Post-traumatic stress disorder (PTSD) is a trauma and stressor-related disorder anxiety disorder that develops after a traumatic event. PTSD has also been called "shell shock" or "battle fatigue."

Causes

The exact cause of PTSD is unknown. PTSD is triggered by exposure to a traumatic event. Situations in which a person feels intense fear, helplessness, or horror are considered traumatic. PTSD has been reported in people who experienced:

War
Rape
Physical assault
Natural disaster such as earthquakes, hurricanes, or fires
Sexual abuse
Motor vehicle accidents
Animal attack

Researchers are studying how problems with synapses in the brain may be linked to PTSD.

Risk Factors

Not everyone who experiences a traumatic event will develop PTSD. Symptoms of PTSD are more likely to occur if the person has:

Previous traumatic experiences
A history of being physically abused
Poor coping skills
Lack of social support
Existing ongoing stress
A social environment that produces shame, guilt, stigmatization, or self-hatred
Alcohol use disorder
Family history of mental health problems

Symptoms

People with PTSD experience symptoms of anxiety following a traumatic event. These symptoms fall into 3 categories:

Re-experiencing of the event:
- Dreams or nightmares
- Intrusive memories
- Flashbacks
- Anxious reactions to reminders of the event
Avoidance:
- Avoidance of external reminders of the event, such as places, people, or situations
- Efforts to avoid feelings, thoughts, or memories related to the event
Negative changes in mood and cognition related to trauma:
- Detachment
- Numbness
- Difficulty remembering relevant details of the trauma
Arousal:
- Difficulty falling asleep or staying asleep
- Anger and irritability
- Difficulty concentrating or paying attention
- Being easily startled
- Hypervigilance

People with PTSD may also have:

Substance abuse problems
Physical symptoms, such as pain, rapid breathing or heart rate, and sweating
Depression or anxiety
Relationship problems

Diagnosis

You will be asked about your symptoms and medical history. This may be done by using a structured interview and/or a questionnaire. You will also likely be given a psychological assessment. PTSD will be diagnosed if you have:

Symptoms of PTSD, which have lasted for more than one month
Both emotional distress and disturbed functioning (like problems at school, work, or home) due to the symptoms

PTSD is categorized according to when symptoms occur and how long they last. There are 3 types of PTSD:

Acute—symptoms last between 1-3 months after the event
Chronic—symptoms last more than 3 months after the event
Delayed onset—symptoms do not appear until at least 6 months after the event

Treatment

There are many treatments available to help manage PTSD. General goals include learning how to cope with symptoms, reducing symptoms, and strategies to improve relationships with family or friends. Treatment will also focus on any other conditions you may have, such as depression or substance abuse. The length of treatment will depend on the individual but can range from a few months to a few years. Treatment can often include a combination of approaches.

Cognitive-Behavior Therapy

Cognitive-behavior therapy (CBT) is a very effective type of counseling for PTSD. Therapy focuses on:

Learning about your current PTSD symptoms
Better awareness of thoughts, feelings, and negative patterns
Learning coping skills to manage thoughts about the trauma and current day challenges
Understand and find the balance between your beliefs before the trauma and beliefs after the trauma

There are a few different types of CBT including:

Cognitive processing therapy (CPT)—Focuses on better understanding and management of distressing thoughts. The therapy focuses on the changes to your thought pattern since the trauma and how this change affects how you act and feel.
Prolonged exposure therapy—Uses repeated discussion of the trauma with a therapist. The goal is to decrease negative feelings from the trauma, help you develop relaxation skills during stressful times, and eventually decrease the influence of the memory. Though it sounds basic, this process should be done with a therapist to help introduce traumatic memories in a safe method and safe place.

Eye Movement Desensitization and Reprocessing (EMDR)

During this type of therapy, you are asked to talk about the traumatic event, including your memories, feelings, and sensations. While talking, you will be asked to do simple tasks like hand-tapping, following therapist's hand with your eyes, or listening to tones through headphones. The reason why is not clear, but repeating the story with the physical distraction allows your brain to process the trauma in a different way. In effect the process overwrites some of the negative thought processes related to the trauma.

Other Therapy

Other therapeutic options that may help include:

Stress inoculation therapy (SIT)—During this type of therapy you will be trained in relaxation techniques, positive reframing of negative thoughts, and assertive communication.
Group meetings—Meeting in a group with other survivors of trauma can be an effective form of therapy for people with PTSD.
Family therapy—May improve relationships between family members, give family members support, and help family understand your PTSD challenges.
Mindfulness meditation—Paying attention to breathing and focusing on present experiences may help you manage stress.

Medication

Medication can help manage some symptoms while you go through counseling or during a crisis period. They may help manage anxiety, depression, and insomnia. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) are often prescribed.

Prevention

The events that trigger PTSD cannot be predicted or prevented. However, there are some factors that might prevent PTSD from developing after a traumatic event, such as:

Working with a cognitive-behavioral therapist
Having a strong network of social support

RESOURCES:

Anxiety and Depression Association of America
https://adaa.org

National Center for PTSD—US Department of Veterans Affairs
https://www.ptsd.va.gov

CANADIAN RESOURCES:

Canadian Psychiatric Association
https://www.cpa-apc.org

Canadian Psychological Association
https://cpa.ca

References:

Jeffereys M. Clinician's guide to medications for PTSD. National Center for PTSD—US Department of Veterans Affairs website. Available at: https://www.ptsd.va.gov/professional/treatment/overview/clinicians-guide-to-medications-for-ptsd.asp. Updated November 17, 2017. Accessed January 31, 2018.

Post-traumatic stress disorder. American Psychiatric Association website. Available at:
...(Click grey area to select URL)
Accessed January 31, 2018.

Posttraumatic stress disorder (PTSD). EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated June 26, 2017. Accessed January 31, 2018.

Treatment. National Center for PTSD—US Department of Veterans Affairs website. Available at:
...(Click grey area to select URL)
Accessed January 31, 2018.

3/16/2007 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820-830.

11/19/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Ji L, Xiaowei Z, Chuanlin W, Wei L. Investigation of posttraumatic stress disorder in children after animal-induced injury in China. Pediatrics. 2010;126(2):e320-e324.

10/12/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Polusny MA, Erbes CR, Thuras P, et al. Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: a randomized clinical trial. JAMA. 2015;314(5):456-465.

Last reviewed November 2018 by EBSCO Medical Review Board Adrian Preda, MD
Last Updated: 1/26/2016

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