Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that can follow witnessing or being a part of a terrifying traumatic event. People with PTSD often have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people like friends and family
PTSD, once referred to as shell shock or battle fatigue, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person’s life or the life of someone close to him or her. Or it could be something witnessed first-hand, such as a natural disaster or mass destruction after a plane crash.
Whatever the traumatic event, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult.
PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person — such as a rape, as opposed to a flood.
Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A flashback may make the person lose touch with reality and reenact the event for a period of seconds or hours or, very rarely, days. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again.
Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do have PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn’t show up until years after the traumatic event.
Specific Symptoms of PTSD
Post-traumatic stress disorder is characterized by exposure to a traumatic event in which the person experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. The exposure leads to a set of intrusive symptoms, persistent avoidance, negative alterations in thoughts and mood, and significant alterations in a person’s arousal and reactivity.
PTSD is defined as:
Exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways:
- Directly experiencing the traumatic event.
- Witnessing, in person, the event as it occurred to others.
- Learning that the traumatic event occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders, police officers). This symptom does not apply to exposure through electronic media, TV, movies or pictures, unless the exposure is work-related.
Presence of one or more of the following intrusive symptoms associated with the traumatic event, beginning after the traumatic event occurred:
- Recurrent, involuntary and intrusive distressing memories of the traumatic event.
- Recurrent distressing dreams in which the content or affect of the dream are related to the traumatic event.
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event were recurring. Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event
The individual also has persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event.
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
Negative alterations in thought and mood associated with the traumatic event, beginning or worsening after the event occurred, as evidence by two or more of the following:
- Inability to remember an important aspect of the traumatic event.
- Persistent and exaggerated negative beliefs or expectations about oneself, others or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous.”)
- Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame him or herself, or others.
- Persistent negative emotional state (e.g., fear, horror, anger, guilt or shame).
- Markedly diminished interest or participation in significant activities.
- Feeling of detachment or estrangement from others.
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Significant alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the event occurred, as evidenced by two or more of the following:
- Irritable behavior and angry outbursts (with little or not provocation) typically expressed as verbal or physical aggression toward people or objects.
- Reckless or self-destructive behavior.
- Sleep disturbance (e.g., difficulty falling or staying asleep).
- Problems with concentration.
- Exaggerated startle response.
The disturbance, which has lasted for at least a month, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
PTSD can be specified with or without dissociative symptoms, which can either be marked by depersonalization (persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body) or derealization (persistent or recurrent experiences of unreality of surroundings).
Last, PTSD can be specified “with delayed expression” if the full diagnostic criteria are not met until at least 6 months after the event.
Symptoms of PTSD are different for children 6 years and younger.
Updated for the DSM-5.
Psych Central. (2013). Posttraumatic Stress Disorder (PTSD) Symptoms. Psych Central. Retrieved on March 9, 2014, from http://psychcentral.com/disorders/posttraumatic-stress-disorder-ptsd-symptoms/
Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Last reviewed: By John M. Grohol, Psy.D. on 21 Oct 2013
Published on PsychCentral.com. All rights reserved.