What is Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )?
Posttraumatic stress disorder (PTSD) is a mental health condition that can happen after someone goes through a traumatic event. It can lead to a wide range of symptoms that affect a person’s thinking patterns, mood, physical experience, and behavior. PTSD can have a long-term impact, cause additional mental health problems, and increase the risk of suicide.
PTSD was officially recognized as a disorder in 1980 in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This acknowledgment highlights the significant effect trauma can have on a person’s mental well-being. The criteria for PTSD diagnosis in the DSM includes having been through a traumatic event and displaying specific symptoms like persistent memories or nightmares, avoidance behaviors, negative mood and thinking changes, and increased alertness. Including PTSD in the DSM has helped improve the understanding, diagnosis, and treatment of people who have undergone trauma.
The care for PTSD is complex because every person’s trauma experience is unique, causing different PTSD symptoms. Prevention and treatment strategies involve both psychological therapies and medication.
What Causes Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )?
Some people who go through traumatic events might end up with long-term mental health problems, but not everyone does. In the context of Post-Traumatic Stress Disorder (PTSD), trauma can be a life-threatening situation, severe injury, or sexual assault. It could be a situation that a person directly experiences, sees someone else going through, or learns that it happened to someone close to them.
There are several theories that try to explain why some people develop PTSD after a traumatic event. One of these is the shattered assumptions theory. This theory suggests that traumatic experiences can change how a person thinks about themselves and the world around them, compared to their views before the event. The assumptions that “the world is good,” “the world is meaningful,” and “I am a good person” can be shaken after a traumatic event.
Another perspective comes from psychodynamic psychology, which studies how life experiences affect our mental state, behaviors, and emotions. While it’s not true that all mental illnesses come from trauma, traumatic experiences (especially early in life) can greatly influence the development of mental illness. For those who have experienced trauma, they might have a hard time trusting that the world is safe or that people won’t hurt them emotionally or physically.
Behavioral scientists also provide insight on how trauma affects our thinking processes. For example, a person can learn to fear certain things after going through a traumatic event. This is often seen in people suffering from PTSD. Those who have been exposed to recurring traumatic situations, such as ongoing abuse, can develop a conditioned fear response to trauma.
Whether or not a person has support after a traumatic event can also impact their chances of developing PTSD. People with a strong support system are less likely to develop PTSD than those who don’t have support or feel isolated after the traumatic event. Moreover, PTSD risk might increase due to factors like lower education levels, lower socioeconomic status, experiencing hardship during childhood, being of a certain gender or race, having a physical injury (including traumatic brain injury), and reacting severely to the initial trauma.
Risk Factors and Frequency for Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
PTSD, or Post-Traumatic Stress Disorder, affects a significant percentage of the adult population in the United States and Canada. The percentage of people who experience PTSD at some point in their life is between 6.1% and 9.2%, while in a single year, between 3.5% and 4.7% people may develop PTSD. Certain populations such as indigenous peoples and refugees in the Western Hemisphere are more likely to experience PTSD. However, PTSD rates tend to be lower outside of the Western Hemisphere, and it is not clear why this is the case.
- Trauma that happens on purpose, like abuse or assault, is more closely linked to PTSD than accidental or nonviolent trauma.
- Having repeated trauma or being exposed to trauma for a longer period increases the risk of PTSD.
- Both men and women can develop PTSD after trauma, but women are more likely to develop it. However, this can vary based on the type of traumatic experience.
Signs and Symptoms of Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
PTSD, or Post-Traumatic Stress Disorder, can vary when it comes to individuals’ histories and symptoms. Many factors can contribute to this condition, such as different kinds of trauma one might experience. Types of trauma can range from sexual assaults to physical injury, medical illness, military or combat exposure, and being a refugee from a mass political upheaval. It’s crucial to understand each person’s background and history.
Notably, PTSD in adults often stems from a traumatic event that they experienced in their childhood. It’s important to understand how long the person has been suffering from symptoms, as the duration can help differentiate PTSD from other mental health disorders.
Some individuals with PTSD might also exhibit dissociative symptoms, like:
- Depersonalization: Feeling detached from one’s body and experiencing a sensation of “floating” above it.
- Derealization: Feeling disconnected from reality, almost as if one’s surroundings are like a dream.
When talking about their trauma, every individual is different. Some can discuss it openly, while others struggle due to the pain it causes them. It’s crucial to be sensitive and respectful during such discussions, asking the patient how much they’re comfortable sharing. The details of the trauma aren’t usually needed for a PTSD diagnosis but can be necessary for some types of therapy.
In diagnosing PTSD, some general questions that could be asked might be about the frequency of traumatic event recollections, nightmares or flashbacks relating to the trauma, avoidance of triggers, and struggles with persistent sadness.
Physical manifestation of PTSD might not be obvious, with signs usually being nonspecific. PTSD primarily affects the psyche, but chronic stress and arousal can lead to physical symptoms in some people. These can include heightened heart rate, increased blood pressure, muscle tension, and disrupted sleep patterns. When talking about their trauma or during flashbacks, people with PTSD might show these symptoms.
A physical examination might reveal scars, hypervigilant behavior, mood changes ranging from fear and anxiety to apathy or depression. It’s also important to evaluate thought content for any indication of suicidal thoughts or self-harm behaviors. The individual typically understands their illness, but it might be hard for them to connect it to other potential mental health problems they might have like major depression or substance misuse. Finally, their judgment can be assessed based on their presentation and their ability to make rational decisions about their treatment options.
If medications affecting blood pressure are prescribed for PTSD, it is crucial to monitor blood pressure when adjusting medication dosages accordingly.
Testing for Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
Psychiatrists play a crucial role in diagnosing Post-Traumatic Stress Disorder (PTSD). For circumstances where a psychiatric specialist cannot be present, there are tried-and-tested rating scales that health professionals can use to diagnose PTSD. Some of these include the PTSD Checklist for DSM-5 and the Trauma Symptom Checklist-40. There also exists a 30-item structured interview known as the Clinician-Administers PTSD scale.
To formally determine if a person has PTSD, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR) criteria has been established. Diagnosing a patient would include careful evaluation of their personal history, any information from collateral sources, and a mental status examination (MSE). This ensures that the person’s symptoms, daily functioning, and overall mental state align with the diagnostic criteria.
According to the DSM-5-TR, the criteria for diagnosing PTSD in adults and children above the age of 6 is as follows:
In respect to Criterion A, the individual must have been exposed to a real or perceived threat of death, injury, or sexual violence in a few number of ways. These include experiencing the trauma first-hand, witnessing the incident happen to another person, or by learning about a close friend or family member’s exposure to trauma. Professionals constantly exposed to distressing details of traumatic events can also meet this criterion.
Criterion B involves the presence of one or more intrusion symptoms which became noticeable after the trauma. These include recurrent and involuntary distressing thoughts or nightmares related to the trauma and severe emotional distress or physical reactions to anything that reminds the individual of the traumatic event.
Criterion C pertains to a persistent effort to avoid anything (events, thoughts, or external factors) that may bring about memories of the traumatic incident.
Symptoms under Criterion D refer to two or more negative changes in mood or thoughts that worsened after the trauma. These can range from an inability to recall aspects of the event, to persistent negative beliefs, to having persistent negative emotions or feelings of isolation.
When it comes to Criterion E, alterations in arousal and reactivity have to be noticed after the trauma. These alterations include irritable or aggressive behaviour, hypervigilance, problems with concentration, or sleep disturbances.
Criterion F involves the persistence of symptoms from Criteria B, C, D, and E for more than a month.
Criterion G states that the disturbances or symptoms must cause significant distress or impact in different areas of life such as work or social interactions.
Lastly, Criterion H clearly states that the disturbance shouldn’t be attributable to substance use, medication, or other medical conditions.
There are also specifications like late onset PTSD (Delayed Expression) which may present at or after 6 months from the target trauma, or PTSD associated with dissociative symptoms.
This all-encompassing assessment process enables mental health professionals to accurately diagnose and treat PTSD.
Treatment Options for Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
The treatment for Post-Traumatic Stress Disorder (PTSD) needs to be tailored to the patient’s specific needs and they should agree to any treatment. Some people with PTSD are hesitant to seek treatment, and others may find their symptoms do not improve with treatment. Treatment may be a mix of medicine and therapy and patients should have the choice between the two. Therapy is generally the first choice, but people with very severe symptoms or other illnesses might not be able to start with therapy treatments and instead, might need to begin with medicine, with therapy added later when they are more capable.
Psychotherapy Approaches
Trauma-focused psychotherapy is usually the preferred treatment for PTSD. It includes various types of therapy like cognitive-behavioral therapy, exposure-based therapy, and Eye Movement Desensitization and Reprocessing Therapy (EMDR). Studies have demonstrated that patients who receive trauma-focused therapy show better improvement than those who don’t have treatment. In fact, therapy may have slightly better results than medication.
Cognitive behavioral therapy teaches you to identify and correct distorted, unhealthy beliefs that can arise after a traumatic experience. It can include education, relaxation exercises, learning how to cope with stress, and stress management.
Exposure-based therapy is more commonly used for anxiety disorders, such as specific phobias. It gradually reintroduces the fear-inducing stimulus to the patient, aiming to eventually eliminate the fear. However, it requires the patient’s consent and commitment, and might not be suitable for all cases.
EMDR involves thinking about a distressing memory while voluntarily adjusting your eye movements. This can reduce the anxiety associated with the memory. While it can lessen the impact of traumatic memories and improve positive self-belief, the ways it works in therapy is still not completely understood.
Supportive psychotherapy can help individuals dealing with immediate trauma and those having acute stress disorder.
Medication Approaches
Selective serotonin reuptake inhibitors (SSRI), like sertraline and paroxetine, are officially approved for treating PTSD. Other SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRI) can also be used, but are not officially approved. Both types of medication have been found to reduce symptoms better than a placebo, but no particular brand has been singled out as being most effective.
For people who experience a lot of sleep disturbances or nightmares, off-label medications like Prazosin are often used. The idea is that it reduces the sympathetic response, which can decrease the intensity or frequency of nightmares. However, the effectiveness of Prazosin for this use has had mixed results.
Other medications less commonly used for PTSD include second-generation antipsychotics, which can be helpful in patients who also experience psychotic symptoms or depression that doesn’t improve with treatment.
Novel Approaches
In 2020, the FDA cleared a new tool which uses a common smart-watch to monitor heart rate during sleep in PTSD patients. The aim is to connect the body’s response (biofeedback) to PTSD-related nightmares.
What else can Posttraumatic Stress Disorder (Stress and Anxiety After Trauma ) be?
When trying to diagnose post-traumatic stress disorder, or PTSD, doctors have to consider several other conditions that may appear similar. Here are some of them:
- Acute Stress Disorder: This shares many of the same signs as PTSD, but they last for less than a month.
- Dissociative Disorders: There are various types of these, including dissociative identity disorder, which involves having multiple distinct personalities, and dissociative amnesia, which involves not being able to remember traumatic or stressful events. There’s also depersonalization/derealization disorder, which shares some symptoms with PTSD.
- Major Depressive Disorder: This can occur alongside PTSD. It involves at least one major episode of depression, characterized by a persistently low mood for two weeks or more.
- Adjustment Disorder: This is when emotional or behavioral symptoms develop in response to a stressful event, usually within three months of it occurring. These symptoms typically don’t last for more than six additional months.
- Other Psychiatric Disorders: Even if a person’s PTSD symptoms improve over time, they may still have other mental health issues that require treatment. It’s important for doctors to be aware of this and continually assess their patient’s condition.
Doctors must carefully evaluate all these possibilities in order to make an accurate diagnosis.
What to expect with Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
The effects of PTSD (post-traumatic stress disorder) can differ greatly from person to person due to various factors. Those who receive treatment for PTSD generally have better outcomes compared to those who do not seek treatment. Chronic PTSD, where symptoms persist for years, is quite common. It’s estimated that a third of patients still experience symptoms a year after diagnosis, and another third still have symptoms a decade later.
On a positive note, the field of positive psychology highlights the possibilities of psychological resilience after trauma and what is known as ‘posttraumatic growth.’ This refers to positive changes in how a person perceives themselves, how they interact with others, and their life philosophy that can occur when they recover from trauma and PTSD. These changes often result in increased self-awareness, confidence, open-mindedness, and a greater appreciation for life. However, it’s important to note that not everyone experiences this kind of major growth after trauma – it’s an optional rather than guaranteed outcome, and might even be rare. The study of how positive psychology can be used in PTSD treatment needs more research.
Possible Complications When Diagnosed with Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
People experiencing symptoms of Post-Traumatic Stress Disorder (PTSD) can recover, but these symptoms can also develop into other mental health conditions. Experiencing trauma increases the risk of developing Major Depressive Disorder (MDD), borderline personality disorder, anxiety disorders, substance use disorders, and even psychotic disorders.
It should be noted that people suffering from PTSD are at a higher risk of committing suicide. Medical professionals are recommended to regularly check these individuals for any thoughts of suicide.
Moreover, individuals with PTSD are more likely to have trouble with their jobs compared to those without PTSD and have increased disability rates. Particularly, individuals who have experienced sexual trauma may have more problems in their intimate relationships.
Given all, it’s important to recognize and address PTSD symptoms to mitigate risks:
- Development of Major Depressive Disorder
- Development of borderline personality disorder
- Development of anxiety disorders
- Development of substance use disorders
- Development of psychotic disorders
- Increase in suicide risk
- Occupational problems
- Increased disability rates
- Problems with intimate relationships
Preventing Posttraumatic Stress Disorder (Stress and Anxiety After Trauma )
Strategies to prevent and manage Post-Traumatic Stress Disorder (PTSD) are focused on lessening the effect of traumatic events and reducing the chance of developing serious emotional distress. The primary methods involve strengthening resilience, improving coping abilities, and encouraging supportive social networks to better equip individuals in dealing with stress. It’s crucial for healthcare professionals to carefully monitor patients who might need PTSD screening. Routine checks for PTSD are especially important for military personnel and veterans. It’s also vital for healthcare providers to be alert to patients who come in with new anxiety, fear, and sleeplessness, as these might be signs of trauma. Education about trauma and early intervention strategies within communities can also aid in creating environments that minimize trauma exposure and its impacts.
Secondary preventive measures concentrate on providing prompt and specific interventions for individuals at higher risk, such as those with a past trauma or those working in high-stress jobs, to prevent the worsening of symptoms. Introducing trauma-focused mental health practices across different sectors, like education, healthcare, and emergency services, is crucial in cultivating a culture of prevention and support. The goal is to lessen the occurrence and seriousness of PTSD by managing risk factors and fostering resilience on both personal and societal levels, which ultimately leads to improved mental health outcomes.
