a tailored therapist match from the largest online network of therapists in the world. Experience affordable, high quality therapy with a match in as little as 24 hours. Enjoy 20% off your first month of therapy TAKE ASSESSMENT 4 Access Preferred million+ therapy by 94% helped 24/7 of users Risk factors of PTSD Researchers still don’t know why some people develop PTSD and others do not. But there are a handful of factors that may increase the chances of diagnosis. Some of these include: lack of a support network history of other mental health conditions past experiences of abuse, often in childhood poor physical health being female getting physically hurt :  Another factor that may contribute to PTSD is experiencing a stressful event after a traumatic event, such as getting a divorce shortly after a serious car accident. Genetics might also play a role. In brain scans of people with PTSD, research suggests that the hippocampus — the part of the brain that deals with memories and emotional regulation — is smaller and shaped differently than in those without PTSD. ADVERTISEMENT Symptoms of PTSD In the few days after a traumatic event, it’s normal to feel overwhelmed, cry, or have difficulty focusing. These symptoms don’t necessarily point to a longer-term condition. :  Symptoms of PTSD tend to last longer, disrupt your everyday activities, and negatively impact your overall quality of life. They usually surface within 3 months after the traumatic event, though they can arise at a later point as well. Intrusion symptoms These symptoms — referred to as re- experiencing symptoms in older versions of the DSM — are those that take you back to the trauma. flashbacks or dissociative reactions nightmares or distressing dreams intense, unpleasant memories, images, or thoughts emotional or physical distress when you think about the traumatic event Avoidance symptoms These symptoms or behaviors are exactly what they sound like. You will likely avoid anything that reminds you of the traumatic event, including: people places situations :  You might also avoid thinking and talking about the traumatic event. For example, if you’re experiencing PTSD due to a car accident, you might avoid the place where the accident happened or avoid driving altogether. Other external reminders can include sounds and smells. Arousal and reactivity symptoms This category of symptoms includes physical reactions to trauma or reminders of trauma. Examples include: irritability feeling on edge difficulty with concentration heightened startle response sudden bursts of anger Mood and cognition symptoms Our thoughts, beliefs, and feelings are affected by our mood. Conversely, our moods are affected by our feelings, thoughts, and beliefs. Unhealthy thinking patterns can be a product of PTSD. Some of these include: negative self-talk :  feelings of guilt or self-blame memory issues lack of interest in things you love Physical symptoms Though not discussed in the newest version of the DSM, the physical symptoms of PTSD can mimic a panic attack. Some physical symptoms include: sweating shaking dizziness headaches chest pain upset stomach unexplained aches and pains fatigue from nightmares or sleep disturbances PTSD symptoms in children Adults aren’t the only ones who get PTSD — it can occur at any age. In children, some of the symptoms of PTSD might be: bedwetting nightmares :  increased clinginess with adults expression of trauma through art or games In the case of trauma from sexual abuse, children might exhibit: low self-worth fear, sadness, isolation aggression abnormal sexual behavior self-harm alcohol or drug abuse Diagnosis of PTSD For an accurate diagnosis of PTSD, certain criteria must be met. You were exposed to or witnessed death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. You experience one or more intrusion symptoms, avoidance symptoms, reactivity symptoms, and mood and cognition symptoms. Your symptoms have been present for at least 1 month. Your symptoms cause difficulty in social :  or occupational settings. Your symptoms are not related to medication, substance use, or illness. If you’re experiencing any of these, consider reaching out to your healthcare professional, if available. A physical exam might be performed during your evaluation to make sure a medical issue is not the cause of your symptoms. A psychological evaluation may also be done to discuss your signs and symptoms and the event or events that might have caused them. You might also be asked to complete a questionnaire and answer questions about your personal and family history. A primary care physician or healthcare professional will likely refer you to a specialist for further evaluation if needed. Only a mental health specialist — such as a psychologist, psychiatrist, or clinical social worker — can accurately diagnose PTSD. Treatment for PTSD While there’s no way to prevent a traumatic event from occurring, there are ways to manage any symptoms that arise in the aftermath of a trauma. :  Researchers have noted a few resilience factors, which are characteristics of people who can adapt and grow after trauma. These include: the ability to reach out and seek support success in developing coping strategies a feeling of positivity around how they responded to their trauma Those who practice “active coping,” in this way, may recover from PTSD more quickly. According to the National Institute of Mental Health (NIMH) , some make a recovery within 6 months. For others, treatment may last several years. Treatment for PTSD often includes a combination of psychotherapy and medication. Psychotherapy Research shows that psychotherapy, also known as a talk therapy, may be an effective treatment option for PTSD. Cognitive processing therapy (CPT). This technique is used to help process a trauma, since many people aren’t able to process it directly after it happens. CPT can also help someone restructure their beliefs around what happened in more :  helpful ways. Prolonged exposure therapy. This is a type of cognitive behavioral therapy that involves gradually approaching trauma- related memories or situations that you’ve been avoiding since the event. This technique is done slowly, safely, and systematically. You might also learn breathing techniques to help manage your anxiety. Eye movement desensitization and reprocessing (EMDR). EMDR uses gentle tones or tapes to interrupt thought patterns or beliefs. Research  shows that it can reduce anxiety, depression, fatigue, and paranoia. Medications Some medications may have a positive impact on PTSD symptoms, like anxiety, depression, and sleep disturbances. The American Psychological Association (APA) recommends selective serotonin reuptake inhibitors (SSRIs) for the treatment of PTSD symptoms. The most commonly prescribed medications are: paroxetine (Paxil) fluoxetine (Prozac) :  sertraline (Zoloft) Other antidepressants, like venlafaxine (Effexor), might also help reduce symptoms. Alternative therapies PTSD is effectively managed with medications and psychotherapy. There are other strategies — known as complementary and alternative medicine — that you can try to help manage your symptoms. However, there’s not enough research to support their effectiveness. If you’re interested in trying these complementary and alternative strategies, work closely with your doctor to discuss options. Art therapy Art therapy can help people with PTSD process traumatic events in a different way. Art can be a way to express how an individual is feeling when words are not enough. Creative mediums like painting, drawing, coloring, and sculpture are often used in art therapy. One 2017 pilot study suggests that art therapy eased symptoms of PTSD due to multiple or prolonged trauma, such as people who’d experienced early childhood trauma and :  refugees from different cultures. Other research suggests that art therapy might help to reduce symptoms for combat-related PTSD and depression. Yoga and meditation A recent study has found that yoga might be helpful for managing symptoms of PTSD. It works by increasing mindfulness and helping people feel grounded and safe in their body, as trauma can create a sense of detachment. A 2017 review  suggests that meditation and yoga are promising treatments for PTSD. However, studies were small and more research is needed. New research areas There is emerging research into other strategies that might be helpful for symptoms of PTSD. However, there is not enough evidence to support these techniques, and none of the below substances are approved by the Food and Drug Administration (FDA) to treat PTSD. More research into these techniques is needed. :  Psychedelics There’s a growing body of evidence in support of psychedelic-assisted psychotherapy, as in using controlled doses in a therapeutic setting. Research shows that MDMA and psilocybin from “magic mushrooms” might help treat symptoms of PTSD and depression. Other psychedelics show promising results for PTSD as well, such as LSD and ayahuasca, though they are still in the early research stage. Ketamine A new study published in the American Journal of Psychiatry explored the effectiveness of ketamine for treating PTSD. In the study, some participants were given repeated doses of ketamine intravenously (IV), while others were given midazolam — a benzodiazepine that acts as a sedative and is often given before medical procedures and surgery. More participants responded to IV infusions of ketamine over 2 weeks than those given midazolam. Video games Among veterans, there is some research  to suggest that playing video games can reduce symptoms of PTSD. :  It may help with adaptive coping, well-being and confidence, and a sense of “brotherhood” and companionship. Emotional freedom technique (EFT) In this technique, a trained therapist can help you tap certain parts of your hands, head, face, and collarbones while reciting a “setup statement” related to the traumatic event. For example, “Even though I vividly recall the horror of the car accident, I deeply love and accept myself.” In session, you will be asked to rate the intensity of the event on a scale of 1 to 10, with 10 being the most intense. As treatment progresses, the goal is to reduce the emotional charge around the event to a lower number by “tapping in” a new belief. Research  has shown that EFT tapping can help reduce anxiety, stress, and pain. ADVERTISEMENT :  Self-care strategies Recovery takes time, but having more tools in your toolkit certainly helps the process along. Here are some lifestyle adjustments you can make to support your treatment: Educate yourself about PTSD. Find a support group of people with PTSD. Eat nutrient-dense, unprocessed foods. Sleep at least 8 hours a night. Talk about your triggers with loved ones. Spend time out in nature or “greenspace.” Get physical exercise, like walking or swimming. Create a consistent meditation or yoga practice. Remember, you don’t have to do this all at once. Try making little changes at a time. Take it one day at a time. Every little bit helps. Complications Beyond the traditional symptoms of PTSD, the :  condition may lead to complications, especially if left untreated. These include: work difficulties strained relationships increased risk of heart problems higher risk of chronic disease chronic pain Prolonged stress can also decrease immune system function, which can lead someone with PTSD to experience more frequent infections, like the cold and flu. Coexisting conditions Over the long term, PTSD may lead to changes in the structure of the brain, due to a decrease in size of the hippocampus — the part of the brain that helps regulate emotions and memory. People who live with PTSD may also experience the following conditions: anxiety depression substance use personality disorder :  Suicide prevention If you’re considering self-harm or suicide, help is available right now: Call the National Suicide Prevention Lifeline at 800-273-8255. Text “HOME” to the Crisis Text Line at 741741. Call the Veterans Crisis Line at 800- 273-8255 #1. Living with PTSD When you live with PTSD, every day can feel like a silent battle. Life may suddenly be divided into two distinct chapters — before the trauma, and after it — and it’s difficult to put any of it into words. Maybe you don’t quite feel like “you.” Perhaps you’re set off by little things, scared to do the activities you used to love, or unsure how to relate to people at home or work anymore. Each of us responds differently to trauma, and no two experiences are alike. But when things feel out of sorts, something that can help us all is knowing that we’re not alone. :  Even if the people around you don’t quite understand what you’re going through, there are people out there who do. Reading about other people’s journeys with PTSD may help you feel less isolated in your experience. Here are some articles that can shed light on the different facets of PTSD: Postpartum PTSD Postpartum depression & post-traumatic stress disorder Understanding PTSD and its effects on marriage Relationship PTSD How does PTSD Affect Relationships? How PTSD, cPTSD, and BPD can impact relationships Understanding relationship, sexual, and intimate betrayal as trauma Domestic violence, PTSD, and triggers Medical PTSD Minimizing the risks of PTSD from the COVID-19 pandemic cPTSD and eating disorders PTSD and chronic pain :  Resources and support If you’re ready to find support, the Anxiety & Depression Association of America and the International Society for Traumatic Stress Studies can help you locate a mental health professional who specializes in trauma. For inpatient services or treatment facilities, the Substance Abuse and Mental Health Administration (SAMSA) offers a Behavioral Health Services Locator. The PTSD Coach app provides education about PTSD, a self-assessment tool, and tools to manage symptoms. Other places where you can find support include: AboutFace Real Warriors My HealtheVet In Transition Military OneSource, part of the U.S. Department of Defense network of support International Society for Traumatic Stress Studies Helping someone with PTSD :  If someone you love is living with PTSD, it’s normal to want to reach out and help. But when it comes to PTSD, it can be difficult to know how to support them. If you think a loved one could be experiencing PTSD, there are ways you can offer support. The National Alliance on Mental Illness offers some helpful guides: PTSD Help Guide PTSD e-learning module Veterans & Active Duty offers more information about veteran mental health NAMI Homefront offers free, six-session educational program for families, caregivers, and friends of military service members and veterans Be sure to fill your own cup and seek out the support of a trusted friend or therapist. For more information, tips, and general support, download the PTSD Family Coach app. Let’s recap PTSD is a complex mental health condition, but it’s treatable with psychotherapy, medication, and complementary treatments. :  All of us experience trauma differently, but that doesn’t mean you have to go through this alone. There are support groups, articles, apps, hotlines, and mental health professionals ready to support you at every step. You can support your treatment efforts with a balanced, mindful lifestyle — get plenty of rest, try to exercise, and eat nutrient-dense foods. As you navigate PTSD, be patient with yourself and your loved ones. Recovery time is different for everyone, but you’re well on your way already. And finally, most importantly, there is always — always — hope. ADVERTISEMENT Explore online talk therapy options 4.5 FROM TRUSTPILOT Therapy via messaging, phone, or live video chat Great for a large network of licensed therapists :  Flexible cancellation at any time $65 to 90/week, billed every 4 weeks 20% off your first month LEARN MORE 4.6 (2.1K+) FROM App Store Medication for anxiety and depression FDA-approved medication for anxiety and depression available Unlimited check-ins via online messaging $49 to $85/month, billed monthly $49 per month or less than $2 per day. LEARN MORE :  4.8 (29.8k) FROM App Store Combine therapy and prescription management Therapy via messaging, phone, or live video chat Psychiatry and prescription management available Covered members pay an average copay of $30 Special Offer: $85 off LEARN MORE 4.7 (2.9k) FROM ONLINE-THERAPY.COM Holistic programs with videos, journaling, and yoga Great for cognitive behavioral therapy Therapy via messaging, live video chat, and worksheets $40 to $88/week, billed monthly :  20% off your first month LEARN MORE  17 sources Akiki TJ, et al. (2017). The association of PTSD symptom severity with localized hippocampus and amygdala abnormalities. https://journals.sagepub.com/doi/full/10.1177/24705 47017724069 Carras MC, et al. (2018). Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems. https://pubmed.ncbi.nlm.nih.gov/30257787/ Church D, et al. (2018). Guidelines for the treatment of PTSD using clinical EFT (Emotional Freedom Techniques). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC631 6206/ Decker KP, et al. (2019). Quantitatively improved treatment outcomes for combat-associated PTSD with adjunctive art therapy: Randomized controlled trial. https://www.tandfonline.com/doi/abs/10.1080/0742 1656.2018.1540822 Gallegos AM, et al. (2018). Meditation and yoga for post-traumatic stress disorder: A meta-analytic review of randomized controlled trials. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC593 9561/ Krediet E, et al. (2020). Reviewing the potential of :  psychedelics for the treatment of PTSD. https://academic.oup.com/ijnp/article/23/6/385/58 05249 LaFrance EM, et al. (2020). Short and long-term effects of cannabis on symptoms of post-traumatic stress disorder. https://www.sciencedirect.com/science/article/pii/S 0165032720306364 Medications for PTSD. (n.d.). https://www.apa.org/ptsd- guideline/treatments/medications Posttraumatic stress disorder. (n.d.). https://www.nami.org/About-Mental-Illness/Mental- Health-Conditions/Posttraumatic-Stress-Disorder PTSD: National center for PTSD. (n.d.). https://www.ptsd.va.gov/understand/common/com mon_veterans.asp PTSD treatments. (n.d.). https://www.apa.org/ptsd- guideline/treatments%E2%80%A8 Reiff CM, et al. (2020). Psychedelics and psychedelic-assisted psychotherapy. https://ajp.psychiatryonline.org/doi/full/10.1176/appi. ajp.2019.19010035 Schouten KA, et al. (2017). Trauma-focused art therapy in the treatment of post-traumatic stress disorder: A pilot study. https://www.tandfonline.com/doi/abs/10.1080/1529 9732.2018.1502712 Stein MB, et al. (2021). Ketamine for PTSD: Well, isn't that special. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp. :  2020.20121677 West J, et al. (2018). Trauma sensitive yoga as a complementary treatment for post-traumatic stress disorder: A qualitative descriptive analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC540 4814/ Wilson G, et al. (2018). The use of eye-movement desensitization reprocessing (EMDR) therapy in treating post-traumatic Stress Disorder—A systematic narrative review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC599 7931/ Zaccari B, et al. (2020). Yoga for veterans with PTSD: Cognitive functioning, mental health, and salivary cortisol. https://psycnet.apa.org/record/2020-58802-001 v  FEEDBACK:  RE AD AD THIS T THIS HIS NE NEXT N EXT XT What Causes PTSD? No matter who you are, trauma can be overwhelming. 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