What is PTSD?

PTSD, or posttraumatic stress disorder, is a mental health condition that develops in some people after experiencing or witnessing traumatic events [3]. These events, which can include accidents, natural disasters, acts of terror, combat, or personal violations like assault, are highly distressing and can pose serious threats [3].

When someone has PTSD, their brain stays in a state of high alert even after the danger has passed, leading to symptoms that disrupt daily life [3]. These symptoms can range from mild to severe and may affect relationships, work, and emotional well-being [3]. However, PTSD is treatable, and with the right help, people can manage or even overcome their symptoms. It is estimated that about 7-8% of people will experience PTSD at some point in their lives [3].

Understanding PTSD

Posttraumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. The symptoms of PTSD are grouped into four categories, each reflecting different aspects of the disorder.

1. Intrusion

Intrusion involves the persistent re-experiencing of the traumatic event. This can manifest as involuntary, distressing memories, recurring nightmares, or vivid flashbacks where the individual feels as though the traumatic event is happening again. These intrusive thoughts can be highly disturbing and disruptive to daily life [2].

2. Avoidance

Traumatic event avoidance symptoms occur when individuals try to evade reminders of the traumatic event. This may include steering clear of people, places, activities, or objects that trigger distressing memories. Affected individuals might also avoid thinking about or discussing the event and their feelings related to it [2].

3. Alterations in Cognition and Mood

This category includes changes in thoughts and emotions following the traumatic event. People might have trouble remembering key details of the trauma, develop negative beliefs about themselves or others, and feel ongoing fear, horror, anger, guilt, or shame. They may lose interest in activities they once enjoyed, feel detached from others, and struggle to experience positive emotions [2].

4. Alterations in Arousal and Reactivity

Symptoms in this category involve heightened arousal and reactivity, such as irritability, angry outbursts, reckless or self-destructive behavior, and being overly watchful or easily startled. These symptoms can also include difficulty concentrating or sleeping [2].

Each of these categories reflects different ways in which PTSD can impact an individual’s mental and emotional well-being. It’s important to note that these symptoms must persist for over a month and significantly impair daily functioning to meet the criteria for a PTSD diagnosis [2].

PTSD Symptoms

Some people may develop Post-traumatic stress disorder (PTSD) after experiencing or witnessing a traumatic event. Symptoms typically start within three months of the event and may include:

Re-experiencing symptoms (Flashbacks)

Flashbacks, such as reliving the traumatic event with physical symptoms like a racing heart or sweating
Recurring memories or dreams related to the event
Distressing thoughts
Physical signs of stress

Avoidance symptoms

Avoiding places, things, and events that are reminders of the traumatic experience
Avoiding thinking about or acknowledging the thoughts and emotions associated with the traumatic event.

Arousal and reactivity symptoms

Heightened startle response
Feeling tense or “on edge”
Difficulty concentrating
Trouble falling asleep or staying asleep
Irritability or angry outbursts
Engaging in risky or destructive behavior

Cognition and mood symptoms

Trouble remembering key details of the traumatic event
Negative thoughts about oneself or the world
Feelings of guilt or blame
Persistent negative emotions (fear, anger, guilt, shame)
Loss of interest in activities once enjoyed
Feelings of social isolation
Difficulty experiencing positive emotions

Post-traumatic stress disorder affects an estimated 3.9% of the global population at some point in their lives [20]. Women are more affected by PTSD than men. Effective treatments are available, yet in low- and middle-income countries, only 25% of those with PTSD seek treatment due to barriers such as stigma and lack of services. Social support following a traumatic event can significantly reduce the risk of developing PTSD [20].

What is Complex PTSD (C-PTSD)?

Complex PTSD, or complex post-traumatic stress disorder, isn’t officially recognized in the DSM-5, but it’s acknowledged in the ICD [17]. C-PTSD is a set of symptoms that arises after enduring repeated, severe traumatic experiences, often during childhood [17]. Unlike PTSD, which can result from a single event, complex PTSD develops from ongoing trauma, like abuse or violence, over months or years [17].

People with complex PTSD may struggle with anger control, low self-esteem, trust issues, and difficulty forming relationships. They might feel intense guilt, worthlessness, or despair, which can disrupt their daily life. Complex PTSD often leads to deeper emotional turmoil, chaotic relationships, and impulsive behavior [17].

Core symptoms of complex PTSD include re-experiencing the trauma, avoiding reminders of it, and feeling constantly on edge. People may also react strongly to minor stressors, have outbursts of anger, or engage in risky behavior. Some may become emotionally numb or blame themselves for their trauma [17].

Causes of PTSD

Types of Traumatic Events

PTSD can stem from various traumatic experiences, ranging from accidents to deliberate acts of harm or exposure to distressing situations. Some of these events may include [14]:

Serious accidents: Involvement in life-threatening accidents or witnessing traumatic incidents.
Physical or sexual assault: Direct experience of physical or sexual violence.
Abuse (including childhood or domestic): Enduring emotional, physical, or sexual abuse over an extended period.
Exposure to traumatic events at work: Witnessing or experiencing traumatic events in the workplace, such as first responders or military personnel.
Serious health problems: Facing life-threatening illnesses or medical emergencies, including admission to intensive care.
Childbirth experiences: Trauma experienced during childbirth, such as losing a baby or complications during delivery.
Death of someone close: Grieving the loss of a loved one, particularly in sudden or traumatic circumstances.
War and conflict: Exposure to combat situations, including witnessing violence, death, or injury.
Torture: Enduring physical or psychological torture, often in captivity or conflict zones.

While combat, sexual assault, and severe accidents are commonly associated with posr-traumatic stress disorder, the disorder can also stem from less overtly violent yet profoundly distressing experiences.

Other Causes and Risk Factors

Workplace Bullying or Abuse: Workplace bullying can lead to severe, long-term emotional trauma, including PTSD symptoms [19]. According to the Workplace Bullying Institute (WBI), 49% of Americans surveyed have either experienced workplace bullying firsthand or witnessed it.
Divorce: The end of a marriage can be a highly traumatic experience, potentially leading to PTSD symptoms in some individuals. The emotional upheaval, stress, and life changes associated with divorce can have long-lasting psychological impacts.
Financial Issues: Severe financial stress, such as bankruptcy, significant debt, or sudden loss of wealth, can trigger PTSD-like symptoms in some people. Chronic financial instability can lead to persistent anxiety and hypervigilance.
Interpersonal Conflict: Ongoing, intense conflicts with family members, friends, or colleagues can sometimes result in PTSD-like symptoms. Repeated exposure to hostile environments or relationships can lead to hyperarousal and avoidance behaviors characteristic of PTSD.
Death of a Loved One: While grief is a normal response to loss, in some cases, the death of a loved one, especially if sudden or violent, can lead to PTSD. This is particularly true if the person witnessed the death or found the body.
Rejection: Severe or repeated experiences of rejection, whether in personal relationships or professional settings, can sometimes lead to trauma responses. This might include symptoms like hypervigilance in social situations or avoidance of potential rejection scenarios.
Loss of a Job: Sudden job loss, especially in cases where one’s career is closely tied to one’s identity, can be traumatic. The resulting financial stress, loss of routine, and impact on self-esteem can sometimes manifest as PTSD-like symptoms in vulnerable individuals.

Risk Factors

Experiencing certain factors can raise the chance of developing PTSD after going through a trauma. These may include [14]:

History of depression or anxiety: Individuals with a pre-existing mental health condition are more susceptible to developing PTSD after a traumatic event.
Lack of support from family or friends: Limited social support networks can exacerbate the impact of trauma and increase the risk of PTSD.
Genetic predisposition: A family history of mental health problems, such as PTSD, may heighten an individual’s susceptibility to the condition. Further research is needed to understand the specific genetic factors involved in this predisposition.

Theories on PTSD Development

While it isn’t fully understood why some people develop PTSD and others don’t, there are several theories, such as [14]:

Several theories attempt to explain why PTSD develops in some individuals after traumatic events.

Survival Mechanism: Symptoms of PTSD, such as flashbacks and hyperarousal, may serve as instinctive mechanisms for future threat preparedness. However, these responses can hinder recovery.
High Adrenaline Levels: people with PTSD exhibit abnormal stress hormone levels, with continued production of stress hormones even in the absence of danger. This leads to numbed emotions and hyperarousal.
Changes in the Brain: Brain scans of PTSD patients reveal differences in regions responsible for emotional processing, such as the hippocampus. These changes may contribute to fear, anxiety, memory problems, and flashbacks. Treatment aids in-memory processing, reducing symptoms over time.

Will PTSD stay with you for life?

PTSD doesn’t necessarily stay with a person for life, but it can. Some individuals may recover over time, especially with appropriate treatment and support. However, for others, PTSD may become chronic, lasting for years or even a lifetime. Factors such as the severity of the trauma, the presence of other mental health conditions, and the availability of support networks can influence the course of PTSD. Additionally, the impact of PTSD on an individual’s life can vary widely, affecting relationships, work, and overall quality of life [5].

When should I seek help?

Knowing when to seek help for PTSD is crucial for starting the journey toward recovery. If you’re experiencing symptoms like denial, avoidance, social isolation, or overwhelming distress, it’s essential to recognize that something isn’t right and act. Seeking early help can validate your experiences, leading to understanding and acceptance.

Getting a PTSD diagnosis can offer reassurance and hope, prompting you to take responsibility for your emotions and actions. Look for understanding and collaborative therapists that are trauma informed offering psychological safety and support. Remember, recovery is a gradual process, and seeking help is the first step.

How is PTSD Diagnosed?

Diagnosing PTSD involves a thorough evaluation by a mental health professional. They might use standardized questionnaires to help identify symptoms, especially if a specialist isn’t available [9]. These questionnaires include things like the PTSD Checklist and the Trauma Symptom Checklist [9].

Diagnostic Criteria for PTSD

To be diagnosed with PTSD, an individual must meet the following criteria for at least one month [15]:

Experiencing real or potential risk of death, severe injury, or sexual violence through:

Direct experience
Witnessing the event
Learning it occurred to a close friend/family member
Repeated exposure to the details of the event, such as first responders

Presence of at least one re-experiencing symptom:

Flashbacks
Recurring nightmares/memories
Distressing thoughts/feelings
Physical reactions to reminders

Presence of at least one avoidance symptom:

Avoiding trauma-related thoughts/feelings
Avoiding trauma reminders

Presence of at least two arousal/reactivity symptoms:

Hypervigilance
Exaggerated startle response
Problems concentrating
Sleep disturbance

Presence of at least two negative cognition/mood symptoms:

Inability to recall key trauma details
Persistent negative beliefs/emotions
Diminished interest in activities
Detachment from others
Inability to experience positive emotions [15].

The symptoms must cause significant distress/impairment and cannot be due to substance use or medical conditions [15].

Can someone with PTSD live a normal life?

Living a “normal” life with PTSD is possible, but it often requires ongoing management and support. Treatment options such as therapy and medication can help alleviate symptoms and improve quality of life. However, not everyone responds to treatment; some may experience persistent symptoms despite interventions. PTSD can lead to long-lasting effects on physical well-being, raising the likelihood of developing conditions such as cardiovascular disease and stroke [5].

How can PTSD change a person?

PTSD can profoundly alter a person’s life. It brings on a host of symptoms, like intrusive memories, flashbacks, and severe anxiety, all stemming from past traumatic experiences. These symptoms disrupt daily life, causing problems in relationships and making it hard to function normally. Some may recover without treatment, but for others, the effects linger for years, impacting work, social life, and overall well-being.

PTSD Treatments

Several different mental health services and treatments are available to treat PTSD. Some primary forms of treatment include medications, therapy, or a combination of the two. Still, there have been new advancements in other treatments, such as Transcranial Magnetic Stimulation (TMS), which may also be used in conjunction with medication and/or therapy. Let’s take a look at these treatments in a little more detail.

Medications

Several different types of medications may be used. Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are two types of antidepressant medications commonly used to treat PTSD. SSRIs like Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine, or SNRIs like Venlafaxine (Effexor) may be prescribed.

Psychotherapy (Talk Therapy)

Psychotherapy, often referred to as talk therapy, encompasses various approaches used by a licensed mental health professional aimed at alleviating the symptoms of PTSD. Here are some common types of therapy:

Cognitive Behavioral Therapy (CBT)

CBT targets PTSD by addressing detrimental thought patterns and behaviors stemming from the traumatic event. A specialized version known as Trauma-focused Cognitive Behavioral Therapy (TF-CBT) is tailored explicitly for PTSD [8].

Exposure Therapy

This method involves confronting traumatic memories in a controlled environment to reduce emotional distress gradually. With guidance from a therapist, individuals can regain control over their emotions and experience a decrease in PTSD symptoms [18].

Cognitive Processing Therapy (CPT)

CPT is a form of CBT that centers on recognizing and confronting negative beliefs that have developed as a result of trauma. Through structured sessions, individuals learn to confront and understand these beliefs, often through writing exercises. CPT has been shown to be effective both in person and via telehealth, increasing accessibility, especially during events like the COVID-19 pandemic [13].

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR combines exposure therapy with guided eye movements to help process traumatic memories and change their reactions. By engaging both brain hemispheres and employing cognitive restructuring techniques, EMDR aims to foster healthier coping mechanisms [8, 11,13].

These therapies offer different approaches tailored to the unique needs of individuals who have PTSD, providing hope for healing and recovery.

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) offers a non-invasive approach to stimulating specific brain regions using magnetic fields. By delivering electromagnetic pulses to targeted areas, TMS modulates neuronal activity, presenting a potential avenue for addressing dysregulation in PTSD [7].

In PTSD, several crucial brain regions are implicated:

The ventromedial prefrontal cortex (vmPFC): This area tends to be underactive in individuals with PTSD.
The amygdala: Overactivity in the amygdala is associated with heightened fear and anxiety.
The hippocampus: As a center for memory and temporal context processing, its dysfunction contributes to difficulties distinguishing past traumas from present experiences.

By employing high-frequency TMS to stimulate the vmPFC, it’s theorized that normalizing its activity may lead to improved regulation of hyperactive regions like the amygdala, offering potential relief from PTSD symptoms. Additionally, low-frequency TMS to the right dorsolateral prefrontal cortex (DLPFC) could help mitigate hyperactivation associated with trauma re-experiencing [16].

TMS has shown promise as a safe and well-tolerated intervention for PTSD, with mild side effects like headache and scalp pain.

Explore the transformative potential of TMS therapy for PTSD with us at Neuro Wellness Spa. With over 128,000 sessions (and counting) and a solid 73% response rate, our team is dedicated to providing effective mental health solutions.

Ongoing Research

Brain Mechanism Behind Anxiety Disorders

Researchers from the University of California San Diego set out to investigate the biochemical changes in the brain that lead to generalized fear responses, contributing to anxiety disorders such as post-traumatic stress disorder [4]. Their research included examining mice and postmortem human brains to understand how acute stress affects neurotransmitter production [4].

They found that stress causes neurons in the dorsal raphe area of the brainstem to switch from producing excitatory glutamate to inhibitory GABA neurotransmitters, which leads to generalized fear [4]. Blocking GABA production in mice prevented this fear response, and treating mice with fluoxetine after stress also averted the neurotransmitter switch and subsequent fear [4

Their findings suggest that early intervention may prevent anxiety disorders, as the neurotransmitter switch persists in mice for a period equivalent to three years in humans [4]. The researchers aim to develop targeted treatments to reverse this switch, potentially offering new ways to treat anxiety disorders and PTSD [4].

New Research

One study, which examined over 1.2 million people, identified 95 genome regions linked to PTSD, including 80 previously unknown regions [6]. This research, conducted by the Psychiatric Genomics Consortium and Cohen Veterans Bioscience, is the largest and most diverse genetic study of PTSD to date [6]. It aimed to understand the genetic factors contributing to PTSD. Researchers identified 43 genes related to PTSD, involving brain functions, neurotransmitters, ion channels, and the immune system [6].

The study found that PTSD shares many genetic features with depression and discovered several PTSD-specific genetic regions [6]. These findings confirm the genetic basis of PTSD and offer new targets for prevention and treatment [6]. The study also highlighted the need for more diverse genetic research, as current genetic risk scores for PTSD are not universally applicable across different populations [6]. Future research could lead to better interventions and treatments for PTSD [6].

A separate study looked into different biomarkers associated with post-traumatic stress disorder to better understand its causes, diagnosis, and treatment outcomes [1]. The study analyzed data from individuals diagnosed with PTSD and those who experienced trauma but did not develop the disorder [1]. The findings showed that certain genetic, neurobiological, and physiological factors are linked to PTSD [1]. These discoveries have the potential to improve how we diagnose and treat PTSD [1]. However, more research and testing are necessary before these biomarkers can be widely used in medical practice [1].

Help and Support for PTSD

PTSD is a complex mental health condition that can have profound effects on individuals who have experienced or witnessed traumatic events. Understanding the symptoms, causes, and available treatment options is crucial for both those living with PTSD and their support networks.

While the path to recovery can be challenging, it’s important to remember that help and treatments are available. With the proper support, many individuals can manage their symptoms and lead fulfilling lives. By raising awareness, reducing stigma, and advocating for accessible mental health care, we can work towards creating a world where those affected by PTSD receive the support and understanding they deserve.

If you or a loved one is navigating PTSD or other mental disorders, take the first step toward healing today. Reach out to Neuro Wellness Spa. Our team of compassionate mental health professionals is dedicated to supporting you through every step of your journey. With various treatments available, including in-person and online psychiatry offering medication management if necessary, in-person and online therapy utilizing effective modalities for treating and managing PTSD, and TMS therapy, we’re here to provide personalized care tailored to your needs. Contact us now to start your path toward a brighter tomorrow.

References:

Al Jowf, G. I., Ahmed, Z. T., Reijnders, R. A., de Nijs, L., & Eijssen, L. M. T. (2023). To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers. International Journal of Molecular Sciences, 24(6), 5238. https://doi.org/10.3390/ijms24065238
American Psychiatric Association. What is Posttraumatic Stress Disorder (PTSD)? Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
American Psychological Association. PTSD Treatment: Information for Patients and Families. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families
Bertagnolli, M. M. (2024, April 4). Fear Switch in the Brain May Point to Target for Treating Anxiety Disorders Including PTSD [Blog post]. NIH Director’s Blog. https://directorsblog.nih.gov/2024/04/04/fear-switch-in-the-brain-may-point-to-target-for-treating-anxiety-disorders-including-ptsd/
Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder; Board on the Health of Select Populations; Institute of Medicine. (2014). Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. Washington, DC: National Academies Press. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224874/
DiCorato, A. (2024, April 18). Scientists uncover 95 regions of the genome linked to PTSD. Broad Institute. Retrieved from https://www.broadinstitute.org/news/scientists-uncover-95-regions-genome-linked-ptsd
Edinoff, A. N., Hegefeld, T. L., Petersen, M., Patterson, J. C., 2nd, Yossi, C., Slizewski, J., Osumi, A., Cornett, E. M., Kaye, A., Kaye, J. S., Javalkar, V., Viswanath, O., Urits, I., & Kaye, A. D. (2022). Transcranial Magnetic Stimulation for Post-traumatic Stress Disorder. Frontiers in Psychiatry, 13, 701348. https://doi.org/10.3389/fpsyt.2022.701348
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Mann, S. K., Marwaha, R., & Torrico, T. J. (2024). Posttraumatic Stress Disorder. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559129/
Marter, J. (2022, November 9). How to Stop Workplace Bullying. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/mental-wealth/202211/how-to-stop-workplace-bullying
Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment Guidelines for PTSD: A Systematic Review. Journal of Clinical Medicine, 10(18), 4175. https://doi.org/10.3390/jcm10184175
McMenamin, L. (2021, April 19). Why long-term workplace trauma is a real phenomenon. BBC. Retrieved from https://www.bbc.com/worklife/article/20210415-why-long-term-workplace-trauma-is-a-real-phenomenon
Moring, J. C., Dondanville, K. A., Fina, B. A., Hassija, C., Chard, K., Monson, C., LoSavio, S. T., Wells, S. Y., Morland, L. A., Kaysen, D., Galovski, T. E., & Resick, P. A. (2020). Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic. Journal of Traumatic Stress, 33(4), 371–379. https://doi.org/10.1002/jts.22544
NHS. (n.d.). Causes – Post-traumatic stress disorder. Retrieved from https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/causes/
National Institute of Mental Health. (n.d.). Post-Traumatic Stress Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
Petrosino, N. J., Cosmo, C., Berlow, Y. A., Zandvakili, A., van ‘t Wout-Frank, M., & Philip, N. S. (2021). Transcranial magnetic stimulation for post-traumatic stress disorder. Therapeutic Advances in Psychopharmacology, 11, 20451253211049921. https://doi.org/10.1177/20451253211049921
Psychology Today. (n.d.). Complex PTSD. Retrieved from https://www.psychologytoday.com/us/basics/complex-ptsd
Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research and Development, 49(5), 679–687. https://doi.org/10.1682/jrrd.2011.08.0152
Workplace Bullying Institute. (n.d.). 2021 WBI U.S. Workplace Bullying Survey. Retrieved from https://workplacebullying.org/2021-wbi-survey/
World Health Organization. (n.d.). Post-traumatic stress disorder. Retrieved from https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder