Post Traumatic Stress Disorder (PTSD)

Table of Contents

What is Post Traumatic Stress Disorder (PTSD)?

PTSD (Post Traumatic Stress Disorder) is a severe mental health condition that can develop in a person after experiencing or witnessing a traumatic event.
PTSD generally occurs after events like natural disasters, war, serious accidents, abuse and violence.
PTSD occurs in people of any age, profession, culture and fields.
PTSD is categorized under trauma-and stressor-related disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
PTSD progresses in about 1 in 3 people who experience severe trauma.
Still, there is not enough understanding of why some people develop the disorder while others do not.
However, certain factors make several people to develop PTSD more.
The risk for PTSD is higher for the ones who are exposed to traumatic events along with risks like depression, panic disorder, generalized anxiety disorder, and substance abuse, as compared with those who have not experienced distressing events.
Diagnosis of PTSD is to be given only to the individual, who has been exposed to an extreme stressor or upsetting event to which he or she reacted with panic, defenselessness, or shock and have three distinctive types of symptoms comprising of re-experiencing of the event, averting recaps of the event, and hyperarousal for at least a month.
The re-experiencing of such events denotes undesirable reminiscences of the incident in the form of troubling images, hallucinations, or flashbacks.
After a traumatic experience, traumatized individuals might meet the diagnostic conditions for acute stress disorder within the first month.
However, acute stress disorder is not always followed by PTSD but connected with an increased risk of PTSD.

Characteristics of PTSD

Defenselessness
Disturbing thoughts
Avoidance behaviors
Negative mood
Hyperarousal
Irritation
Insomnia and difficulty in concentration
Hopelessness
Nightmares and stressful memories
Somatic symptoms and physical ailments, mainly hypertension, asthma, and chronic pain syndromes can be seen in those individuals suffering from PTSD.

Risk factors of PTSD

Severity of trauma
Pre-existing mental health condition
Lack of family and social support
Genetic predisposition
Repeated exposure/experience to traumatic events

Causes

Severe accidents
Physical or sexual assault.
Exploitation together with childhood or domestic abuse.
Exposure to distressing events at work, including remote exposure.
Serious health problems, for instance, admitted to intensive care.
Childbirth experiences, such as miscarriage.
Hostilities and conflict.
Extensive effects of PTSD on women and their relationships were found due to childbirth-related experiences.

Diagnosis and Assessment

PTSD diagnosis is made through clinical interviews, structured questionnaires, and symptom checklists. The DSM-5 criteria require that symptoms persist for more than one month and cause significant functional impairment.

Commonly Used Diagnostic Tools:

Clinician-Administered PTSD Scale (CAPS)
PTSD Checklist for DSM-5 (PCL-5)
Impact of Event Scale-Revised (IES-R)

It’s important to differentiate PTSD from other mental disorders like depression, anxiety disorders, and acute stress disorder (ASD), which may share overlapping symptoms.

Neurobiology of PTSD

PTSD is not only a psychological issue but also a neurobiological disorder. It involves changes in brain structures like the amygdala, hippocampus, and prefrontal cortex.

Amygdala: Overactive in PTSD, leading to heightened fear responses.
Hippocampus: Often shrinks in volume, affecting memory and contextualization of the trauma.
Prefrontal Cortex: Becomes underactive, reducing regulation of emotional responses.

Additionally, hormonal imbalances, particularly involving cortisol and norepinephrine, contribute to the stress reactivity seen in PTSD patients.

Types of PTSD

1. Acute PTSD: symptoms appear within 3 months of trauma/traumatic events

2. Chronic PTSD: symptoms appear for more than 3 months of the trauma

3. Delayed-onset PTSD: symptoms begin after 6 months or more of the traumatic event

4. Complex PTSD: These type of PTSD results from prolonged and repeated trauma (e.g. childhood abuse, gender based violence (GBV), marital rape etc.)

Effects/Consequences of PTSD

Evidence shows that 1% – 2% of women go through post-traumatic stress disorder (PTSD) because of childbirth.
Changes in physical health, attitude and behavior, social communication, and fear of childbirth.
Negative effects on the relationship with their partner, with sexual dysfunction, disparities, and blame for events of birth are the effects of PTSD in women, which also extremely affected the mother-baby bond.
Initial feelings of rejection towards the baby, avoidant or fearful affections with their child were the effects on women, which concludes that childbirth-related PTSD can have severe and long-term effects on women and their relationships with their partner and children.
Attempts to deny recaps of the event, including people, places, or even thoughts connected with the incident are symptoms of avoidance.
Physiological expressions, such as insomnia, bad temper, compromised concentration, hypervigilance, and increased shock reactions denote the symptoms of hyper arousal.

Effect of PTSD in Different Populations

a) Children and Adolescents

Children may show different symptoms such as:

Regression (bedwetting, thumb sucking)
Re-enacting trauma through play
Clinginess or aggression

b) Military Personnel and Veterans

Combat-related PTSD includes survivor’s guilt, substance use, and difficulty transitioning to civilian life. Specialized interventions like prolonged exposure therapy are common.

c) Women and Sexual Violence Survivors

Women, especially survivors of sexual abuse or domestic violence, are at a higher risk. PTSD in these cases often overlaps with depression and dissociative symptoms.

Coping Mechanisms for PTSD

Effective coping strategies support individuals to endure, reduce, admit or ignore what one cannot cope with and to moderate the consequences of traumatic, disturbing events.
In life-threatening events, basic assumptions are frequently reexamined and improved. For that reason, trauma needs re-education.
Cognitive-behavioral therapy: Cognitive group work assists methods of grieving, working-through of traumatic material, increasing emotional mindfulness and increasing creativity in coping.
Supportive interventions like: peer support groups, family therapy, music therapy etc.

Treatment and Management

Effective treatment of PTSD includes a combination of psychotherapy, medications, and social support. The goal is to reduce symptoms, improve functioning, and enhance quality of life.

1. Psychotherapy

a. Cognitive Behavioral Therapy (CBT)

The most evidence-based approach.
Helps challenge negative thought patterns and modify maladaptive behaviors.

b. Prolonged Exposure (PE) Therapy

Involves safely confronting trauma-related cues in a controlled environment to reduce fear responses.

c. Eye Movement Desensitization and Reprocessing (EMDR)

Combines recall of traumatic memories with guided eye movements to reduce emotional impact.

d. Trauma-Focused CBT (TF-CBT)

Tailored for children and adolescents with PTSD.

2. Medications

SSRIs (Selective Serotonin Reuptake Inhibitors) such as sertraline and paroxetine are FDA-approved.
Prazosin is used off-label to reduce nightmares.
Medications should be combined with psychotherapy for best outcomes.

3. Supportive Interventions

Peer support groups
Family therapy
Mindfulness-based stress reduction (MBSR)
Art and music therapy

Challenges for Management of PTSD

Stigma regarding PTSD
Lack of adequate mental health resources and expertise to handle patients with PTSD
Co-occurring conditions that regularly trigger PTSD
Lack of proper diagnosis due to limited awareness and limited professional capacity