Table of Contents
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is often linked to images of military personnel amid war and combat. However, Post-Traumatic Stress Disorder goes much further than battle and the difficulties of war. Take, for example, a story from P.K. Philips. Several traumas, including a childhood of physical, mental, sexual abuse and ultimately an attack at knifepoint, lead Philips to significant experiences of flashbacks and nightmares. Unable to sleep, Philips became nervous and anxious at home. Once symptoms subsided, years went by until another traumatic event brought back the panic and anxiousness. Philips sought help and was diagnosed with Post-Traumatic Stress Disorder.1
PTSD is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event. Traumatic events can include natural disasters, serious accidents, physical, mental and sexual abuses, war, and combat.2 More than half of adults in the United States have experienced a traumatic event at least once in their lives, and 20% go on to develop PTSD. Traumatic events make people feel threatened, anxious, or frightened. About 8 million people have post-traumatic stress disorder at any given time. Women are more likely to be diagnosed with PTSD. 10% of women develop PTSD in their lifetimes, compared to 4% of men.3
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Populations at High Risk of PTSD
PTSD can develop at any age and to any gender.4 Here are some of the populations at the highest risk of PTSD.
PTSD in Women
While the lifetime prevalence of exposure to traumas was lower among women, women are subjected to specific traumas with a higher risk of PTSD like rape, sexual assault, and childhood sexual abuse. The instances of these types of trauma are high because 91% of rape and sexual assault victims are women, and 20% of women experience rape at some point in their lives compared to 1.4% of men.5
- Easily startled
- Feeling numb
- Avoidance behavior
- Depression and anxiety
PTSD in LGBTQ Youth
Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) youth commonly experience trauma at higher rates than their cisgender heterosexual peers. All these experiences contribute to higher PTSD rates in the LGBTQ+ community.8 These experiences can include:
55% of LGBTQ+ Students Experience Bullying
55%
24% of LGBTQ+ Students Experience Online Bullying
24%
9% of LGBTQ+ Students Received Death Threats
9%
Physical and Sexual Abuse
35% of LGBTQ+ students suffer physical assault and 12% suffer sexual violence.11 LGBTQ+ youth lack safe arenas to discuss sexual orientation, putting them at increased risk for sexual exploitation and abuse.
35% of LGBTQ+ Students Suffer Physical Assault
35%
12% of LGBTQ+ Students Suffer Sexual Violence
12%
Traumatic Loss of Family and Friends
40% of LGBTQ+ youth report rejection by family or friends.13 Levels of acceptance from family and friends impact healthy identity development in LGBTQ+ youth. Less parental rejection creates a greater likelihood of having an affirmed sexual identity. Conversely, more parental rejection is linked to poor mental and physical health outcomes.14
40% of LGBTQ+ Youth Report Rejection by Family or Friends
40%
Societal Stigma, Bias, and Rejection
LGBTQ+ youth suffer trauma through institutional discrimination in different settings like workplaces and places of worship. The LGBTQ+ unemployment rate is double that of the general population.11
PTSD in Children
Children have adverse childhood experiences (ACEs) that lead to PTSD. Children experiencing post-traumatic stress disorder typically experience three types of symptoms. Children will re-experience the trauma through flashbacks, nightmares, or through play by reenacting the event. Children will avoid anything related to the traumatic event, whether it’s an object, thought, or place. The child will likely show signs of increased agitation, being on guard or on edge, and show extreme caution if another dangerous situation comes up. This agitation can come out in disruptive behavior or fear of separation from a caregiver. Typical childhood traumas that can result in PTSD symptoms include:
- Witnessing domestic violence
- Experiencing physical, sexual, or emotional abuses
- Having a severe injury or accident
- Witnessing violence in school or the community
- Global Pandemics
- Civil Unrest
PTSD in Adults Who Experienced an Adverse Childhood Experience
Adverse childhood experiences are associated with numerous risk behaviors and mental health outcomes. One study found that ACEs led to higher rates of adult PTSD. Adults who suffered an adverse childhood experience are at a much higher rate of intimate partner violence. ACEs could lead an adult to assault an intimate partner. ACEs could also increase the chances of being a victim of intimate partner violence.
Adverse childhood experiences cause PTSD, but they also create a vicious circle where ACEs cause intimate partner violence that leads to more PTSD.12
Current Factors that Increase the Risk of PTSD
Experiencing Trauma
Sexual assault frequently occurs in the United States, with one-third of women experiencing sexual assault at some point in their lives. Survivors of childhood sexual assault have an increased likelihood of being assaulted again in adulthood. Living through these experiences increases the risk of developing PTSD and other mental health conditions. National estimates in the United States indicate that 20 people are being abused by an intimate partner every minute. The data adds up to about 10 million people per year.
Having Little Or No Social Support
Social support is vital in treating post-traumatic stress disorder. It can potentially be an essential piece in understanding the condition, including prevention and treatment.7 Research consistently shows that limited social support is associated with more severe forms of PTSD symptoms, including more severe impairment and thoughts of suicide. Emotional support is positively associated with better responses to PTSD treatment.
Self-Isolation
People with PTSD may prefer to self-isolate to protect themselves from PTSD triggers and other stressful events. But, the self-isolation worsens their mental health, leading to an increase in PTSD symptoms. People with PTSD need to stay connected to their support network of friends, family, and professionals to reduce PTSD symptoms.
On PTSD and Introverts
PTSD symptoms can seem like an individual is introverted due to avoidance symptoms, but that doesn’t necessarily explain the full story. While psychiatrists speak of four main signs that define PTSD, avoidance being one of them, this doesn’t necessarily mean an introvert is experiencing PTSD symptoms. The critical thing to note is the difference between how they feel about being alone. Isolation can increase flashbacks, which are described as frequent, undesired memories that replay the triggering event, making it challenging to take pleasure in things once enjoyed before. Someone experiencing PTSD may become more passive and appear distant and withdrawn.
Extra Stressful Events
There are extra stressful events in life that can lead to symptoms of PTSD. Take, for example, the death of a loved one. Humans are very social creatures and build countless relationships throughout their lives. Family members, coworkers, and neighbors are examples of relationships that can produce deep connections. It makes sense that a loved one’s death can create psychological issues, including PTSD, especially if the death is unexpected. A recent study published that an unexpected death elevated odds of PTSD, panic disorder, and depressive episodes at all stages of life.
Loss of Employment
Other examples of stressful events can be the loss of a job. Many people tie their identities to their jobs and experience extreme stress if that identity is taken away. Also, many believe self-worth is linked to the work they perform. These people may feel worthless if they can no longer work. Losing employment also comes with financial stresses, which can then trigger relationship issues. So, it is not unusual for those who lose their job to experience symptoms of PTSD.
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Mental Illness and Substance Abuse Increases Risk of PTSD
Mental Illness and PTSD
Traumatic life events are common among people living with severe mental illnesses. There has been growing awareness in recent years about trauma and how it shapes people’s lives. PTSD plays a crucial role in the adverse effects on mental illnesses and can exacerbate these mental illnesses. While the evidence shows that PTSD can make schizophrenia worse, other evidence suggests it can also impact other diseases like bipolar disorder and depression. With high rates of trauma across these disorders, it is essential to realize PTSD’s impact on these illnesses.
Substance Abuse
Individuals diagnosed with PTSD are three times more likely to have struggled with substance use disorder.8 Substance abuse and addiction are linked to disorders like PTSD, depression, and anxiety. PTSD can trigger addiction, or addiction can lead to PTSD. Whichever came first, the statistics show that people seeking treatment for PTSD are 14 more times likely to be diagnosed with a SUD.
Accidents & Natural Disasters are PTSD Risk Factors
Accidents and natural disasters are events that can lead to struggles with symptoms of PTSD. Individuals who experience an event like a severe motor vehicle accident have an increased risk for developing PTSD, among other psychological issues.9 For example, take this story of a woman sharing her experiences with PTSD from a significant car accident. Cathy had been sitting at a traffic light when her car was hit from behind, and she vaulted forward. Cathy was worried about her daughter in the backseat of the vehicle. Although a reasonably typical wreck, Cathy experienced terrible dreams about the collision and had a hard time driving following the accident. Her story is a familiar one, with over 6.2 million traffic accidents reported each year, resulting in approximately 2.8 million injuries.10 Symptoms following a severe car accident can include re-experiencing the trauma or avoiding situations related to the accident and detachment from others. While the symptoms can vary, these accidents can create PTSD symptoms.
Climate Change Increases the Risk of PTSD from Natural Disasters
Natural disasters have become more frequent in recent years. Climate change creates more severe hurricanes, floods, and wildfires. Research is showing a clear connection between experiencing a natural disaster and PTSD. PTSD symptoms seem to be highest when a natural disaster is related to the death of someone close, forced displacement from their homes, and pre-existing vulnerabilities from other traumas that give individuals the highest risk.11
Veterans and PTSD
Veteran rates of PTSD continue to increase with the United States military continuing to have a presence in the Middle East. In 2016, a dramatic increase was seen in the number of war veterans seeking help for PTSD. Treatment options continue to be a discussion to care for these Veterans. PTSD extends beyond war and combat, but this population is at higher risk for suffering from PTSD symptoms.
PTSD Rates by Theater of Conflict
Veterans with PTSD vary by the era of service. In the Vietnam War era, about 15 out of every 100 Veterans were diagnosed with PTSD. In the Gulf War-era, about 12 of every 100 Veterans were diagnosed with PTSD. During Operations Iraqi and Enduring Freedom, about 11 to 20 of every 100 Veterans were diagnosed with PTSD.12
PTSD Risk Factors from Military Service
PTSD symptoms usually begin after a traumatic event, but they can appear much later than the actual event. Causes of PTSD in Veterans can vary. In research published in Clinical Psychological Science, researchers defined three areas of concern in the development of PTSD; severity of combat exposure (life-threatening experiences), pre-war vulnerabilities (childhood physical abuse), and involvement in harming civilians or prisoners.13
PTSD isn’t military-specific, but the problem is focused on war Veterans. These Veterans are at higher risk of suffering PTSD and face barriers in getting treatment, including stigma and discharge from the military.
Is PTSD a Disability?
PTSD can be considered a disability; cases are approved by the Social Security Administration (SSA) if the circumstances meet the established criteria. However, getting disability from the SSA can be a long and frustrating process, with the majority of applicants waiting almost two years for the benefits to start.14
Veterans may be eligible for disability benefits through VA Compensation if they meet requirements like:
- The traumatic event happened during service or was made worse by service
- The Veteran must not be able to function in work activities
- A doctor's diagnosis of PTSD
Another type of aide for Veterans is service dogs. Veterans sometimes have specially trained service animals that help them perform tasks or give reminders to take medications. They can even calm a person with PTSD during an anxiety attack. Service animals are working animals and not pets. Some service members are eligible for these types of benefits through the VA.
Signs and Symptoms of PTSD
PTSD can start within a month of a traumatic event, or sometimes symptoms appear years after the event. Signs and symptoms of PTSD are commonly grouped into four areas: re-experiencing symptoms, avoidance symptoms, arousal, and reactivity symptoms, and cognition and mood symptoms.
Re-experiencing Symptoms
Re-experiencing symptoms may include having recurring or distressing memories of the traumatic event, having flashbacks or reliving the event, having nightmares or recurring dreams of the event, or distress when interacting with themes that remind them of the event.
Symptoms of Avoidance
Symptoms of avoidance can include removing themselves from thinking or talking about the event or avoiding places and activities that remind them of the event. An excellent example of this would be avoiding highway driving after experiencing an accident on the interstate.
Arousal Changes
Symptoms of changes in reactivity or emotional reactions (arousal) may include being frightened easily, being on guard, self-destructive behavior (drinking or driving too fast), trouble sleeping, trouble concentrating, angry outbursts, and overwhelming guilt and shame.
Mood Changes
Symptoms of cognition or mood changes may be negative thoughts about yourself, hopelessness, memory problems, difficulty in close friendships, feeling detached from family and friends, feeling numb, or trouble experiencing positive emotions.
Diagnosis of PTSD
To diagnose PTSD, a doctor will:
- Perform a physical exam to check for medical problems associated with symptoms
- Do a psychological evaluation discussing symptoms and the traumatic events leading up to them
- Look into the diagnostic and statistical manual of mental disorders (DMS-5) criteria for PTSD
DSM-5 criteria for PTSD are separated into similar defining symptoms:
- Defining a stressful event
- Intrusion symptoms (memories, nightmares, etc.)
- Avoidance (avoiding anything related to the trauma)
- Negative thoughts or feelings
- Arousal & Reactivity (aggression, easily startled or on guard)
- Symptoms lasting more than one month
- Exclusion
The diagnostic team may also use the ICD-10 diagnostic criteria when determining PTSD like symptoms. Medical professionals will follow similar standards by documenting whether an individual has experienced the following:
- Stressful event
- Reliving the trauma
- Patient exhibiting avoidance
- Inability to recall the event completely
- Increased arousal to the stressor
These diagnoses help the care provider learn the best ways to understand the situation and manage your care.
Related Conditions
PTSD is related to other conditions like acute stress disorder, adjustment disorder, disinhibited social engagement disorder, and reactive attachment disorder.
Acute stress disorder can manifest anywhere from three days up to one month after a traumatic event. Adjustment disorder is a group of symptoms like stress, sadness, and feelings of hopelessness accompanying a stressful life event. Disinhibited social engagement disorder usually is an attachment disorder that can make it difficult for children to form meaningful connections with others. In adults, reactive attachment disorder is when adults show symptoms of the inability to maintain significant relationships, whether romantic or platonic. All of these disorders can be related to PTSD.
PTSD Treatments
Once there is a diagnosis of PTSD, the treatment begins. Common treatments include: 15
- Cognitive behavioral therapy
- Exposure therapy
- Psychotherapy
- Eye movement desensitization and reprocessing (EMDR) therapy
Cognitive Behavioral Therapy (CBT)
This therapy focuses on the relationship among thoughts, feelings, and behaviors, addresses current problems and works on changing behavior patterns.
Exposure Therapy
Exposure therapy teaches individuals to gradually approach these trauma-related memories. This helps them to reengage and learn that these situations do not need to be avoided.
Psychotherapy
Psychotherapy combines elements of CBT and focuses on changing the emotions of shame and guilt.
EMDR
EMDR is a structured therapy that encourages patients to focus on a trauma memory while experiencing bilateral stimulation (eye movements), reducing vividness and emotion associated with the trauma.
Reprocessing Therapy
Reprocessing therapy or Narrative Exposure Therapy (NET) helps establish a coherent life narrative that gives context to the trauma to change behavior.
Medications
Medications often associated with PTSD symptoms are antidepressants like Venlafaxine, anti-anxiety medications, and serotonin reuptake inhibitors. Each drug and treatment is dependent on the care and situation of the individual experiencing symptoms as not all medications are right for different people.
Coping and Support
During recovery from PTSD symptoms, it’s essential to work with a doctor to establish a treatment plan to follow. The journey is only beginning, and educating yourself about PTSD and the symptoms and causes is an excellent first step. Good sleep, nutrition, and exercise are recommended. Building connections and support groups can help you find individuals experiencing similar symptoms and situations. The internet has expanded how we communicate and offers virtual support groups to aid on that journey.
Finding Help for PTSD
Finding help is imperative when PTSD-like symptoms appear. You are not alone. Over 8 million Americans in any given year experience PTSD symptoms, and resources for support are available.
Numerous telehealth resources are available and can support the journey as you determine a path forward. Local community groups and more extensive programs like Veteran Affairs can also provide guidance and support for recovery from PTSD.
For resources in your state, visit your State’s Department of Mental Health to determine how you can get local help near you.
Resources
- https://adaa.org/living-with-anxiety/personal-stories/my-story-survival-battling-ptsd
- https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
- https://www.ptsd.va.gov/understand/common/common_adults.asp
- https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
- https://www.nsvrc.org/sites/default/files/publications_nsvrc_factsheet_media-packet_statistics-about-sexual-violence_0.pdf
- https://www.nctsn.org/what-is-child-trauma/populations-at-risk/lgbtq-youth
- https://www.hcp.med.harvard.edu/ncs/ncs_data.php
- https://www.ncbi.nlm.nih.gov/pubmed/25527902
- https://bulliesout.com/need-support/young-people/lgbt-bullying/
- https://www.mhanational.org/bullying-lgbt-youth
- https://www.psychiatry.org/psychiatrists/cultural-competency/education/stress-and-trauma/lgbtq
- https://pubmed.ncbi.nlm.nih.gov/25753285/
- https://www.asumag.com/construction/washrooms-locker-rooms/article/20853709/trump-administration-rescinds-rules-on-bathrooms-and-transgender-students
- https://www.cbsnews.com/news/gay-lesbian-bisexual-transgender-survey-finds-nearly-4-in-10-rejected-by-family-or-friend/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127283/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507582/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415609/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396820/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396820/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432967/
- https://www.ptsd.va.gov/understand/common/common_veterans.asp
- https://www.disability-benefits-help.org/disabling-conditions/post-traumatic-stress-disorder-and-social-security-disability
- https://www.va.gov/disability/eligibility/ptsd/
- https://www.apa.org/ptsd-guideline/treatments
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