Post-traumatic stress disorder (PTSD) is an ongoing and intense physical and emotional disorder that develops in response to a traumatic event. Despite it being recognized initially in war veterans, it can happen to anyone that has experienced trauma.1
Everyone experiences a range of emotions after a traumatic event, and that is entirely natural. Reactions and feelings will vary from person to person. Most people will recover from these initial symptoms and emotions naturally within a few weeks. However, if problems continue, it could potentially be due to PTSD.2
In the United States (US), PTSD affected 3.6% of adults over the last year.3 This equates to approximately 8 million adults experiencing PTSD symptoms just in the US alone.4
When looking globally, it is estimated that 354 million adult war survivors have PTSD and/or major depression - and that only takes into account war survivors, no other traumatic life events.5
PTSD is more common in women than men, with sexual assault being the most frequent type of trauma experienced by women who have PTSD.6 Approximately 10 in every 100 women develop PTSD sometime during their lifetime compared with about 4 in every 100 men.4
Therefore, as you can see, it is a prevalent condition affecting millions and millions of people worldwide every day. PTSD can happen to anyone.
What causes PTSD?
It is not rare to experience trauma. In fact, it is estimated that 6 in 10 men (or 60%) and 5 in 10 women (or 50%) will experience trauma at some point in their life.4
Marc served in the military for eight years and developed PTSD due to non-combat-related events. First, he was involved in a serious road traffic collision. He then went on to find out that two of his colleagues had completed suicide with quite violent methods. The combination of these traumatic events was what lead to Marc experiencing symptoms of PTSD. Unfortunately, Marc's story is not unusual, and there are many events that can cause PTSD.
The types of events that may lead to PTSD include:
Violent assaults (physical or sexual)
Military combat or being involved in a terrorist attack
Being held hostage
Natural or human-caused disasters
Accidents (like road traffic accidents or incidents with machinery)
Ongoing abuse or harassment
Traumatic childbirth
Repeatedly witnessing distressing events (for example, when working in the military, police, or emergency services)
Seeing someone else being hurt or killed
Being in a situation where you are fearful for your life
This is by no means an exhaustive list. Many harmful events might cause someone to develop PTSD. Everyone experiences PTSD differently. It is very unique to the person. Even people who live through the same traumatic event are affected differently and experience varying symptoms.
Signs and Symptoms
Symptoms of PTSD are categorized into four different types:
Re-experiencing symptoms: such as nightmares, flashbacks, scary thoughts, and emotional/physical reactions to bad memories.
Avoidance symptoms: feeling detached, staying away from people, activities, or places that remind you of the trauma, avoiding talking about the event, or suppressing feelings about the event.
Arousal and reactivity symptoms: difficulty sleeping, feeling edgy, irritability, being overly alert, or outbursts of anger.
Cognition and mood symptoms: negative and depressive thoughts, distorted feelings of guilt or blame, loss of interest in activities you used to enjoy, difficulty remembering specifics about the traumatic event, feelings estranged, isolated, or suicidal.
An adult must have all of the following symptoms for at least one month to be diagnosed with PTSD:2
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
When speaking to Marc, he explained that he first noticed changes in his mood, temper, and relationships. These symptoms worsened until he attempted suicide. In the end, PTSD ended Marc's career in the military.
He talked through some of the day-to-day symptoms that he still battles with; "I struggle now to socialize face to face, with separation anxiety, paranoia, depression, etc. I struggle to leave my house on my own and, when I do, I'm in a constant state of hyper-alertness. It's also affected my chances of employment, but I've been fortunate enough to start my own online business."
Ned also served in the military and developed PTSD due to a situation he faced in combat. "I was responsible for a team of soldiers," explained Ned, "and I placed one of them - a young female - in a position of danger. Years later, I developed anxiety attacks, and I couldn't figure out why. After some investigation, I realized that I was suffering from PTSD. I still feel pangs of guilt when I see females in what I consider to be a dangerous position - either physically or mentally. I also have 'the shakes', which I've sought help with and can't cure."
With such a vast range of symptoms, it can sometimes make it challenging to diagnose PTSD, advises Jonathan Ugalde, Licensed Professional Counselor - Executive Director of Operations and Finance & Therapist at Calming Wind Counseling Services. "It can take time to rule out medical conditions that might be contributing to symptoms," explains Ugalde, "which can be one of the barriers to reaching the right type of support."
Several other barriers often mean that getting the correct type of support for PTSD can be difficult. Ugalde discusses a few more of these; "many people are concerned about their employment, financial implications, or believe that mental health care is ineffective. In some cases, they do not know about available resources or do not have the right resources available to them. Sometimes the barriers can be that a provider is not adequately trained or does not have enough time to see more clients who need care."
On top of these barriers, the addition of the impact of the actual PTSD symptoms can also make it hard to seek help.
Reaching out for Support
When delving into this topic further with Ugalde, he explained some of the experiences he has witnessed in his practice. "In my experience, individuals who have PTSD can focus on wanting to show their best selves and put off reaching out for support. There is a desire to be seen as whole instead of broken."
Marc very much echoed the feeling of being broken from a personal perspective. "For a long time, I thought I was broken and that my head didn't work. This thought bounced around my head 24/7, it depreciated my self-worth and self-image, and I lost all confidence."
Marc goes on to add some advice from his own experiences to anyone struggling with PTSD, "please do not think you are broken. You are not broken. PTSD is an illness. Your brain is unwell and needs help and love, just the same as your body would need if it were fighting disease or illness."
Ned echoes these thoughts and encourages people to seek help. "Don't be afraid to communicate. Talk! There isn't the stigma attached to mental health that there used to be. My family and friends were extremely supportive - especially friends. The value of true friendship is very underestimated."
Reaching out to family and friends can make a very positive difference in managing and recovering from PTSD.
Supporting a Friend or Family Member with PTSD
"I have a few clients struggling with PTSD that have expressed that having strong family supports allows them to get up each day while someone else they know struggling with PTSD that does not have strong supports can experience even more suffering," discusses Ugalde.
If you are worried that a loved one is suffering from symptoms of PTSD, there are signs that you can look out for. These include:
Isolating from others
Substance use
Self-harm
Binge eating
Traumatic and distressing nightmares
Flashbacks to a traumatic event
Diminished interest in activities
Signs of being constantly on guard
Signs of feeling alienated/detached/estranged
It can be incredibly hard to watch someone close to you have PTSD. If you've not experienced PTSD yourself, then try not to judge someone. It's important not to blame them or put pressure on them. They need time and support. And, the support from family and friends can make a big difference.
Marc offers the following advice to family and friends; "Don't make their experience your own. They are likely struggling enough with the guilt of what they are putting you through, so they don't need to be reminded of it daily. Be patient; the person you love may have changed dramatically. Some things will be different, and their memory might not be what it used to. Be there to listen. Sometimes, all that is needed is a friendly face to bend an ear to."
As well as listening, there are several things you can do to support someone with PTSD.
Communicate. Give people time to talk and listen in a non-judgemental way.
Learn their triggers. If someone is affected by specific triggers, it can help talk about what sorts of situations or conversations trigger flashbacks or difficult feelings. Not only can it help avoid situations being triggered, but it can help you support a loved one if a situation is triggered,
Stay calm. If someone is experiencing a flashback, stay calm. Gently remind them that they are experiencing a flashback and are in a safe space. Don't make any sudden movements. Encourage calming breathes. Help them talk through their surroundings to feel secure where they are.
Respect personal space. Not everyone wants to be hugged. Some people with PTSD might feel jumpy or on edge. Leaning in for a hug without permission might make them feel uncomfortable or startled.
Look out for warning signs (see list above). If you are worried you notice warning signs in a loved one, why not reach out to them? Ask them how they are feeling and encourage them to open up.
Help find support. If you think someone needs extra support, it may be that they need to help to find it. They may even want someone to go with them as moral support. Talk openly about what options are available.
Why encourage someone to get help from a professional? Well, there are various therapies and medications proven to help people with PTSD successfully. There isn't a 'one size fits all' approach, and there are many treatment options for PTSD, which are individualized to the person.
Types of Treatment
Ugalde advises that treatment options available to people with PTSD include:
Cognitive behavioral therapy (CBT). The American Psychology Association explains that "Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts, and feelings that lead to difficulties in functioning." 7
Cognitive processing therapy. This is a type of CBT that that helps people to learn how to modify and challenge unhelpful beliefs related to trauma.
Eye movement desensitization reprocessing (EMDR). This type of treatment involves recalling the traumatic incident in detail while making eye movements, usually by following the movement of your therapist's finger. It helps to change the negative way you think about a traumatic experience.8
Prolonged exposure therapy. This helps individuals to approach their trauma-related memories, feelings, and situations gradually. It teaches you to realize that trauma-related memories are not dangerous and do not need to be avoided.9
Additionally, there are medications that allow prescribers to assist people in managing their anxiety, depression, and other symptoms that may occur alongside their post-traumatic stress symptoms.
Ugalde advises that "in particular, cognitive processing therapy and EMDR have been shown to be highly effective in allowing clients with PTSD to recover."
A strong evidence base of research shows prolonged exposure, cognitive processing therapy, and trauma-focused CBT are very effective treatments.10
It's also worth exploring other forms of support that might be available to you in your area. There are many charities and support groups that offer programs specifically developed for PTSD. Ned was referred to a program called The Warrior Course which is specifically designed for ex-military personnel. Ned found that this was very beneficial for him - "I began to find myself and believe in myself again by using the tools they gave me."
Treatment is a different process and experience for everyone. For many people, treatments can get rid of symptoms altogether. Some people find that treatment lessens symptoms and makes life more manageable. Most people report a better quality of life after accessing support.
You may not think you need treatment or that it might not work for you. However, when PTSD isn't treated, it usually doesn't get better. It may even get worse. It's unlikely that symptoms will just go away over time. With most people experiencing life-changing results from the various types of treatment available, it's a positive thing to seek support.
A Few Final Words
Marc offers one final piece of advice, "if you're reading this and struggling, please speak up and get some help. I've lost seven friends in two years to PTSD, and it is heartbreaking every time. Getting help is a permanent solution to a temporary issue. Please speak out."
Ugalde adds, "allow yourself to take time to experience what you can, recover, seek support, and then continue working on yourself with patience, kindness, and forgiveness."
If you are in need of help and feel that you are in a crisis please reach out by contacting your local community services board, calling a hotline or helpline, and seeking assistance where possible. Ugalde shared that there are helplines available that are listed on the Calming Wind Counseling Website.
Some specific hotlines and helplines for those with PTSD include:
National Suicide Prevention Lifeline (also affiliated with Mental Health America): (800) 273-TALK (8255). Available any time of day or night, 365 days a year, this toll-free PTSD helpline has trained volunteers standing by to provide crisis intervention, to offer support for people in distress, and to give information and referrals to people with PTSD and their loved ones.
Veterans Crisis Line: (800) 273-TALK (8255) and press “1”. This toll-free hotline is available for veterans and their loved ones. You can also send a text message to 838255 to receive confidential, free support and referrals.
Crisis Text Line: Text HOME to 741741. This service is available 24/7 and provides free crisis support and information via text.
National Hopeline Network: (800) 442-HOPE (4673). Available 365 days a year, volunteers who staff this toll-free hotline are specially trained in crisis intervention to provide support, information, and referrals to people in need. You can also access services via chat by pressing the “Chat Now” button on its website.
PTSD Foundation of America, Veteran Line: (877) 717-PTSD (7873). Providing referrals, information, and helpful resources to veterans and their families, this toll-free hotline is available 24/7.
Lifeline for Vets: (888) 777-4443. Also geared toward veterans and their families, this toll-free PTSD helpline provides crisis intervention, referrals, and information.
References:
About PTSD. Mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/about-ptsd/. Published 2021. Accessed June 24, 2021.
NIMH » Post-Traumatic Stress Disorder. Nimh.nih.gov. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/. Published 2021. Accessed June 24, 2021.
NIMH » Post-Traumatic Stress Disorder (PTSD). Nimh.nih.gov. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd. Published 2021. Accessed June 24, 2021.
VA.gov | Veterans Affairs. Ptsd.va.gov. https://www.ptsd.va.gov/understand/common/common_adults.asp. Published 2021. Accessed June 24, 2021.
Hoppen T, Morina N. The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. Eur J Psychotraumatol. 2019;10(1):1578637. doi:10.1080/20008198.2019.1578637
Chivers-Wilson KA. Sexual assault and post-traumatic stress disorder: a review of the biological, psychological and sociological factors and treatments. Mcgill J Med. 2006;9(2):111-118.
Cognitive Behavioral Therapy (CBT) for Treatment of PTSD. https://www.apa.org. https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy. Published 2021. Accessed June 24, 2021.
Treatment- Post-traumatic stress disorder. nhs.uk. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/treatment/. Published 2021. Accessed June 24, 2021.
Prolonged Exposure (PE). https://www.apa.org. https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure. Published 2021. Accessed June 24, 2021.
Watkins L, Sprang K, Rothbaum B. Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Front Behav Neurosci. 2018;12. doi:10.3389/fnbeh.2018.00258
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