Post-traumatic Stress Disorder (PTSD): Signs, Risk Factors, Types, and Treatment

Post-traumatic stress disorder, or PTSD, is a mental health condition that is triggered after either experiencing or witnessing a traumatizing event. Patients with PTSD suffer from episodes of emotional and mental distress with anxiety, flashbacks, and recurring memories associated with that particular event. 

The signs and symptoms of PTSD include PTSD-induced nightmares, partial Memory Loss, sleep disturbances, negative thoughts, avoiding thinking about traumatic events, difficulty concentrating, feelings of hopelessness, and reduced interest in activities.

The causes of PTSD include serious accidents, natural disasters, wars, physical, sexual, or emotional abuse, and other forms of violence. 

The types of PTSD include acute stress disorder,  complex PTSD (C-PTSD), normal stress response, uncomplicated PTSD, and comorbid PTSD.

The treatment options for PTSD include cognitive behavioral therapy (CBT), prolonged exposure therapy (PE), group therapy, and medication. 

What is PTSD? 

The Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition (DSM-5), defines PTSD as exposure to the actual or threatened situation of death, injury, or violence through either experiencing it directly, witnessing it, hearing about it as it happened to someone close, or constant exposure to the details of some traumatic event. For the identification of PTSD presence, the symptoms must be present for more than a month and cause major mental, emotional, or physical distress. 

What is the prevalence of PTSD?

PTSD affects a significant portion of the population in the United States. According to the National Center for PTSD, 7-8% of the population in the US has experienced PTSD at some point in life. As per this data, almost 8 million people suffer from PTSD in a year. Women are usually more prone to developing PTSD than men. While 10% of women are diagnosed with PTSD, in contrast, 4% of men are diagnosed with it. 

What are the Signs and Symptoms of Post-traumatic Stress Disorder (PTSD)?

The signs and symptoms of PTSD include PTSD-induced nightmares, partial Memory Loss, sleep disturbances, negative thoughts, avoiding thinking about traumatic events, difficulty concentrating, feelings of hopelessness, and reduced interest in activities.

Some signs and symptoms of PTSD  are listed below. 

• PTSD-induced nightmares: Nightmares are among the common symptoms of PTSD including distressing dreams related to the traumatic event. As per the National Center for PTSD, these nightmares can lead to feelings of fear and anxiety that disrupt the quality of sleep. People with PTD tend to relive the trauma in the form of the nightmares they might experience. This further leads to bad sleeping patterns and more anxiety during the daytime. 

• Partial memory loss: Partial memory loss refers to forgetting significant parts of your life. PTSD can lead to partial memory loss especially related to the events of traumatic episodes. This symptom is also known as dissociative amnesia and it serves as a coping mechanism that helps to protect the individual from being overwhelmed by stress. According to Harbor Psychiatry and Mental Health, This form of memory loss can make it difficult for the individual to piece together the timeline and details of the traumatic event. This further interferes with the ability to comprehend and recover from the incident. 

• Sleep disturbances: Sleep disturbance leads to people having trouble falling or staying asleep, waking up after short intervals, and restless sleep. According to NIH, it is a common symptom among people suffering from PTSD. Usually, some symptoms like anxiety, nightmares, and sleep disturbances combine to cause chronic sleep deprivation which can lead to overall impairment. 

• Negative thoughts: Negative thoughts about the world, oneself, and any situation the individual might encounter are a common symptom of PTSD. As per the Perelman School of Medicine, these mainly include feelings of worthlessness, guilt, and shame. This greatly contributes to the emotional distress experienced by the person and can further lead to them withdrawing from social interactions and choosing isolation.

• Avoiding thinking about traumatic events: Avoidance is among the top symptoms associated with PTSD. People suffering from PTSD constantly try to avoid thinking about the thoughts, feelings, emotions, and experiences related to the event. As per NHS, they also try to avoid the places, things, and people that might remind them of the trauma. While it’s an attempt to avoid the distress caused by the event, it can, however, disrupt the healing and recovery prolonging the disorder.

• Difficulty concentrating: Trouble while concentrating usually comes out in the form of not being able to focus, losing memory, and inability to complete daily tasks. As per NIH, It is common in PTSD. This can have a great impact on academic, personal, or professional life and goals. In this way, distress caused by PTSD is increased. 

• Feelings of hopelessness: Losing hope means feeling there is no solution to the problem. PTSD can make a person feel completely hopeless about the future. As per the National Center for PTSD, they might feel like their situation might never improve and recovery is impossible. This further leads to depression and suicidal thoughts. 

• Reduced interest in activities: People with PTSD usually lose interest in the daily activities they once enjoyed. This symptom is also known as anhedonia. As per NIH, It can result from emotional numbness, depression, and isolation from any form of social interaction. This further leads to reduced quality of life and worsening of the situation. 

​​What are the Causes of Post-traumatic Stress Disorder (PTSD)?

The causes of PTSD include serious accidents, natural disasters, wars, physical, sexual, or emotional abuse, and other forms of violence. People who witness or experience such events tend to develop PTSD as their body is reacting to the distressing situation. The reaction happens in the form of stress and fear induced by the trauma. 

Biological factors like changes in brain chemistry and function or hormonal changes can lead to changes in the intensity and persistence of the symptoms. Genetics can also play a part in the development of PTSD. People with a history of depression and anxiety in the family tend to be more prone to the development of PTSD.

What are the Risk Factors of PTSD?

The high-risk factors of PTSD include sex (gender), family history of depression, traumatic life events, gender identity, and drug addiction.

Some of the high-risk factors of PTSD are mentioned below:

• Sex (Gender): Women are more likely to develop PTSD than men. This is due to the higher prevalence of sexual violence and interpersonal trauma that exists within females. Hormonal irregularities and the varying responses to stress might also contribute to the higher risk in females. 

• Family history of depression: A family history of mental disorders like depression and anxiety are great risk factors for PTSD. People with such relation to mental illness within their close circle are more prone to develop serious symptoms of PTSD.

• Traumatic life events: Experiencing or witnessing traumatic events like accidents, assaults or violence can contribute greatly to the development of PTSD. The severity of symptoms depends on the duration of exposure to the traumatic events.

• Gender identity: Gender discrimination often leads to PTSD as people identifying as a gender other than their birth gender might experience severe discrimination, violence, and social rejection. This can lead to the risk of traumatic events and the onset of PTSD.

• Drug addiction: Drugs and substances are often used as coping mechanisms to deal with trauma. However, they impair the senses and emotions which leads to further worsening of the PTSD symptoms. Hence, the use of drugs hinders recovery and healing.

Who is at Risk for PTSD?

Individuals at risk of PTSD include those who have witnessed or experienced traumatic events like assault, violence, abuse, war crimes, accidents, or natural disasters. Females are at greater risk of developing PTSD due to the greater prevalence of sexual violence and abuse. People who have experienced prolonged or repeated trauma are also at risk. Expressing trauma indirectly while hearing about it happening to someone close to you can also lead to PTSD. Moreover, people facing discrimination and violence at the expense of gender identity are also at risk of developing PTSD. 

What are the Types of Post-traumatic Stress Disorder (PTSD)?

The types of PTSD include acute stress disorder,  complex PTSD (C-PTSD), normal stress response, uncomplicated PTSD, and comorbid PTSD.

Types of PTSD are listed below: 

• Type 1- Acute Stress Disorder: Acute stress disorder is a condition that can occur immediately after experiencing a traumatic event. While symptoms are similar to PTSD, the duration may vary and last for a few days or a month after the traumatic event. According to NIH, the symptoms can include intrusive memories, dissociation, and avoidance. For some individuals, acute stress disorder can further lead to the development of PTSD.

• Type 2 -Complex PTSD (C-PTSD): Complex PTSD results after a long exposure to repeated experiences of trauma. As per NHS, this form of PTSD usually occurs either in childhood or in a situation where escape is difficult such as domestic violence or captivity. Symptoms can include difficulty in processing emotions, self-perception, and having trouble managing relationships. While it has symptoms of standard PTSD, it’s usually broader. 

• Type 3 – Normal stress response: A normal stress response indicates the normal reactions people have in a stressful situation. These reactions are sometimes temporary and tend to go away once the situation is over. Symptoms usually include heightened alertness, anxiety, and an increased heart rate. Unlike standard PTSD, it does not cause long-term disruptions. 

• Type 4- Uncomplicated PTSD: Uncomplicated PTSD is identified by the primary symptoms of PTSD without the addition of complications from other mental health disorders. These symptoms can include avoidance of trauma, nightmares, and negative impact on mood and behavior. Uncomplicated PTSD is considered rather easy to treat compared to other types. 

• Type 5 – Comorbid PTSD: Comorbid PTSD happens when the individual is suffering from other mental health disorders along with PTSD. These disorders might include depression, anxiety, drug abuse, or personality disorders. This combination of mental health disorders can make it difficult to identify and treat PTSD. 

How is PTSD diagnosed?

Post-traumatic stress disorder (PTSD) is diagnosed based on a series of evaluation steps in order to ensure the right identification. Initially, a mental health professional like a psychiatrist or psychologist sits and talks with the patient in order to gather info about the patient’s symptoms and background of the traumatic event. They further review the patient’s medical and psychological history.

Moreover, the symptoms are then assessed based on the DSM-5 criteria. It is characterized by a person experiencing a traumatic event and then exhibiting symptoms from the four categories including intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. These symptoms must be present for over a month and must be causing distress and impairment. 

When does PTSD begin?

PTSD often begins at any age from childhood to adulthood based on the occurrence of a traumatic event. Usually, symptoms start to appear after 3 months. However, in some cases, the symptoms might not appear until a year later. 

Some studies by NIH show that most patients start to experience the symptoms within 1 month of the traumatic event while some might take up to 6 months. 

What traumatic events can lead to PTSD?

The types of traumatic events that can lead to PTSD include combat exposure, natural disasters, serious accidents, physical or sexual assault, kidnapping, terrorist attacks, and the death of a loved one. Exposure to such traumatic events can lead a person to develop various symptoms of PTSD.

Can you prevent PTSD?

Prevention of PTSD is complicated. However, precautions can be taken to reduce the risk and intensity of symptoms. Strategies like psychological support and CBT can help with this. 

Is PTSD genetic?

PTSD is not directly developed through genetics. Genetics usually increase the risk of PTSD symptoms development. 

When to get emergency help for PTSD?

Emergency help should be considered when the symptoms get intense and start to put the individuals and others around them at risk.

Is PTSD a mental disability?

Yes, PTSD is considered a mental disability as it impairs one’s ability to function normally in daily life causing distress in their personal and professional life.

Does PTSD affect brain function?

Yes, PTSD can have an impact on the brain functions altering the way people process emotions, and memories and react to stress. The main areas affected by PTSD include the amygdala, hippocampus, and prefrontal cortex.

What is the relationship between PTSD and Depression?

PTSD is a disorder that develops in some individuals after they experience some form of trauma in their life. Depression is a mood disorder that is characterized by constant feelings of sadness, hopelessness, and lack of interest in everything. PTSD and depression usually co-occur as individuals with PTSD are at higher risk of developing depression. While PTSD develops due to a traumatic event, depression has several reasons for development, like genetics, environment, and gender. 

What is the relationship between PTSD and Anxiety?

PTSD is a mental health disorder that develops upon exposure to stressful and traumatic experiences. Anxiety on the other hand is a disorder that is characterized by the presence of constant fear, and excessive worry. Some symptoms of anxiety usually overlap with those of PTSD like worry and avoidance. While PTSD is triggered by a traumatic event, anxiety can develop due to several factors like stress, genetics, or brain chemistry. 

What is the relationship between PTSD and Substance Use Disorder?

PTSD and Substance Use Disorder (SUD) frequently co-occur. A study of Iraq and Afghanistan veterans found that among those with a lifetime PTSD diagnosis, 34.2% of men also had an Alcohol Use Disorder (AUD), and 17.3% had a Substance Use Disorder (SUD). For women, 20.1% had an AUD, while 10.5% had a SUD. This connection is largely due to individuals using substances as a means to self-medicate the distressing symptoms of PTSD, such as anxiety, intrusive memories, and emotional pain. This self-medication can lead to dependency and exacerbate both conditions. Both PTSD and Substance Use Disorder share common risk factors, including genetic predispositions and environmental stressors.​

What are the treatment options for Post-traumatic Stress Disorder (PTSD)?

The treatment options for PTSD include cognitive behavioral therapy (CBT), prolonged exposure therapy (PE), group therapy, medication, 

The treatment options for PTSD are listed below:

• Cognitive behavioral therapy (CBT): Cognitive behavioral therapy is a form of psychotherapy that helps patients identify, address, and change the negative thoughts related to PTSD. CBT usually involves sessions over a time period of 12-16 weeks. It is beneficial for overall mental health and provides a long-term coping strategy. However, it might require a long time commitment and PTSD patients might not be very comfortable confronting the trauma for a long time.

• Prolonged exposure therapy (PE): Prolonged exposure therapy (PE) is a particular type of CBT where the patient is made to confront the thoughts and memories of the traumatic event that they might be avoiding. This therapy usually lasts for 8-15 months. It helps to bring down the avoidance behaviors, but it can be emotionally intense and challenging for the patient. 

• Group therapy: Group therapy involves having sessions where other individuals suffering from PTSD are involved as well. This allows all the patients to share experiences and connect under the guidance of a therapist. The duration of the therapy sessions can vary. It’s good to provide social support and reduce isolation. It might be difficult for some people to share trauma with an audience. 

• Medication: Medications like SSRIs are usually used to treat PTSD. It can be very helpful to manage symptoms like depression, anxiety, and insomnia. Recovery time can vary based on the individual. Some might recover in a few days while others might take longer. While it’s good for providing relief from severe forms of symptoms, it might lead to side effects like weight gain and nausea. 
• Combination Therapies: Effective treatment for co-occurring PTSD and SUD requires an integrated approach, combining therapies like Cognitive Behavioral Therapy (CBT) and trauma-focused treatments with substance use treatments, along with supportive measures to address both conditions concurrently.