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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Old Nam Doc

I’m new here. I was a REMF (rear echelon)Medic in Viet Nam. I went there in 1966 during the big buildup. due to the fact that they needed many Medics, in a very short time, they cut our training by two weeks, leaving out much of the hospital training, that we would then get on the job, is assigned to a hospital. Most of us would be “Field Medics” and only needed the basics. I ended up being neither. I was assigned to an aviation battalion, which was mostly helicopters. My main job was to provide emergency coverage at the airfield for large operations, (about forty helicopters). In the event of a crash, our instructions were to drive the ambulance out near the crash and park about 50 to 100 feet from the helicopter an broad side it. Then go and assist casualties by getting them away from the helicopter before it caught fire or exploded. By parking broadside to the crash, any casualties injured, but extracted to the ambulance had a better chance of survival, since the back doors would be open. If the helicopter blew up while we were there at the moment, it was bad luck and probably the end of our career. The ambulance was always running during the time there were helicopters preparing to takeoff or when they were coming in for a landing. We never had a crash during a battalion size operation, but did have one on a Sunday afternoon when only one was flying. A new pilot was parking a Huey and his rotors hit another Huey that was parked. When that happens, everything comes apart. I won’t give graphic details, because those who convinced me to in the past didn’t eat for a couple days after I did. The only thing I remember doing the rest of the day was taking the pistol out of the pilots shoulder holster and turning it in at the operations shack. I ha ve no recollection of anything else that day. I’m assuming I washed the blood off and started drinking, but I can’t recall anything. I don’t think anyone spoke to me. That happened 49 years ago last August. There was no other traumatic events while I was here, but after that, nothing ever bothered me.

We would provide clinics in some of the local villages almost every week. Most of the people had no access medical care. If they had a serious infection, they could go to a government hospital and get put on a waiting list. If they were still alive 5 or 6 months later, they would get treated.

The Australian Government sent teams of doctors and nurses there to help in patient care and train the local doctors and nurses. We gave them medical supplies. At that time most medical supplies were not disposable. We had glass syringes, powdered Penicillin and vials of sterile water. We had no equipment to clean and re-sterilize the syringes, so we gave them, the penicillin and sterile water to the hospital. People often died from a scratch that got infected. I saw things in these clinics that can’t be openly discussed also.

Back in my late 20’s and early 30’s, I began having nightmares, with night sweats, then waking up terrified. Later they became night terrors. with the help of Paxil I do a lot better now.

I have always been hyper-vigilant to some degree and it is more intense now.
 
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Fed Coronado

In my meager opinion, nobody has the right to make judgements about the existance, or lack of PTSD. I will admit I find a few so called cases of PTSD lacking severely. I lost 8 of the men under my command on my first patrol out of My FOB. The number ended up being 23, all close and personal, and the guilt is neverending. We were guarding our FOB base gate, and a young 6 to 8 year approached us without heeding the order to halt, in his own langauge, and it was fairly obvious he was wearing a bomb belt. My CO ordered the shot so I put a5.56 by 45 mm 61 grain Nato round square between his eyes. I was responsible for a dozen or so headshots on female terrorist finally got my unit with and IED. Held 3 while they died. I was discharged. Traumatic Brain Injury, havent had a mirror for over 8 months as I dont want to see my face i dont want your pity, I knew what was possible. I dont want to take from your PTSD, but think how truly harmless most of them are. Pick some cerebrial matter fron your best friend off your BDUs. I cant function. At all. Its all drugs now. I know its hard, but its really not that bad. I’ll trade you any day.
 

anthony

Founder
I’m new here. I was a REMF (rear echelon)Medic in Viet Nam. I went there in 1966 during the big buildup. due to...
Yup… war is harsh. As an Australian ex-Army soldier, deployments started of mildly traumatic, which were humanitarian based, dead bodies, burnt people, hunger, machete incidents, things like that. Then East Timor 99, war zone, that was interesting times. That one screwed with my head after the fact. On top of all prior deployments (4 previously), that was the straw that broke the camels back for myself.

It was actually refreshing returning there a couple of years later, seeing that the country was moving forwards and not backwards, like Bouganville did consistently, even with help — it just kept getting worse there. Go figure.

Conflicts suck… that is what I know. I still today feel good around hostile environments. I can deal with that… I can’t deal with society worrying about forgetting the milk and being all stressed out about it.
 
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Valerie perreault

When your 9 year old and your father divorces and leave the house, and 1 year later it’s your mom who leaves you and you have to go to dad and live with his highly critical wife. Is it consider ptsd? I’m 45 now, in therapy for 5 months now and being paralysed for fear of being abandonned again that i think i’m having a depression now. I,m litterally paralized…
 

anthony

Founder
Hi Valerie, whilst what you explain certainly has been, still is, traumatic for you, that alone does not meet PTSD.

Abandonment can certainly be traumatic, and it certainly impacts a persons life in negative ways, as you seem to be experiencing. PTSD though is different, in that the level of trauma required for PTSD is exposure to death, torture, rape, that level of abuse.

Has this level of trauma happened to you in your life? Events such as these can often sit in the background, and may be the cause of PTSD which some can attribute to a later life event that may not meet the criterion (i.e. a person thinks a relationship breakdown causes PTSD, yet they were raped some decades prior and is actually causing the excessive fallout now giving the belief it was the relationship failure).
 
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Lou Brasi

I was in the Army a couple of years and I was diagnosed w adjustment disorders while in the Army but after the Army I was diagnosed with PTSD. My fiancé and I can have an argument but when it gets bad I blackout in some type of sense because I don’t remember what was actually said, or did, but I just remember that it happened. I don’t know what to do, I just wear my earphones a lot after.
 

anthony

Founder
Ok, that sounds like dissociation / derealisation. The difference:

Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).

Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
 
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Lou Brasi

Thank you Anthony. I did some research last night. I think the therapist I had before mentioned it once. I did more talking then listening during my sessions when on the meds they put me on.
 
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Mel1

“In my meager opinion, nobody has the right to make judgements about the existance”
I agree Fed.
We all have personal experience and no One can say how you are affected by things what happened to you. There’s endless possibilities which can cause ptsd and endless possibilities how for instance “torture” can manifest.
Take care Valerie.
 
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