Post-Traumatic Stress Disorder

Post-traumatic stress disorder is a disorder in which a person has difficulty emotionally recovering after experiencing or witnessing a traumatic event(s).

Outside of the traumatic event itself, PTSD is grouped into four clusters of symptoms: intrusion/re-experiencing symptoms, avoidance symptoms, negative changes in mood and/or thought, and changes in reactivity. Rarely do all symptoms appear in the same individual.

For example, one individual may exhibit primarily re-experiencing symptoms, another avoidant symptoms, while another reactive symptoms. However, at least one symptom from each cluster must be met to be classified as a diagnosis of PTSD.

It’s treatable!

Remember, mental health conditions are treatable. See the Therapeutic Response section to learn more.

Symptoms

1. Intrusive/re-experiencing symptoms: The individual re-experiences the trauma in one or more ways, including:
   • Flashbacks (dissociative response, acting or feeling as though one is reliving the event).
   • Nightmares.
   • Distressing and intense memories.
   • Emotional distress or physical reactions after being exposed to reminders, known as “triggers.”
2. Avoidance symptoms: This occurs when a person tries to avoid reminders of the trauma, including:
   • Avoiding external reminders of what happened (e.g. people, places, conversations, activities).
   • Avoiding trauma-related thoughts or emotions.
3. Negative changes to mood or thoughts:
   • Blaming self or others for the trauma.
   • Decreased interest in things that were once enjoyable.
   • Negative feelings about self and the world.
   • Inability to remember the trauma clearly.
   • Persistent negative emotional state (e.g. fear, guilt, shame).
   • Feelings of detachment from others.
   • Difficulty feeling positive emotions.
4. Changes in reactivity:
   • Aggression or irritability.
   • Reckless, self-destructive or risky behaviors.
   • Hypervigilance and overly on-guard.
   • Difficulty concentrating.
   • Difficulty sleeping.
   • Heightened startle response.

All of these symptoms must have persisted at least one month. It is also important to note that the frequency, duration and level of distress is important to recognize, to determine if the symptoms one may be experiencing truly meet criteria for PTSD, or if they are short-term normative responses, or are better accounted for by another trauma reaction and/or other mental health diagnosis.

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Development of symptoms

Although medical professionals previously categorized PTSD to originate from one traumatic event, it is now recognized that continuous exposure to stressful situations, or cumulative stress, can also cause symptoms of PTSD.

• Repeated exposure to disaster, accidents, deaths or violent acts.
• Frequent need to deliver traumatic news to others.
• Regular exposure to the abuse of children.

Symptoms usually begin within the first three months after the trauma, although there may be a delay of months, or even years, before criteria for the diagnosis are met.

There is evidence for what DSM-5 calls “delayed expression,” with the recognition that some symptoms typically appear immediately and that the delay is in meeting full criteria.

Frequently, an individual’s reaction to a trauma initially meets criteria for acute stress disorder in the immediate aftermath of the trauma.

Course of symptoms

Duration of the symptoms varies — complete recovery within three months occurring in approximately one-half of adults.

Symptom recurrence and intensification may occur in response to reminders of the original trauma, ongoing life stressors, or newly experienced traumatic events. For older individuals, declining health, worsening cognitive functioning, and social isolation may exacerbate PTSD symptoms.

Risk and prognostic factors

Pre-trauma factors:

• Individual temperament – general negativity, perception of trauma severity, avoidant coping style.
• Exposure to prior trauma.
• Environment.
• Prior mental health diagnoses.

Peri-trauma factors:

• Severity of the trauma.
• Perceived life threat, personal injury, interpersonal violence.

Post-trauma factors:

• Individual temperament.
• Environment.
• Subsequent exposure to repeated upsetting reminders, subsequent adverse life events.

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