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Ivan was walking to his car after work down a side street when he was attacked and mugged.
The thief brandished a gun, grabbing Ivan and holding it to his head, threatening to shoot if he didn’t hand over all his money. Frozen in fear, he suddenly felt like his life could end in an instant.
Ivan handed over his wallet, watch and phone, but he lost so much more that day. He lost his sense of safety – his ability to walk down the street without jumping whenever anyone walked up behind him.
As the mugger ran away and Ivan ran for help, he couldn’t stop shaking. For weeks afterwards, he would have nightmares about guns. He was anxious, tense and easily startled. He found himself taking the long way around to avoid the street where it happened. When he heard a truck back-fire, he jumped involuntarily – his heart pounding.
Ivan turned to alcohol to help him calm down and sleep, but he still felt pent up and irritable – like he was always on guard.
A terrifying attack such as this can result in PTSD (Post-Traumatic Stress Disorder) – a disorder that develops in some people who have experienced a frightening, startling or dangerous event 1.
Feeling afraid in a situation like this is normal. Our fight-or-flight response kicks in during these traumatic experiences. However, normally your fight or flight response should turn off again after the trauma is no longer present. If it doesn’t, and the symptoms of fear and stress continue to persist long after the danger is gone – this can be PTSD.
One in 11 people in the USA will experience PTSD at some point in their lives 2.
One of the common effects of PTSD is hyperarousal, which makes you startle easily. You may feel jumpy and on-edge, as well as more sensitive to sensory stimulation.
For example, if a friend walks up behind you and taps you on the shoulder – you might react with a jump and a scream of fear. Your reaction is disproportionate to the actual amount of danger, as your mind is hypervigilant and looking for danger.
This heightened arousal can make it difficult to fall asleep, which is why insomnia is another common symptom of PTSD. This is a downward spiral, as sleep deprivation worsens the effects and prevents healing.
Intrusive thoughts are disturbing, upsetting, destructive and violent thoughts that seemingly appear out of nowhere in your mind. They can be very disconcerting and can cause a lot of stress.
For example, you might be walking along a bridge and have a sudden thought of throwing yourself over the edge and into the rushing water below. Or you might be slicing vegetables and suddenly wonder what it would be like to stab someone with the knife.
Your intrusive thoughts can also be memories of the traumatic event. They can pop up suddenly and cause you a great deal of distress.
Avoidance behavior in PTSD sufferers comes from an attempt to avoid distressing memories, feelings or thoughts that will bring the traumatizing event to mind.
If you are engaging in avoidance you might also have other emotional numbing symptoms, such as feeling distant from others and losing interest in activities you used to enjoy.
You might find yourself trying to avoid pushing away your emotions. This includes emotions about the traumatic experience, but also your overall feelings in general. Unfortunately, while this might help you to temporarily suppress your emotions, they may grow more difficult to ignore over time.
Essentially, if suppressed, your emotions “fight back” in an attempt to serve their functions. As your emotions grow stronger, more and more effort is needed to keep them at bay. Also, using all your energy to avoid certain emotions makes you exhausted and poorly equipped to handle other stresses in your life.
PTSD can cause changes in thoughts and can even include problems with concentration and memory. It can cause a new, negative thinking style and cause your mood to gravitate to negative emotions such as fear, shame, guilt and anger.
It can also cause you to feel detached from the world around you and make you unable to form happy memories or feel positive emotions such as satisfaction, happiness and love.
What are the common causes of PTSD? Here are some of the reasons this condition can develop:
One of the most common reasons for PTSD to develop is because of a stressful, frightening or traumatic experience.
Epidemiological research has disclosed that up to 90% of US citizens will be exposed to at least one traumatic event over the course of their lives 3.
This can be a one time experience, such as being in a car accident, being raped, being attacked or living through a natural disaster. Or, it can be an ongoing, long term situation such as living in a war zone or being in a violent and abusive relationship.
Other common experiences that can cause PTSD include serious health problems, loss of a baby, torture and being involved in battle. (During World War I it was known as “shell shock” and during World War II it was called “combat fatigue.”)
It can also be caused by seeing traumatic experiences happen to others. For example, if you are a firefighter, police officer or EMT who regularly sees other people seriously hurt or even dying in the course of your job.
It’s important to note that trauma is relative. Many people feel like the event they experienced wasn’t “serious enough” to warrant PTSD. This can cause additional layers of guilt and shame, making you feel like you are “overreacting” and you should “get over it.” 4 Remember that your experiences are individual to you. If you’re having symptoms of PTSD, clearly the event was significant enough to cause them.
According to an article from Clinical Psychiatry News, a study showed that experiencing a family history of mental health problems, substance abuse and depression can put you at a higher risk for PTSD.
The results of the study revealed that if individuals experienced or witnessed a physical assault, their risk of developing PTSD after the event was more than twice as high if they also had a family history of mental health problems or drug problems 5.
Also, childhood abuse is a common cause of PTSD. According to research, childhood abuse contributes to almost all types of mental illness – including PTSD, anxiety, depression and more 6.
Anxiety, depression and PTSD are linked. It’s possible to have all of these conditions at once, and in fact having one of them increases your risk of having the other 7. If you also have other mental health issues such as depression and anxiety, you will be more susceptible to developing PTSD after a traumatic event.
Depression is a chronic mood disorder, which is intense and lasts much longer than simply feeling sad. It involves feeling sad and hopeless, a sense of exhaustion and an emotional numbness that does not allow you to get any pleasure from activities you used to enjoy. Depression also results in having a difficult time making decisions and focusing, as well as feelings of worthlessness and complemplation of suicide or death.
If you already have a depressive mood disorder, you are more likely to develop PTSD.
Research suggests that almost half of people who have had PTSD, also have depression 8.
Anxiety disorders are also linked to PTSD 9. We know that worry is a common symptom of PTSD. With anxiety, as well as with PTSD, the worry response is hyper-aroused. Worries and fear can be exaggerated to the point where they are difficult to control.
There is also a genetic factor involved in developing PTSD. Having a parent with a mental health problem is generally thought to increase your chances of developing this condition 10.
Therefore, someone who already struggles with anxiety, then experiences a traumatic event, is more likely to experience symptoms of PTSD. Because the person already has a pre-existing tendency toward excessive worry, that worry is magnified by the event 11.
What are some of the complications commonly associated with PTSD? Here are a few of the complications this disorder is likely to lead to:
Also, PTSD does affect the brain. The higher levels of cortisol (the stress hormone) and the decrease in the size of the hippocampus can reduce the ability to process emotion and memory.
How is PTSD diagnosed?
It’s important that not everyone who experiences a traumatic event will develop PTSD. After all, it’s normal to have some level of stress, sadness and anxiety after something terrible happens. Some people may even have nightmares, recurring memories or problems sleeping and this doesn’t necessarily mean they have PTSD.
To put it this way, a headache can be a symptom of a brain tumor – but if you have a headache that doesn’t necessarily mean you have a brain tumor. So, it’s important to determine whether your symptoms are part of your body’s normal response to stress – or if they require a diagnosis of PTSD.
Approximately one in three people who experience severe trauma will develop PTSD 10.
The doctor will likely perform a physical exam to check for any medical problems that might explain your symptoms. They will then do a psychological evaluation to understand your signs and symptoms and the events causing them.
Then, to diagnose PTSD, a medical professional will likely examine you with the DSM-5 Diagnostic Criteria in mind. This is a checklist of certain criteria that must apply for your symptoms to be classified as PTSD. There are a different set of criteria for children 6 years or younger, as their PTSD tends to manifest differently.
Traumatic events can also result in a number of related conditions, which can be both caused by and exacerbated by PTSD.
Acute Stress Disorder is a very intense reaction that begins immediately after a traumatic event and usually lasts less than a month.
Generally, if your symptoms last less than a month and then go away, you have likely experienced Acute Stress Disorder. If they last longer than a month, you may be diagnosed as having PTSD.
A common symptom of Acute Stress Disorder is dissociative symptoms. You may feel numb or emotionally disconnected from the world around you. You may even have the disconcerting feeling that nothing you are experiencing is real 13.
To correctly diagnose Acute Stress Disorder, you must have had at least 9 of these symptoms for 3 days to a month.
This is a type of short-term condition that develops when you have difficulty coping with a major life change or event. It is also known as “stress response syndrome 14.” It often occurs during large life changes, such as moving somewhere new, the death of a loved one, the end of a relationship or losing or changing your job.
This disorder is also known as “situational depression”, because unlike major depression, it doesn’t have many of the physical and emotional symptoms of clinical depression such as changes in appetite, sleep or energy. It is also not as severe as major depression and doesn’t include suicidal ideation or behavior.
This is a disorder that occurs in children, which causes them to actively approach and interact with unfamiliar adults. For example, they might sit on the lap of a stranger, or walk up to them and hold their hand.
Children with this disorder have no fear of adult strangers and no shyness when meeting new people. The disorder often develops when children lack appropriate nurturing from their parents. As a result of these unfulfilled needs, the child does not form a bond with their parents and feels just as comfortable with strangers as they are with their primary caregivers.
This is a rare yet serious condition where an infant or a young child is not able to establish healthy attachments with their caregivers or parents 15. It is another type of attachment trauma that is often caused by childhood abuse or neglect.
While many people experience some worry and anxiety in their lifetimes, PTSD can be linked to more severe anxiety and panic disorders. It is not uncommon for someone with PTSD to be also diagnosed with a panic disorder.
The symptoms of a panic disorder include trembling, shaking, sweating, chest pain and difficulty breathing. These are somatic feelings that can be so strong that you feel like you are having a heart attack, or losing control 16.
What are some of the ways you can help prevent PTSD from developing after experiencing a traumatic event? Here are some tips to keep in mind to help with prevention:
Some medications designed to treat depression can also be effective in preventing PTSD if they are given in the days immediately after the traumatic event 17.
There are several treatments that have been found to be helpful in the treatment of PTSD:
You’ll meet with a therapist, who will help you talk through what you are feeling and teach you specific skills to manage your PTSD symptoms.
This type of talk therapy typically includes 12 sessions and encourages patients to identify their “stuck points” and process the emotions and feelings they have been avoiding about them.
This is a treatment in which the traumatic memory is repeatedly re-told in order to help you confront your fears 18.
This stands for Eye Movement Desensitisation and Reprocessing – and it’s a relatively new treatment that has been found to reduce the symptoms of PTSD.
In this type of therapy, you’ll learn a variety of coping skills for managing your stress – including muscle relaxation, deep breathing and silently talking yourself through the fear 19.
Several medications have been found to offer relief for PTSD sufferers, including fluoxetine, sertraline and paroxetine 20.
When should you seek help if you or a loved one is suffering from PTSD?
If you have had mild symptoms, or if you have only had symptoms for less than four weeks, you should watch and monitor your symptoms to see if they improve.
Approximately ⅔ of people will get better in this situation over time, without any treatment 21.
You can book a follow up appointment with your doctor and keep a journal to record your thoughts, feelings and symptoms and see if they are improving over time.
If the symptoms don’t improve, or get worse after this period of watchful observation, you should ask your GP to refer you to a clinic that specializes in treating PTSD.