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By: Jordan Stachel
Post-traumatic stress disorder (PTSD) occurs in 1 in 20 adults in the United States each year, with an estimated 6 percent of people being affected in their lifetime. While incidence rates are difficult to gauge, PTSD is reported at higher rates in women than in men (8 in 100 versus 4 in 100), primarily due to the types of traumas, like sexual assault, that women suffer compared to men. PTSD is also more common among veterans than civilians, with 7 percent of veterans experiencing it.
Part of the challenge of diagnosing PTSD is underreporting, leading to an overall underdiagnosis of the condition. In addition, if someone goes through a traumatic event (and about 70 percent of American adults experience at least one), it is not guaranteed they will develop PTSD. If PTSD does develop, it typically does so over time, also affecting reporting rates.
What Are the Types of PTSD?
While there aren’t distinguishable types of PTSD, the following two conditions are closely related to the disorder:
Acute stress disorder (ASD): ASD is a shorter-term mental health condition that typically occurs within the first month of experiencing trauma, lasting at least three to 30 days. ASD typically presents with symptoms like anxiety, intense fear, flashbacks, nightmares, feelings of numbness, and avoidance of situations that may trigger reminders of the trauma. Some common types of traumatic events that may cause ASD include natural disasters, sexual and physical assault, verbal abuse, witnessing harm or death, serious accidents, sudden illness, injury, or war.
Complex PTSD (CPTSD): This mental health condition can occur if someone experiences long-term trauma. Examples of types of traumatic events that may cause CPTSD are long-term abuse or domestic violence, human or sex trafficking, war, or frequent violence in one’s community.
What Are the Symptoms and Early Signs of PTSD?
PTSD can manifest in many different ways. To receive a diagnosis, symptoms must be present for at least one month, cause distress, and impede one’s ability to function on a daily basis. Symptoms may begin within a month of the traumatic event or years later.
Common symptoms of PTSD are classified into the following four categories:
- Intrusive Thoughts
- Recurrent, upsetting memories of the trauma.
- Reliving the event through flashbacks.
- Nightmares.
- Adverse emotional or physical reactions to things that remind you of the event.
- Avoidance
- Avoidance of situations that may trigger reminders of the trauma.
- Avoidance of thinking about the event.
- Avoidance of talking about the event.
- Cognitive or Mood-Based Symptoms
- Hopelessness.
- Memory loss.
- Ongoing distorted thoughts about yourself or the world.
- Feelings of detachment.
- Loss of interest in things you previously enjoyed.
- Feeling numb.
- Difficulty feeling positive emotions.
- Reactional Changes
- Easily frightened.
- Easily angered or experiencing rageful outbursts.
- Reckless behavior.
- Hypervigilance.
- Difficulty sleeping.
- Difficulty concentrating.
- Intense feelings of guilt or shame
It is important to note that symptoms may present differently among different age groups and populations. Children may not express feelings of PTSD the same way adults do. For example, children 6 or younger may reenact the traumatic event through play or have nightmares that may or may not have to do with the event.
What Causes PTSD?
While the exact mechanism behind why PTSD develops after a person experiences a traumatic event is not well understood, it is generally believed to be caused by a combination of genetics, neurobiology, and other personal traits and experiences. Some experts theorize that symptoms may persist as a way of the body trying to help you survive future crises. For instance, symptoms such as flashbacks or hypervigilance may be the brain’s way of protecting an individual from experiencing further traumas. Additionally, some brain scans of people with PTSD show that the hippocampus, the structure responsible for memory and emotion, tends to be smaller in those with PTSD. This may be because experiencing symptoms of PTSD may shrink the brain as a protective mechanism to shield it from the traumatic memory.
In addition, the amygdala (responsible for processing emotions and fear) seems to be overactive in people with PTSD, changing the brain’s overall neurophysiology.
Research indicates that those who experience PTSD have altered neurotransmitter and neurohormonal functioning. PTSD affects cortisol levels and elevates corticotropin-releasing factor (CRF), the neuropeptide responsible for releasing the neurotransmitter norepinephrine. Despite their ongoing distress, people with PTSD appear to have normal or lower levels of cortisol, the stress hormone. However, they have higher levels of CRF, which, by stimulating the release of norepinephrine, can lead to the hypothalamus triggering “fight-or-flight” responses like higher heart rate, blood pressure, and likelihood of becoming startled. In addition, lower levels of the main inhibitory neurotransmitter gamma-aminobutyric acid (GABA) can lead to increased feelings of dissociation and/or derealization.
Many instances of trauma can trigger an individual to develop PTSD. Some of these include:
- Serious accidents, like car accidents or those resulting in injury.
- Physical or sexual assault.
- Childhood or domestic abuse.
- Significant health problems.
- Death of a close family member or friend.
- War.
- Torture.
Who Is More Likely to Develop PTSD?
While anyone can develop PTSD if they experience or perceive the threat of a traumatic event, some populations are at greater risk.
Some of the factors that increase one’s likelihood of developing PTSD include:
Genetics: Some research indicates that those with a hereditary history of psychiatric disorders are at a greater likelihood of developing PTSD. While more research is needed in this area, preliminary findings suggest that subsets of genes responsible for neuroendocrine functioning are heritable. This indicates that if mental health conditions run in your family and you experience a traumatic event, it is worthwhile to take additional measures to seek proactive treatment to prevent PTSD development.
Sex: Women are more likely to develop PTSD than men. While trauma and PTSD can occur in anyone at any age, one study indicated that men are most heavily affected in their early 40s and women in their early 50s, according to data gathered from the Harvard Trauma Questionnaire. Of note, women had a two- to nearly three-fold prevalence of PTSD across all age groups. Women represent almost 75 percent of young adults 21 to 25 years old with PTSD. This is speculated to be due to report bias, gender roles, and emotional vulnerability, as women are more likely to report and seek help for this condition than men.
Race: Some research, such as a 2014 paper published in Behavioral Sciences, indicates rates of PTSD may be higher among African Americans than those of European descent. Traumas related to racism may contribute to this, the paper’s authors wrote.
Mental health disorders: Having a history of other mental health conditions like anxiety or depression increases one’s risk of developing PTSD.
Personality traits: Certain traits like poor coping abilities, temperament, poor resilience to stress, cognitive patterns, and responses to the memory of adverse events can increase one’s risk for PTSD. Neuroticism, especially, appears to be a predictor of long-term PTSD.
Lack of support system: People with a weak support system or lacking mental health resources may be at a greater risk of developing PTSD.
Traumatic occupations: People who work in dangerous situations, such as veterans of war or people who work in jails or within unsafe environments, are at a higher risk of experiencing PTSD.
How Is PTSD Diagnosed?
An adult must have the following symptoms for at least one month to be diagnosed with PTSD:
- Relive or flashback to the event at least once.
- One or more avoidance symptoms.
- At least two reactional changes.
- Two or more cognition or mood-based symptoms.
PTSD diagnosis may start with a self-screening questionnaire, or a clinician may ask the screening questions. The result guides whether further assessment is needed. The PTSD diagnosis process typically includes the following:
Answering questions about the traumatic event experienced.
An in-depth assessment that can take 15 minutes to two hours of the traumatic events that unfolded and the difficulties experienced around these events.
Completion of surveys with questions around general thoughts and feelings.
Questioning family or friends who may provide insight into observed behaviors.
Two main measures used to assess PTSD include structured interviews and self-reported questionnaires. Structured interviews may use a clinician-administered PTSD scale (CAPS), a standard PTSD screening tool. A structured clinical interview for DSM (SCID) may be used to assess PTSD, along with potential other mental health disorders. If self-reported questionnaires are used, the most common is the PTSD checklist (PCL), which may ask an individual about how often symptoms are experienced over a set period.
What Are the Complications of PTSD?
PTSD can spawn several possible complications, with areas most affected being the neurological system and one’s quality of life.
Some of the more common complications include:
- Substance abuse issues.
- Anxiety, depression, or other mental disorders.
- Eating disorders.
- Suicidal ideation or behavior.
- Fibromyalgia, or chronic, widespread pain.
PTSD can affect others around the afflicted individual as much as it affects the individual himself or herself. Because someone with PTSD may frequently experience nightmares and/or triggers that may make them behave differently, family units can be negatively impacted. Children living with family members with PTSD are especially vulnerable to adverse effects.
