Ptsd basics


PTSD Definition

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.

PTSD Symptoms

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.

PTSD Medications

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.

PTSD Treatment

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.

Comorbid Disorders

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 Myths

  • 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.
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My boyfriend has served and is a war hero. He has had complete custody of his children for several years now. He has been diagnosed with ptsd. when we get close he pushes me away. I m in love with him the kids love me. And things are good. But after 2 or 3 days hes ready for me to leave. He wants me to send a good morning text daily. He doesn’t understand why i care for him the way I do. But I know he knows how to love the kids, but I’m different. He pushes me away. I’ve been researching about ptsd. An know not to take it personally when he says he feels claustrophobic. I need to leave.
Hi, I wrote on here several years ago but left because I was dealing with an acquired brain injury (and found it odd that no mention how closely symptoms of PTSD mimic brain/neuro injury) and other serious injuries and spent my time/energy trying to learn/teach about brain injury and how medics VERY OFTEN (because of psychs’ lies) fob patients off with mental health diagnoses (and drugs) which are totally inappropriate for brain injury (and many/most other injuries/diseases).

Plus on this site you had (and still have) no mention whatsoever (odd omission) of the torture of awake paralysis with suffocation – before, during or after an operation.

Plus NO mention of the massive traumas caused by doctors (and their medical defence unions – which we pay for), hospitals (and their legal teams – which we pay for) and counsellors (especially when given secret briefs by the guilty hospital and its “patients’ advocate”) when they deny OUR reality, the TRUTH, because it is inconvenient for them, their careers and reputations. We (the injured, the victims) don’t matter, we are punished because of how we were, how I was injured and by whom. I got no medical/remedial care, no help with adjusting to a damaged brain+, no rehab, and was lied to over & over by docs and hospitals – in person, in letters and worse: lies direct from the hospital to my GP via letter and phone = this latter which my GP refused (at least twice) to tell me the content of but the results were clear: do NOT believe this patient, she is not injured, do NOT ask more questions, do NOT refer on without also sending a warning. I was punished over & over for how I got injured/disabled, who did it and where. THAT is a MASSIVE trauma, not just once by one person but over & over again: my reputation smashed, me branded a liar, neglect of my life-threatening injuries.

And NO remedy, NO help with added costs, lost my job, my income, my health, my friends/family, my home, some possessions, my security, my safety… oh but I’m alive. (think they wished I was dead = they lie and get off scott-free). MEDICAL COVER-UPS, why no mention here of those traumas?

Anthony, I see now to your list of causes you have added: ‘medical crisis (waking during surgery, anaphylactic shock)’ – but I need to correct it a bit.

Purely ‘waking during surgery’ if that is all you suffer, would be very unlikely to cause PTSD or any trauma. It would not be threatening or scary (just unexpected/unusual) = IF no paralysing drugs were used and IF no pain could be felt because enough morphine/painkiller drugs were administered, and IF you could breathe = we can if no paralysing drugs given, airway not blocked with tube, secretions, blood etc. but IF you can move you cough to clear your own secretions, if paralysed or given too much morphine you can’t. And this latter on its own depresses breathing and consciousness.

If you aren’t given paralysing drugs the anaesthetists will see you move (in response to pain+) so they know you haven’t been given enough anaesthetic and they deepen it = make you more unconscious.

The trama is when you can’t move OR breathe (and for so many PLUS feeling the pain of being cut, sawn and so on. I was lucky, I felt no pain. But I suffocated and because I was paralysed I couldn’t save myself so after fighting so hard (in my head, none of me could move) and utter TERROR, I was dying and aftera bit I became calm and had to accept this: I couldn’t save myself and the anaesthetist lied about me (the last thing I heard = I was ANGRY on top, DESPAIR). I died, or thought/knew I had. Weird out of body experience too. But then I woke in recovery: alive. But VERY injured.

But they all denied it. The surgeon lied to me in ward round in front of many others. The consultant surgeon said nothing at all but the letter from him to my GP said he ‘responded’ to my questions when he knew he hadn’t: he ignored me, totally. The hospital sent me a letter saying ‘nothing went wrong’ and refused to talk to me/reply to another letter from me. They said I had to go through the next tier of NHS complaints (here in the UK at that time). ‘Local resolution’ was finished. They conspired against me.

Another trauma you haven’t mentioned: being judged guilty when innocent. NO help to put the record straight or get evidence to back up what we say. Imagine if you were in prison/on death row/murdered by the death penalty (kills their kids/families, family life too) but INNOCENT, that’s torture isn’t it?

My awake paralysis with suffocation was HELL, TORTURE, but nothing at all compared to what happened after: by so many and for so long. Memories of what I and they say, didn’t say, the looks GPs and doctors gave me, their refusal even to examine me or attempt to see if I was telling the truth ALL replay year after year, almost a decade now. And all your advice about being positive and facing triggers doesn’t help me: I need info, truth and JUSTICE. But even then my life will be very hard with my injuries and disability. And NO income, mega fear of becoming homeless and for a future of debt and worsening disability. THOSE too are traumas: stress, fear, nightmares, and now panic attacks = never had panics after the awareness and never slept long enough to dream but woke at start unable to breathe: they damaged my brain, throat, cervical spine, abdomen, neurological system, vision, muscles… Oh but ‘nothing went wrong’. Please add these (not rare) events to your list of causes Anthony, thanks.

It isn’t TRIGGERS which set off my memories, they replay, float up on their own no matter what I’m doing: having fun, in the sea, painting, on the back of friend’s motorbike = hanging on! I can’t stop them so please do NOT tell us to deal with ‘triggers’ coz often there are none, well actually continual lack of honesty, truth, wrongly accused, falsely branded a liar. Plus THEIR ‘truth’ passed around as ‘reality’ and ‘fact’. THAT is trauma.

Too much to say, tired, but paroxetine is a POISON: I took some by mistake (same colours foil and design on back), I thought it was Xanax (Alprazolam) and it took THREE DAYS to clear it from my system = IF it is, I fear lasting nerve damage from it. AWFUL dangerous stuff, how on EARTH could that ever be good for anyone or ‘cure’ ANYTHING? How can it be it’s ‘approved’ at all?

You say: ‘A Post Traumatic Stress Disorder (PTSD) diagnosis applies to those exposed to catastrophic trauma’ – just ONE event? My injuries are termed catastrophic and lots of people are catastrohically injured – but then to be NEGLECTED – as so very many with brain injury are: we’re told it’s just ‘depression’ or ‘anxiety’ and told to take drugs.

I bet DSM (or whatever it’s called, their bible/holy book) doesn’t mention MY/OUR traumas either, does it? Hmm, odd omissions = by accident?

I’d love a chat with you anthony, if you would like, LOADS to discuss and I’ve hurt my already-injured neck big-time typing this (silly me). But no option of phoning you for communication.

Please advertise to people injured by MEDICINE and those innocent in prison/on death row and families traumatised by having their loved one ‘legally’ murdered – and to those who ensure these things continue = governments and tribes such as psychiatrists (‘mental health’) and pharmaceutical companies. Thanks.
I’m sorry to hear of your suffering and hope you obtain the treatment you need to get better.

Much of what you have said, to be honest, is personalisation. You’re personalising your experience as though every facet should be documented to corroborate your feelings and experiences. Medicine does not work that way, and we both know this.

I actually feel you’re even blaming this site, myself even, because we don’t mention everything related to you. Again, personalising your experience to the reality that is medicine.

Does everything need to be a mental health condition? No, is the simple answer. It is normal to feel certain things, frustration, hopelessness, so forth — which are normal and do not need psychiatric association.

What is mentioned in this article is from the DSM. I do not get to decide what is traumatic enough for PTSD diagnosis. You either accept that the thousands of medical doctors who collaborate to build diagnosis models based on their collective knowledge and experience, get it close to suit the majority of cases. If we all had a say — it would be a nightmare and nothing good would be the outcome — like you have done above, you would want all your own personal experiences mentioned to feel validated. Unfortunately, it just doesn’t work that way.

Mental health is new in the scheme of public awareness. It was a dirty secret swept under the rug for decades prior, if not centuries. Mental health has a long way to go before being 90% accurate medicine. Right now, its a lot of best guess and collective experience from experts, who are medical doctors, lets not forget. The brain is marginally understood by science, thus mental health is marginally understood in the scheme of what occurs within our brains.

I can only say that your experiences are all valid — but you should not try and fit them into the box that is PTSD, or any other mental health disorder. Leave that to the experts. Try to focus instead of fixing just one thing that you don’t like about yourself, how you feel, and improve that. Then another, and so forth. Being angry at the world will not fix anything for you, now, or your future. I have my own personal experience at this type of thing, and I was wrong with my approach. Being angry at others for what happened to me, didn’t solve a thing. Focusing inwards on what I was feeling, what was going on within me, then actioning that, one at a time, got me to a much better place.

I feel as though there is a lot of blaming in your above words… which isn’t going to help you. I hope you feel better soon and work hard to improve your life using known methods that work effectively.
You are misjudging me because you don’t know how hard I tried to learn, try understand, WHY the docs/hospitals covered up: culture and putting themselves first = the opposite of their duty.

Sometimes it is RIGHT to blame and if somebody had injured me this badly, anyone else, say somebody in the street, they would have been arrested, interrogated and punished. Instead it is ME who’s punished. That is WRONG.

You don’t know but I have worked VERY hard to try to change the sick culture of docs, hospitals and their insurers/legal teams and tried (for nearly a decade) to explain how this feels and the effects on so many, the whole of society.

I’m sick of being told I (ME) must change. Sick of being told what I (ME) must do. Sick of being told MY behaviour and feelings are wrong and invalid. But ‘they’ and so many others are allowed to get away with THEIR behaviour.

Try to fix just one thing that I don’t like about myself? tried SO hard and am proud – but even that MEGA work (tried to fix so many bits of me) denied, ‘unreal’, ‘not true’.

Fix how I feel? How can I when imprisoned in ‘home’ I HATE, which injures me both physically and mentally? Earlier on I accepted how I was (but still pain, massive daily struggle) but now after years more of abuses and mistreatment = I’m worse and now hate myself and how I am because I’m told off all the time for how I am. THEY must accept how I am, my difference.

I will try to understand your attitude: you lack knowledge and you don’t know all the facts.

You say: ‘I actually feel you’re even blaming this site, myself even, because we don’t mention everything related to you. Again, personalising your experience to the reality that is medicine.’
It is obvious you (and medicine) choose to ignore the thousands/millions who suffer the torture of awake paralysis – some plus pain, some plus suffocation. It is personal but it also effects EVERYONE: you or your loved ones might have to endure this – and you might be injured by medicine and then get punshed by neglect and outcasting. I’m trying to describe how this FEELS and what it DOES to me and others. As you claim to be a site for support for those who have experienced (or still are experiencing) trauma/s I thought you would like to include me/this massive group of people? If not why not?

Oh and to heal we need to be safe, for the abuses to stop. Mine haven’t, almost a decade now.

It’s common sense that this neglect, exclusion and severe mistreatment kills and maims. Laypeople can easily see what the results would be, are, very odd that experts (including doctors and lawyers) can’t see the obvious.

I did NOT blame at the start (though I knew where the blame lies) but instead tried to co-operate, learn, teach them = you have no idea how hard I tried to do this. So, as usual, I’m blamed, I/ME am wrong and I (only ME) must change. Yawn.
If you’re referring to Anesthesia awareness, then this is covered already under the medical category of the DSM. Again though, that has no reflection of this pages content. Lots of people experience this… C-sections come to mind — and yes, a small percentage who are not knowingly aware do get PTSD from this type of trauma. Again though, this is just fact, not personalisation.
You: ‘and yes, a small percentage who are not knowingly aware do get PTSD from this type of trauma. Again though, this is just fact, not personalisation.’

Fact, really? Because docs/anaesthetists say so? Their symptoms described as PTSD – odd that occasionally we read that their drugs, errors, anaesthesia etc. can/do cause brain damage but shh, ‘they had a full recovery’ = in EXPERTS’ opinion, those who caused it or their con-frères/colleagues.

Yes, my reactions normal to extremely abnormal events. Some of my clothes/things STILL stink really bad since somebody (who, purpose etc.?) came into my place and sprayed stinky stuff all around, made me VERY ill. Ahh, but nobody would believe that – including judges/psychs, = my ‘delusions’? SICK of it.

I don’t understand your stuff about personalisation, too complicated/not clear = my brain injury/stupidness – not my fault.

No idea who you are, maybe you’re party to more of my true history than me – or think you are?! Others laugh at me for how easy I am to manipulate and believe themselves immune (and believe ‘evidence’ they are presented with), who is the most deluded?
Hi Anthony, I have complex PTSD – due to my chosen profession. I also believe in retrospect due to some childhood traumas too. Totally found you by accident. I have been referred by a consultant to a PTSD Clinic but most of them are military. Not sure how they will accept me. What do you think. Margot
Treating military and treating civilians, vastly different audiences, not sure how it will go. Treating complex PTSD persons, in and of itself, can be complex, and require a lot of spontenaity on the therapists behalf based on what they see and hear.
My Fiancé has been in the army for 6 years. We have been together for a year and 3 months. He has admitted to me that he PTSD and all the ramifications of the diseas such as Bi polar disorder and depression. I’m trying my very hardest to cope with this diseas. I feel like I try so hard to comfort him and understand him but It’s very difficult. At the beginning of our relationship he was very loving and kind, there were times when he would get really ugly with me and we still had the same issues we have now just not as severe. He’s told me before that he doesn’t want to be with me and then he says he’s so sorry for everything. It’s a constant roller coaster. I cry myself to sleep many nights not knowing what to do or say. He also smokes a lot of weed. I’m trying to get him to stop it but he repeatedly tells me he can’t. Tonight he told me he loved me and that he would call me but it’s now 10:30 pm and I still haven’t received a call. I feel like I’m at the end of my rope. Any advice ?
Relationships are hard work Allie, and PTSD just adds another layer to the existing mountain that is a relationship. As for advice, only you can really provide that to yourself, by way of an answer to your self. What are you willing to put up with, and what aren’t you? If the unacceptable outweighs the acceptable, then you have your answer. Vice versa.

PTSD sufferer or not, if a person wants to be in a relationship, they will move mountains to slowly change themselves and their behaviours, within limits, that are acceptable to both parties. Change does not happen overnight… it takes time. Maybe you need to have a discussion with him about the positives and negatives or the relationship, and what you would like him to change so that you can accept those aspects of him better. Ask him for the same from you.

It isn’t tit for tat, but if you want to tell someone their flaws and want them to change, chances are they will have a list of yours also.
When I was five years old i was put in the Foster Care system because my biological parents were doing horrible bad things. I went through different foster homes and several group homes before I was adopted at 14 and not very many people want a black kid or a teenager or so i’ve heard. But i got adopted by these amazing people and I love my mom and dad. Almost four years later I’m graduated out of High school and in my second semester of my freshman year f college and i’m 19. i couldn’t be happier with how my life turned out but thats not really the point, the point is I was diagnosed with PTSD,ADD,ADHD and ODD because of how my past was. I have severe anxiety [problems and have to take meds for them. PTSD is a serious condition depending on the person, and it can be cured for some people.