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Post-Traumatic Stress Disorder (PTSD) in Adults

Summary: Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to traumatic events where one was exposed to or witnessed danger, such as with violence or disasters. With PTSD, the brain's alarm system is triggered by the trauma, leading to symptoms such as being hyper vigilant (i.e. constantly on alert).
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Do I have PTSD?

Have you been through traumatic events (such as violence, crime, combat or abuse) in the past?

If so, then do any of the following apply to you:

  1. As a result of that event, do you avoid being reminded of this experience by staying away from certain places, people or activities? Yes/No
  2. Did you lose interest in activities that were once important or enjoyable? Yes/No
  3. Did you begin to feel more isolated or distant from other people? Yes/No
  4. Did you find it hard to have love or affection for other people? Yes/No
  5. Did you begin to feel that there was no point in planning for the future? Yes/No
  6. After this experience were you having more trouble than usual falling asleep or staying asleep? Yes/No
  7. Did you become jumpy or get easily startled by ordinary noises or movements? Yes/No

Did you answer yes to four or more questions?

  • If so, this indicates a high likelihood of having PTSD. Speak with a health professional.
  • If not, then it indicates a lower likelihood of having PTSD. Nonetheless, if you are concerned, you should always speak with your health provider.

What is Post-Traumatic Stress Disorder (PTSD)?

When a situation has been stressful or traumatic  (e.g. violence, war, abuse, natural disasters), it is natural that one might be cautious or worried at reminders of those situations. Having just enough fear and anxiety helps protect us from those stresses and traumas being repeated. 

However, when the anxiety and fear is excessive, to the point where it interferes with daily life, then it may be a problem. 

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that can develop after exposure to stressful or traumatic events. 

What Causes PTSD?

The good news is that after a traumatic event, most people do not develop symptoms of PTSD.

PTSD happens when 1) a vulnerable person experiences 2) stressful, traumatic event. 

What makes someone vulnerable?

  • Someone might be vulnerable if they have already experienced significant stresses earlier in life; 
  • Some people are simply wired to be more sensitive. In the right setting, sensitive, compassionate people are great at helping others. However, too much sensitivity can make one more sensitive to developing PTSD. 

What types of events are traumatic and/or stressful? 

  • Situations where one was exposed to actual danger, such as 
    • Being a victim of violence
    • War or combat
    • Being a first responder such as a paramedic, police officer or firefighter
    • Car accidents and plane crashes
    • Natural disasters such as hurricanes, tornadoes, and fires
    • Violent crimes, like a robbery or shooting.
    • The death or serious illness of a loved one
    • Difficult medical treatments.
  • Witnessing or being threatened danger (e.g. seeing others getting hurt, being bullied or intimated.)  

When Does PTSD Start?

Symptoms may start soon after a traumatic event and then continue. Other people develop new or more severe signs months or even years later.

At What Age Does PTSD Start?

PTSD can happen at any age. When children have been through stressful situations, they can also develop symptoms of PTSD.

 

Common symptoms include:

  • Physical problems
    • Complaining of stomach problems or headaches a lot
  • Behavioural and emotional symptoms 
    • Regressing, i.e. behaving like they did when they were younger. E.g. a child who was toilet trained then has trouble with toilet training. 
    • Being unable to talk, i.e. when trauma has been severe, it is so overwhelming that the person may be unable to talk. 
    • Refusing to go places or play with friends.
    • Separation anxiety, i.e. needing to be near their parents more
    • Troubles sleeping 
  • Re-experiencing
    • E.g. Re-enacting stressful situations through play, drawings or stories

As children get older their symptoms are more like those of adults.

Terms

When one's symptoms have lasted less than 4-weeks, it is known as "acute stress disorder".

When one's symptoms have lasted more then 4-weeks, it is called "post-traumatic stress disorder (PTSD)".

Symptoms of PTSD

When trauma is severe, the following happens:

  • The logical brain becomes overwhelmed, and is unable to process the experience of what has happened.
  • The emotional brain may become overwhelmed, leading the person to become emotionally distressed, with feelings such as sadness, guilt, anxiety or anger. 
  • The primitive brain may become overwhelmed, leading the person to be in a state of 
    • Fight, i.e. feeling angry;  
    • Flight, i.e. feeling anxiety and avoidance; 
    • Freeze, i.e. being so overwhelmed, one does not know whether to take fight or flight;
    • Shut down, i.e. zoning out, dissociating, spacing out, which is a way for the brain to protect itself from overwhelming stress.  

Symptoms include: 

1. Reliving the event (also called re-experiencing symptoms)Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include:
  • Hearing firecrackers may trigger memories for a combat veteran;
  • Reading about a car accident in the news may trigger flashbacks for a crash survivor;
  • Hearing someone mention sexual assault may trigger memories for a woman who was sexually assaulted herself.
2. Avoiding any reminders of the eventYou may try to avoid situations or people that trigger thoughts or feelings of the traumatic event, or avoid talking or thinking about the event. For example:
  • A person who survived a flood may avoid watching television shows or movies in which there are floods;
  • A person who was robbed on the street may avoid going out in public;
  • A person may simply avoid leaving home in order to try to stay safe, and end up being housebound.
3. Feeling numbThrough no fault of your own, your body may be "numb" and you may notice that you do not experience feelings as before. Examples:
  • You may lose interest in people and activities that you used to enjoy;
  • You may end up detaching from people in your life;
  • You may forget about parts of the traumatic event or not be able to talk about them.
4.Feeling keyed up (also called hyperarousal)
You may be jittery, or always alert and on the lookout for danger. It can cause you to:
  • Suddenly become angry or irritable
  • Have a hard time sleeping
  • Have trouble concentrating
  • Fear for your safety and always feel on guard
  • Be very startled by other people.

 

Other Problems Can Be Seen Along with PTSD

PTSD can contribute to:

  • Drinking or drug problems
  • Feelings of hopelessness, shame, or despair
  • Employment problems
  • Relationships problems including divorce and violence
  • Physical symptoms

Because of all the ways that PTSD can disrupt not just the person's life but the lives of friends and family, it makes it all the more important to get help and treatment for PTSD

Treatments for PTSD 

Left untreated, PTSD can significantly interfere with your everyday activities, work, and relationships.

The good news is that effective treatments for PTSD are available, and can help most people with PTSD lead productive, fulfilling lives. 

Types of Treatment 

There are many types of treatment for PTSD and the recommended treatment will vary depending on the person's situation.

 

1. Counselling/therapy


Cognitive-behavioural therapy (CBT): Helps you overcome PTSD by dealing with your cognitions (thoughts) and behaviours (learning coping strategies).

In cognitive (behavioural) therapy (CBT), your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.

You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You also learn ways to cope with feelings such as anger, guilt, and fear.

After a traumatic event, people often blame themselves and feel guilty for things that they could not have changed.

  • For example, a soldier may feel guilty about decisions he or she had to make during war. Hindsight is 20/20; it is easy to think about what one should have done, after it has already happened. But knowing what you could have done does not mean that you are wrong or to blame for what happened.
  • Furthermore, feeling responsible for what happened, lets the person feel a sense of control over the situation. But the reality is that they were not in control; and it was not their fault. Children who are abused often blame themselves for the abuse. Rationally, this makes no sense. But the blame may happen because by blaming oneself for the abuse, it lets the child feel responsible and have some sense of control.
Exposure Therapy

In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event

By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over time.

With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.

You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed.

You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this.

Eye movement desensitization and reprocessing (EMDR): EMDR practitioners use eye movements (or other means of 'dual attention stimulation'), traumatic movements are processed into non-distressing memories.

Eye movement desensitization and reprocessing (EMDR) is a fairly new therapy for PTSD.

While talking about your memories, you'll focus on distractions like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes.

Research suggests that helps by reducing the distress from traumatic memories, but the exact way it helps is still being researched.

BrainspottingA promising intervention that uses eye movements to help the brain process traumatic and/or stressful situations.
Group therapyMany people want to talk about their trauma with others who have had similar experiences. In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.

Group therapy helps you build relationships with others who understand what you've been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You'll learn to focus on your present life, rather than feeling overwhelmed by the past.
Brief psychodynamic psychotherapyIn this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.

Your therapist can help you:

  • Identify what triggers your stressful memories and other symptoms.
  • Find ways to cope with intense feelings about the past.
  • Become more aware of your thoughts and feelings, so you can change your reactions to them.
  • Raise your self-esteem.
Family therapyPTSD can impact your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you're under so much stress. They may feel scared, guilty, or even angry about your condition.

Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.

In family therapy, each person can express his or her fears and concerns. It's important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you.

You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.



Advantages of psychotherapy are:

  • People learn valuable skills that can benefit them even after the PTSD has improved.

Disadvantages of psychotherapy 

  • Psychotherapy may be harder to access in certain areas.
  • Psychotherapy takes a mental effort that may be overwhelming when someone has had PTSD. 

2. Medication

 

Medications can sometimes be helpful. A type of medication known as selective serotonin reuptake inhibitor (SSRI), which is also used for depression, are used for PTSD. For some people they can be very helpful. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft). They work by raising the level of serotonin (a type of brain chemical) in the brain.

Advantages of medication:

  • Taking a medication is less work than seeing a therapist and having to talk or do therapy, and can thus be helpful when trauma is too severe to talk about or see a therapist.

Disadvantages of medications

  • Medications can cause side effects. 

How long does treatment last?

For some people, treatment for PTSD can last 3 to 6 months. If you have other mental health problems as well as PTSD, treatment for PTSD may last for 1 to 2 years or longer.  

What will we work on in therapy?

When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are focused on reducing their symptoms.

 

Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness? Perhaps you would like to work on improving your relationships at work, or communication issues with your friends and family.

 

Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.  

Self-Help Strategies for PTSD

  • Make sure you are safe. First of all, make sure that you are no longer in danger, and that you are safe! For example, if your trauma is from abuse or violence in the home, then get help first in getting to safety. Speak to your doctor or contact an emergency shelter.
  • Educate yourself about PTSD. Because the symptoms of PTSD (nightmares, flashbacks and feeling that you are re-living the trauma) are so distressing, people with PTSD often worry that they are going crazy. Relax - you are not going crazy. The problem is rather that you have anxiety because of a traumatic event. Fortunately, there are coping skills (in addition to treatment) that can help cope with this anxiety.
  • Take good care of yourself. When under stress, sometimes we neglect our sleep, proper nutrition or exercise. So make sure that you are 1) getting enough sleep, 2) eating a healthy diet with at least three healthy meals a day, and 3) getting regular exercise.

Common anxiety strategies for relaxing the body

  • Deep Breathing: When people get anxious, their breathing tends to quicken, which further worsens the situation.
  • Progressive Muscle Relaxation: If you are feeling tense and jumpy, progressive muscle relaxation is a way of relaxing your body.
  • Grounding Techniques: Grounding is a way of bringing your body back to the present, particularly if you are having flashbacks and losing touch with the present. Grounding works by re-setting and focusing your attention on the present.

Examples

  • Touch objects around you, and describe them (texture, colour). For example, "I'm sitting on the couch, and its very soft and comfortable. I'm smelling my coffee and I'm hearing the television."
  • Run water over your hands, and describe aloud how it feels.
  • Name all the different types of animals you can think of (e.g., dog, cat, chicken, cow, etc...)
  • Count backwards from 100
  • Say the alphabet backwards

Additional tips for grounding:

  • Keep Your Eyes Open: While grounding yourself, keep your eyes open so you can see and focus on the present. It also helps to talk out aloud about what you are seeing and doing.
  • Practise: Don't be disappointed if it doesn't work the first time you try it. Like any other skill or sport you have done, this is a skill that gets better over time. It works best if you have tried and practised it ahead of time while calm.
  • Stay active in life. People with PTSD often find that they drop out of activities that they previously enjoyed doing, but this is not helpful. It may be difficult, but get back into the normal routine of your life as much as possible, which includes; work, friends, family, hobbies and sports. Even if you can't get back 100% into all the things you used to do, then start with little steps.
  • Exposure: Face your fears and don't let the PTSD control you. The anxiety from PTSD often makes people avoid certain things. Unfortunately, these fears have a tendency to grow, and then people end up avoiding more and more things in life. The best way to fight back is to gradually face those fears, step by step.

Examples:

  • A person who has a trauma from falling off a horse. The longer the person avoids horses and horseback-riding, the harder it will be. The solution is to get back on a horse as soon as possible.
  • A person experiences a mugging in a shopping mall parking lot at nighttime. The person starts to avoid parking lots at nighttime, then parking lots at daytime, then shopping malls entirely, and then even going out. The solution is to gradually face those fears, and get back into those situations, step-by-step.
  • Avoid unhealthy coping strategies such as drugs and alcohol. Though they may appear to temporarily help in the short-term, using alcohol or other drugs will make it worse in the long run.

For More Information about PTSD

Anxiety BC has an excellent set of resources, including Self-Help Strategies for PTSD
http://www.anxietybc.com/resources/pdfs/hmptsd.pdf

The National Center of PTSD at the United States Department of Veterans Affairs
http://www.mentalhealth.va.gov/MENTALHEALTH/ptsd/fs_what_is_ptsd0ddb.asp

The National Institute of Mental Health (NIMH)
http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

National Center for PTSD
http://www.mentalhealth.va.gov/MENTALHEALTH/ptsd/fs_treatmentforptsd.asp

PTSD and Acute Stress Disorder, by Dr. Martin Anthony, retrieved Nov 1, 2008
http://www.anxietytreatment.ca/posttrauma.htm

Interactive Tutorial on PTSD from Medline Plus

http://www.nlm.nih.gov/medlineplus/tutorials/ptsd/htm/index.htm

References

Breslau N, Peterson E, Kessler R, Schultz L: Short screening scale for DSM-IV posttraumatic stress disorder. The American Journal of Psychiatry 1999;156:908-911.

About this Document

Written by the eMentalHealth Team.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance. 

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Date Posted: Nov 1, 2008
Date of Last Revision: May 25, 2020

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