PTSD

Understanding PTSD: What Is It, and How Do We Recover?

November 8, 2019

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Though it affects around 3.5 percent of the US population, there are still many misconceptions surrounding post-traumatic stress disorder (PTSD), especially in terms of what causes it and perhaps even more fundamental, what it is. While there are several different ways to treat PTSD, the first step is always recognizing its symptoms and finding help.

Like the majority of psychological conditions, the medical community is still trying to understand PTSD, how it works, and how to treat it. Recently, many researchers have started to argue that PTSD should be considered a mental injury rather than an illness. Keep reading to find out: 

  • What we know about PTSD
  • The theory that PTSD is a mental injury, not a mental illness
  • Treatment options for PTSD

What We Know 

Fortunately, we live in a time where we know more about the brain than ever before. But unfortunately, we still have a lot to learn. That being said, years of research on PTSD have given medical professionals some background on the condition. These are a few of the things that we know about PTSD. 

1. It’s not a new phenomenon. 

While PTSD wasn’t recognized by the American Psychiatric Association until 1980, there’s no doubt that people suffered from it well before then. Perhaps the first time that members of the public became collectively aware of PTSD was after World War I when many soldiers returned home displaying symptoms of what was known as “shell shock.” 

Soldiers in battle during World War I.
Sadly, shell shock became associated with weakness, and many of the soldiers who experienced it were ashamed of themselves for what they believed to be a sign of cowardice. Image courtesy of PBS

2. It can be a result of any form of trauma, not just war. 

Though veterans of war are definitely at a high risk of developing PTSD, military combat is far from the only type of trauma that can cause PTSD. Furthermore, trauma is not limited to glaringly obvious incidents of events, like a public shooting or terrorist attack. For this reason, experts often classify trauma as being either “obvious” or “non-obvious.” 

Obvious forms of trauma include but are not limited to:

  • War
  • Child abuse 
  • Physical abuse and domestic violence 
  • Sexual assault and rape
  • Natural disaster

Non-obvious forms of trauma include but are not limited to: 

  • Bullying
  • Emotional or verbal abuse
  • Car accidents
  • Being neglected or ignored as a child
Top 4 reasons men and women suffer PTSD.
PTSD is found in one out of every ten individuals who have suffered a traumatic event. Rape is thought to be the most common cause of PTSD for both men and women. Image courtesy of Psycom

3. There is a range of symptoms and no established timeline for experiencing them. 

PTSD manifests itself in many different forms, and there is no way to know when a person might start experiencing their symptoms of it. This means that while PTSD might be recognizable immediately following the trauma, it also might not appear for years afterward. 

Symptoms of PTSD are typically broken down into four categories: 

  • Intrusive memories — Recurrent, unwanted memories concerning the trauma; flashbacks or reliving the trauma; nightmares and upsetting dreams; experiencing severe distress when reminded of the trauma. 
  • Avoidance — Trying to avoid thinking or talking about the trauma; avoiding specific places, activities, or people directly or indirectly associated with the trauma. 
  • Negative changes in thinking and mood — Persisting feelings of hopelessness; feeling numb; lack of interest in once-enjoyed activities; trouble with memory, including not being able to recall certain details or events of the trauma. 
  • Altered physical and emotional reactions — Being easily startled, frightened, or constantly on edge; self-destructive behavior (e.g. drinking too much, binge eating, driving too fast, etc.); inability to sleep; inability to concentrate; angry outbursts and unwarranted aggression; overwhelming feelings of guilt and shame. 
Signs of PTSD in children following a trauma.
PTSD might look different in children than it does in adults. Reenacting trauma while playing and having nightmares are both common warning signs that a child with PTSD might display. Image courtesy of Verywell

Mental Injury vs. Mental Illness 

In an article published by Psychology Today, Tracy S. Hutchinson, Ph.D., supports the argument that PTSD is a mental injury, not a mental illness, writing that “PTSD symptoms are a natural reaction to a distressing event where one may have felt overwhelmed, afraid, or helpless. Historically, mental illness is pathologized as something that is ‘wrong’ with the person, versus simply a manifestation of how most people would respond.” 

Diagram depicting brain circuits in PTSD relating to fear and re-experiencing.
PTSD affects the brain on a structural level, changing the way that the brain processes fear and triggering the fight or flight response. Image courtesy of Psych Scene Hub

Can PTSD Be Prevented?

The medical community is currently researching ways to potentially prevent PTSD. For instance, a model that is known as “critical incident stress debriefing” is being used as a preventative measure against PTSD by encouraging people to talk about the traumatic incident early on and warning them about common stress reactions. However, there has been little success with this method. Preventative medicine is also being considered, yet the testing and trials are still in the early stages. 

Treatment Options for PTSD 

Even if PTSD isn’t preventable, it’s important to remember that it is treatable. Of course, the first step in the treatment process is being diagnosed. Diagnosing PTSD can be difficult, as many individuals do not realize that this is what they are suffering from. Furthermore, symptoms of PTSD don’t always present themselves right away, which means that being diagnosed with PTSD might happen years after the trauma has taken place. In this section, we’ll look at the different treatment options that exist for PTSD. 

Psychotherapy

Psychotherapy is usually the first method through which mental health professionals try to treat PTSD. There are several different approaches to psychotherapy—commonly known as talk therapy or counseling—and most therapists use a combination of these approaches. 

Cognitive Therapy

Cognitive therapy is a type of therapy that involves working to develop healthy thinking patterns and become more conscious of unhealthy thinking. 

Exposure Therapy

While CBT aims to confront the harmful thinking patterns that accompany PTSD, exposure therapy is more geared toward treating specific fears that have developed as a result of the trauma. There are various subsets of exposure therapy, some of which include:

  • In Vivo Exposure — This method of exposure therapy utilizes direct confrontation of the fear (under professional supervision). For instance, if someone has trauma associated with a specific location and as a result, they avoid that place or others like it, their therapist might escort them there to work through the trauma together. 
  • Imaginal Exposure — This method of exposure therapy involves mental confrontation rather than physical or literal confrontation and is usually used if it is not safe or possible for the patient to directly confront the object of their trauma. For instance, a combat veteran might be asked to picture being back in the situation in which their trauma occurred, as it would not be safe (or, in most cases, possible) for them to return to the actual site or situation. 
  • Interoceptive Exposure — This method of exposure therapy focuses on developing coping mechanisms for the physical symptoms of PTSD, such as those that might come with a panic attack. Interoceptive exposure was initially used to treat panic disorder, but evidence suggests that it can be effective in treating PTSD as well, as the two share some similarities in physical manifestation (e.g., hyperventilation). 
  • Prolonged Exposure — This method of exposure therapy is a combination of the other types and involves practices from each one for a more well-rounded approach to treating trauma. The therapist might employ different relevant techniques from in vivo exposure, imaginal exposure, and interoceptive exposure to treat certain symptoms. 

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) uses targeted memories and directed eye movements to help a patient process trauma and change the way that they react to painful memories. During the treatment, the therapist will have the patient recall an element of the trauma as they direct the patient’s eye movements. 

EMDR infographic
EMDR isn’t only used to treat PTSD. It can also be used to treat other mental health conditions like phobias and anxiety. Image courtesy of Kindred Counseling

Stress Inoculation Training

Similar to interoceptive exposure therapy, stress inoculation training introduces the patient to various coping mechanisms that might help with the anxiety that comes with PTSD. Some of these coping mechanisms are physical exercises, such as deep breathing and muscle relaxation. However, stress inoculation training also includes mental and verbal practices to work through the symptoms of PTSD in a healthy way. Some of these practices include role-playing, mindfulness, and recognizing harmful behaviors that come from negative thinking. 

Medication

Medications might also be prescribed to a patient suffering from PTSD. Antidepressants and anti-anxiety medications are both frequently used to treat PTSD. However, because PTSD has such deep psychological roots, medication is mostly used to manage symptoms rather than address the condition as a whole. 

Possible Treatment Option: Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is a noninvasive therapy that uses magnetic pulses to create electrical currents in the brain, thus altering the brain’s chemistry. Currently, TMS is only FDA-approved to treat major depressive disorder and obsessive compulsive disorder. However, research indicates that TMS could be an effective way to treat PTSD

Female patient being treated with NeuroStar TMS therapy.
During a TMS treatment, magnetic waves pass through a conductive coil that is placed against the patient’s head. The magnetic waves then superficially penetrate the skull. Image courtesy of The Spokesman-Review

TMS is thought to have a “rewiring” effect on the brain, as it impacts neural pathways and can increase connectivity between different parts of the brain. One of the appeals of TMS is that it does not come with a long list of side effects, like many medications. Furthermore, while the treatment can be uncomfortable, it considered extremely tolerable, and as it is non-invasive, the patient does not need to be sedated to undergo treatment.  Psychology Today writes, “For someone who has failed to respond to prior standard treatments (usually psychiatric medication and psychotherapy), TMS can offer substantial relief to a significant fraction, without high risk of major adverse reactions.” 

Don’t Wait to Find Help

If you or a loved one has experienced a traumatic event, make sure that you know the signs of PTSD so that you can recognize it and find help as soon as possible. Remember that PTSD can look different in children, but just because it doesn’t look the same doesn’t mean that they can’t develop it or that they don’t have it already. 

Regardless of whether it’s an illness or an injury, PTSD is a serious condition that needs to be treated as soon as possible. Many people think that their trauma wasn’t “bad” enough to result in PTSD, but this is a false notion that stems from a lack of information. Don’t wait to find help—because the sooner you find help, the sooner you can get better. 

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