Post-traumatic stress disorder (PTSD)
Overview of post-traumatic stress disorder – Post-traumatic stress disorder is characterized by nightmares and flashbacks of past traumatic events, avoidance of reminders of the trauma, intrusive thoughts, sleep disturbances.
All of these symptoms can lead to occupational, social, and interpersonal dysfunction.
Symptoms of post-traumatic stress disorder
Symptoms of PTSD may start within one month of the event, but sometimes symptoms may not appear until years after the event. Symptoms may vary from person to person and include
- Flashbacks of the traumatic event
- Nightmares about the traumatic event
- Severe emotional distress to something that reminds you of the traumatic event
- Difficulty maintaining relationships
- Feeling detached from family and friends
- Lack of interest in activities and feeling emotionally numb
- Angry outbursts or aggressive behavior
- Trouble sleeping and concentrating
Traumatic events – The common events leading to post-traumatic stress disorder are –
- Combat exposure
- Physical abuse in childhood
- Sexual violence
- Physical assault
- Plane crash
Complications of post-traumatic stress disorder
- Substance abuse
- Anxiety and depression
- Eating disorders
- Suicidal thoughts and actions
DSM-5 diagnostic criteria for PTSD – The following criteria apply to adults, adolescents, and children older than 6 years.
- Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work-related.
- Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
- Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
- Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
- Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
- Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
- Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
- Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
- Reckless or self-destructive behavior.
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
- Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
- The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
- Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
- Derealization: Persistent or recurrent experiences of the unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
Management of post-traumatic stress disorder –
- Lifestyle management –
- Follow the treatment plan and routinely communicate with your mental health professional.
- Follow a healthy diet and exercise. Avoid drinking too much coffee, and quit smoking, as these can worsen anxiety.
- Spend more time with your family and friends
- Psychotherapy – Exposure therapy, a combination of exposure and cognitive therapy, eye movement desensitization and reprocessing
- Pharmacologic management –
- Antidepressants – Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) – Paroxetine, sertraline, fluvoxamine, fluoxetine, citalopram, escitalopram, venlafaxine.
- Antianxiety medications
- Prazosin may reduce nightmares in people with PTSD.
Assessment tool – (PCL-5), a 20-item self-report measure, can be used to screen patients for PTSD and monitor the severity of symptoms over time.
Please fill out this form as many times as recommended by your doctor and share it with your doctor regularly.
- Seek immediate medical help, If you or someone you know with PTSD has suicidal thoughts
- Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.