Posttraumatic Stress Disorder

Recognizing Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD) is a disorder that can develop after an individual has experienced, witnessed or been repeatedly exposed to a major trauma.

What kind of trauma leads to PTSD?

1. Exposure to:

  1. Actual or threatened death (e.g. witnessing a murder, an earthquake, a serious car accident, war)
  2. Serious injury (e.g. extensive hospitalizations, severe burns)
  3. Sexual Violence (e.g. sexual assault, rape)

2. Exposure can be:

  1. Directly experiencing the event
  2. Witnessing the event in person as it happens to others (e.g. witnessing a kidnapping)
  3. Learning that it occurred to a close family member or close friend (if actual or threatened death ­ must have been violent or accidental: e.g. seeing a friend die in a car accident)
  4. Experiencing repeated or extreme exposure to aversive details of the event (e.g. police officers repeatedly exposed to violent murder victims)

Does trauma always lead to PTSD?

  • Several studies have shown that a majority of people will likely experience at least 1 traumatic event in their lives but many of them will NOT develop PTSD
  • The chance of developing PTSD goes up if the trauma was very severe, chronic (that is, lasted a long time), or you were physically close to the event, that is, if the trauma happened right next to you or in front of you
  • Certain traumas are more likely to lead to PTSD than others. For example, you are more likely to develop PTSD if the trauma you experienced was a rape/sexual assault, combat exposure or childhood neglect/physical abuse

Symptoms of PTSD

In order to receive a diagnosis of PTSD, you need to be currently experiencing symptoms from each of the following categories:

1. Intrusive symptoms (at least 1 symptom for diagnosis)

  • Upsetting, recurring, unwanted memories about the event: This involves having vivid images about the trauma come up again and again even when you do not want to have them. For example, if you were physically attacked, you might keep remembering your attacker's face. Or, if you were in a car accident, you might have strong memories about the sound of the crash or a vivid picture of blood all over yourself or someone else involved.
  • Nightmares about the trauma: People with PTSD will often have very vivid nightmares of either the trauma or themes surrounding the trauma. For example, if you were in a car accident, you might have frequent nightmares about being in the accident yourself, or about other people being involved in accidents. Some people with PTSD who were assaulted will have nightmares of being chased, and the person chasing them in the dream might not be the person who assaulted them.
  • Acting as if the trauma were happening again ("reliving the trauma"): This is also called "dissociation", where an individual loses touch with the present and feels as if they are living through the trauma again. Some people with this symptom might speak and act as if they are physically in the traumatic situation, whereas others might appear to simply stare off into space for a period of time. Some people with PTSD will also have "flashbacks", which are very vivid images of the trauma they experienced. Flashbacks can seem very real, and some people describe it as a picture or movie that they can see clearly in their minds.
  • Distress when reminded of the trauma: Some people with PTSD become extremely upset or feel very anxious whenever they are confronted with a person, place, situation, or conversation that reminds them of the trauma. This can include becoming very upset when hearing tires squeal if you were in a car accident, or feeling anxious when watching violence on TV, if you were assaulted.
  • Significant body sensations (physiological reactions) when reminded of the trauma: Some people with PTSD experience changes in their body when confronted with a person, place, situation, or conversation that reminds them of the trauma. This can include panic-like symptoms. For example, someone might experience an increase in heart rate, sweat and increased body temperature when passing the site of their car accident.

Why do I have flashbacks and upsetting intrusive thoughts? When you live through a traumatic experience, your mind processes and stores the memory a little differently than it stores regular experiences. Sensory information about the trauma, that is, smells, sights, sounds, tastes, and the feel of things, is given high priority in the mind, and is remembered as something threatening. Once this happens, whenever you are faced with a touch or feel, taste, smell, or a sight that reminds you of your trauma, the memory (and the feeling of threat) comes back up and you might have vivid memories or flashbacks about the trauma. This is just the way the mind works. It is not dangerous or a sign that you are going crazy.

2. Symptoms of avoidance (at least 1 symptom for diagnosis)

  • Avoiding thoughts, feelings or memories related to the trauma. Although many people with PTSD will avoid any reminders of their traumatic experience, it is also common for people to avoid even thinking about what happened. For example, if you have thoughts or memories about what happened, you might try to push them out of your head.
  • Reminders can include:
    • Conversations (e.g. speaking about someone else's experience in combat)
    • Activities (e.g. going out for drinks with a friend, if your trauma involved being assaulted at a bar)
    • Objects (e.g. the clothes you were wearing during your trauma)
    • Situations (e.g. getting into a confrontation with someone if you were abused as a child by an angry parent)
    • People (e.g. people who remind you of the perpetrator of a sexual assault)
    • Places (e.g. the site of your car accident)

3. Negative changes in thinking or mood (at least 2 symptoms for diagnosis):

  • Not able to recall parts of the trauma (e.g. forgetting details or feeling confused about the timeline)
  • Very negative beliefs and expectations: After a trauma people will sometimes develop beliefs about themselves or the world that are persistent and exaggerated (e.g. The world is dangerous, I am a bad person)
  • Distorted beliefs about the cause or consequences of the trauma (e.g. It is all my fault)
  • Persistent negative mood or state (e.g. guilt, fear, anger)
  • Decreased interest in activities
  • Feeling detached or distant from others
  • Inability to experience positive feelings (e.g. can’t feel love)

4. Arousal (at least 2 symptoms for diagnosis):

  • Irritability and anger outbursts (with little to no provocation)
  • Self-destructive and reckless behavior (e.g. driving erratically, unsafe sexual promiscuity)
  • Hypervigilance: After a trauma people will sometimes feel on guard all the time (e.g. needing to look at every person who enters a restaurant to assess them as a possible threat)
  • Easily startled (e.g. jumping when the phone rings)
  • Difficulty concentrating
  • Sleep problems (e.g. difficulty falling asleep, staying asleep)

KEEP IN MIND: Although most people with PTSD will develop symptoms within 3 months of the traumatic event, some people don't notice any symptoms until years after it occurred. A major increase in stress, or exposure to a reminder of the trauma, can trigger symptoms to appear months or years later.

When It Is (and When It Is Not) PTSD

As you probably noticed, there are many symptoms of PTSD, and very few people have all of them. Also, not everyone who experiences a trauma will develop PTSD. So how do you know if you might have PTSD? Here are 2 tips that might be helpful:

Tip #1: If you have at least 1 symptom in each of the 4 categories, and your symptoms only started AFTER a traumatic event, then you might have PTSD. If your anxiety symptoms were already present before the trauma, then it is probably not PTSD.

Tip #2: It is normal to feel more anxious right after a trauma. But over time, these anxious feelings will settle down. If these symptoms do not settle down then you might have PTSD.

My Anxiety Plan for Post-Traumatic Stress Disorder

For your PTSD MAP click here.

PTSD Video


  

Stories

John's Story
Sharon's Story
John is a 54-year-old man who witnessed his grandson die in an automobile accident. A semi-truck trailer crashed into the car John was driving. His grandson was a passenger in the front seat. Although John had some minor injuries after the accident, his grandson died at the scene. Before the accident, John ran a successful small business and was very close to his family.
 
Since the accident 8 months ago, John has been having flashbacks, or very vivid images, of the crash; these flashbacks will sometimes cause him to dissociate, that is, he will lose track of where he is and feel like he is back at the scene of the accident. He is very scared of these flashbacks, and worries that it is a sign that he is going "crazy". He tries to avoid anything that reminds him of the crash, and will avoid looking at pictures of his grandson, going to his grave site, or talking about him with friends and family.
 
John also seems to be using work as a way of avoiding thinking about the accident. His wife is very concerned, because he is working over 10 hours a day and has started going in to work most weekends. However, when he is at work, he is constantly distracted and has difficulty concentrating. He also finds it hard to make important decisions. Several of his employees have told him that they are worried about the changes they have seen in him.
 
John has started drinking every day when he gets home. He does this to try to stop the memories and to lessen his feelings of anxiety. He feels angry and irritable much of the time. Although he is worried that he is pushing his family and friends away, he says that he often feels numb. He says that he has not felt positive feelings of love, joy, or sexual arousal for quite some time. He has not been able to drive by the place where the accident took place, and he will not take any passengers in his car. He is also extremely nervous when driving alone, and as a result tries to use public transit as much as possible, despite the inconvenience. John has difficulty remembering certain parts of the accident, even though he did not lose consciousness or hit his head. Recently, he has been thinking that life is not worth living this way, even though he never thought he would consider taking his own life. He does not want to hurt his family.
Sharon is a 23-year-old single woman who lives with her older sister. She left university two years ago after being raped while out on a date with a male student she met through class. Since being assaulted, she has experienced a variety of symptoms that have not gone away with time. She has unwanted memories of her trauma whenever she sees a man who looks like the person who assaulted her. She often has nightmares about the rape, and sometimes they are so upsetting that she is not able to fall back asleep without leaving the lights on or taking an extra sleeping pill. She has also had several panic attacks when thinking about the rape, and avoids watching movies that may show a rape scene. She has not been able to talk about the assault with her family doctor, even though she is afraid that she may have been exposed to a sexually transmitted disease. She has never told any friends or family about it either, because she is scared that they won't believe her or that they will think badly of her.
 
Sharon has been unable to go back to university, because she fears that she might see the man who raped her. She also worries that she won't be able to pay attention in class and do her homework because she now has a very hard time concentrating. Sharon says that she no longer feels any enjoyment when she is with her friends and family. She has let all of her hobbies go, including quitting the soccer team and not reading her favourite books anymore. She says that she feels cut off from everyone around her, and she doubts that she will ever be able to be intimate with a man again. This is especially upsetting to her, because she is afraid that this means she will never be able to start a family, and having children some day has always been very important to her.
 
When Sharon is out in public, she is constantly on guard, especially if men are around. She is finding it difficult to keep a job, and she lives with her sister because she no longer feels safe living on her own. Recently, she got very angry at her sister when she brought some male friends over to their apartment. Sharon's relationship with her sister is now quite tense.