What is Post-traumatic Stress Disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is an emotional and psychological reaction to trauma. People develop PTSD after experiencing a shocking or frightening event, such as a natural disaster, a car accident, or sexual assault.
People with PTSD often seem jumpy and irritable, haunted by recurring memories called “flashbacks.” A flashback can be triggered by a loud noise, a distinctive odor, a disturbing image, or a violent emotion — even a holiday that evokes the traumatic event. Untreated PTSD symptoms often come and go for decades.
Trauma survivors remain hyper-vigilant, reliving their ordeal over and over in their minds. People suffering from PTSD don’t just remember the traumatic event — they feel like it’s happening in the present.
When the after-effects of trauma linger, symptoms tend to cluster into four categories:
- Intrusive re-experiencing. More than memories, flashbacks cause people with PTSD to lose contact with reality. The events are re-experienced as though they were happening in the present. Symptoms include nightmares, agitation, anxiety, aggression, and depression.
- Avoidance and numbing. People shut down and avoid thinking about the traumatic event. They often appear distant to family and friends. They lose interest in the activities they once enjoyed. Constant avoidance of disturbing thoughts and memories leaves people feeling isolated and disconnected.
- Negative changes in beliefs and feelings. PTSD causes people to hold persistent and exaggerated negative beliefs. Sometimes individuals blame themselves or others for the traumatic events.
- Excessive arousal. Individuals are hyper-vigilant, scanning their surroundings with alarm. They are often easily startled, have trouble sleeping, and have outbursts of irritability or anger.
What Causes PTSD?
PTSD occurs after a traumatic event or a significant stressor. It’s normal to experience an immediate panicked reaction to a brutal attack, combat injury, or a natural disaster.
By contrast, Post-traumatic stress disorder is marked by a lasting emotional response. Symptoms of PTSD usually begin early, within three months of the traumatic incident, but may take months or years to surface.
Sometimes, an insignificant event reawakens forgotten or suppressed emotions. Combat veterans often struggle with buried emotions that lurk just below the edge of conscious memory.
Is PTSD Hereditary?
Genetic factors influence whether or not an individual will develop Post Traumatic Stress Disorder. In 2017, the Psychiatric Genomics Consortium found molecular evidence pointing to genetic risk for PTSD after trauma. The study showed that the risk of PTSD is strongest among women.
Using a technique called a genome-wide association study (GWAS), the researchers found that, among American women of European descent, 29% of the risk for developing PTSD is influenced by genetic factors. The genetic risk for PTSD is substantially lower in men.
The study analyzed 20,000 people who participated in 11 multi-ethnic studies around the world. The results reinforced the role of gene variants in PTSD, which had been previously documented on a smaller scale in studies of twins.
How Is PTSD Detected?
Most people experience intense emotions after a traumatic event. Under extreme stress, the brain reverts to primitive, survival-oriented thinking. The body activates the “fight-or-flight” response in a split-second when confronted by danger. Some people freeze, unable to stop reliving the horror.
Post Traumatic Stress Disorder worsens as the individual consciously tries not to think about what happened. Constant avoidance of disturbing thoughts and memories leaves people emotionally numb.
Anger, irritability, disrupted sleep, and substance use disorders are among the warning signs of PTSD. While it’s normal to experience acute anxiety after a traumatic event, fear usually goes away in time. The disorder is diagnosed when symptoms last longer than four weeks, cause significant distress, or disrupt daily life.
How Is PTSD Diagnosed?
A doctor with experience in diagnosing mental illnesses, such as a psychiatrist or psychologist, can diagnose Post-traumatic stress disorder. To be diagnosed with PTSD, an adult must have all of the following for at least one month:
- At least one re-experiencing symptom.
- At least one avoidance symptom
- At least two arousal and reactivity symptoms
- At least two cognition and mood symptoms
PTSD symptoms must be severe enough to interfere with relationships or work. Some people recover within six months, while others have PTSD symptoms that come and go for decades.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is PTSD Treated?
Medical professionals have developed ways to treat the disorder effectively. People with PTSD often respond well to a combination of medication, therapy, and behavioral changes. Cognitive-behavioral therapy (CBT) helps people recognize how their thinking influences their emotions.
Targeted interventions are developed to treat the unique experiences of individuals. Behavioral therapies, combined with medications — and techniques like mindfulness and meditation — successfully treat the disorder.
Therapists focus on retraining the brain to reduce behavioral symptoms associated with hypervigilance. People with PTSD are always on guard against perceived threats. People with PTSD often benefit from yoga, meditation, massage, and relaxation techniques. Sleep heals and restores the brain.
Medications work best in combination with other therapies. Antidepressant drugs called SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are prescribed for PTSD. Antidepressants relieve PTSD symptoms of depression, aggression, restlessness, and anxiety.
Four SSRIs/SNRIs are recommended for PTSD:
- Zoloft® (sertraline)
- Paxil® (paroxetine)
- Prozac® (fluoxetine)
- Effexor® (venlafaxine)
Some doctors prescribe anti-anxiety drugs called benzodiazepines. However, drugs like Xanax® (alprazolam) or Ativan® (lorazepam) are not a good treatment for PTSD. They can be addictive, cause other mental health problems, and reduce the effectiveness of PTSD therapies.
Non-Pharmaceutical PTSD treatments
The following techniques can be helpful when treating PTSD, sometimes in combination with medication:
- Cognitive-behavioral therapy (CBT) helps people change their thought patterns by talking about the trauma or unearthing the origins of their fears. CBT is a safe and effective intervention for both acute and chronic PTSD. The therapeutic technique helps individuals integrate their thoughts, feelings, and behaviors.
- Cognitive processing therapy (CPT) is an effective treatment for PTSD. Patients treated with CPT take part in 12 weekly therapy sessions. People learn to recognize and challenge negative thoughts about their traumatic event. Homework assignments are completed between sessions.
- Cognitive restructuring (CR) is a short-term (12-16 weeks) therapy. This non-exposure treatment is designed to break harmful patterns of thinking. The technique involves breathing exercises, education, and skills for developing new ways of thinking.
- Desensitization. PTSD treatment may involve repeated exposure to fearful thoughts in a safe environment. The goal is to reduce reactive emotions through controlled exposure to the traumatic event. Over time, an individual’s anxiety lessens with support from a trained therapist.
- Eye Movement Desensitization and Reprocessing (EMDR). The technique involves watching or listening to something — a hand movement, flashing light, or tapping sound — while concentrating on the traumatic experience. The goal is to heal the mind by removing blocks in the brain’s information-processing center.
- Prolonged Exposure Therapy (PE). The therapeutic technique helps people confront things they’ve been avoiding. PE involves eight to 15 sessions, usually 90 minutes each. Breathing techniques help ease anxiety about the traumatic event.
- Trauma-focused cognitive behavioral therapy (TFCBT) helps children, adolescents, adult survivors, and families recover from the damaging effects of early trauma.
- Emotional support dogs. PTSD service dogs perform tasks for trauma survivors or combat veterans. Service dogs are specially trained to help people with disabilities. For example, dogs can calm someone with PTSD during an anxiety attack. They can retrieve medications, turn on lights when someone experiences night terrors, and provide reassurance.
How Does PTSD Progress?
Scientists continue to study complex brain changes related to PTSD. The brains of people with PTSD are wired differently. Trauma survivors in a state of hyperarousal perceive danger everywhere. Critical neurotransmitters in the brain trigger a “fight or flight” response even when no imminent threat exists.
Over time, people with PTSD can develop intense feelings of anger and aggression. Tormenting memories and deeply suppressed anger may spark outbursts that are difficult to control. Bottled-up feelings of hyperarousal sometimes explode into violent rages. The need for intervention by a trained professional often becomes evident as the disorder progresses.
Warning signs of PTSD include:
- Anger and irritability
- Anxiety and worry
- Alcohol and drug use
- Relationship violence
- Self-destructive behaviors or threats
How Is PTSD Prevented?
Experts think PTSD is one of the most preventable psychiatric disorders. Studies show that cognitive-behavioral therapy (CBT) can be effective immediately after major disasters. Counselors are often brought in to help people deal with the immediate aftermath of a tragedy.
Many types of interventions are effective in preventing PTSD right after someone experiences a traumatic event. Intensive therapy isn’t needed for everyone. Knowing which individuals are at the highest genetic risk for PTSD could someday help doctors target interventions more effectively.
PTSD Caregiver Tips
The most important thing you can do for a loved one with PTSD is to be supportive and caring. The disorder affects the perception of reality.
- Create a calm, comforting environment.
- Don’t argue with someone who is fearful and hyper-vigilant.
- Don’t keep firearms in the house.
- Be open to the individual’s concerns while being careful not to validate paranoid ideas).
- Be patient with irritability and anger. Everyone with PTSD has different triggers. Help find healthy ways to release anger, such as exercise, support groups, music, meditation, massage — or even aromatherapy.
- Be ready for violent outbursts.
- Embrace a daily routine.
- Reassure people that you are there to help.
- Encourage daily physical activity.
- Avoid the news or shows that trigger flashbacks.
Many people with PTSD also suffer from other brain and mental health-related issues, a condition called co-morbidity. Most people with PTSD have at least one other psychiatric disorder, and many PTSD sufferers have three or more other mental health-related issues. Here are a few of the disorders commonly associated with PTSD:
PTSD Brain Science
The brain is susceptible to the effects of traumatic stress. Brain scans show that areas of the brain differ significantly in trauma survivors compared to healthy individuals.
PTSD disrupts the brain’s normal response to stress. Long after the traumatic experience, the individual continues to feel threatened.
Researchers are trying to understand the underlying biological mechanisms that drive PTSD. People with PTSD relive a traumatic event acutely enough to disrupt their daily lives. They suffer from avoidance, emotional numbness, anxiety, depression, and anger.
Traumatic stress can be associated with lasting changes in three brain areas. The regions implicated in PTSD include:
- The amygdala, an almond-shaped mass of gray matter, is the brain region that experiences emotions and recognizes them in other people. Trauma activates the amygdala, sparking the body’s fear-response system.
- The hippocampus, a seahorse-shaped structure, is the center of memory, emotions, and motivation. Antidepressant drugs appear to counteract stress by acting on the hippocampus.
- The prefrontal cortex regulates negative emotions such as fear. The ventromedial prefrontal cortex [a region of the brain’s frontal lobe] plays a role in triggering emotions. Severe emotional trauma can cause lasting changes in the prefrontal cortex.
Trauma has also been linked to an increase in the stress hormone cortisol. Other hormones drive hyperarousal. Individuals with PTSD tend to startle easily and have an exaggerated response to loud noises. Sights, smells, or disturbing thoughts can trigger flashbacks.
Childhood trauma doesn’t just go away. Chronic stress turns into complex PTSD, leaving adults vulnerable to health problems and personality disorders. The landmark Childhood Adverse Experiences (ACEs) study of the mid-1990s showed the impact of childhood physical and sexual abuse, neglect, parental mental illness, substance abuse, and domestic violence. The repeated stress of abuse and parental issues changes the brain for life.
The American Brain Society proudly champions and supports PTSD research. We diligently vet each research project to ensure the efficacy of each project.
Combining neurobiology and new learning – Ketamine and Prolonged exposure (PE): A potential rapid treatment for PTSD
The overall goal is to provide more effective and long-lasting treatment for PTSD. About 50% of individuals diagnosed with PTSD do not improve with the currently available therapies.