What is PTSD?
It is typical for people to experience emotional distress after a traumatic event. As time passes, symptoms often decrease in intensity as they heal. In Post Traumatic Stress Disorder or PTSD, symptoms persist long after the trauma. People with PTSD continue to have flashbacks and feel that they re-experience the traumatic event. There must be a high level of ongoing distress and significant life impairment to meet the criteria for the disorder. Fortunately, there are effective treatments.
How common is PTSD?
It is important to note that most people who have a traumatic experience will not develop Post Traumatic Stress Disorder. PTSD does affect 3.5% of the U.S. adult population, about 8 million Americans. About 1 out of 9 women develop PTSD. That makes women about twice as likely as men to experience PTSD. Anyone can develop PTSD at any age.
How do we define a traumatic event?
The human condition is full of diverse and meaningful experiences. Unfortunately, there is no way around the fact that some of those experiences will be emotionally painful. Up to 70% of adults in America have experienced a traumatic event. The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) states that a traumatic event involves a threat to a person’s life or witnessing such threats to loved ones. These events are typically sudden and unexpected and could be anything from seeing a death, being in a car accident, sexual assault, combat, or a natural disaster. They are capable of creating a moment of extreme, sheer panic in which one fears for one’s life or the life of a loved one.
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
- At least one re-experiencing symptom
- At least one avoidance symptom
- At least two cognition and mood symptoms
- At least two arousal and reactivity symptoms
Types of PTSD
Basic symptom criteria are the same across the broad diagnosis of PTSD, remember that anyone can develop it at any age. PTSD may present in distinctly different ways. The identified types of PTSD defined by the DSM-5 include:
- Delayed onset/expression
The most recent edition of the DSM-5 included a new specifier for PTSD symptoms in children six years or younger. Symptoms of PTSD in children may appear differently, nightmares do not need to contain content related directly to the traumatic event, and they may express distress through play.
Why do some people develop PTSD?
Not everyone who lives through a dangerous event develops PTSD. Factors present before, during, and after the trauma play a role.
Risk factors that may increase the likelihood of developing the disorder include:
- Exposure to dangerous events or traumas
- Getting hurt or seeing people hurt or killed
- Childhood trauma
- Feeling horror, helplessness, or extreme fear
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a personal history or family history of mental illness or substance use
Resilience factors that may reduce the likelihood of developing PTSD include:
- Seeking out support from friends, family, or support groups
- Learning to feel okay with one’s actions in response to a traumatic event
- Having a coping strategy for getting through and learning from a traumatic event
- Being prepared and able to respond to upsetting events as they occur, despite feeling fear.
Myth: Only war veterans develop PTSD.
Fact: Anyone can develop PTSD at any time.
Myth: A trauma is any difficult event in life.
Fact: There are many things in life that cause feelings of upset, but not just any event can cause PTSD. For example, breakup, job loss, or the death of a pet cannot cause PTSD.
Myth: Only weak people get PTSD.
Fact: PTSD is not determined by strength or weakness. There are many different risk factors that contribute to developing PTSD.
Myth: PTSD is not a treatable condition.
Fact: There are currently several well researched, effective PTSD treatments.
The symptoms of PTSD can be debilitating if left untreated. It is important to seek help. There are several known effective PTSD treatments. Sometimes a combination of psychotherapy and medication are used. The recommended treatment programs for PTSD are “trauma-focused” psychotherapies and are most often treated at an outpatient level of care. These treatments focus on the memory of the traumatic event or its meaning. They use different techniques to help you process the trauma including visualizing, talking or thinking about it. Cognitive Behavioral Therapy approaches focus on changing unhelpful beliefs about the trauma.
Prolonged Exposure (PE)
Prolonged Exposure (PE) is an evidence based psychotherapy/ exposure therapy for PTSD. It is one specific type of Cognitive Behavioral Therapy. PE teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By approaching and confronting these challenges, you can actually decrease your PTSD symptoms. Research has shown it as among the more effective PTSD treatments.
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy (CPT) is one specific type of Cognitive Behavioral Therapy. It is completed in 12-sessions. CPT works on the concept that if you change your thoughts, you can change the way you feel. CPT teaches you to evaluate and change the upsetting thoughts you have experienced since your trauma.
After a trauma, the way you think about yourself and the world can change. You may not trust that the world is a safe place and blame yourself for what happened. Self-blame and viewing the world as dangerous may keep you stuck in your PTSD symptoms and cause you to miss out on pleasure in life. CPT teaches skills to handle upsetting, recurring thoughts. You can discover more helpful ways to think about traumatic events. You will learn how to decide whether the facts support your thought or do not support your thought. Is your current perspective useful, or can you think about things differently?
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a psychotherapy that can help you process upsetting memories, thoughts, and feelings related to the trauma. Processing these experiences, leads to relief from PTSD symptoms.
After trauma, people with PTSD often have trouble making sense of what happened to them. EMDR helps you process the trauma, which can allow you to start to heal. While processing, You pay attention to a back-and-forth movement or sound while you call to mind the upsetting memory. You continue to do a bilateral stimulation while focusing on your target until shifts occur in the way that you experience that memory and information from the past. Although EMDR is one of the effective treatments for PTSD, there is disagreement about how it works. Some research shows that the back and forth movement is an important part of treatment. Other research shows the opposite.
OCD & PTSD
Post traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) can co-occur in people with a history of trauma. Research shows that the likelihood of a person diagnosed with PTSD developing OCD within a year is about 30 percent. Our treatment center, serving Philadelphia and the Mainline has Therapists who are experienced in treating PTSD and OCD.
Trauma is a part of life that affects most people at some point. If distressing symptoms persist after the experience it can be debilitating. PTSD can develop in any of us at any age and is treatable. If you or someone you know is struggling to cope with trauma, it may be time to contact a mental health provider for support. No one should face PTSD alone and help is available. A professional evaluation can help determine the most appropriate treatment and level of care including medication management, outpatient or even residential treatment if indicated.