People who have survived a shocking, frightening or life-endangering experience may show signs of profound emotional and psychological upset that is completely natural. The body’s instinctive “fight or flight” mode has been triggered. When symptoms of shock and defending against danger don’t go away naturally after a reasonable period of time and cause distress or impairment, a medical condition called Post-Traumatic Stress Disorder (PTSD) may be diagnosed.
PTSD is a spectrum of traumatic stress disorders which develop along a time line, from Acute Stress Reaction to Acute Stress Disorder to Acute PTSD, and, finally, Chronic PTSD. Patients report feeling stressed and afraid even in harmless situations well after the danger has passed.
Veterans who have participated in acts of extreme combat violence and sustained a concussion are considered high risk for developing PTSD. Women are at higher risk for PTSD than men.
Children and adults who have suffered a physical or sexual assault, abuse, accident, disaster or some other serious events may not be able to shake off the trauma. Any sudden shock, such as the death of a beloved family member or close friend, has the potential to cause PTSD.
Sometimes, PTSD symptoms severe enough to interfere with relationships or work show up years after a triggering event. The National Center for PTSD estimates that 7-8 out of 100 people will experience PTSD at some point in their lives.
Individual tolerances for stress are different. Some people are “thick-skinned” and nothing seems to get them down. But others respond to the same disaster by plunging into a lingering state of depression. Decreased concentration and memory, fatigue, and anxiety are other common reactions to stressful situations.
Risk factors known to make someone more likely to develop 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
On the other hand, the following resilience factors have been linked to a quicker recovery from an extreme stressor:
- 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
When the following symptoms linger more than one month after a traumatic experience that has caused significant distress or impairment in social, occupational or other important areas of functioning, a qualified physician will issue a diagnosis of Acute PTSD after other disorders have been ruled out:
- At least one re-experiencing symptom
- At least one avoidance symptom
- At least two arousal and reactivity symptoms
- At least two cognition and mood symptoms
Re-experiencing symptoms can be triggered by words, objects, or situations that remind the victim of the event, upsetting the daily routine, and include:
- Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
- Bad dreams
- Frightening thoughts
Avoidance symptoms make the victim change their routines:
- Staying away from places, events, or objects that are reminders of the traumatic experience
- Avoiding thoughts or feelings related to the traumatic event
Arousal and reactivity symptoms are usually constant, producing feelings of anger and stress, and include:
- Being easily startled
- Feeling tense or “on edge”
- Having difficulty sleeping
- Having angry outbursts
If symptoms last more than three months after the traumatic event, Chronic PTSD is diagnosed. Although it can occur alone, PTSD is often accompanied by a variety of other highly disruptive conditions, including:
- Persistent difficulties in interpersonal relations
- Chronic pain
- Sleep disturbances
- Somatization (the physical manifestation of psychological concerns)
- Profound identity problems
- Psychiatric disorders such as substance abuse, depression, and anxiety disorder
Cognition and mood symptoms tend to make the person feel alienated or detached from friends or family members and include:
- Trouble remembering key features of the traumatic event
- Negative thoughts about oneself or the world
- Distorted feelings like guilt or blame
- Loss of interest in enjoyable activities
Screening for PTSD can be an effective way to avoid treatments later. Evidence suggests that early identification of PTSD and quick treatment can shorten a patient’s suffering and lessen the severity of his or her functional impairment.
Once diagnosed, treatments for PTSD include cognitive behavior therapies, counseling, and medications.