What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.
It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most people recover from initial symptoms over time. Those who continue to experience problems may be diagnosed with PTSD.
Who develops PTSD?
Anyone can develop PTSD at any age. This includes combat veterans and people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, or other serious events. People who have PTSD may feel stressed or frightened, even when they are not in danger.
Not everyone with PTSD has been through a dangerous event. Sometimes, learning that a friend or family member experienced trauma can cause PTSD.
What are the signs and symptoms of PTSD?
Symptoms of PTSD usually begin within 3 months of the traumatic event, but they sometimes emerge later. To meet the criteria for PTSD, a person must have symptoms for longer than 1 month, and the symptoms must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness.
The course of the disorder varies. Some people recover within 6 months, while others have symptoms that last for 1 year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.
After a dangerous event, it is natural to have some symptoms. For example, some people may feel detached from the experience, as though they are observing things rather than experiencing them. A mental health professional who has experience helping people with PTSD, such as a psychiatrist, psychologist, or clinical social worker, can determine whether symptoms meet the criteria for PTSD.
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 arousal and reactivity symptoms
- At least two cognition and mood symptoms
Re-experiencing symptoms
- Flashbacks—reliving the traumatic event, including physical symptoms, such as a racing heart or sweating
- Recurring memories or dreams related to the event
- Distressing thoughts
- Physical signs of stress
Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.
Avoidance symptoms
- Staying away from places, events, or objects that are reminders of the experience
- Avoiding thoughts or feelings related to the traumatic event
Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident.
Arousal and reactivity symptoms
- Being easily startled
- Feeling tense, on guard, or on edge
- Having difficulty concentrating
- Having difficulty falling asleep or staying asleep
- Feeling irritable and having angry or aggressive outbursts
- Engaging in risky, reckless, or destructive behaviour
Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.
Cognition and mood symptoms
- Trouble remembering key features of the traumatic event
- Negative thoughts about oneself or the world
- Exaggerated feelings of blame directed toward oneself or others
- Ongoing negative emotions, such as fear, anger, guilt, or shame
- Loss of interest in previous activities
- Feelings of social isolation
- Difficulty feeling positive emotions, such as happiness or satisfaction
Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead people to feel detached from friends or family members.
How do children and teens react to trauma?
Children and teens can have extreme reactions to traumatic events, but their symptoms may not be the same as those seen in adults. In children younger than age 6, symptoms can include:
- Wetting the bed after having learned to use the toilet
- Forgetting how to talk or being unable to talk
- Acting out the scary event during playtime
- Being unusually clingy with a parent or other adult
Older children and teens usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful, or destructive behaviours. Older children and teens may feel guilt over not preventing injury or death or have thoughts of revenge.
Why do some people develop PTSD and other people do not?
Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; others play a role during and after a traumatic event.
Risk factors that may increase the likelihood of developing PTSD include:
- Exposure to previous traumatic experiences, particularly during childhood
- Getting hurt or seeing people hurt or killed
- Feeling horror, helplessness, or extreme fear
- Having little or no social support after the event
- Dealing with stressors after the event, such as the 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
How is PTSD treated?
It is important for people with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy, medications, or a combination of psychotherapy and medications. An experienced mental health professional can help people find the best treatment plan for their symptoms and needs.
Some people with PTSD, such as those in abusive relationships, may be living through ongoing trauma. In these cases, treatment is usually most effective when it addresses both the traumatic situation and the symptoms of PTSD. People who experience traumatic events or who have PTSD may also experience panic disorder, depression, substance use, or suicidal thoughts. Treatment for these conditions can help with recovery after trauma. Research shows that support from family and friends also can be an essential part of recovery.
Psychotherapy
Psychotherapy, sometimes called talk therapy, includes a variety of treatment techniques that mental health professionals use to help people identify and change troubling emotions, thoughts, and behaviours. Psychotherapy can provide support, education, and guidance to people with PTSD and their families. Treatment can take place one-on-one or in a group setting and usually lasts 6 to 12 weeks but can last longer.
Some types of psychotherapy target PTSD symptoms, while others focus on social, family, or job-related problems. Effective psychotherapies often emphasize a few key components, including learning skills to help identify triggers and manage symptoms.
A common type of psychotherapy called cognitive behavioural therapy can include exposure therapy and cognitive restructuring.
- Exposure therapy helps people learn to manage their fear by gradually exposing them, in a safe way, to the trauma they experienced. As part of exposure therapy, people may think or write about the trauma or visit the place where it happened. This therapy can help people with PTSD reduce symptoms that cause them distress.
- Cognitive restructuring helps people make sense of the traumatic event. Sometimes people remember the event differently from how it happened, or they may feel guilt or shame about something that is not their fault. Cognitive restructuring can help people with PTSD think about what happened in a realistic way.
What can I do to help myself?
You can get better with treatment. Here are some things you can do to help yourself:
- Talk with your healthcare provider about treatment options and follow your treatment plan.
- Engage in exercise, mindfulness, or other activities that help reduce stress.
- Try to maintain routines for meals, exercise, and sleep.
- Set realistic goals and focus on what you can manage.
- Spend time with trusted friends or relatives and tell them about things that may trigger symptoms.
- Expect your symptoms to improve gradually, not immediately.
- Avoid the use of alcohol or drugs.
How can I help a loved one with PTSD?
If you know someone who may be experiencing PTSD, the most important thing you can do is to help that person get the right diagnosis and treatment. Some people may need help making an appointment with their healthcare provider; others may benefit from having someone accompany them to their healthcare visits.
If a close friend or relative is diagnosed with PTSD, you can encourage them to follow their treatment plan. If their symptoms do not improve after 6 to 8 weeks, you can encourage them to talk about it with their healthcare provider. You also can:
- Offer emotional support, understanding, patience, and encouragement.
- Learn about PTSD so you can understand what your friend is experiencing.
- Listen carefully. Pay attention to the person’s feelings and the situations that may trigger PTSD symptoms.
- Share positive distractions, such as walks, outings, and other activities.
Summary
Post-traumatic stress disorder is a mental health condition that can occur after a person experiences or witnesses a traumatic event.
A person with PTSD may experience intrusive thoughts and memories. They may consciously or unconsciously avoid places or people that remind them of the trauma. A person may also experience difficulty sleeping and feel tense, anxious, and irritable.
A person should see a doctor if they develop symptoms that disrupt their home, work, or social life after experiencing a traumatic event. A healthcare professional will be able to diagnose PTSD and provide support.