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Post-traumatic Stress Disorder (PTSD)

What is post-traumatic stress disorder, or PTSD?

Some people develop post-traumatic stress disorder (PTSD) after experiencing a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear is a part of the body’s normal “fight-or-flight” response, which helps us avoid or respond to potential danger. People may experience a range of reactions after trauma, and most will recover from their symptoms over time. Those who continue to experience symptoms may be diagnosed with PTSD.

Who develops PTSD?
Anyone can develop PTSD at any age. This includes combat veterans as well as people who have experienced or witnessed a physical or sexual assault, abuse, an accident, a disaster, a terror attack, or other serious events. People who have PTSD may feel stressed or frightened, even when they are no longer in danger. Not everyone with PTSD has been through a dangerous event. In some cases, learning that a relative or close friend experienced trauma can cause PTSD. According to the National Center for PTSD, a program of the U.S. Department of Veterans Affairs, about seven or eight of every 100 people will experience PTSD in their lifetime. Women are more likely than men to develop PTSD. Certain aspects of the traumatic event and some biological factors (such as genes) may make some people more likely to develop PTSD.

What are the symptoms of PTSD?
Symptoms of PTSD usually begin within 3 months of the traumatic incident, but they sometimes emerge later. To meet the criteria for PTSD, symptoms must last longer than 1 month, and they must be severe enough to interfere with aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness. The course of the illness varies: Although some people recover within 6 months, others have symptoms that last for a year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders. After a dangerous event, it is natural to have some symptoms or even to feel detached from the experience, as though you are observing things rather than experiencing them. A health care provider—such as a psychiatrist, psychologist, or clinical social worker—who has experience helping people with mental illnesses can determine whether symptoms meet the criteria for PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

⊲ 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

⊲ Flashbacks—reliving the traumatic event, including physical symptoms such as a racing heart or sweating
⊲ Reoccurring memories or dreams related to the event
⊲ Distressing thoughts
⊲ Physical signs of stress

Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.

Avoidance symptoms
⊲ Staying away from places, events, or objects that are reminders of the experience
⊲ Avoiding thoughts or feelings related to the traumatic event

Avoidance symptoms may cause people to change their routines. For example, after a serious car accident, a person may avoid driving or riding in a car.

Arousal and reactivity symptoms
⊲ Being easily startled
⊲ Feeling tense, on guard, or “on edge”
⊲ Having difficulty concentrating
⊲ Having difficulty falling asleep or staying asleep
⊲ Feeling irritable and having angry or aggressive outbursts
⊲ Engaging in risky, reckless, or destructive behavior

Arousal symptoms are often present—they can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.

Cognition and mood symptoms
⊲ Trouble remembering key features of the traumatic event
⊲ Negative thoughts about oneself or the world
⊲ Distorted thoughts about the event that cause feelings of blame
⊲ Ongoing negative emotions, such as fear, anger, guilt, or shame
⊲ Loss of interest in previous activities
⊲ Feelings of social isolation
⊲ Difficulty feeling positive emotions, such as happiness or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event and can lead a person to feel detached from friends or family members.

How do children and teens react to trauma?

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as those seen in adults.

In young children under the age of 6, symptoms can include:

⊲ Wetting the bed after having learned to use the toilet
⊲ Forgetting how 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 usually show symptoms more like those seen in adults. They also may develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They also may have thoughts of revenge.

Why do some people develop PTSD and other people do not?

Not everyone who lives through a dangerous event develops PTSD—many factors play a part. Some of these factors are present before the trauma; others become important during and after a traumatic event.

Risk factors that may increase the likelihood of developing PTSD include:

⊲ Exposure to dangerous events or traumas
⊲ Getting hurt or seeing people hurt or killed
⊲ 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 personal history or family history of mental illness or substance use

Resilience factors that may reduce the likelihood of developing PTSD include:

⊲ Seeking out support from friends, family, or support groups
⊲ Learning to feel okay with one’s actions in response to a traumatic event
⊲ Having a coping strategy for getting through and learning from a traumatic event
⊲ Being prepared and able to respond to upsetting events as they occur, despite feeling fear