Post-Traumatic Stress Disorder (PTSD)
It's natural to be afraid and upset something terrible happens to you or someone you know. But sometimes people experience an event that is so overwhelming that it continues to have a serious effect on them, long after the danger has passed. If you feel afraid and upset weeks or months later, it's time to talk with your doctor. You might have post-traumatic stress disorder (PTSD). Fortunately, even if you have PTSD, you can get treatment and feel better.
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to traumatic events where one was exposed to or witnessed danger, such as with violence or disasters.
It can happen to those who are physically hurt. It can also happen even if you weren't physically hurt, simply through witnessing others being traumatized.
PTSD can happen to anyone at any age.
PTSD starts at different times for different people. Signs of PTSD may start soon after a frightening event and then continue. Other people develop new or more severe signs months or even years later.
Living through or seeing something that's upsetting and dangerous can cause PTSD. This can include, but is not limited to the following:
- Being a victim of violence, or seeing violence
- War or combat
- Being a first responder such as a paramedic, police officer or firefighter
- Car accidents and plane crashes
- Hurricanes, tornadoes, and fires
- Violent crimes, like a robbery or shooting.
- The death or serious illness of a loved one
Strong emotions caused by the event create changes in the brain that may result in PTSD.
People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled.
Symptoms of PTSD can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.
PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD.
There are four types of symptoms: reliving the event, avoidance, numbing, and feeling keyed up.
1. Reliving the event (also called re-experiencing symptoms): Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include:
- Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran
- Seeing a car accident, which can remind a crash survivor of his or her own accident
- Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped
2. Avoiding situations that remind you of the event: You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. Examples:
- A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes
- A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants
- Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.
3. Feeling numb: You may find it hard to express your feelings. This is another way to avoid memories. Examples:
- You may not have positive or loving feelings toward other people and may stay away from relationships
- You may not be interested in activities you used to enjoy
- You may forget about parts of the traumatic event or not be able to talk about them.
4. Feeling keyed up (also called hyperarousal): You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to:
- Suddenly become angry or irritable
- Have a hard time sleeping
- Have trouble concentrating
- Fear for your safety and always feel on guard
- Be very startled when someone surprises you
(Information from the National Center for PTSD
A similar condition to PTSD is Acute Stress Disorder:
- Acute Stress Disorder: when one's symptoms have lasted less than 4-weeks
- Post-Traumatic Stress Disorder (PTSD): when one's symptoms have lasted more than 4-weeks
Untreated, PTSD can lead to many problems, and can essentially prevent a person from leading a normal life. In particular, PTSD can contribute to:
- Drinking or drug problems
- Feelings of hopelessness, shame, or despair
- Employment problems
- Relationships problems including divorce and violence
- Physical symptoms
Because of all the ways that PTSD can disrupt not just the person's life but the lives of friends and family, it makes it all the more important to get help and treatment for PTSD.
Children can have PTSD. They may have the same symptoms as adults, or they may be different depending on how old they are.
Common symptoms may include:
- Behaving like they did when they were younger
- Being unable to talk
- Complaining of stomach problems or headaches a lot
- Refusing to go places or play with friends.
Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom
Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.
As children get older their symptoms are more like those of adults.
If you are wondering if you may have PTSD, go see your doctor.
In addition, you can take the following screening questionnaire, developed by Breslau and colleagues (Breslau, 1999).
If you answer yes to four or more questions, it indicates a high likelihood of having PTSD, and you should speak with a health professional. As the questionnaire is for screening purposes only, it is not a substitute for diagnosis, or seeing a health professional. If you have any concerns at all, speak with your doctor.
If you have been through traumatic events (such as violence, crime, combat or abuse)...
- As a result of that event, do you avoid being reminded of this experience by staying away from certain places, people or activities? Yes/No
- Did you lose interest in activities that were once important or enjoyable? Yes/No
- Did you begin to feel more isolated or distant from other people? Yes/No
- Did you find it hard to have love or affection for other people? Yes/No
- Did you begin to feel that there was no point in planning for the future? Yes/No
- After this experience were you having more trouble than usual falling asleep or staying asleep? Yes/No
- Did you become jumpy or get easily startled by ordinary noises or movements? Yes/No
Special thanks for Dr. Breslau and colleagues (Breslau N, Peterson E, Kessler R, Schultz L: Short screening scale for DSM-IV posttraumatic stress disorder. The American Journal of Psychiatry 1999;156:908-911.)
Effective treatments for PTSD are available, and can help most people with PTSD lead productive, fulfilling lives. PTSD does not have to interfere with your everyday activities, work, and relationships.
There are many types of treatment for PTSD and the recommended treatment will vary depending on the person's situation.
Cognitive-behavioural therapy (CBT): helps you overcome PTSD by dealing with your cognitions (thoughts) and behaviours (learning coping strategies).
Eye movement desensitization and reprocessing (EMDR): EMDR practitioners report that by using eye movements (or other means of 'dual attention stimulation'), traumatic movements are processed into non-distressing memories.
Medications can sometimes be helpful. A type of medication known as selective serotonin reuptake inhibitor (SSRI), which is also used for depression, are used for PTSD. For some people they can be very helpful. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft). They work by raising the level of serotonin (a type of brain chemical) in the brain.
Cognitive behavioural therapy (CBT)
In cognitive (behavioural) therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.
You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You also learn ways to cope with feelings such as anger, guilt, and fear.
After a traumatic event, people often blame themselves and feel guilty for things that they could not have changed.
- For example, a soldier may feel guilty about decisions he or she had to make during war. Hindsight is 20/20; it is easy to think about what one should have done, after it has already happened. But knowing what you could have done does not mean that you are wrong or to blame for what happened.
- Furthermore, feeling responsible for what happened, lets the person feel a sense of control over the situation. But the reality is that they were not in control; and it was not their fault. Children who are abused often blame themselves for the abuse. Rationally, this makes no sense. But the blame may happen because by blaming oneself for the abuse, it lets the child feel responsible and have some sense of control.
In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event.
By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over time.
With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.
You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed.
You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye movement desensitization and reprocessing (EMDR) is a fairly new therapy for PTSD, and there are controversies around its use.
While talking about your memories, you'll focus on distractions like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes.
Research suggests that helps by reducing the distress from traumatic memories, but the exact way it helps is still being researched.
Other Types of Counselling/Therapy
Many people want to talk about their trauma with others who have had similar experiences.
In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.
Group therapy helps you build relationships with others who understand what you've been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You'll learn to focus on your present life, rather than feeling overwhelmed by the past.
Brief psychodynamic psychotherapy
In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.
Your therapist can help you:
- Identify what triggers your stressful memories and other symptoms.
- Find ways to cope with intense feelings about the past.
- Become more aware of your thoughts and feelings, so you can change your reactions to them.
- Raise your self-esteem.
PTSD can impact your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you're under so much stress. They may feel scared, guilty, or even angry about your condition.
Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.
In family therapy, each person can express his or her fears and concerns. It's important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you.
You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.
How long does treatment last?
For some people, treatment for PTSD can last 3 to 6 months. If you have other mental health problems as well as PTSD, treatment for PTSD may last for 1 to 2 years or longer.
What will we work on in therapy?
When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are focused on reducing their symptoms.
Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness? Perhaps you would like to work on improving your relationships at work, or communication issues with your friends and family.
Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.
What can I expect from my therapist?
Your therapist should give you a good explanation for the therapy. You should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they see if it is working.
The two of you should agree at the beginning that this plan makes sense for you and what you will do if it does not seem to be working. If you have any questions about the treatment your therapist should be able to answer them.
You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.
If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion.
Make sure you are safe. First of all, make sure that you are no longer in danger, and that you are safe! For example, if your trauma is from abuse or violence in the home, then get help first in getting to safety. Speak to your doctor or contact an emergency shelter.
Educate yourself about PTSD. Because the symptoms of PTSD (nightmares, flashbacks and feeling that you are re-living the trauma) are so distressing, people with PTSD often worry that they are going crazy. Relax - you are not going crazy. The problem is rather that you have anxiety because of a traumatic event. Fortunately, there are coping skills (in addition to treatment) that can help cope with this anxiety.
Take good care of yourself. When under stress, sometimes we neglect our sleep, proper nutrition or exercise. So make sure that you are 1) getting enough sleep, 2) eating a healthy diet with at least three healthy meals a day, and 3) getting regular exercise.
Common anxiety strategies for relaxing the body
Deep Breathing: When people get anxious, their breathing tends to quicken, which further worsens the situation.
Progressive Muscle Relaxation: If you are feeling tense and jumpy, progressive muscle relaxation is a way of relaxing your body.
Grounding Techniques: Grounding is a way of bringing your body back to the present, particularly if you are having flashbacks and losing touch with the present. Grounding works by re-setting and focusing your attention on the present.
Touch objects around you, and describe them (texture, colour). For example, "I'm sitting on the couch, and its very soft and comfortable. I'm smelling my coffee and I'm hearing the television."
Run water over your hands, and describe aloud how it feels.
Name all the different types of animals you can think of (e.g., dog, cat, chicken, cow, etc...)
Count backwards from 100
Say the alphabet backwards
Additional tips for grounding:
Keep Your Eyes Open: While grounding yourself, keep your eyes open so you can see and focus on the present. It also helps to talk out aloud about what you are seeing and doing.
Practise: Don't be disappointed if it doesn't work the first time you try it. Like any other skill or sport you have done, this is a skill that gets better over time. It works best if you have tried and practised it ahead of time while calm.
Stay active in life. People with PTSD often find that they drop out of activities that they previously enjoyed doing, but this is not helpful. It may be difficult, but get back into the normal routine of your life as much as possible, which includes; work, friends, family, hobbies and sports. Even if you can't get back 100% into all the things you used to do, then start with little steps.
Exposure: Face your fears and don't let the PTSD control you. The anxiety from PTSD often makes people avoid certain things. Unfortunately, these fears have a tendency to grow, and then people end up avoiding more and more things in life. The best way to fight back is to gradually face those fears, step by step.
- A person who has a trauma from falling off a horse. The longer the person avoids horses and horseback-riding, the harder it will be. The solution is to get back on a horse as soon as possible.
- A person experiences a mugging in a shopping mall parking lot at nighttime. The person starts to avoid parking lots at nighttime, then parking lots at daytime, then shopping malls entirely, and then even going out. The solution is to gradually face those fears, and get back into those situations, step-by-step.
- Avoid unhealthy coping strategies such as drugs and alcohol. Though they may appear to temporarily help in the short-term, using alcohol or other drugs will make it worse in the long run.
The National Center of PTSD at the United States Department of Veterans Affairs
The National Institute of Mental Health (NIMH)
National Center for PTSD
PTSD and Acute Stress Disorder, by Dr. Martin Anthony, retrieved Nov 1, 2008
Anxiety BC has an excellent set of resources, including Self-Help Strategies for PTSD
Interactive Tutorial on PTSD from Medline Plus
Written by the eMentalHealth Team.
Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.
You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/
Date of Last Revision: Jan 13, 2017