Updated: Jan 9, 2019
Post Traumatic Stress Disorder
Per the National Institute of Mental Health, PTSD is a disorder that develops in some people who have experienced a shocking, frigthening, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear triggers 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. 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 Symptoms
Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Even experiences, as the sudden 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. For a diagnosis of PTSD, symptoms must last more than a month and be severe enough to interfere with relationships or work. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic. For a diagnosis of PTSD, the person must have experienced symptoms of avoidance, and at least two arousal and reactivity symptoms, as well two cognitive and mood symptoms.
Avoidance symptoms include:
Staying away from places, events, or objects that are reminders of the traumatic experience, avoiding thoughts or feelings related to the traumatic event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.
Arousal and reactivity symptoms include:
Being easily startled, feeling tense or “on edge,”having difficulty sleeping, having angry outbursts. Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.
Cognitive and mood symptoms include:
Trouble remembering key features of the traumatic event, having negative thoughts about oneself or the world, having distorted feelings like guilt or blame. Experiencing loss of interest in enjoyable activities. These symptoms can make the person feel alienated or detached from friends or family members. 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 can be accompanied by depression, substance abuse, or one or more of the other anxiety disorders.
Anyone can develop PTSD at any age. This includes children, war veterans, people who have been through 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, death of a loved one can also lead to PTSD.
Why do some people develop PTSD and other people do not?
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. 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. Some researchers expect to able to predict who is likely to develop PTSD and to prevent it in the future.
Treatments and Therapies
The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Additional treatments for PTSD also include Somatic Experiencing, and art therapy. 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.
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. For example, although it is not currently FDA approved, research has shown that Prazosin may be helpful with sleep problems, particularly nightmares, commonly experienced by people with PTSD.
Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.
Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.
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 helpful form of therapy is called cognitive behavioral therapy, or CBT. It can include:
Exposure therapy. This helps people face and control their fear. 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.
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 Somatic Experiencing, and some view it as the missing link in current talk and exposure therapies. People with PTSD should talk about all treatment options with a therapist. Some specialists believe treatment should equip individuals with the skills to manage their symptoms, and allow to be able to participate in activities they enjoyed prior to the trauma. Other practitioners believe treatment should resolve symptoms, and even resolve their trauma allowing them to resume their production lives as prior to PTSD.
The transformation and reparation of trauma through relationship involves multiple moments that support the unfolding of trust, safety, and co-regulation. Psychotherapy is a corrective experience, because it includes a consistently empathetic relationship with another individual who can respond empathetically to anger, fear, and mistrust from the traumatized person. Verbal therapy contains valuable and effective relational qualities, such as well-chosen words, gesture and eye contact. Talk therapy can also teach practical skills as helpful ways to react to the frightening events that trigger their PTSD symptoms, teach about trauma and its effects. It usually uses relaxation and anger-control skills. It provide tips for better sleep, diet, and exercise habits. It can help people identify and deal with guilt, shame, and other feelings about the event. It can focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.
Per many practitioners, Somatic Experiencing is the missing link in the current therapies for PTSD. Per Therapist Peter Levin, who has been researching trauma in wild animals and in people for almost fifty years, as well as treating thousands of patients over the years, the physiological trauma needs releasing as well. Current therapies address cognitive and behavioral components, without addressing the pent up energy that gets stored in the body after the traumatic experience.
The International Society for Traumatic Stress Studies (ISTSS) (Foa et al, 2009) offers a summary of the role of the creative art therapies in the treatment of post traumatic stress disorder. The ISTSS points to the growing interest in the relationship between the creative arts therapies and the brain, including how the brain processes traumatic events and the possibilities for reparation through expressive arts therapies-- art, music, movement, play, and drama interventions. Trauma-informed expressive arts therapy is based on the idea that art expression is helpful in reconnecting implicit (sensory) and explicit (declarative) memories of trauma in the treatment of PTSD (Malchiodi, 2012). This approach assists the individual's capacity to self-regulate emotions and modulate the body's reactions to traumatic experiences in the earliest stages helping prepare the individual for eventual trauma integration and recovery. Expressive arts therapy serves a unique role in traumatized individuals, by helping bring in implicit sensory and body-based elements to psychotherapeutic dynamics that are not always available even through very skilled verbal exchanges. In some cases, introducing expressive arts may be the only starting point to developing and restoring connection to others for those activated by personal narrative or unable to talk about any details of their trauma. This is specially so for individuals who lived through developmental, relational, and interpersonal trauma.