Post Traumatic Stress Disorder (PTSD) is a psychological disorder formed by exposure to actual or threatened death, serious injury, or sexual violence. It is linked to physiological changes within the brain, affecting the hippocampus, amygdala, and prefrontal cortex. PTSD has biological, psychological and environmental causation and implication.
Post traumatic stress disorder can be treated, though has no medical cure to date.
There are eight criteria to be met for a PTSD diagnosis, four of which are arranged in symptom clusters.
These symptom clusters comprise:
- Intrusive symptoms of the traumatic event (memories, dreams, flashbacks, traumatic event reminders)
- Avoidance of traumatic aspects (feelings, memories, places)
- Negative alterations of mind and mood (inability to remember specifics, negative beliefs, distorted memories, emotional instability, avoidance, detachment)
- Reactive alterations (irritable, recklessness, hyper-vigilance, startled, concentration, sleep issues)
Read our PTSD diagnosis pages for more in-depth detail, and to see the full PTSD diagnostic criteria.
Having symptoms does not mean you have PTSD. You must satisfy all eight (8) criterion. It is possible to experience severe trauma and never develop PTSD.
Causes of PTSD
A Post Traumatic Stress Disorder (PTSD) diagnosis applies to those exposed to catastrophic trauma, such as war (combatant or civilian), threatened or actual physical assault (robbery, mugging, physical attack, childhood physical abuse), threatened or actual sexual violation (forced sexual penetration, alcohol / drug-facilitated sexual penetration, abusive sexual contact, non-contact sexual abuse, sexual trafficking), threatened or actual loss of life (self or others), being kidnapped and/or taken hostage, terrorist attack, torture, being a prisoner of war, natural or man-made disasters, medical crisis (waking during surgery, anaphylactic shock) and severe vehicular accidents.
For all other trauma exposure, see alternative diagnoses, such as other post-traumatic syndromes, anxiety disorders, mood disorders, adjustment disorders, dissociative disorders, psychotic disorders, et cetera.
Who’s at Risk
No one is exempt from Post Traumatic Stress Disorder after having been exposed to catastrophic trauma. A brain subjected to enough psychological pressure (known as a stressor), will eventually break – and every person has a breaking point. This is also how one may experience a catastrophic trauma and not develop PTSD – the individual in that case may not have been exposed to the stressor strongly enough, or for long enough.
Although the mechanism that causes PTSD is the same regardless of the type of trauma experienced, the disorder manifests itself differently within each individual. PTSD affects each person uniquely, ranging from mildly to severely debilitating, and from full recovery to lifetime symptom suffering.
Pharmacology attempts to treat the biological aspects of PTSD, which can then flow onwards to alleviate psychological and environmental symptoms. Medication is hit or miss, and requires a patient, trial-and-error approach. As of this writing, the only medications approved by the Food and Drug Administration (FDA) for PTSD, are sertraline (Zoloft) and paroxetine (Paxil). All other medications are considered “off label”, although many do have practice guidelines and data to support their use.
More recent data over the past five years demonstrate pharmacological intervention with Selective Serotonin Reuptake Inhibitors (SSRI’s) has a low success rate in the treatment of PTSD.
The proven, most effective treatment for Post Traumatic Stress Disorder is psychotherapy using a Cognitive and Behavioral Therapy (CBT) foundation. Such treatments include Prolonged Exposure (PE) therapy, Cognitive Processing Therapy (CPT), Trauma Focused CBT (TF-CBT), and Eye Movement Desensitization and Reprocessing (EMDR). These models have an approximate success rate of 50% – 60%.
Experimental PTSD Treatments
Using the compound 3,4-Methylenedioxy-Methamphetamine (MDMA) within the above therapy types, called MDMA assisted psychotherapy, has demonstrated improved success rates, to approximately 80% average recovery. This does not mean the consumption of MDMA alone will help you – it will only lead to a serious drug addiction, and additional problem to treat. However, the use of pharmacological MDMA, within a therapeutic environment only, apparently allows a therapist to quickly break through problematic barriers with less resistance, as MDMA opens the brains’ pathways while simultaneously lowering client inhibitions for secrets, deceptive behaviors, or fears. As of this writing, US trials have begun and researchers indicate a desire to have MDMA fully approved for legal psychotherapeutic use by 2021.
Cannabis (marijuana) is also currently in trials as a treatment for PTSD. Although cannabis has been considered as an “off-label” treatment for some time, the focus has been purely on symptom management. Research in 2015 is heading towards an understanding of the relationship of cannabinoids (the active elements of cannabis) to the process of fear extinction in the human brain. Early results suggest a connection, which may lead to cannabis being administered as a prophylactic treatment following a traumatic event, thereby preventing PTSD from developing.
An excellent article for further information is The Pros And Cons Of Using Cannabis For Ptsd.
A comorbid disorder is an additional disorder/s that exists and interacts in combination with the other. For example, you may be diagnosed with PTSD and Major Depressive Disorder (MDD). If the MDD didn’t exist prior to you developing PTSD, then MDD is comorbid to PTSD. Recover PTSD and your MDD dissipates or disappears.
Individuals with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder (e.g. depressive, bipolar, anxiety, or substance use disorders). Comorbid substance use disorder and conduct disorder are more common among males than females. Among U.S. veterans in Afghanistan and Iraq, co-occurrence of PTSD and Traumatic Brain Injury (TBI) is 48%, which causes considerable comorbidity between PTSD and the neurocognitive disorders associated with TBI, as well as some overlapping symptoms between them.
- PTSD is inherited – Post Traumatic Stress Disorder is not subject to genetics, as PTSD requires a traumatic event for diagnosis. Traumatic events are not passed through genes, due to their environmental origin. Evidence suggests genome traits, such as anxiety and depression, can increase your risk for the disorder, but you must be exposed to a traumatic event in order to develop PTSD.
- PTSD is an anxiety disorder – PTSD is not an anxiety disorder. It used to be classified as such by the Diagnostic and Statistical Manual of Mental Disorders (DSM), though with the publication of the DSM-5 in 2013, a new category was created – Trauma and Stressor-Related Disorders. The change was due to research ultimately revealing that PTSD has no specific roots in any other disorder, as trauma is complex, and outcomes are specific to each person.
- PTSD only affects military – Statistically, civilians suffer more with PTSD than military personnel. Military populations are over-identified with PTSD, as they’re the largest collective employment group that can be measured with ease. Civilians are spread far and wide for treatment, whereas military are treated within data-mined and controlled Veterans Affairs establishments.
- Symptoms appear immediately after trauma – Symptoms can appear months, years, even decades after exposure to trauma. The majority of PTSD sufferers will show symptoms after 12 months. In order to be diagnosed with PTSD, symptoms from the four main clusters must be present for a minimum of one month.
- PTSD causes violent behavior – Associations are made primarily by sensationalized media coverage of veterans with Post Traumatic Stress Disorder – however, the majority of PTSD sufferers have never had a violent episode. Anger and violent behavior demonstrated by veterans is more likely due to military training, not PTSD.
- Read more PTSD myths and discuss.