Post Traumatic Stress Disorder
In DSM-5, PTSD is in a section called Trauma- and Stressor-Related Disorders, as opposed to being included with Anxiety Disorders, as it had been in this manual’s previous version.
PTSD develops in response to exposure to a traumatic or life threatening event. People of all ages and backgrounds can develop PTSD, as no one is immune to childhood abuse or neglect, violence, medical procedures, accidents, natural disasters, war, and other serious events.
In fact, traumatic events are more common than most people realize. Why some people develop PTSD and others do not following seeming similar life experiences is not fully understood. However, research suggests some factors that make it more likely a person will develop this problem. These variables include the individual’s prior trauma exposure as well as the presence of a pre-existing mental health issue. There may also be genetic patterns that predispose some individuals to PTSD. Conversely, some studies suggest that a high level of social support may help to prevent the onset of PTSD.
PTSD symptoms are divided into 3 categories: Re-experiencing symptoms, Avoidance/ Numbing symptoms, and Hyperarousal symptoms.
Re-experiencing symptoms include persistent, unwanted thoughts and images related to the trauma, nightmares, or flashbacks, where the person feels as if the traumatic event is happening in the present time.
Individuals with PTSD often avoid thinking about, talking about, or visiting places that remind them of the trauma. They may also experience feelings of numbness, have trouble relating to other people or remembering aspects of the trauma, and feel as though they have lost interest in things they used to enjoy. Additionally, PTSD is often associated with feeling jumpy and tense, having difficulty sleeping, and difficulty controlling anger.
Being repeatedly exposed to trauma, as is often the case in childhood abuse, may result in broader PTSD-related difficulties, such as problems tolerating emotions, as well as “flashbacks” or losing time. Self-injury or using substances to self-medicate or manage difficult emotions is not uncommon in this population.
Young children who have experienced a traumatic event may revert to behaviors they previously mastered (i.e., bedwetting, being excessively clingy). They may also exhibit a “freeze response” when startled and be observed acting out the traumatic event in some fashion during play.
Those who have experienced a single traumatic event may respond very well to Cognitive Behavioral Therapy (CBT) alone. However, individuals who have experienced prolonged trauma, may require a more comprehensive approach to treatment focused on achieving initial stabilization via skills acquisition prior to addressing trauma issues more directly. Such individuals often benefit from Dialectical Behavioral Therapy (DBT)—a form of CBT that utilizes mindfulness among other Eastern-style strategies. CBT/DBT plus medications is a common protocol for severe PTSD.
PTSD treatment often includes an exposure component, which means the person is asked to face and become desensitized to the uncomfortable thoughts, feelings, or memories they have been avoiding. While this can be discomforting at first, it is often the cornerstone of successful intervention. Because many with PTSD maintain self-defeating thoughts (e.g., beliefs that only they are responsible for what happened to them; beliefs that they cannot trust others ever again), learning how to think in more constructive ways is another essential element of treatment. Prolonged exposure (PE) treatments have been successfully utilized with combat veterans.