Post-Traumatic Stress Disorder (PTSD)

People of all ages can have PTSD, and there is no way to predict who will develop the disorder after a traumatic event. However, PTSD is more common among people who have experienced the following: 

• Violet trauma, such as a physical or sexual assault
• Military combat
• An adverse childhood event (ACE)
• A severe physical accident
• Injuries during an event
• Being threatened with a weapon
• Horror, helplessness, or extreme fear at the time of the event
• Witnessing disturbing scenes, for example as a first responder
• A lack of social support after a traumatic event
• Long-lasting or recurring trauma
• Other mental health problems, such as anxiety and depression
• Substance abuse
• Life-threatening events

The risk for developing PTSD is also higher among those with a family history of mental health issues, such as relatives who have had PTSD themselves, or depression. 

It is not yet fully understood why some people develop PTSD and others do not. The type and severity of the traumatic event likely play a role, as does a person’s emotional temperament and the way the brain regulates chemicals and hormones released in response to stress. 

While PTSD is typically thought of as a psychological disorder, individuals experiencing post-traumatic stress have been found to have certain physical differences in brain function and anatomy compared to those who are not: 

• The size of the hippocampus (which regulates motivation, emotion, learning, and memory) decreases. 
• The amygdala (which processes emotions and fear responses) is overly reactive. 
• The medial prefrontal cortex (which partly controls the emotional reactivity of the amygdala) appears to be smaller and less responsive. 

PTSD symptoms may appear within the first three months after a traumatic event, but sometimes they may not surface until years later. If they last more than a month, cause problems in social or work situations, or affect the ability to do usual daily tasks, it is recommended to speak with a doctor or therapist, who may recommend taking a PTSD assessment for a possible diagnosis. 

Symptoms vary from person to person, but they are generally grouped into four types, and a symptom from each type is required for an official diagnosis: 

Intrusive memories

• Repeated, involuntary, and distressing memories of a traumatic event. 
• Experiencing vivid flashbacks (feeling as if you are reliving a traumatic event as if it were happening again). 
• Nightmares or upsetting dreams. 
• Severe emotional distress or physical reactions to something (such as a news report, seeing an accident, or hearing fireworks) that reminds you of a traumatic event. This is called a trauma reminder, cue, or trigger. 

Avoidance

• Trying not to remember or think about a traumatic event. 
• Unwillingness to talk about what happened or how you feel about it. 
• Staying away from people, places, activities, media, or situations that remind you of a traumatic event. 

Thinking and mood

• Ongoing negative and distorted thoughts and feelings about yourself, other people, or the world. 
• Persistent emotions of fear, horror, blame, guilt, anger, or shame. 
• Memory problems, including forgetting important aspects of a traumatic event. 
• Feeling detached from others, including family and friends. 
• Loss of interest in activities you once enjoyed. 
• Difficulty or inability to feel positive emotions. 
• Feeling emotionally numb and unable to have positive or loving feelings toward other people. 
• Distorted thoughts about the cause of a traumatic event, leading to wrongfully blaming yourself or others. 
• In some cases, believing that the world is completely dangerous and no one can be trusted.

Changes in physical and emotional reactions (also called arousal and reactivity)

• Physical reactions, such as rapid breathing, sweating, shaking, or having a fast heartbeat. 
• Being easily startled or frightened. 
• Hypervigilance, or being overly watchful of your surroundings and always on guard for danger. 
• Reckless, unhealthy, or self-destructive behavior, such as smoking, abusing drugs or alcohol, or driving aggressively. 
• Difficulty sleeping or concentrating. 
• Angry outbursts, irritability, or aggressive behavior. 

Symptoms for children with PTSD

As an adult, you might not be aware that a child has experienced a traumatic event. Children with PTSD may have a hard time expressing how they’re feeling, or they may seem restless, fidgety, or struggle to pay attention or stay organized. These symptoms can be confused with those of attention-deficit/hyperactivity disorder (ADHD), so it is best to consult with a child psychologist. 

Other PTSD symptoms for children 6 years old and younger may include getting worried and upset if their parents are not close by, re-enacting aspects of a traumatic event through play, or having trouble sleeping. They might have frightening dreams, which may or may not feature aspects of an experienced traumatic event.  

As children get older, their symptoms start to resemble those of adults. They may act out the trauma through drawings or stories, have nightmares, become more aggressive and irritable, or they may want to avoid school or have difficulty with schoolwork or friends. Teenagers with PTSD may experience depression and/or anxiety, withdraw from others, or engage in reckless behavior like substance abuse or running away. 

For an official diagnosis of PTSD, the symptoms must last for more than a month and cause significant distress or difficulties in daily functioning. Using the diagnostic criteria of the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), a person must present the following:

• At least one intrusion symptom 
• At least one avoidance symptom 
• At least two thinking and mood symptoms 
• At least two arousal and reactivity symptoms 

A psychologist or other trained healthcare provider makes the diagnosis by asking about a patient’s symptoms, medical history, mental health history, and the traumatic experience. Speaking about the experience may be difficult, but it is a necessary part of getting help. Many patients who have suffered a traumatic experience find it helpful to bring a loved one with them to the appointment for support and to assist with providing details. 

The primary treatment for PTSD is psychotherapy (otherwise known as counseling or talk therapy) focused on trauma. This therapy should be undertaken with a trained, licensed mental health professional, such as a psychologist or psychiatrist. Therapy sessions might include an approach called cognitive behavioral therapy (CBT), specifically form called cognitive processing therapy. Designed specifically for treating PTSD, this method focuses on working to change painful negative emotions (like guilt and shame) and beliefs stemming from the traumatic experience. It also helps patients confront distressing memories and emotions, reframe problematic thinking patterns, and learn skills to manage symptoms. 

A second psychological approach might include prolonged exposure therapy, which gets patients to talk about the trauma repeatedly until it is no longer upsetting. This can help patients regain control of their thoughts and feelings and overcome their avoidance of safe places and situations. A third option is eye movement desensitization and reprocessing (EMDR), a method that involves following guided instructions and moving the eyes in a specific way while thinking about traumatic memories. The idea is to help patients “reprocess” their memories of a traumatic event, which can help to reduce the tendency to relive it through involuntary flashbacks. EMDR has proven to be an effective treatment for PTSD in several studies, although a conclusive explanation for this effectiveness has yet to be discovered. 

There is currently no FDA-approved medication to treat PTSD specifically, but doctors may prescribe certain drugs to help reduce the symptoms. These include common antidepressants selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs), or anti-anxiety medications. For example, doctors might prescribe sertraline, paroxetine, or venlafaxine, depending on various individual health factors. 

Currently, the National Institute of Mental Health (NIMH) is supporting research to try to determine what causes specific PTSD symptoms and why they differ from person to person, in terms of the type and severity of those symptoms. Their research is also attempting to find ways to differentiate trauma survivors who are likely to recover naturally compared to those who will need or benefit from treatment.

Next Generation Research Grant recipient Dr. Deborah Rose is studying how adverse childhood experiences are associated with cognitive performance and neurodegeneration, and how this association differs across ethnic and racial groups. Other research projects are focused on improving mental health treatments for trauma survivors through new medications, devices, psychotherapy approaches, and on improving equity across different settings and populations. 

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