Post-Traumatic Stress Disorder (PTSD)

The essential feature of posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. Individuals may be exposed to traumatic events by directly experiencing them, witnessing them, or indirectly learning about them.

Directly experienced traumatic events include, but are not limited to, exposure to war as a combatant or civilian, threatened or actual physical assault (e.g., physical attack, robbery, mugging, childhood physical abuse), threatened or actual sexual violence (e.g., forced sexual penetration, alcohol/drug-facilitated sexual penetration, abusive sexual contact, noncontact sexual abuse, sexual trafficking)(Basile et al. 2013), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war, natural or human-made disasters, and severe motor vehicle accidents. On the other hand, witnessed events include, but are not limited to, observing threatened or serious injury, unnatural death, physical or sexual abuse of another person due to violent assault, domestic violence, accident, war or disaster, or a medical catastrophe in one’s child (e.g., a life-threatening hemorrhage). Indirect exposure through learning about an event is limited to experiences affecting close relatives or friends and experiences that are violent or accidental (e.g., death due to natural causes does not qualify).

The traumatic event can be re-experienced in various ways under various triggering cues (e.g., windy days after a hurricane; seeing someone who resembles one’s perpetrator). Commonly, the individual has recurrent, involuntary, and intrusive recollections of the event. The individual may experience dissociative states that last from a few seconds to several hours or even days, psychological distress or physiological reactivity.

Negative alterations in cognitions or mood associated with the event begin or worsen after exposure to the event. These negative alterations can take various forms, including an inability to remember an important aspect of the traumatic event; persistent (i.e., always or almost always) and exaggerated negative expectations regarding important aspects of life applied to oneself, others, or the future; persistent erroneous cognitions, persistent negative mood state, etc. These may result in quick temperedness, aggressive verbal and/or physical behavior, reckless or self-destructive behavior, concentration difficulties.

An individual with PTSD may experience these symptoms:

  • Negative judgement to oneself and others (e.g. “I have always had bad judgment”; “I can’t trust anyone ever again”)
  • Persistent negative mood state (e.g., fear, horror, anger, guilt, shame)
  • Markedly less interest or participation in previously enjoyed activities
  • Persistent inability to feel positive emotions
  • Aggressive verbal and/or physical behavior with little or no provocation (e.g., yelling at people, getting into fights, destroying objects)
  • Reckless or self-destructive behavior such as dangerous driving, excessive alcohol or drug use
  • Heightened startle responses, or jumpiness, to loud noises or unexpected movements (e.g., jumping markedly in response to a telephone ringing)
  • Concentration difficulties, including difficulty remembering daily events (e.g., forgetting one’s telephone number) or attending to focused tasks
  • Sleeping Difficulties
  • Persistent dissociative symptoms of detachment from their bodies or the world around them

PTSD can be caused by factors such as severity (dose) of the trauma (the greater the magnitude of trauma, the greater the likelihood of PTSD), perceived life threat, personal injury, interpersonal violence (particularly trauma perpetrated by a caregiver or involving a witnessed threat to a caregiver in children)(Scheeringa et al. 2006), and, for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy.

It can also be caused in part by pre-traumatic factors such as lower socioeconomic status; lower education; exposure to prior trauma (especially during childhood)(Binder et al. 2008; Cougle et al. 2009; Smith et al. 2008); childhood adversity (e.g., economic deprivation, family dysfunction, parental separation or death); cultural characteristics (e.g., fatalistic or self-blaming coping strategies); lower intelligence; minority racial/ethnic status; and a family psychiatric history.

PTSD is associated with suicidal ideation and suicide attempts(Sareen et al. 2005; Sareen et al. 2007). It can also lead to other functional consequences such as high levels of social, occupational, and physical disability, as well as considerable economic costs and high levels of medical utilization(Arnow et al. 2000; Kartha et al. 2008; Kessler et al. 2005a).

There are treatments for individuals who experience PTSD. If you suspect you may have PTSD, please mention this to your therapist and we can assess your symptoms and present treatment options to address your concerns.

Works Cited

American Psychiatric Association. (2013). Trauma- and Stressor-Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Arnow BA , Hart S , Hayward C , et al: Severity of child maltreatment, pain complaints and medical utilization among women. J Psychiatr Res 34(6):413–421, 2000

Basile KC , Smith SG , Breiding M , et al: Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 2.0. Atlanta, GA, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2013

Binder EB , Bradley RG , Liu W , et al: Association of FKBP5 polymorphisms and childhood abuse with risk of postraumatic stress disorder symptoms in adults. JAMA 299(11):1291–1305, 2008

Cougle JR , Resnick H , Kilpatrick DG : Does exposure to interpersonal violence increase risk of PTSD following subsequent exposure? Behav Res Ther 47(12):1012–1017, 2009

Kartha A , Brower V , Saitz R , et al: The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients. Med Care 46(4):388–393, 2008

Smith TC , Wingard DL , Ryan MA , et al: Prior assault and posttraumatic stress disorder after combat deployment. Epidemiology 19(3):505–512, 2008

Scheeringa MS , Wright MJ , Hunt JP , Zeanah CH : Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. Am J Psychiatry 163(4):644–651, 2006

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