Trauma and PTSD
Post-Traumatic Stress Disorder Overview by NIHM
PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.
It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.
Signs and SymptomsNot every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.
A doctor who has experience helping people with mental illnesses, such as a Dr., Psychiatrist or Psychologist, Marriage and Family Therapist, Social Worker can diagnose PTSD. The criteria below are specific to adults, adolescents, and children older than six years.
All of the criteria are required for the diagnosis of PTSD. The following DSM-5 text summarizes the diagnostic criteria:
Criterion A: stressor (one required)
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B: intrusion symptoms (one required)
The traumatic event is persistently re-experienced in the following way(s):
- Unwanted upsetting memories
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criterion C: avoidance (one required)
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related external reminders
Criterion D: negative alterations in cognitions and mood (two required)
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criterion E: alterations in arousal and reactivity -Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Criterion F: duration (required) Symptoms last for more than 1 month.
Criterion G: functional significance (required) Symptoms create distress or functional impairment (e.g., social, occupational).
Criterion H: exclusion (required) Symptoms are not due to medication, substance use, or other illness.
Dissociative Specification In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
- Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
- Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").
- Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.
It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders. The below information is supplied by NIHM.
Do children react differently than adults? Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include:
- Wetting the bed after having learned to use the toilet
- Forgetting how to or being unable to talk
- Acting out the scary event during playtime
- Being unusually clingy with a parent or other adult
Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. For additional information, visit the Learn More section below. The National Institute of Mental Health (NIMH) offers free print materials in English and Spanish. These can be read online, downloaded, or delivered to you in the mail.
Risk Factors: Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or many other serious events. According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others.
Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to PTSD.
Why do some people develop PTSD and other people do not?
It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.
Many factors play a part in whether a person will develop PTSD. Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.
- Risk Factors and Resilience Factors for PTSD
- Some factors that increase risk for PTSD include:
- Living through dangerous events and traumas
- Getting hurt
- Seeing another person hurt, or seeing a dead body
- Childhood trauma
- Feeling horror, helplessness, or extreme fear
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a history of mental illness or substance abuse
- Some resilience factors that may reduce the risk of PTSD include:
- Seeking out support from other people, such as friends and family
- Finding a support group after a traumatic event
- Learning to feel good about one’s own actions in the face of danger
- Having a positive coping strategy, or a way of getting through the bad event and learning from it
- Being able to act and respond effectively despite feeling fear
- Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology. With more research, someday it may be possible to predict who is likely to develop PTSD and to prevent it.
Treatments and Therapies: The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and PTSD affects people differently so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.
If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.
Medications: The most studied medications for treating PTSD include antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Antidepressants and other medications may be prescribed along with psychotherapy. Other medications may be helpful for specific PTSD symptoms.
Psychotherapy: Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. In office therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.
Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One very helpful form of therapy is called cognitive behavioral therapy, or CBT. CBT can include:
Exposure therapy. This helps people face and control their fear and works for some. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.
How Talk Therapies Help People Overcome PTSD
Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:
- Teach about trauma and its effects
- Use relaxation and anger-control skills
- Provide tips for better sleep, diet, and exercise habits
- Help people identify and deal with guilt, shame, and other feelings about the event
- Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.
Beyond Treatment: How can I help myself? It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check NIMH's Help for Mental Illnesses page or search online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and information.
To help yourself while in treatment:
- Talk with your doctor about treatment options
- Engage in mild physical activity or exercise to help reduce stress
- Set realistic goals for yourself
- Break up large tasks into small ones, set some priorities, and do what you can as you can
- Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
- Expect your symptoms to improve gradually, not immediately
- Identify and seek out comforting situations, places, and people
TRAUMA (by NIHM)
A traumatic event is a shocking, scary, or dangerous experience that affects someone emotionally. These situations may be natural, like a tornado or earthquake. They can also be caused by other people, like a car accident, crime, or terror attack.
How individuals respond to traumatic events is an important area of research for the National Institute of Mental Health (NIMH). Researchers are exploring the factors that help people cope as well as the factors that increase their risk for problems following the event.
There are many different responses to potentially traumatic events. Most people have intense responses immediately following, and often for several weeks or even months after, a traumatic event. These responses can include:
- Feeling anxious, sad, or angry
- Trouble concentrating and sleeping
- Continually thinking about what happened
For most people, these are normal and expected responses and generally lessen with time. Healthy ways of coping in this time period include avoiding alcohol and other drugs, spending time with loved ones and trusted friends who are supportive, trying to maintain normal routines for meals, exercise, and sleep. In general, staying active is a good way to cope with stressful feelings.
However, in some cases, the stressful thoughts and feelings after a trauma continue for a long time and interfere with everyday life. For people who continue to feel the effects of the trauma, it is important to seek professional help. Some signs that an individual may need help include:
- Worrying a lot or feeling very anxious, sad, or fearful
- Crying often
- Having trouble thinking clearly
- Having frightening thoughts, reliving the experience
- Feeling angry
- Having nightmares or difficulty sleeping
- Avoiding places or people that bring back disturbing memories and responses.
Physical responses to trauma may also mean that an individual needs help. Physical symptoms may include:
- Stomach pain and digestive issues
- Feeling tired
- Racing heart and sweating
- Being very jumpy and easily startled
Those who already had mental health problems or who have had traumatic experiences in the past, who are faced with ongoing stress, or who lack support from friends and family may be more likely to develop stronger symptoms and need additional help. Some people turn to alcohol or other drugs to cope with their symptoms. Although substance use can temporarily cover up symptoms, it can also make life more difficult.
Treatment: Although there are many similarities in the treatment of PTSD and Trauma, including the use of CBT (Cognitive Behavioral Therapy), which is proven successful, trauma patients benefit from a three part approach in therapy quite often:
- Safety and Stabilization
- Mourning and Remembrance
- Reconnection and Integration
Seek help as soon as possible. You don't have to feel so bad.