Post-Traumatic Stress Disorder (PTSD) in Adults
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:
- 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
- Did you lose interest in activities that were once important or enjoyable? Yes/No
- Did you begin to feel more isolated or distant from other people? Yes/No
- Did you find it hard to have love or affection for other people? Yes/No
- Did you begin to feel that there was no point in planning for the future? Yes/No
- After this experience were you having more trouble than usual falling asleep or staying asleep? Yes/No
- 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.
Our bodies have developed an alarm system that becomes triggered when there is danger. When a situation has been stressful or traumatic (e.g. violence, war, abuse, natural disasters), this triggers our alarm system. it is natural that one might be cautious or worried at reminders of those situations. Having just enough fear and anxiety helps people avoid these situations from happening in the future.
However, when the alarm system is unable to turn off, then the anxiety and fear becomes excessive, to the point where it interferes with daily life.
Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that can develop after exposure to stressful or traumatic events.
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. On the other hand, 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 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 (which includes our body's alarm system aka autonomic system and "fight-flight" system) 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 (like a "deer in headlights").
- Shut down, i.e. zoning out, dissociating, spacing out, which is a way for the brain to protect itself from overwhelming stress.
Symptoms may start soon after a traumatic event and then continue. Other people develop new or more severe signs months or even years later.
When symptoms have lasted less than 4-weeks, they are officially referred to as "acute stress disorder". When symptoms have lasted more than 4-weeks, then the official term is "post-traumatic stress disorder".
Classic symptoms of PTSD in adults are:
|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:|
|2. Avoiding any reminders of the event||You 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:|
|3. Feeling numb||Through no fault of your own, your body may be "numb" and you may notice that you do not experience feelings as before. Examples:|
|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:|
PTSD can happen at any age. When children have been through stressful situations, they can also develop symptoms of PTSD.
Symptoms in children can 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
- E.g. Re-enacting stressful situations through play, drawings or stories
PTSD can contribute to:
- Drinking or drug problems, as people try to cope with their symptoms using drugs or alcohol. Although this might work in the short-run, it only makes things worse in the long run.
- Mood problems such as depression, feelings of hopelessness, shame, or despair.
- Problems functioning in your work, home life and relationships, including separation, divorce and violence. Because your body's "fight/flight" system is triggered, it can make you angry at your loved ones, exploding at them for no reason, and even being violent and aggressive towards them.
Because of all the ways that untreated PTSD can disrupt not just your life but the lives of your family and friends, it makes it all the more important to get help and treatment for PTSD. If not for yourself, get help for those around you.
The good news is that are many types of effective treatments for PTSD.
|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.
|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.
|Brainspotting||A promising intervention that uses eye movements to help the brain process traumatic and/or stressful situations.|
|Group therapy||Many 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 psychotherapy||In 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:
|Family therapy||PTSD 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.
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.
Are there troubles functioning despite trying counseling/therapy? Or is counseling/therapy not possible? If so, then medications may be helpful. Medications known as selective serotonin reuptake inhibitor (SSRI), also used for depression, may be helpful for PTSD. 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. However, note that side effects often go away, or can be managed with lowering the dosage of the medication, or changing the medication if necessary.
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.
Ways to Relax Your Body (by Turning Down Your Body's Alarm System)
Deep Breathing: When people get anxious, their breathing tends to quicken, which further worsens the situation. Purposely slowly your breathing can be helpful. There are now many online videos and apps that you can quickly view to help you in the moment with deep breathing.
- 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 of a sensory grounding would be:
- Visual: Look around you and describe what you see, e.g. "I'm in the living room, and I see pictures of my family."
- Hearing: Listen around you and describe what you hear, e.g. "I'm hearing birds outside."
- Touch: Scan your body and describe what you feel, e.g. "I'm sitting on the couch, I can feel it against me. I can feel my hand on my face."
- Smell: Take a deep breath through your nose, and describe what you smell, e.g. "I can smell my coffee."
Calming Exercises. There are many ways to move your body that may be calming for your nervous system. These can be especially powerful because when we are overwhelmed, we may simply not be able to talk about our feelings, or even accept validation and empathy from others.Here is a link to a website that has videos showing how to do various movements: https://www.r4r.support
- Examples include the Butterfly Hug https://www.r4r.support/finding-safety-and-connection
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.
- 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.
The National Center of PTSD at the United States Department of Veterans Affairs
The National Institute of Mental Health (NIMH)
National Center for PTSD
PTSD and Acute Stress Disorder, by Dr. Martin Anthony, retrieved Nov 1, 2008
Interactive Tutorial on PTSD from Medline Plus
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.
Written by the eMentalHealth Team.
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 of Last Revision: Jul 11, 2020