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Post Traumatic Stress Disorder (PTSD)

No one wants to suffer from post-traumatic stress disorder, or PTSD. That's because to get PTSD, you have to go through trauma, and many of these traumas can be so painful that they create lasting problems controlling your stress and anxiety levels.

PTSD is possible the only anxiety disorder that has a known cause. Most other anxiety disorders are caused by an infinite number of factors that can never be truly known, and while there may be some events that are a bit more "anxiety causing" than others, the truth is that anxiety is often too complex to narrow down to any specific event.

This is not true of post-traumatic stress disorder. By its very nature, to suffer from PTSD you have to have experienced some sort of traumatic event. This is unique, and helps slightly with PTSD treatment because therapists and counselors can target the issue directly.

What is PTSD?

Still, PTSD isn't well understood. Most people recognize that it stems from a traumatic event, but what few people realize is how one person can go from controlling their anxiety to suddenly being unable to control their anxiety after a single event. Even though memories of the event itself play a part in PTSD symptoms, the memory itself is not the basis of diagnosis. The following qualifications play a role in diagnosis:

  • You relive the trauma through memories, sensations, nightmares, flashbacks or more.
  • You experience anxiety, emotional numbness, or detachment.
  • You go out of your way to avoid situations that may relate to the event.
  • You find yourself hyper-vigilant, often with an easy startle reflex, the inability to concentrate on tasks, or becoming easily irritable.

PTSD often has triggers that create further anxiety, and those with PTSD may have a lower threshold for further anxiety and stress – meaning, something that causes even a small amount of fear or stress causes a greater amount of fear or stress in someone with PTSD, whose stress baseline is so high that a small addition creates full blown anxiety attacks.

What Traumas Can Create PTSD?

There is no "wrong" trauma for PTSD. Anything that feels like a traumatic event may inspire PTSD, and those that have anxiety in their lives already may also have a higher tendency of developing PTSD. Still, the following represent the most common traumas for triggering post-traumatic stress disorder:

  • Surviving life threatening situations, such as those that fight in wars.
  • Surviving physical or sexual assault.
  • Surviving or witnessing violent acts.
  • Surviving incarceration or torture.
  • Surviving a natural catastrophe.
  • Surviving a life threatening disease.
  • Surviving any dangerous situation – like a car crash.

However, while most of those that develop post-traumatic stress disorder survived the event, it's possible to develop PTSD through witnessing others survive an event. It's been found that empathy for someone close to you can trigger PTSD (for example, seeing someone in the hospital as a result of a traumatic event), and in some cases witnessing the tragedy of others can also cause PTSD (such as the witnesses of 9/11). In rare cases, the very idea of an event can trigger PTSD symptoms, though this is less common.

In any event, if you've endured any of the above scenarios, or scenarios not yet listed, there is a chance of developing PTSD. It's important to note that there is a difference between general fear after an event and PTSD. Those that are simply on edge after a traumatic event may be experiencing normal anxiety, or a condition known as "Acute Stress Disorder," which is very similar to PTSD and could develop into PTSD someday. Those that have dealt with severe anxiety symptoms for longer than 30 days after the event, a diagnosis of PTSD is more likely.

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How Common is PTSD?

Post-traumatic stress disorder prevalence varies depending on the population. In Vietnam veterans, as many as 30% were diagnosed with PTSD because of the problems related to the Vietnam War. Research has also shown that 57% of rape victims will develop some degree of PTSD (Foa & Riggs), and as many as 9% of all of those injured in motor vehicle accidents.

Generally, early symptoms of PTSD manifest in a few days. In some cases, however, it may take months or even years for PTSD to kick in. It does not appear that age or gender plays a role in the development of PTSD, once types of trauma are accounted for.

Not everyone that experiences trauma will develop PTSD, and unfortunately there is no clear reason why some people develop the anxiety disorder while others don't. Some theorize that the extremely high levels of stress that occur as a result of trauma cause the brain and body to start misfiring neurotransmitters and hormones. In a way, the reason the person seems to relive the trauma is because their body is still releasing stress signals as though the trauma is still happening. It's likely that this problem doesn't occur in all cases of traumatic events, depending on the body's ability to handle the high levels of stress hormones and neurotransmitters.

Another issue to take into account is that 50% of all PTSD cases resolve themselves within 3 months of onset of the disorder. In these cases, the symptoms simply disappear as the shock wears off, for reasons that are still unclear (but may relate to the misfiring as noted above). Still, those that are suffering should not sit back and hope that their PTSD goes away. Seeking treatment is always the smartest decision.

How is Post Traumatic Stress Disorder Treated?

Treatment of PTSD is often tailored to the symptoms, and the cause of the treatment. Most successful treatments have their basis in cognitive behavioral therapy, or CBT. PTSD treatments often involve three core components:

  • Learning Anxiety Management Skills – Those with PTSD may need to re-learn ways to cope with their anxiety and stress, as well as PTSD specific symptoms. They'll be taught how to handle hyper-arousal and hyper-vigilance, along with their startle reflex and more.
  • Adapting to Prolonged Exposure – In an controlled setting, a therapist will often have you purposely relive the event until it causes you less anxiety. The unfortunate issue with PTSD is that the more you try to avoid thinking about your traumatic event, the worse your symptoms tend to be.
  • Cognitive Restructuring – Those with PTSD will then be taught how to change their cognitions in a way that allows them to better cope with their traumatic experience, as well as learning to adjust to their physical and mental sensations.

Medication may also be used to combat PTSD, and in some cases the client may be given exposure therapy techniques if the PTSD manifests itself in a way that resembles phobias.

What is Cognitive Restructuring?

A common issue with those that develop PTSD is negative thought patterns. These thought patterns are the result of extreme stress, and they have a tendency to inhibit recovery as they produce further negative attitudes about the trauma. These are some examples of negative cognitions:

  • Distorted Automatic Thoughts
    • “No one but me is to blame for this trauma.”
    • “I should have known better.”
    • “I ought to have prevented the trauma.”
    • “This shouldn’t affect me after so long.”
    • “People don’t care about my feelings.”
  • Maladaptative Assumptions
    • “Bad things will happen, control is an illusion.”
    • “I must stay in control because there might be danger.”
    • “I can’t think about what happened, or I will just feel bad.”
    • “Dying would be better than re-living something like that.”
    • “Unless I stay very alert, something terrible may happen.”
  • Dysfunctional Schemas
    • “Life is pointless and meaningless.”
    • “I must be a bad person or this wouldn’t have happened.”
    • “The world is a terrible and dark place to live in.”
    • “There is no future for me aside from suffering.”
    • “Catastrophe will strike, there’s nothing I can do about it.”

These are the negative thought patterns that prevent recovery from PTSD. A trained therapist will work with these negative thought patterns to transform them into something healthier, such as "I was not at fault for the trauma" or "I still have a great life ahead of me." These types of affirmations are an important tool for combatting PTSD.

Success of Post-Traumatic Stress Disorder Treatment

Some estimates put the success rate for overcoming PTSD as high as 80 to 85%. The remaining 15% can also still find successful treatments, but may need to commit longer or look at other changes that can be integrated into their lifestyle that promote less anxiety.

When I've helped people overcome their PTSD, I start them off with my free 7 minute anxiety test. The test is designed to look at all of your symptoms, get an idea for how you're suffering, and base treatments on your responses.

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References

Butler, Dennis J., H. STEVEN Moffic, and Nick W. Turkal. Post-traumatic stress reactions following motor vehicle accidents. American family physician 60.2 (1999): 524.

Horowitz, Mardi Jon. Stress response syndromes: PTSD, grief, and adjustment disorders. Jason Aronson, 1997.

Direct, PTSD After. Individual Differences in Post Traumatic Distress: Problems with the DSM-IV Model. Can J Psychiatry 44 (1999): 21-33.

Weathers, Frank W., et al. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Annual meeting of the international society for traumatic stress studies, San Antonio, TX. 1993.

Foa, Edna B., et al., eds. Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies. The Guilford Press, 2008.

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