Understanding post-traumatic stress disorder

For many people, post-traumatic stress disorder (PTSD) is a condition they associate with active members of the military and veterans. While this mental health condition is slightly more common in veterans, affecting 7% of veterans at some point in their lives according to the National Center for PTSD, about 6% of adults in the general U.S. population experience PTSD during their lifetime.

PTSD can be caused by experiencing or witnessing a traumatic event. It can also occur when you learn about someone close to you experiencing trauma even though you were not present when it occurred.

A very wide range of types of events can cause PTSD, including:

• Witnessing, being threatened with, and experiencing violence
• Witnessing a death
• Being the victim of or a witness to a violent crime
• Serious accidents or injuries
• Emotional of physical abuse
• Acts of terrorism
• Natural disasters
• Birth trauma (prolonged, painful childbirth, medical complications during birth, emergency C-section, injury or death of child during childbirth)
• Life-threatening illness and/or time in the ICU
• Race, ethnicity, gender and sexual orientation-based, and faith-targeted violence

What are the symptoms of PTSD?

The appearance of PTSD symptoms can occur within a month of the traumatic experience or can be delayed, causing the first symptoms to appear years after the experience. The criteria for a PTSD diagnosis include experiencing symptoms that are severe enough to interfere with daily life for more than a month.

Symptoms are grouped into four categories—intrusive memories, avoidance, changes in thinking and mood, and changes in physical and emotional reactions. They can change over time and not every person experiences the same set of symptoms.

Examples of symptoms include:

• Flashbacks that involve reliving the trauma as if it were occurring again
• Recurrent, upsetting, vivid memories of the trauma
• Frequent distressing dreams and nightmares about the event
• Experiencing physical signs of stress like a racing heart rate, shortness of breath, sweating without a current cause
• Avoiding places, events, or people that remind you of the trauma
• Trying not to think or talk about the event
• Negative thoughts about yourself or the world
• Memory issues, including being unable to remember details of the trauma
• Hopelessness
• Relationship issues, including feeling detached from loved ones and having trouble maintaining close relationships
• Loss of interest in things you used to enjoy
• Feeling numb and/or not experiencing positive emotions
• Being startled or frightened easily
• Hypervigilance
• Being easily upset or angered
• Irritability
• Trouble sleeping
• Trouble concentrating
• Alcohol and substance use
• Risk-taking behaviors
• Strong feelings of shame or guilt

Symptoms of PTSD in children and teens

Children with PTSD can experience the same symptoms as adults, but children who are six or younger may also experience additional symptoms like regressive behavior (wetting the bed after being toilet trained, forgetting how to talk or refusing to talk, thumb sucking), being more clingy than usual with parents and caregivers, acting out the trauma while playing, having physical symptoms like headaches and stomachaches, having problems in school with attention and ability to sit still, and worrying about dying.

Older children and teens may become disruptive, disrespectful, or take part in destructive behaviors in addition to experiencing common adult PTSD symptoms.

Children and teens who have experienced trauma are at risk of being misdiagnosed with ADHD, anxiety, and conduct disorders, so it’s important to get your child assessed by a mental health provider who has experience diagnosing and treating PTSD in children and to let teachers, caregivers, and others know that your child has been affected by a traumatic event.

PTSD risk factors

Not everyone who experiences trauma develops PTSD. There are, however, some risk factors that may increase the likelihood of developing this condition. Those factors include:

• Previous traumatic experiences, especially childhood trauma
• Lack of social support after experiencing trauma
• A personal or family history of mental health conditions such as anxiety, depression, and substance use disorder
• Experiencing trauma over a long period of time, like child abuse or intimate partner abuse
• The intensity of the trauma you experience

Complex PTSD

In general, PTSD develops after a single traumatic event. Complex PTSD can occur when someone experiences a series of traumatic events over time or a prolonged traumatic experience. The symptoms are similar to PTSD but are usually more extreme and last longer.

How is PTSD diagnosed and treated?

If you think you may be living with PTSD, make an appointment with your primary care provider. Your provider will perform a physical examination to check to see if another medical issue could be the underlying cause of your symptoms. Your provider can also do a preliminary psychological exam to identify your symptoms, how long you’ve been experiencing them, how severe they are, and the traumatic event or events you’ve experienced. Your provider can also screen for other mental health conditions that may be responsible for your symptoms or may be a co-occurring condition with PTSD.

Your provider will refer you to a mental health provider or, if you prefer, you can start the diagnostic process by seeing a mental health provider first. Your PinnacleCare Health Advisor can connect you with providers who have experience treating people with PTSD and provide information on potential treatment options to help you make an informed decision.

Treatment often includes several approaches. Your provider may recommend:

• Psychotherapy: Several different psychotherapeutic approaches are used to treat PTSD. Cognitive therapy or talk therapy approaches include cognitive processing therapy (learning to modify and challenge unhelpful thoughts about the trauma), cognitive therapy (learning to recognize and counter negative though patterns), exposure or prolonged exposure therapy ( learning to gradually and safely approach thoughts, feelings, and situations related to the trauma so you can learn to cope with them), and eye movement desensitization and reprocessing or EMDR ( a combination of exposure therapy and guided rapid eye movements to help you change how you react to memories of the trauma). Your provider will also help you build coping and stress management skills to help you manage your symptoms.
• Medications: Your provider may prescribe antidepressants, mood stabilizers, anti-anxiety medications, and/or alpha-1 blockers like prazosin, which can reduce nightmares and sleep disturbances and decrease your startle and fear responses.

Alternative therapies and lifestyle changes may also help you manage your symptoms and improve your wellbeing. Some options are meditation, acupuncture, trauma-sensitive yoga and other movement-based practices, meditation, and breathwork.

Some research has found an association between PTSD and an increased risk of developing metabolic and cardiovascular disease. Healthy lifestyle behaviors like regular physical activity, mindfulness, and getting enough sleep can both help lower the risk of developing these diseases and may also help improve your mood.

Diet may also play a role in PTSD recovery. One research team looked at the connection between the gut microbiome, diet, and PTSD symptoms. They found that a Mediterranean diet was associated with fewer PTSD symptoms, while a diet that included red and processed meat was associated with PTSD symptoms. More study is needed to determine if there is a cause-and-effect relationship between diet and PTSD symptoms.

Emerging treatments for PTSD

In addition to gold standard PTSD treatments, there are a number of new approaches to treating the condition. Most are still in development and not yet FDA-approved, but your PinnacleCare Health Advisor can help you find a clinical trial if other treatment approaches haven’t helped you.

Researchers are also exploring the effects of hepatitis C virus direct acting antivirals, including glecaprevir, pibrentasvir, and velpatasvir, on PTSD symptoms, and have found that these medications were associated with clinically significant symptom reduction. Medications that inhibit FAAH (fatty acid amid hydrolase) and affect the body’s endocannabinoid system are also being looked at, as well as medications to lower activity in the amygdala, the part of the brain that governs emotion and motivation.

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